Moreover, it has been noted that severely handicapped and disabled persons who must change their lifestyle to accommodate the effects of illness or injury might also go through a process in which they move toward acceptance of a new self and a new way of life. Denial and disbelief are the initial responses to the knowledge that one is dying. It often is only a holding action until the person is ready to move forward to the next stage. It can be useful if the period is used to find a way to deal with death. During this stage the caregiver should neither agree with and reinforce the patient's denial nor attempt to force progress toward acceptance.
Anger is a typical response to frustration and loss of control over one's life.
The anger might be misplaced and directed toward the caregivers or relatives and significant others rather than on events and circumstances over which the dying person has no control and against which there is a feeling of helplessness. Caregivers should not take patients' expressions of anger and frustration personally. It is appropriate to allow angry patients opportunities to express their anger and feelings of helplessness in a nonjudgmental and accepting environment. Bargaining is the stage in which dying persons begin to try making some arrangement whereby they give up something in return for an extension of life. The bargaining often is with God or a Supreme Being who the patient feels has the power to prolong life.