Death with True Dignity

When my grandfather was in hospice care toward the end of his life, my mother made a calendar for him so that he could know what he had to look forward to. He was 96 years old and, while still intellectually sharp, clearly nearing the end of life. On the calendar, I remember there were only three things: holidays, bridge, and visits.

I’m Canadian and, in my country, it is becoming increasingly popular for people to put the date of their death on the calendar. This may sound peculiar, like finding a cemetery that has been arranged in alphabetical order. I can explain.

Since the federal government legalized euthanasia in 2016, the number of citizens asking physicians to end their lives at an appointed time has increased to the extent that 3.3% of all Canadian deaths in 2021 were the result of euthanasia. 

The reasons for requesting euthanasia are numerous, but according to a recent government survey of people’s motivations, the leading factor is “the loss of ability to engage in meaningful activities.” And so, if someone has no holidays, no bridge, and no visits, then they might begin to feel that they have lived a “completed life” and consider it time to schedule, as one Dying with Dignity spokesperson put it, her “choiceful death date.”

I do not believe that anyone truly desires an appointment to die, though, and it was the novelist Leo Tolstoy who helped show me why.

At the beginning of his novella, The Death of Ivan Ilyich, a man announces that their colleague Ivan is dead. Tolstoy then informs us “the first thought of each of the gentlemen assembled in the office was of what this death might mean in terms of transfers or promotions of the members themselves or of their acquaintances.”

Next, Tolstoy discusses how there was a feeling of joy among them, “that it was [Ivan] who was dead and not I” combined with the frustrated reluctance that they were now required “to fulfill the very boring obligations of decency” by attending the funeral and consoling the family.

What striking observations of human nature and indictment of human selfishness! By stating these tendencies so explicitly, Tolstoy makes us repulsed at the idea of someone’s death being first and foremost an inconvenience—or worse—a self-serving opportunity. Yet, how often is this unfortunately the case?

Part of the desire for people to control the timing of their own deaths is an attempt to mitigate the inconvenience and disruption that their death may be to other people’s plans and prerogatives. It is good therefore to consider our own attitudes. Does a suffering and dying person pose an interruption to my daily activities, or present an occasion for me to thoughtfully interrogate for myself the meaning and value of my activities and relationships? 

Everyone has had the experience of being sick and wanting to be left alone. But no one wants to be abandoned, and certainly not at the moment of death.

Tolstoy notices how viewing a corpse usually implies such a confrontation when he describes Ivan’s dead body saying, “but, as with all dead people, his face was more handsome, and above all, more significant, than it had been in the living man. […] Besides that, there was also in that expression a reproach or a reminder to the living.”

That the dead can provide “a reproach or a reminder to the living” makes me recall that philosopher Dietrich von Hildebrand observed how death summons us to what is essential. In Jaws of Death: Gate of Heaven, he writes:

Death offers a striking contrast to all that is ungenuine and unnecessary. It has a solitary and authentic grandeur. Much that is worthless may exist somehow tied up with each of us, although by no means in the same degree. But death, with its uniqueness and singularity, with its deep significance and ultimate reality, forms a deep contrast to all the vanities and empty and false attitudes that surround our separate existences.

The life of Ivan Ilyich was characterized by just such vanity and false attitudes which Tolstoy designates through his repeated use of the expression, comme il faut (as must be, according to convention). Ivan’s recurring obsession is to live his life in such a way as to obtain “the approval of highly placed people.” He wanted to live his life “as he believed life ought to go: easily, pleasantly, decently.” Throughout the novella, all this acting comme il faut clearly represents to the reader an impoverished life of existential deprival. Yet, how easily we can see ourselves in Ivan whenever we would compare ourselves to others or orient our lives largely in attempts to obtain the approval of those “highly placed people.” It took his death to be imminent for Ivan to confront the shallowness of his life. But the thought—“Maybe I did not live as I should have?”—can be hard to bear.

Perhaps most importantly of all, Tolstoy then goes on to show that avoiding suffering and death involves manufacturing and participating in a lie that reduces the solemn act of a person’s death, most painfully for the dying person. Consider how Tolstoy describes Ivan’s inner experience:

The main torment for Ivan Ilyich was the lie, that lie for some reason acknowledged by everyone, that he was merely ill and not dying, and that he needed only to keep calm and be treated and then something very good would come of it. While he knew that whatever they did, nothing would come of it except still more tormenting suffering and death. And he was tormented by that lie, tormented that no one wanted to acknowledge what they all knew and he knew, but wanted to lie to him about his terrible situation, and wanted him and even forced him to participate in the lie. The lie, this lie, perpetuated upon him on the eve of his death, the lie that must needs reduce the dreadful, solemn act of his death to the level of all their visits, curtains, sturgeon dinners … was terribly tormenting for Ivan Ilyich.

It is tormenting for someone who is dying to have the “solemn act of his death” reduced to the predictable level of a legal appointment or a coffee date. The dying person loses the opportunity to be the deserving center of attention. The weightiness of this person’s suffering is crudely flattened to the same level as the superficiality that characterizes mass life. By scheduling a death, there is no need to keep vigil with the attentiveness demanded by an event that is, at once, anticipated but impossible to predict precisely. The death is curated to be palatable to others so that it does not cause them any distress. As one of my friends put it recently, “If your life has been a reel, then your death may not be real.” By trying to make death as “ideal” as our social media profiles, we can easily rob the dying person, who eminently deserves to be at the center of the drama, of an intimate experience that is of an entirely different nature—no filter, no edits.

Tolstoy admits us to the cry of a dying person’s interiority in all its rawness and sincerity: “There were moments, after prolonged suffering, when Ivan Ilyich wanted most of all, however embarrassed he would have been to admit it, to be pitied by someone like a sick child. He wanted to be caressed, kissed, wept over, as children are caressed and comforted.”

Everyone has had the experience of being sick and wanting to be left alone. But no one wants to be abandoned, not in moments of extreme suffering—whether physical or psychological—and certainly not at the moment of death. Even when we are sick, we want someone to check in on us, to offer to go to the pharmacy for us, to order UberEats for us, and things like that. And when we are dying, we want to know that, with death, our memory in the lives and rhythms of our loved ones will not be completely ended but changed.

Eventually, Ivan pronounces that “Death is finished.” This is magnificent because it is evocative that death had its task to do and so accomplished it. Death finished up its service to Ivan and to the reader by shaking us out of our superficiality and complacency and of the mediocrity that seduces us to ask that we live lives only “as I lived before, nicely, pleasantly.”

Life is not really complete unless and until we die real deaths. The dying person deserves to be the center of attention. Anything that instrumentalizes someone’s death either as a mere service to another, or to suit our convenience, is an injustice against the dignity of the person. Real death, like real life, will always have some element of surprise and mystery.