Death education in American medical schools: Tolstoy's challenge to Kübler-Ross

No one has done more to shape contemporary physicians' and nurses' understandings of dying and death than Elisabeth Kübler-Ross. A comparison of her views to those of another era, as delineated by Leo Tolstoy, raises questions concerning Kübler-Ross' five-stage theory and points out inadequacies in current medical education and in the values that shape American culture. According to Kübler-Ross, the dying person angrily asks "Why me?" Tolstoy's Ivan Ilych is more concerned about the implications for cosmic justice than for self-perpetuation, and angrily asks "Why death?" One's sadness is born of depression (sadness over the nearness of one's death), the other's is born of despair (sadness over the apparent meaninglessness of life or of life as one has lived it). Kübler-Ross and Tolstoy also differ in their views of what can be done to "sweeten the pill," whether "acceptance" is the best way to face death, and whether death ought to be viewed as a barrier to self-fulfillment or a means of self-transcendence.