The Lost Art of Dying, L. S. Dugdale. New York: Harper One, 2020.

Summary: A physician challenges our over-medicalized treatment of the dying, advocating a recovery of the “art of dying,” which also makes it possible to live well.

He died three times in one night. Mr. Turner was an elderly man dying of metastatic cancer that had invaded much of his body. But the family insisted everything be done to keep him alive. So when he “coded,” much of the hospital mobilized to resuscitate him. Chest compressions broke frail ribs. Breathing tubes were inserted. Injections of powerful drugs were injected to restart the heart. This happened twice more that night. The final time, the team worked twenty minutes to no avail. Mr. Turner was pronounced dead. The author, one of the physicians on this team asks whether this is a good way to die.

This incident, during her residency, began a process of questioning about what it meant to die well, leading to her discovery of the Ars Moriendi, The Art of Dying, a fourteenth century handbook arising out of the plagues, when anyone might expect to die an early death. Dying well begins with recognizing one’s finitude, reckoning on and appropriately planning for one’s death. Dying well happens best in community, where the dying acknowledges wrongs and seeks forgiveness, where love is expressed, and where bystanders rehearse their own death. Dugdale also talks about how context matters, and the preference where appropriate care can be given, for death at home, and in the hospital, only when that affords the best care.

Often our inability to die well, and the actions that hinder dying well reflect our fear of death. She confronts the real terror, even for the religious, of the unknown void of death. Dugdale’s counsel is that each of us has to wrestle with what it means to die into life. In an extended reflection on the Isenheim Altarpiece, she considers what happens to the body in disease and death–its corruption into dust. She describes the reality summarized in one terrified patient’s words–“I don’t know what I believe”–and the vital work of facing the existential questions of meaning to both live and die well.

Her final chapters describe the rituals that follow death, and the wisdom in the Jewish tradition around grief. She concludes with some recommendations that might form a modern Art of Dying. Think twice about hospitalization. Discern when further treatment is futile. Live well at the end through good, and early, palliative care when death is imminent. Reconsider resuscitation. Start giving away your stuff. Live with purpose. Die in community.

The book concludes with a series of ink drawings by Michael W. Dugger, similar to the woodcuts in the original Ars Moriendi around the themes of each chapter of the book. They are a fitting way to invite us to reflect once more on this book’s message: we desperately need to recover the art of dying well. It isn’t to be found in the over-medicalized, hospital-centric practices of our modern way of death. Nor is it to be found in the denial of our finitude, our efforts to suppress our fears.

This book gives much to think about in our current pandemic, including the terrible tragedy of how it results in lonely deaths. A blessing upon the caregivers who treat the dying with dignity and compassion! It also makes me wonder if our inability to pursue for an extended time the disciplines that guard our health and that of our neighbors reflects the fact that we haven’t done the work of preparing to die well. We act as if we are invulnerable. We risk our lives for a night of clubbing. To not adequately reckon with death is to not adequately  treasure the gift of the life we have, the community with whom we share it, and betrays the thinness of our efforts to consider the existential questions of life. All this suggests that this book could not have come at a better time.

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Disclosure of Material Connection: I received a complimentary review copy of this book from the publisher. The opinions I have expressed are my own.