Dr. Dugdale attempts to revive the ars morendi, a set of medieval practices surrounding the event of death. Dimensions include finitude, community, context, fear, body, spirit, ritual, and life. Death was much different in the Middle Ages, a common event that almost always occurred at home. Plagues were frequent, other conditions untreatable, so society developed an art of dying that considered and included best practices for each of death’s dimensions. Dr. Dugdale updates these ancient methods to the present, and identifies specific ways in which modern society and medical practice could learn from them.
The author returns repeatedly to a few issues that clearly are important to her. Most frequent is her discussion of the tension between the benefits of using medical technology to resuscitate clinically dead against the implications for what that revived life will be like. This is her area of medical expertise and practice, so she is acutely aware of the downsides of living with intubation and intravenous infusions, trying to keep a frail body from expiring, and the relative shortness of a revived person’s life extension. While some can recover and live a long time in relative health, others last a short time, to then expire again, until revival is completely ineffective.
Death in a hospital ICU is seldom in the context of family and friends, and offers little to no opportunity for final conversations or religious practices. (And this was written before the COVID-19 crisis excluded even immediate family from hospital visits). Some fear death so greatly that they will do anything, accept any pain or indignity, to extend existence a few more hours or days. In other cases, loved ones do not want their relative to die prematurely, sometimes against the wishes of the terminally ill.
Dr. Dugdale advocates that whenever possible, those facing death (everyone) develop a plan for their final hours, such as where they want to die (she suggests most prefer home if given the choice) and who they want present as death draws near, and communicate their plan to those who will speak for them in their final hours. There is a fascinating digression about the evolution of hospitals from their origin, of providing basic care for the indigent, to their modern role as the locus of modern, conveyer-belt medical technology for those who can afford it.
The final chapter points out that the ultimate key to dying well is to live well and have no regrets. While citing the example of Jacob’s last words, she does not speak to the other side of death’s door. Matthew 25:21 & 23 give us the ultimate life goal - to be told by The Lord “Well done, good and faithful servant; enter into the joy of your master.” If one fears the final judgment and is not at peace with God, fear of death is rational. The aphorism, “there are no atheists in foxholes” dating to at least World War II, speaks to the deepest human response to imminent death. How can we be confident in what lies beyond death’s door? Creeds, sacraments, and works as public testimonies of faith all are scriptural. But true confidence comes from a relationship with Jesus that is built on these foundations. Jesus said, “My sheep hear My voice, and I know them, and they follow Me; and I give eternal life to them, and they will never perish; and no one will snatch them out of My hand.” (John 10:27-28) The art of dying well must be based on this, or else it is a superficial facade.
Yes indeed
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