Ars Moriendi, or “The Art of Dying,” was an immensely popular and influential medieval text aimed at equipping the faithful for death and dying. It appeared by order of the Council of Constance sometime between 1414 and 1418, and although its author is anonymous, some scholars speculate that it was a Dominican friar.

It is no surprise that the Church would focus on death-related themes at this time: one of the central pastoral preoccupations of the late medieval Church was preparing souls for death, which included saving them from damnation and shortening their stay in purgatory. To suppose that this focus on death was primarily driven by the effects of the bubonic plague is probably an oversimplification; it seems, rather, to be a foundational characteristic of medieval piety, resulting from a flourishing belief in the reality of life after death and the salvific efficacy of the sacraments. Hence, securing the ministrations of a priest in the final hours of death was a chief concern. But the impact of the bubonic plague, including the loss of clergy who would assist the dying, heightened the need for additional forms of guidance—thus arose the Ars Moriendi, a standard for deathbed pastoral practice intended for the use of dying persons and their loved ones assisting them.

The span of centuries notwithstanding, some modern-day bioethicists have looked to the medieval Ars Moriendi for inspiration in discussing contemporary approaches to death and dying. They recognize that patients nearing the end of life today often are overwhelmed by the complexity of health care and miss the opportunity to prepare well for death. A modern-day Ars Moriendi, then, would serve as a corrective to the prevailing over-medicalized, technologically driven death. Whereas bioethicists generally have sought to use the medieval text as inspiration for an approach that accommodates a wide variety of belief systems, religious and secular, it seems vital that the expressed religious intent be preserved in such a work; in fact, certain insights from the medieval text may provide a helpful addition to contemporary pastoral approaches at the end of life.

Just a cursory look at the medieval Ars Moriendi may suffice to draw out some of these insights. As the text emphasizes, dying persons are commonly faced with temptations that threaten to rob them of salvation, including the temptation against faith, the temptation of despair, and the temptation of pride that leads to complacency. When faced with these temptations, such persons must realize the importance of dying in the faith of Christ and in union with the Church to attain salvation, which is true happiness. This includes the reception of the sacraments, repeated professions of faith, self-examinations, and prayer.

For sure, the sacraments are the primary means by which the faithful can attain salvation; nevertheless, one can resist the graces offered in the sacraments, and so these other practices are important to help dispose one to receive the sacraments efficaciously. In this way, simply ensuring the visitation of a priest and the reception of the sacraments does not suffice. While efforts must be made to console dying persons that death itself is not to be feared, in light of Christ’s salvific act, it is better to stir them from complacency than to allow them to drift away from God for the sake of comfort.

These insights from the medieval Ars Moriendi may be key in reclaiming an art of dying for the twenty-first century. They give cause for concern that the typical approach for Catholics nearing the end of life today presumes that the reception of the sacraments all but guarantees salvation; typically, little emphasis is placed on the need for regular self-examination, professions of faith, and overcoming common temptations against the love of God. Instead, the focus is on consoling the dying person and loved ones, not necessarily for the sake of overcoming fear of death to remove a barrier to salvation, but out of deference to social sensibilities. Based on these concerns, it seems we truly are in need of a modern-day Ars Moriendi. The medieval text makes clear that the reality of judgment after death and hope for the salvation of souls should take priority over everything else, including attempts to better navigate the complexities and limitations of medical management at the end of life.

This piece was originally written by Br. Columba Thomas, O.P.

“Reclaiming an Art of Dying for the Twenty-First Century,” by Dominicans of the Province of St. Joseph, Word on Fire, July 9, 2019

Also see
– Memento mori
– Readaeer Life Size Replica Realistic Human Skull Head Bone Model
– “The Christian Art of Dying: Learning from Jesus,” by Allen Verhey
– “Being Mortal: Medicine and What Matters in the End,” by Atul Gawande

When Elaine Stratton Hild was eighteen, she volunteered to play her viola at a local hospital. On her first day, a nurse asked her to go to the room of a woman who wanted to hear “Amazing Grace.” She found the woman alone, but closing her eyes and allowing the music to wash gently over them both, Stratton Hild played the song. When she opened her eyes, she saw that the woman had turned toward the window and stopped breathing. She had died with the sound of “Amazing Grace” in her ears.

