Explainer
Creed
Death & life
5 min read

The lost art of dying well and what we can learn from it today

Living well in order to die well doesn’t simply happen. It takes work. It takes preparation. For All Souls Day, Lydia Dugdale asks if we are prepared for death.

Lydia Dugdale is the author of The Lost Art of Dying. She is Professor of Medicine at Columbia University and Director of the Center for Clinical Medical Ethics. She is a specialist in both medical ethics and the treatment of older patients. 

A medieval book illustration of a person dying in bed.
A 15th Century ars moriendi, or ‘art of dying’ image.
Basel University, via WikiCommons.

The first of November marks All Saints Day on many church calendars—a day when we Christians remember our martyrs together with all the faithful, both living and departed. On that day, we celebrate that our communion is not simply with one another on earth but is also with all saints of all time, including those who have died.  

For some people, the notion of fellowship with departed saints might be quite exciting. They may have pondered questions about the saints since school assemblies or RE lessons. What was racing through Abraham’s mind when he attempted to sacrifice his son Isaac? What would Mary say a sinless Jesus was like as a toddler? Did Jonah float around inside the great fish, or did he find something on which to perch himself?  

But others among us might wish to skip All Saints Day altogether. Talk of dead saints feels positively medieval, even a bit morbid. Some of us might wonder about our own saintliness—or lack thereof. Could we really experience ineffable joy in an afterlife? Moreover, the very suggestion of an afterlife implies that we ourselves must die—an uncomfortable prospect for most of us.   

Such divergent reactions to the day are revealing. On the one hand, the idea of having saints to remember is to inspire us to live well. They invite us to examine their lives and to grow ourselves in response. On the other hand, they remind us that our days are numbered. And because our days are numbered, we should attend carefully to what it means to live wisely. Saints teach us that if we want to die well, we must live well. 

But living well in order to die well doesn’t simply happen. It takes work. It takes preparation. Which is why this year on All Saints Day it’s worth asking the question: Am I prepared for death? 

Death exists as a paradox for Christians—as something at once lurking and vanquished. 

In the late Middle Ages, the ars moriendi, or ‘art of dying’ genre of literature developed in response to mass loss of life from a fourteenth-century outbreak of bubonic plague. The genre consisted of a number of handbooks on how to prepare for death. Although the earliest text was anonymous, historians believe that its authorship had a connection to the Western Church. After the Reformation, Protestant versions began to circulate, and later handbooks omitted religious particularity altogether. The handbooks grew in popularity throughout the West for more than 500 years. 

This notion of living well to die well lay at the core of the various iterations of the ars moriendi. Early texts warned readers that five temptations lead to dying poorly—temptations to doubt, despair, impatience, greed, and pride. If you don’t want to die a doubting, despairing, impatient, greedy, and proud person, you must cultivate the virtues of faith, hope, patience, generosity, and humility now. But the ars moriendi texts were very clear that virtue did not happen to a person all at once at the end of life. Rather, it required habituation. Cultivating virtues was the work of a lifetime. If you want to be remembered as a person of sound character, a generous person of hope and good will toward others, you cannot delay making such attributes a regular practice. If you are willing to be martyred for your faith—as some of those early saints were—you have got to be sure it is a faith worth dying for. 

I once met a man who had converted from the religion of radical self-centeredness to Christianity. When I asked him why, he told me that of all the world’s religions, Christianity had the best story. As with the martyred saints, it was for him a story worth dying for. And All Saints Day reminds us that in Christianity, death is stranger than you might think. 

Death exists as a paradox for Christians—as something at once lurking and vanquished. Death is the enemy that at long last will be destroyed, and death has already been swallowed up in victory. But you might ask: if death has already been defeated, what remains to be destroyed? And if death will be destroyed, how has it then been defeated? This enigma might partially explain why many regular church attenders are neither physically nor spiritually prepared for death. Researchers at Harvard University have shown that people who describe themselves as most supported by their religious communities are also most likely to reject hospice care and instead to elect aggressive life-extending technology. 

