The Lost Art of Dying (L.S. Dugdale) - A Review

 

THE LOST ART OF DYING: Reviving Forgotten Wisdom. By L. S. Dugdale. San Francisco: Harper One, 2020. 259 pages.

                We will all die someday. It's not something we should court but it is inevitable. If we will all die, then does it matter how will approach death? When the time comes, will we be prepared to die well? Or will we fear death? Will we go kicking and screaming, asking that everything possible done to keep us alive even for a few hours or days? As a pastor, I have been present for death. I've seen it resisted and welcomed. As for me, in the end, I do have the hope of the resurrection to hold me up, but I do wonder whether I’m truly prepared to die well.

                In the medieval period, especially during the Bubonic Plague as people died in massive quantities, the question of dying well became important. It was in this context of the devastating presence of death that Ars Moriendi manuals emerged. These manuals spoke of the art of dying. As we have watched hundreds of thousands of people die of the COVID-19 pandemic, is it possible that we could use manuals that speak of the art of dying? Whether we experience a pandemic or not, would it not be wise for us as a culture to create resources that help us deal with the reality of death appropriately? One who believes that there is the need for modern-day ars moriendi manuals is L. S. Dugdale, the author of The Lost Art of Dying.

                L. S. Dugdale is a medical doctor and associate professor of medicine and director of the Center for Clinical Medical Ethics at Columbia University. Before that she was the associate director for the Program for Biomedical Ethics and founding co-director of the Program for Medicine, Spirituality, and Religion at the Yale School of Medicine.

                Writing as a medical doctor, and ethicist suggests that we would benefit from such a manual. Thus, she can speak to the question of dying well from both the medical and the ethical perspective. Thus, we have Dugdale’s book The Lost Art ofDying. While this is not specifically a religious book, the author acknowledges the role that religion plays in the art of dying. So, whether one is religiously inclined or not, the book can prove valuable. Ironically, though most religious people believe in some form of life after death, apparently highly religious people tend to struggle with death and seek to put it off. Religious folks are more inclined to ask that extreme measures be implemented than non-religious people. That is very odd. So, maybe it’s the religious folks who need to know to die well. Of course, she also acknowledges that the medical profession has contributed to our culture's avoidance of death. Many doctors are willing and even eager to do whatever is necessary to extend life, even if it is futile. Dugdale is a medical doctor, but she wants to offer us a different perspective, one that recognizes the limits of medicine when it comes to staving off death.  

                Dugdale begins her book with a chapter simply titled “Death.” In this opening chapter, she tells the story of a family that wouldn't let go of their father and asked for continued resuscitation of their father even though there was no hope of survival. She notes here that too often people believe that CPR is foolproof. Just a few chest presses and breaths and people are up and running. The reality is that for most people when CPR is administered in a hospital it only succeeds in a small percentage of cases. To be effective those chest presses, to be effective will break the ribs of the one receiving the CPR. Thus, it’s not like what we see on TV.

                There is a lot of similarity between Dugdale's book and that of Atul Gawande's Being Mortal: Medicine and What Matters in the End. Like Gawande, she takes a close look at the realities of our medical system and the fact that most people will die in a hospital. The problem is that the medical system has become in many ways a conveyor belt. Therefore, the system is not set up to allow for a thoughtful deliberative approach. It reacts to the situation at hand, and if that means resuscitating on intubating, then so be it, whether that is the best course of action. It's in the context of conversations about the nature of death in the modern world that Dugdale wants us to step back for a moment into the fourteenth century. It’s not that she wants to turn back the clock on medicine, but perhaps we can learn something about death by listening to those who experienced the plague and developed the ars moriendi.

                As the book progresses, Dugdale invites us to consider the fact of finitude (chapter 2), the need for community and the challenge of dying alone (chapter 3), and the context of dying, which happens more often than not in hospitals (chapter 4). She speaks to the fear of death (chapter 5), the nature of the body, and the reality of aging (chapter 6). There is a chapter on the "Spirit" (chapter 7), in which Dugdale addresses some of the religious questions about the nature of life and death. Although she is a scientist, she understands the importance of faith in conversations about death. In fact, she points out that even as we become less religious as a society, spirituality is on the rise. Therefore, there is great importance to something like an ars moriendi manual because it deals not only with the physical but the metaphysical as well. So, as we turn to chapter eight, Dugdale speaks of the importance of ritual to the process of dying well. Some rituals are medical in nature, like the process of pulling the plug. Others are spiritual, like a funeral. It is in this chapter that Dugdale speaks of something we likely don’t pay much attention to and that is the ritual of preparing the body, which is itself an art form, so the body will be ready for burial or other forms of disposal of the body such as cremation. I believe this chapter will prove very important for clergy.  

                The final chapter of the book is simply titled "Life" (chapter 9). She writes that "if the ars moriendi teaches us anything, it's that the work of living well is what enables dying well. The tasks of living well include living each day in the context of community with a view to finitude" (pp. 180-181). To me, that is rather powerful. This chapter is practical in some ways—it speaks to questions such as whether to be hospitalized when death approaches or what to do about resuscitation—but it also speaks of living with the virtues. What we have here is a wonderful summation of the message of living well and dying well. In that, it is an art, one that we who are religiously inclined, would be wise to embrace.

                Dugdale points out in her opening chapter, the one that’s titled “Death,” that an early version of the ars moriendi was illustrated. The reason for this was that it was intended to be of use by people whether they were literate or not so that they could contemplate the art of dying. Literacy rates today are much higher than in the medieval world, but there is value in using art and symbols to convey something of importance. So, with that in mind, Dugdale commissioned artist Michael Dugger to create ink renderings that illustrated the message of the nine chapters of the book. These renderings emulate the original woodcuts that were part of those early manuals. So, the book concludes with artwork and brief commentary that summarizes the chapters we’ve read.

                Speaking as a member of the clergy, I highly recommend L. S. Dugdale's The Lost Art of Dying. That’s because clergy are tasked with walking with those who are dying and with their loved ones. This should prove helpful. I also recommend it to anyone who is wrestling with the concept of death. We are a culture that seems unable or unwilling to face the reality of death. We don't like to talk about it, even when loved ones want to have the conversation. Perhaps this book will ease that conversation. Yes, those in the medical profession might find it useful as well. So, take and read so that you can not only die well but also live well!