Please enjoy this complimentary excerpt from The Lost Art of Dying. Special thanks to Dr. L.S Dugdale and Harper Collins Publisher.
Centuries ago, in the aftermath of the Black Plague, a text known as ars moriendi—The Art of Dying provided guidance on preparing for a good death, emphasizing the importance of living well. Dr. Dugdale's discovery of this forgotten Medieval work was a revelation, inspiring her to merge its wisdom with her extensive medical expertise. In "The Lost Art of Dying," she offers a modern-day ars moriendi, blending insights from the past with contemporary knowledge. By addressing our fear of mortality, embracing aging, establishing meaningful end-of-life rituals, and involving our communities in caregiving, this book reshapes our perceptions of living and dying. With the inclusion of nine black-and-white drawings by artist Michael W. Dugger, Dr. Dugdale's work presents a hopeful perspective on death, urging us to apply ancient wisdom to our present lives, ultimately reevaluating our approach to mortality and daily living.
The Lost Art of Dying
Reviving Forgotten Wisdom
L.S. Dugdale
HarperOne
FLOURISHING WHILE DYING
If the art of dying well is in truth the art of living well, then how ought we to live? How might we face death and still flourish? The ancient Greek philosophers Plato and Aristotle thought that if you wanted to do anything well, you had—at the very least—to live a life of virtue.
If a “life of virtue” sounds like a turnoff, hear me out. The Greeks understood the virtues to be excellent habits that a person could cultivate over a lifetime. If you were lucky, Aristotle taught, you were born into a good family that cared about how you were shaped as a human being. As a child you learned such virtues as courage, justice, and self-control. These didn’t necessarily come naturally, but you worked at them. And with a lot of practice and the practical wisdom that comes with age, you could attain a virtuous or excellent life that would make your flourishing possible. In other words, the cultivation of good habits and practices within the context of social relationships leads to human flourishing.
But is it possible to flourish while dying? Aristotle would have said that it isn’t. For Aristotle, a person also needed external goods like health, wealth, and friends to be able to flourish. But Plato and the ancient Stoics believed that virtue was sufficient. According to their logic, someone who had cultivated the habits of excellence could in fact flourish while dying.
As I was completing this book, my grandmother was in decline. When I visited her in the memory unit, she appeared thinner than ever. Although she had no pain, my suspicion was that the tumor in her stomach was growing. It was deemed “inoperable” two years ago when it was discovered—both because of her frailty and because of the extent of its spread. There was no question that Grandma was dying. Yet she flourished, exuding serenity and grace even as her world grew smaller.
This book is filled with stories of people who flourished in their dying. What, then, is the secret? What excellences should we cultivate throughout our lives in order to die well—in order to reinvigorate the art of dying today?
If we adopt Susan Sontag’s notion of illness as metaphor, we might propose developing the virtue of courage in our attempt to vanquish that feared enemy death. But, as I previously suggested, trying to conquer fear of death may be the wrong project. Rather, we are to persist in walking with those we love toward the fear and sadness—a harrowing, noble task.
Others might propose that we concentrate on the much-heralded Western virtue of self-determination. If anything defines America, this may be it. Pioneers and explorers going it alone, forging their own paths. At first blush, we might think rugged individualism a useful excellence for succeeding at anything, including dying well. But Aristotle was correct when he said that no one flourishes in isolation. As spelled out earlier, we are relational beings, and dying is a community affair. It takes a village to flourish while dying.
There are other virtues—ancient and modern—around which we could attempt to create some sort of guide to dying well. Perhaps justice. Perhaps love. These do indeed have merit in and of themselves, yet it strikes me as arbitrary to elect them over any others. So we return to our question about what virtues we must cultivate in order to die well, and our inability to answer this forces us to reconsider the original ars moriendi, which had a very decisive description of what it takes to die well. What habits did the ars moriendi suggest?
Recall the illustrated Ars moriendi, which paired five temptations commonly faced by the dying with five virtues that mitigate the temptations. Remember the image of the dying man, impatient with his slow decline, anxious to get on with death? Impatience, the ars moriendi taught, can be moderated through the lifelong cultivation of the virtue of patience. The transformation does not happen instantly when a person wills it. Patience must be practiced. Like any habit, you have to commit to exercising patience over and over and over again.
So too with the other virtues that the ars moriendi commended the dying to cultivate. The tendency to despair as death approaches can be remedied through a lifetime of exercising hopefulness. The arrogant and self-absorbed might practice humility—a welcoming and inclusive virtue. Those tempted to doubt their religious convictions might find strength through a life of nurturing their faith. And finally, those who cling most stringently to the material goods of this world can mitigate such avarice through the practice of generosity. In fact, since you can’t take it with you and your world will shrink one day anyway, start the habit now of giving your stuff away.
In the end, these virtues—patience, hope, humility, faith, and “letting go”—lead to flourishing through life as through death. In reflecting on the themes of this book, the habit of letting go makes possible the acknowledgment of human finitude, and the habit of humility makes space for community—recognizing finitude and embracing community being the foundational elements of an art of dying. Exercising faith together with hope helps to mitigate fear of death, suggests answers to our deepest existential anxieties, and promotes the cultivation of peace. And nearly all of us could do with more patience—every day of our living and our dying.
But one should not wait to begin cultivating these virtues. The mid-twentieth-century chaplain of the United States Senate, Peter Marshall, might best be known for his telling of the legend of the merchant of Baghdad. The story goes like this.
A merchant sends his servant down to the market. The servant quickly returns. He is agitated and frightened. He says to his master, “Down at the marketplace I was jostled by a woman in the crowd, and when I turned around I saw it was Death that jostled me. She looked at me and made a threatening gesture. Master, please lend me your horse, for I must hasten away to avoid her. I will ride to Samarra and there I will hide, and Death will not find me.”
The merchant agrees, lends his horse, and the servant wastes no time in galloping off. Later that day, the merchant himself heads down to the market and finds Death standing in the crowd. He asks her why she made a threatening gesture at his servant that morning.
Death replies, “That was not a threatening gesture. It was only a start of surprise. I was astonished to see him in Baghdad, for I have an appointment with him tonight in Samarra.”
This story reminds us that none of us escapes our appointment with death. The solution is neither to flee it nor to seek it out. Rather, we must each prepare for Samarra. Death is part of life. The art of dying well must necessarily be wrapped up in the art of living.
Excerpted from THE LOST ART OF DYING by L.S. Dugdale and reprinted with permission from HarperOne/HarperCollins Publishers. Copyright 2021.
Lydia Dugdale MD, MAR, is professor of medicine and director of the Center for Clinical Medical Ethics at Columbia University. Prior to her 2019 move to Columbia, she was Associate Director of the Program for Biomedical Ethics and founding Co-Director of the Program for Medicine, Spirituality, and Religion at Yale School of Medicine. She is an internal medicine primary care doctor and medical ethicist. Her first book, Dying in the Twenty-First Century (MIT Press, 2015), provides the theoretical grounding for this current book. She lives with her husband and daughters in New York City. You can follow Columbia Center for Clinical Medical Ethics (CCME) on Twitter.
"It was a great thing for Scipio to conquer Carthage, It was an even greater thing for him to Conquer Death, "all is well with the Commander " Seneca Epistles