The story goes as follows. Death is an enemy because it suggests rejection of God. From the beginning, God tells our forebearer Adam that he can freely eat of any tree in the garden but one. If he eats from the tree of the knowledge of good and evil, he will die.  Thus, from the beginning, God equates the possibility of human disobedience with the actuality of death.  

Of course, Adam and Eve eat the proverbial apple. And when they do, they don’t immediately die, but they experience a sort of death. For the first time, they become filled with shame and fear. They hide themselves from God. They cast blame. God tells them that moving forward their life will be filled with great suffering. God says to Adam, ‘By the sweat of your face you shall eat bread until you return to the ground, for out of it you were taken. You are dust, and to dust you shall return.’ Disobedience is what Christians call ‘sin’—and it brings death. Sin severs that once harmonious relationship between God and people—a fact that also grieves God, which is why God does not let death have the final word. 

The story gets better. Since we humans cannot possibly undo the drastic results of our disobedience, God becomes fully human in Jesus Christ, so liable to death, while also retaining full, divinity which cannot die. Then, as a human on a cross, he dies as the ultimate sacrifice on behalf of humankind. But this God-Man does not stay dead. After three days in the tomb, Christ is resurrected, defeating death, on what has come to be known as Easter Sunday. Christ’s resurrection functions as a sort of guarantee that all God’s people will one day be resurrected and receive new bodies, that day on which the great enemy of death will be destroyed once and for all. If Adam and Eve brought death into the world, the resurrection hope is that death will be no more.  

This year on All Saints Day we have the opportunity to consider what it means to commune with ‘all saints’ extending back to Adam and forward to future generations. We have the opportunity to study the saints and then examine ourselves. What sort of people are we becoming? Are we living well to die well, as the ars moriendi handbooks teach? And of all the stories out there, which provides the greatest hope in life and in death? 

Essay
Art
Awe and wonder
Creed
Trauma
1 min read

What good is a beautiful Notre Dame to a traumatized world?

Beauty reminds us why life is worth preserving.
Stone columns and walls frame round and arched stain glassed widnows.
Notre Dame interior.
Notredame.fr.

On the day the Notre Dame cathedral burned my daughter was just a few days shy of her fourth birthday. She was serious and silent as we watched, on our computer screen, the flames lick through the roof and the spire fall. When I closed the computer, my daughter slipped quietly upstairs to her bedroom and pulled out her collection of pennies scrounged from parking lots, sidewalks, and in between furniture cushions. She placed them into an envelope along with a drawing of the cathedral (spelling wasn’t in her tool kit yet) and directed me to please post it to Paris “for them to fix Notre Dame with.” 

It was a beautiful thing to do. And while, unfortunately, it was going to take rather a lot more than a few US pennies to do the job, my daughter was instinctively picking up on something that many others were too: first, that we didn’t want to lose Notre Dame, and second, that it was going to cost a lot of money to save it. Within the first 48 hours €900mn were pledged to the restoration effort from French sources alone. 

It was heartwarming at first, France and the rest of the world rallying to save this architectural and historical treasure. But a sour note soon crept in. This sudden appearance of so much money, ready and available to help rebuild the cathedral left many wondering why that money had not been directed toward improving and even saving lives in France and throughout the rest of the world. 

A few weeks later, ethicists Peter Singer and Michael Plant co-authored an article echoing these concerns. Bluntly titled “How Many Lives is Notre Dame Worth?”, Singer and Plant argue that the €1 billion currently pledged to Notre Dame’s reconstruction would be better directed to, for example, bed nets for impoverished people in malaria-stricken regions of the world. They estimated that €1 billion dedicated to this cause could prevent approximately 285,000 premature deaths.   

It made me uncomfortable, the facts stated like that.  Is it right to be devoting so much money to a project that is largely aesthetic when there are people dying of want? If my daughter were in danger of dying from malaria or malnutrition, I would wish for her to be prioritised over a thousand cathedrals.  

And yet, envisioning a world in which everything beautiful, but not strictly necessary to keeping a heart beating – ballet companies, art galleries, poetry publishing houses, infrastructures that protect the world’s national parks, ancient cathedrals – is neglected and left to crumble until every human on the globe has their basic, practical needs met seemed to me to be self-inflicting another kind of deep poverty. What ought we, as people who want to make the world better for everyone, to do with our resources of money, time, and strength? 

