Dying could occur with hope or without hope. In dying with hope, medical intervention is used, but in dying without hope, palliative care becomes an option after medical intervention is deemed as futile. Psychiatrist Elisabeth Kubler-Ross proposes a five-stage model of dying. Some of these stages may not apply to every dying person. Also, a dying person may go back and forth these stages. Thus, Kubler-Ross’s five stages of denial, anger, bargaining, depression, and acceptance should not be understood as progressive. The emotions of anger and sadness associated with dying are universal, yet they are influenced by cultural factors. For example, Kubler-Ross’s stages of dying do not include farewells between dying persons and their loved ones and how or to whom a medical doctor communicates the bad news about dying. Culturally, there are advantages to both sharing the bad news with the dying adolescent/adult directly and with sharing the bad news with the dying person’s family first. Generally, in Western cultures direct communication of the bad news with the dying patient is more valued, whereas in non-Western cultures communication of the bad news with the dying person’s family first is more appreciated.