Elisabeth Kübler Ross: The Development of Five Stages of Grief

The Story of Elisabeth Kübler-Ross
A luminous portrait of the psychiatrist who transformed how the world understands death, grief, and healing. From her groundbreaking work with terminally ill patients to the creation of the Five Stages of Grief, Kübler-Ross challenged taboos and gave voice to the dying. Her teachings reshaped medical and psychological education, inspiring generations of caregivers, counselors, and students to approach end-of-life care with empathy, dignity, and emotional depth. This story traces her journey from war-torn Europe to global influence, revealing a woman who listened deeply, loved fiercely, and taught us that even in our final moments, there is meaning, connection, and hope.

1. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
Elisabeth Kübler-Ross: Pioneer in End-of-Life
Education and Transformative Medical Teaching
Elisabeth Kübler-Ross (1926-2004) stands as one of the most influential figures in
modern medicine, revolutionizing how healthcare professionals approach death, dying, and
patient care through groundbreaking educational innovations that transformed medical
curricula worldwide. Her pioneering work fundamentally changed the landscape of medical
education, introducing compassionate, patient-centered teaching methodologies that
continue to shape healthcare education today.
Background and Early Life
Born on July 8, 1926, in Zurich, Switzerland, as one of triplet sisters weighing only two
pounds at birth, Elisabeth Kübler faced early challenges that would shape her resilience and
determination. Despite her father's traditional expectations that she become a secretary,
Kübler-Ross was determined to pursue medicine from a young age. She left home at 16 to
work various jobs and served as a volunteer during World War II, helping in hospitals and
caring for refugees. These formative experiences, particularly her profound encounter with
the Majdanek concentration camp in Poland where she witnessed butterflies carved into
prison walls by dying inmates, deeply influenced her understanding of death as a
transformative experience rather than merely a medical failure.
After completing her medical degree at the University of Zurich in 1957, Kübler-Ross
married Emanuel Robert Ross, an American medical student, and moved to the United States
in 1958. She specialized in psychiatry and began her groundbreaking work that would
revolutionize medical education and patient care.
Educational Philosophy and Methodology
Kübler-Ross's approach to medical education was revolutionary in its emphasis on
active listening, patient-centered learning, and narrative medicine. Her educational
philosophy centered on treating patients as teachers rather than subjects, fundamentally
shifting the traditional medical hierarchy. She believed that terminally ill patients had the

2. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
most to teach medical students about the human experience of illness, mortality, and the
healing process.
Her teaching methodology emphasized several key principles that became
foundational to modern medical humanities education. First, she advocated for direct patient
engagement, bringing terminally ill patients into classroom settings to share their
experiences with medical students. This approach was unprecedented in the 1960s when
death was considered a taboo subject in medical education. Second, she promoted active
listening as a core clinical skill, teaching students to sit with patients, hear their stories, and
understand their emotional and psychological needs beyond their medical symptoms. Third,
she emphasized the importance of narrative competence, encouraging students to
understand illness through the patient's perspective rather than solely through clinical data.
Revolutionary Teaching Seminars
Beginning in 1962 at the University of Colorado Medical School and continuing at the
University of Chicago in 1965, Kübler-Ross developed innovative seminars that became the
foundation for modern death and dying education. These seminars initially met with
significant resistance from medical colleagues who believed discussing death with patients
was inappropriate or potentially harmful. However, the seminars quickly gained popularity,
eventually drawing standing-room-only audiences.
The seminar format was groundbreaking in its approach. Kübler-Ross would bring
terminally ill patients into the classroom, where medical and theological students could ask
questions about their experiences. This direct engagement broke down the traditional
barriers between medical professionals and dying patients. Rather than treating patients as
cases to be analyzed, students learned to see them as individuals with stories, fears, hopes,
and wisdom to share.
One particularly notable incident occurred when Kübler-Ross invited a 16-year-old
girl dying from leukemia to speak with students. After receiving numerous technical
questions about her condition, the young patient erupted in anger, asking the questions that
truly mattered to her: what it was like to never dream about growing up, attending prom, or
having a future. This moment exemplified Kübler-Ross's teaching philosophy that patients
needed to be heard as whole human beings, not merely as medical cases.

3. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
Impact on Medical Curriculum Development
By July 1982, Kübler-Ross had taught approximately 125,000 students across various
institutions in death and dying courses, including colleges, seminaries, medical schools,
hospitals, and social-work institutions. Her influence extended far beyond individual
classrooms, fundamentally reshaping medical curricula worldwide. Medical schools began
incorporating death and dying education as standard components of medical training,
recognizing that healthcare professionals needed specific preparation for end-of-life care.
Her work contributed to the establishment of thanatology as a legitimate field of
study, combining medical, psychological, and social perspectives on death and dying.
Medical schools began offering dedicated courses on end-of-life care, grief counseling, and
palliative medicine, many directly inspired by Kübler-Ross's pioneering seminars.
The integration of her teaching methods into medical education also promoted
interdisciplinary collaboration. Her seminars included not only medical students but also
theological students, social workers, and other healthcare professionals, fostering a team-
based approach to patient care that became standard in modern hospice and palliative care
settings.
Development of the Five Stages Model
Kübler-Ross's most famous educational contribution emerged from her extensive
patient interviews and teaching seminars. Through her work with over 200 terminally ill
patients over three years, she developed what became known as the Kübler-Ross model or
the Five Stages of Grief: denial, anger, bargaining, depression, and acceptance. This
framework, first detailed in her groundbreaking 1969 book "On Death and Dying," provided
medical professionals with a theoretical foundation for understanding how patients process
terminal diagnoses.
While the five stages model became widely adopted in medical education, Kübler-
Ross herself emphasized that the stages were not necessarily linear or universal. She
intended them as a descriptive framework for understanding common emotional responses
rather than a prescriptive progression that all patients must follow. This nuanced

4. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
understanding became an important aspect of her educational approach, teaching students
to recognize patterns while remaining flexible and responsive to individual patient needs.
Contributions to Narrative Medicine
Long before the formal field of narrative medicine was established, Kübler-Ross
pioneered many of its core principles through her educational approach. She emphasized
the importance of patient storytelling in medical education, teaching students that
understanding a patient's narrative was as crucial as understanding their clinical
presentation. Her method of having patients tell their stories directly to medical students
helped establish the foundation for what would later become known as narrative
competence in medicine.
Her educational approach demonstrated that when healthcare providers actively
listen to patient narratives, they develop greater empathy, improved communication skills,
and more holistic understanding of illness and healing. This methodology influenced the
development of modern medical humanities curricula, which now commonly include
literature, storytelling, and reflective writing as components of medical education.
Global Educational Impact and Legacy
The Elisabeth Kübler-Ross Foundation continues her educational mission through
various programs and initiatives worldwide. The foundation offers certification courses,
workshops, and online education programs that train healthcare professionals in end-of-life
care using her pioneering educational methods. These programs emphasize her core
teaching principles: active listening, patient-centered care, and compassionate
communication.
Her educational innovations have been incorporated into medical schools globally,
with death and dying education now considered an essential component of medical training.
The New York Public Library named "On Death and Dying" one of its "Books of the Century"
in 1999, and Time magazine recognized Kübler-Ross as one of the "100 Most Important
Thinkers" of the 20th century, acknowledging her profound impact on medical education and
practice.

5. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
Influence on Hospice and Palliative Care Education
Kübler-Ross played a crucial role in establishing the hospice movement in the United
States, helping to establish over 50 hospices globally throughout the 1970s and 1980s. Her
educational approach became fundamental to hospice and palliative care training programs,
which emphasize compassionate, patient-centered care that addresses physical, emotional,
and spiritual needs.
Her teaching methods influenced the development of interdisciplinary team
approaches in hospice care, where physicians, nurses, social workers, chaplains, and
volunteers work together to provide comprehensive end-of-life care. This collaborative
model, first demonstrated in her educational seminars, became the standard of care in
hospice and palliative medicine.
Contemporary Applications and Criticisms
While Kübler-Ross's educational contributions remain influential, contemporary
medical education has evolved to address some limitations of her original framework.
Modern educators emphasize that the five stages model should be taught as one of many
frameworks for understanding grief and loss, not as a universal or prescriptive model.
Current medical curricula incorporate multiple theoretical perspectives on death, dying, and
grief to provide students with more comprehensive understanding.
Her emphasis on active listening and patient-centered education, however, remains
central to modern medical humanities and communication training. Medical schools
worldwide continue to incorporate her fundamental teaching principle that patients are
teachers who can provide invaluable insights into the human experience of illness and
healing.
Training Future Healthcare Professionals
Kübler-Ross's educational legacy extends to the training of nurses, social workers,
counselors, and other healthcare professionals. Nursing education programs widely
incorporate her principles of holistic patient care and active listening. Her work
demonstrated that effective end-of-life care requires preparation and education, leading to

6. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
the development of specialized training programs for healthcare professionals working with
terminally ill patients and their families.
Her interdisciplinary approach also influenced the development of team-based
healthcare education, where different professional groups learn together to provide
coordinated patient care. This educational model has become standard in many healthcare
training programs, preparing professionals to work collaboratively in complex healthcare
environments.
Research and Evidence-Based Practice
Kübler-Ross's educational approach emphasized the importance of learning directly
from patients rather than relying solely on theoretical knowledge. This methodology
influenced the development of qualitative research methods in healthcare, particularly in
understanding patient experiences and perspectives. Her pioneering use of patient
interviews as both teaching tools and research methods helped establish the validity of
patient narratives in medical education and research.
Her work contributed to the development of evidence-based practices in end-of-life
care, as her systematic documentation of patient experiences provided empirical foundation
for understanding the dying process. This approach influenced the development of research
methods that prioritize patient voices and experiences in healthcare education and practice.
Elisabeth Kübler-Ross's contributions to education transformed not only how
healthcare professionals approach death and dying but also how medical education itself is
conceived and delivered. Her emphasis on patient-centered learning, active listening, and
compassionate care continues to influence medical education worldwide, preparing
healthcare professionals to provide more humane and effective care to patients facing life's
most challenging moments. Through her pioneering educational methods, she demonstrated
that learning about death and dying ultimately teaches us how to live and care more fully,
creating a lasting legacy that continues to shape healthcare education and practice today.

7. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
References
Corr, C. A. (2019). What nursing can learn from a proper appreciation of the work of Elisabeth
Kübler-Ross? Revista da Escola de Enfermagem da USP, 53, e03513.
Corr, C. A. (2020). Elisabeth Kübler-Ross and the "five stages" model in a sampling of recent
American textbooks. Omega, 82(2), 294-322.
Corr, C. A. (2021). Should we incorporate the work of Elisabeth Kübler-Ross in our current
teaching and practice and, if so, how? Omega, 83(4), 685-704.
Dugan, D. O. (2019). Appreciating the legacy of Kübler-Ross: One clinical ethicist's
perspective. The American Journal of Bioethics, 19(12), 21-23.
Elisabeth Kübler-Ross Foundation. (2024). Elisabeth Kübler-Ross biography. Retrieved from
https://www.ekrfoundation.org/elisabeth-kubler-ross/
Germain, C. P. (1980). Nursing the dying: Implications of Kübler-Ross' staging theory. Annals
of the American Academy of Political and Social Science, 447, 46-58.
Kübler-Ross, E. (1969). On death and dying. Macmillan.
Lyckholm, L. J. (2019). Thirty years later: An oncologist reflects on Kübler-Ross's on death
and dying. The American Journal of Bioethics, 19(12), 24-26.
Malone, E. D. (2018). The Kubler-Ross change curve and the flipped classroom: Moving
students past the pit of despair. Education in Health Professions, 1, 36-40.
Newman, L. (2004). Elisabeth Kübler-Ross. British Medical Journal, 329(7466), 687.
Ross Rothweiler, B. (2019). Reflections on the work of Elisabeth Kübler-Ross M.D. The
American Journal of Bioethics, 19(12), 16-18.
Sisk, B. (2019). The underappreciated influence of Elisabeth Kübler -Ross on the
development of pediatric palliative care. The American Journal of Bioethics, 19(12),
19-21.

8. www.edureaper.com
EDUCATION RESOURCE HU B
www.edureaper.com
EDUCATION RESOURCE HUB
Stroebe, M., Schut, H., & Boerner, K. (2017). Bereaved persons are misguided through the
stages of grief: A response to Worden's criticism of the dual process model. Omega,
74(4), 455-473.
Yang, N., Xiao, H., Wang, W., Li, S., Yan, H., & Wang, Y. (2018). Does narrative medicine
education improve nursing students' empathic abilities and academic achievement?
A cluster randomised controlled trial. BMJ Open, 8(9), e022014.