When people are facing death there are common stages which they might pass through. These include disbelief, shock, denial, isolation, anger, guilt, fear and anxiety/depression. For dying people themselves, their relatives and their friends, these responses can be very disturbing and confusing.

A model of three phases of emotional response to dying is shown below.

However, it is crucial to remember that a model is only a guide and that every person’s experience is unique. It is essential to treat everyone as an individual and to accommodate their needs and feelings, whatever they are.

Expressions of disbelief from clients and carers indicate that the information about impending death is hard to absorb. The most helpful response may be to acknowledge that it must be hard to accept the news.

People in shock are often unable to make decisionsas a result ofbeing emotionally overwhelmed. Many people in shock become forgetful and may experience a loss of concentration. Some dying people and their carers can never accept the diagnosis or the changed circumstances and the shock reaction never wears off. Those that do recover from shock usually do so gradually.

Some people never admit to anyone, not even themselves, that they are dying. Denial is a normal coping mechanism used to avoid reality or deal with unpleasantcircumstances. People may continue to deny throughout all or part of the dying process. Denial, as a defence mechanism, can be viewed as a positive and normal response, which serves to protect  people from the overwhelming threat of death.

As long as people are using denial as a defence and appear to be coping adequately, this should be respected and they should not be forced to face the reality. 

Many dying people and carers experience anger, which can be accompanied by blame. Itcan be directed:

• at the world in general
• at fate or God, possibly leading to a loss of faith
• at anyone trying to help
• at relatives and friends.

Anger is often very painful for people to deal with, even if they accept the reasons for the anger.

People who feel they might have prevented their predicament can experience guilt. For example, a smoker with advanced lung cancer may feel guilt for smoking, or their loved ones may feel guilt for not stopping them. Friends and relatives may feel that if they had insisted the dying person sought helpearlierhe or she would not be dying now.

People who are dying often feel vulnerable, afraid and isolated. Fears include those of pain, the treatment process, dying and death. Dying people fear losing control over their lives and rejection, particularly if the illness has caused disfigurement. Many dying people are afraid of being left alone or being unable to call for help.

Dying people may move towards acceptance. Often, giving up a regular activity or refusing treatment are crucial indications that someone has accepted the situation.

Some dying people welcome death, seeing it as a release from a pain-racked body,and look forward to it with anticipation. Some informal carers respond similarly.

Macmillan: Emotional help

Marie Curie: Providing emotional care.

Scottish Palliative Care Guidelines: Severe uncontrolled distress

Some elements of this section are summarised and adapted from Macmillan Foundations in Palliative Care (FIPC) materials 2020, published by Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, United Kingdom. © Copyright Macmillan Cancer Support 2020, produced by the Digital Health & Care Innovation Centre (DHI). Macmillan Cancer Support accepts no responsibility for the accuracy of the content, which is based on UK practice and guidelines at the date of UK publication; nor for the context in which the content is published; nor for any adaptations made for local use. The content as published in this app/website is solely the responsibility of the Digital Health & Care Innovation Centre, Inovo Building, 121 George St, Glasgow G1 1RD.