Beauty allows the trauma sufferer to discover empathy both for themselves and others (goodness) and thence to recognize themselves once more as human (truth). 

Recently, a book entitled The Ethics of Beauty, by Greek Orthodox ethicist, Timothy Patitsas, has informed my perspective on this quandary. In the preface of his book Patitsas critiques the definition of contemporary ethics (“the rational investigation of morality”) in its elevation of two of the Socratic transcendentals, Truth and Goodness, to the exclusion of the third, Beauty. He writes,  

“. . . we find Ethics identifying itself as the investigation of ‘the Good’ by ‘the True’ . . . But, in discarding Beauty, Ethics itself risks becoming not only unlovely but also an affront to loveliness and loses its power to motivate the human soul except through the force of argument.”   

I recognize this modern approach in Singer and Plant’s article. They extrapolate what goodness would be (directing money toward providing bed netting) from what is true (the number of needy people and the lives that could be saved). Patitsas suggests, instead, an approach to ethics that leads with Beauty, then flowing to Goodness and Truth.  “If we do not begin with Beauty,” he writes, “it is all too easy to miss the full complexity of human personhood.” 

Patitsas believes that only those who have “encountered the very antithesis of Beauty” can judge whether the “Beauty-first” approach has any merit, and so his first chapter is a discussion of how it might serve those who have suffered severe trauma. Citing the work of psychiatrist Jonathan Shay, Patitsas explains that a traumatic experience is the profound learning of a soul-shattering “truth”, resulting in a profound excommunication of the sufferer from their fellow humans, from God, and from themselves:  

“In any all-engulfing experience, you obtain a knowledge that totally overtakes you, but when such an experience includes trauma, other effects are added, including the cutting of communion, the unraveling of character, and the learning of heretical truths.”  

These “heretical truths”, according to Patitsas, are newfound, deep, perhaps unarticulated, revelations that the world is hostile towards the sufferer, and that their life is not situated in a mutually dependent, mutually beneficial relation to their fellow humans. Instead, humankind is a threat to them, and God, at best, has no interest in their flourishing. In other words, it leads the sufferer to view and position themselves as something outside the bounds of humanity. Patitsas writes, “When we experience trauma, our very being is thrust away from coherence and solidity and towards non-being - and this is hell.”  

Shay found that suicide among traumatized war veterans increased significantly when they were treated using talk therapy, an exclusively truth-centric Freudian approach. Instead, Patitsas argues, the trauma sufferer must be “recommunicated” through Beauty – Beauty being the only agent with experiential power sufficient to meet the potency of trauma. Beauty allows the trauma sufferer to discover empathy both for themselves and others (goodness) and thence to recognize themselves once more as human (truth). 

When I first read Patitsas’s description of a Beauty-first path back from trauma I immediately recognized it as my own. In my twenties I experienced, within 18 months of each other, the violent deaths of my brother and my baby son.  And truly I felt like a razor blade had engraved in the marrow of my bones the heretofore concealed truth of the universe: nothing precious will survive. I viewed other people as a threat, either for their propensity to suddenly die and break my heart, or the way they caused harm either deliberately or accidentally. God became my worst enemy, all-powerful and merciless.   

And yet, most of the rest of the world did not appear to know what I now knew, so I felt forced to cut myself off in order to protect myself and to stay true to truth itself. I was a Gollum-like creature living in the shadows, reduced to panic-attacks set off by ordinary noises such as the doorbell ringing or an object being dropped. Sometimes I just lay in a ball on the floor and screamed for no particular reason other than that the world was so terrifying, so horrifying. I used to be a sane person, now “truth” had made me insane.   

The way back to the land of the living was not, for me, through rationality. I cannot, to this day, say why these tragedies happened; I don’t imagine I will ever feel at peace with them. And it was a long time before I was able to speak the truth of what had happened without feeling that I was just twisting the knife in my wound. The first time I caught an inkling that maybe I still might find a place in the world was through a work of fiction. I read of a young Italian who becomes a soldier and is caught up in the ravages of the first World War. He loses everything and everyone precious to him over the course of the war and he witnesses and participates in situations contrary to all moral order. He survives the war, but must discern whether and how to live in its aftermath. The book is his recollection and reflection, as an old man, upon his life. He dies pronouncing the sum of it all as beautiful and precious beyond measure. And reading it I could see that it was. I could recognize myself in much of his pain and struggle, but for the first time I had seen a vision of a way of living that does not deny all that is traumatic and cruel, but can yet hold it within a vessel of costly and weighty beauty.

