Mis pacientes moribundos me enseñaron mucho más que lo que es morirse. Me dieron lecciones sobre lo que podrían haber hecho, lo que deberían haber he… - Elisabeth Kübler-Ross

How, then, do we know when a patient is giving up “too early” when we feel that a little fight on his part combined with the help of the medical profession could give him a chance to live longer? How can we differentiate this from the stage of acceptance, when our wish to prolong his life often contradicts his wish to rest and die in peace? If we are unable to differentiate these two stages we do more harm than good to our patients, we will be frustrated in our efforts, and will make his dying a painful last experience.

Simple people with less education, sophistication, social ties, and professional obligations seem in general to have somewhat less difficulty in facing this final crisis than people of affluence who lose a great deal more in terms of material luxuries, comfort, and number of interpersonal relationships. It appears that people who have gone through a life of suffering, hard work, and labor, who have raised their children and been gratified in their work, have shown greater ease in accepting death with peace and dignity compared to those who have been ambitiously controlling their environment, accumulating material goods, and a great number of social relationships but few meaningful interpersonal relationships which would have been available at the end of life.

Claudia reported that her depression eventually passed and she began to do more and get out more. She went back to work part-time and started accepting offers from friends to do things. “Time had passed; I was better, functional and improving, when suddenly the depression returned. I’d thought I was done with it, but I guess it wasn’t done with me. “This