Death comes for us all, as the English martyr Sir Thomas More reminded his accusers in the play “A Man for All Seasons.” The line echoed poignantly in the mind late last month when death finally came for Elisabeth Kuebler-Ross, the remarkable Swiss-born psychiatrist who had done as much as anyone to take the chill off such thoughts.
We all meet death in different ways, according to our faith, culture, temperament and the particular circumstances in which we depart. We also react differently to the deaths of those we love or revere (or loathe, for that matter), mostly according to what we believe “happens” to them in the hereafter. But it is safe to say that millions of people meet death more calmly, and millions more endure bereavement better, because of Kuebler-Ross’s pioneering work in this grim field.
The point was that the feisty, funny psychiatrist did not see it as grim at all. “Dying,” she once famously said, “is nothing to fear. It can be the most wonderful experience of your life.”
She meant it, spending her professional life in the United States working to persuade people of that profoundly counterintuitive — indeed, revolutionary — view. And while most people will probably never achieve quite her level of enthusiasm about the experience, many will be able to talk about it, prepare for it, even accept it, to a degree they might not have been able to do previously, even if they have never heard of Kuebler-Ross.
As colleagues and obituary writers acknowledged last week, she broke the taboo, first with her best-selling 1969 book, “On Death and Dying,” and later with a long string of related studies, from “On Children and Death” to “AIDS: The Ultimate Challenge.” Medical schools all over the world now include courses on death and dying. The idea that patients have the right to be told about their condition and make choices about their treatment has gained ground, even though in countries like Japan it still has a long way to go. And versions of Kuebler-Ross’s classification of dying and grief into five universally experienced stages — denial, anger, bargaining, depression and acceptance — have become common knowledge, part of the modern vocabulary of death.
She was also adamant that, in the face of death, one’s specific belief or culture receded in importance. “We’re all the same human beings,” she once said. “We all are born the same way. We all die the same way, basically. It only depends how you have lived. If you have lived fully, then you have no regrets, because you have done the best you can do.”
The corollary of this openness about death has been a gradual change in the way dying people are treated, at least in developed countries. Kuebler-Ross’s insistence that the dying should be accorded dignity and respect — including the dignity of choosing, if possible, where they will die — gave rise to the American hospice movement in the 1970s. That country now has thousands of hospices, places where terminally ill people can receive appropriate palliative care in the last stage of life. “I’m not saying that all of them are excellent,” Kuebler-Ross said in a 1986 interview, “but at least every human being in the United States knows what a hospice is.”
That may not yet be true of every human being in Japan, but even here — where attitudes to death remain arguably less open and more taboo-ridden than in Europe and the U.S. — there are now 135 hospice units, serving 42 of the country’s 47 prefectures, according to the Japan Hospice Palliative Care Foundation. On its Web site, the foundation describes the problem it exists to address: “Patients with no prospects of recovery are often forced to stay alive as long as possible without receiving pain relief and adequate psychological care, and many end up dying a painful and lonely death.”
There is a direct line between that perception and Kuebler-Ross’s words to an interviewer 20 years ago: “If you request to die at home you [should] be allowed to die at home. If you don’t want to die in a hospital, you should at least be able to go to a hospice. If you can’t speak anymore, like I couldn’t speak after my stroke, you need somebody who speaks up for you. I hope that when I die, if I can’t speak anymore, that they at least let me go to my farm and die at home, where I can have a cup of coffee and a cigarette.”
It is good to know that when Kuebler-Ross did die, at the age of 78, after suffering several more debilitating strokes, it was at her home in Scottsdale, Arizona, with her friends and family, in a room that a local paper said was filled with flowers and looked out over the desert. Right to the end, she faced death down with dignity.
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