When we encounter something truly beautiful, we do not perceive that we are all-important, but it affirms that we are a precious part of a transcendent whole. 

Another agent of recovery was a recording I owned of the great pianist Artur Rubenstein performing the second movement of Chopin’s first piano concerto. The way he touches the piano keys at certain moments is the tenderest, gentlest thing I have ever known. I used to lay on the floor, a bloody mess, and break my heart into that music and feel it miraculously held. I found that my heart, though black and almost smoking with ruin, surprisingly arose and responded to that gentleness. It could live in that small corner of the universe, completely without fangs.  I could still find a home among such things. 

There was also a very large, old cemetery, an oasis of big trees, flowers and grass, in the midst of the gray concrete city in which we lived. I used to walk the miles of paths through the cemetery and watch the seasons change: the flowers in the spring, the leaves in the autumn, the green grass in the summer, snow in the winter. I would read the inscriptions carved into the gravestones by the people who loved them, and I could not deny that although death was here in abundance, so too was life. 

It was then, once Beauty had cracked the door open and enabled me to at least consider the possibility that I might still be able to live, that was I able to follow where Beauty had gone ahead and allow people to touch me with love. Then I could speak of my pain in a way that could heal instead of just fester the wound. 

As I have spent time pondering Patitsas’s thesis, it occurs to me that a worthy definition of Beauty might be that which regifts to all of us – trauma sufferers or not – the goodness and truth of our humanity. From the earliest days of the Judeo-Christian faith, Beauty has been believed to be a manifestation of God in the world, a showing-forth of his character. Since this tradition also teaches that the primary identity of humans is that we bear God’s image, it seems logical that Beauty might also act as a corrective and restorative mirror to us humans in a world in which our humanity is constantly barraged both from within ourselves and from outside influences. When we encounter something truly beautiful, we do not perceive that we are all-important, but it affirms that we are a precious part of a transcendent whole. Beauty does not flatter us that we need no improvement, but rather, it acknowledges our limited strength, limited power, limited knowledge and wisdom, limited desire and ability to do good, and yet assures us that it can hold these wounds and that we possess incorruptible dignity. And when we grasp the reality and blessedness of our own humanity, we are able to recognise and embrace it in others as well. Then we are moved to provide bed netting for those who need it, food for those who are hungry, medical help for the sick and wounded, companionship for the lonely, and all other acts of kindness and mercy.   

And so, I affirm with all my heart Singer and Plant’s assertion that we ought to make great efforts to save lives and ameliorate suffering. Indeed, these actions are themselves beautiful! However, it is only at our very real and profound peril that we discount Beauty as a waste of resources. If we do not allow Beauty the seat at the head of the table, we are in grave danger of forgetting why it is that we must do what we can to ease suffering, of forgetting why life is worth preserving, of forgetting that it is possible to have every physical need met and yet be dying. 

In this world we are often constrained to choose between tragic options, and there may come a day when Notre Dame must be left to crumble. However, even though I live thousands of miles from Paris, it does my heart good to see it so wonderfully resurrected, and I sense many share my joy.   

Notre Dame is already birthing more Beauty into the world. According to a recent article, the reconstruction project has injected a surge of life into the arts and crafts sector. I hope it will result in the creation and preservation of many good and beautiful things. And I hope that we will, all of us, become artisans of the world, creating and tending Beauty. May Beauty appear as stories, music, art, and architecture. May it show up as the tending and protection of nature. May it be food, clean water, mosquito netting placed into hurting hands. May it be caring medical attention. May it be gardens tended and work well done. May it be patience, forgiveness, and grace extended. May it be measured, considered words spoken and printed. May it be children generous with their pennies.May it be Notre Dame standing another 800 years and more. 

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