More recently, Dr. Stratton Hild (PhD in musicology) has been engaged in a fascinating study of plainsong chants that different communities would sing to dying persons in the Middle Ages. There were entire liturgies to comfort the dying. The presupposition was that the whole community of friends and family would accompany the dying person on their journey through death and beyond. No one, it was assumed, should have to die alone. And no one should die without the support of the community of believers who would care for both their bodily requirements and their emotional and spiritual needs.

Medieval people were not alone in this conviction. Many cultures have developed practices to help “accompany” the dying both physically and spiritually. A mother of three children who had for a time been a novice with a religious community mentioned that, when a certain bell sounded in that community, everyone would leave whatever they were doing to come to the room of the dying sister. The entire community (spilling out into the hallway) would then sing a chant while the person died.

Most of us in the modern secularized world have, it seems, forgotten how to deal with the dying. Our tendency is to lock the dying person away in a room so that no one can see this “failure” of our modern technology.

. . .

The Church, I am now convinced, should offer its help and the consoling presence of the Body of Christ not only in burial, but throughout the entire process of dying. And by “the Church,” I don’t just mean clerics.

I don’t mean to diminish the importance of priests and nuns. I can think of few things more comforting in the hospital than seeing a nurse who is also a religious sister in her habit. Catholics used to see that all the time. We never do anymore. (Why?) But priests and nuns cannot do everything; they cannot do what only a community can do. And we should not presume to “off-load” this work on them out of our sight the way we have off-loaded it onto doctors and nurses.

The one thing every dying person I’ve known has wanted is to die at home. Not one of them did. And in a hospital, the likelihood of a person getting music, chant, a communal liturgy, or the simple presence of friends and family around-the-clock, is nearly non-existent.

We have allowed ourselves to be atomized by modern culture into little separate units. And when we do that, we have no power against the institutions that promise to care for us, but which are increasingly threatening us. The medical community has an invaluable role to play in treating the dying, but it is only a part. No one should have to die alone, in the hospital, far from home.

Music for the Dying

The solitude of so many deaths wears on Mr. [Juan] Plaza, the fear that someday it will be him splayed on the floor in one of these silent apartments. “This job teaches you a lot,” he said. “You learn whatever material stuff you have you should use it and share it. Share yourself. People die with nobody to talk to. They die and relatives come out of the woodwork. ‘He was my uncle. He was my cousin. Give me what he had.’ Gimme, gimme. Yet when he was alive they never visited, never knew the person. From working in this office, my life changed.”

He is 52, also divorced, and without children, but he keeps expanding his base of friends. Every day, he sends them motivational Instagram messages: “With each sunrise, may we value every minute”; “Be kind, smile to the world and it will smile back”; “Share your life with loved ones”; “Love, forgive, forget.”

He said: “When I die, someone will find out the same day or the next day. Since I’ve worked here, my list of friends has gotten longer and longer. I don’t want to die alone.”

. . .

The undertaker was a Christian, and believed that George Bell was already in another place, a better place, but still. “I don’t think everyone should have an elaborate funeral,” he said in a soft voice. “But I think burial or cremation should be with respect, or else what is society about? I think about this man. I believe we’re all connected. We’re all products of the same God. Does it matter that this man should be cremated with respect? Yes, it does.”

. . .

The last time the Dude saw George Bell was about a week before his body was found. Frozen shrimp was on sale at the shopping center. George Bell got some, to take back to the kitchen he did not use.

Mr. Bertone didn’t realize he had died until someone came to Legends with the news. Mr. Kerins was there and he told the Dude. They made some calls to find out more, but got nowhere.

Why did he die alone, no one knowing?

The Dude thought on that. “I don’t know, man,” he said. “I wish I could tell you. But I don’t know.”

On the televisions above the busy bar, a woman was promoting a cleaning product. In the dim light, Mr. Bertone emptied his drink. “You know, I miss him,” he said. “I would have liked to see George one more time. He was my friend. One more time.”

The Lonely Death of George Bell