To Live at the End of Life

Can a dying man flourish? This might seem like an absurdity; after all, don’t we associate the end of life with the pain of illness and frustrations of disability, perhaps the dislocation and discomfort of medical treatment or hospitalization, and, ultimately, with an imminent journey into that “undiscovered country, from whose bourn no traveler has returned”? Without discounting the profound ways in which impending death diminishes flourishing — not least in one’s physical health — we think that there are three important and neglected dimensions of flourishing that may be realized in a uniquely deep way at the end of life: meaning and purpose in the form of narrative integration, close social relationships, and virtue and character.

Mining meaning through ultimate narrative integration

The meaning of one’s life — its significance, its purpose, its overall coherence — arguably only begins to be accessible as one approaches death, and the story of one’s life begins to reach its denouement. The dying are thus given a unique opportunity to mine their lives for meaning, and to begin to tell their own story in a relatively complete way. This might take the form of a deep and searching reflection on one’s past achievements and failures alike, reflection that might paradoxically be facilitated by the immobility imposed by frailty or illness.

Related, this deepening sense of the meaning of one’s life as the end approaches might be an occasion for a new richness in one’s relationships.

Deepening or restoring relationships

Meditation on the meaning of one’s life can occasion joyful reflection with friends and family, as well as repentance for past failings and final efforts at reconciliation and repair. The approach of death also opens up new dimensions of significance within our relationships: The marriage vow, “till death do us part” is given powerful expression as a husband holds his wife’s hand in her final hours, when the vow is ultimately then fulfilled. And there is perhaps no commendation more powerful or enduring than a dying man’s last words of pride and love to his children.

Approaching the end of life through a fresh search for its  meaning and a deep engagement with those we love is no easy matter, however, given the profound suffering, uncertainty, disempowerment, and isolation that all-too-often attend death. But this means that, third and finally, the dying are given unique opportunities exercise to the virtues that allow them to come to terms with their fate.

Cultivating virtue such as courage, patience, and humility

The dying are called to new courage in the face of physical pain and suffering, and to sound new depths of patience, humility, gratitude, and love. Many societies emphasize the period of dying as a crucial phase of life for which we ought to prepare, as through the medieval genre of works on “the art of dying” (ars moriendi). But then, for most of our species’ history, death was ubiquitous and unavoidable, from the chickens slaughtered in the farmyard for that night’s dinner, to the infants and grandparents who died in the home and were carried out from it to the graveyard.

In the contemporary West, by contrast, death happens elsewhere, often in industrial slaughterhouses for animals and sterile hospitals for us, and increasingly without our acceptance; indeed, some “transhumanists” are actively seeking the technological means to defer it indefinitely. This estrangement from death, and our understandable fear of it and all its heralds, whether pain, infirmity, or dependence, is perhaps one cause of the overriding focus in dominant assessments of quality of life at the end of life on coping with illness itself.

Our civilizational recoil from death is perhaps also one cause of the recent wave of legalizations across the rich world of physician-assisted suicide, most recently in Great Britain, and of euthanasia, in which a physician directly kills a patient through lethal injection. In Canada, euthanasia is now the cause of one in every 20 deaths, including many who are not terminally ill, but rather disabled, depressed, or simply poor.

Quite apart from the ways in which these regimes might enable the abuse or stigmatization of the disabled and terminally ill, they are arguably symptoms of a society reluctant to confront the many ways in which death is, at least in this vale of tears, a part of life. Ignoring that fact will not allow us to avoid death, but embracing it might allow the dying unique opportunities for mining meaning, deepening relationships, and cultivating virtue. There are aspects of flourishing that can be attained — and perhaps attained in unique ways — even at the end of life