The Art of Dying

THE ART OF DYING RUSSELL NOYES, JR.* The outlook for the dying person oftoday appears to be bleak despite the advancements of modern science. He faces the possibilities of pain, grief, isolation, and indignity and he faces them quite alone. Present-day society has failed to provide him with an ideal to be striven for in dying [i]. His family and especially his physician have turned away from him in this important final hour. Even the dying man himself has turned away from death and attempted to escape its reality. So it is that he often stumbles upon his dying hour bewildered, unprepared, and lacking either guide or comforter. The modern physician, however, holds the key to change in this matter. Desiring it, he should reexamine his attitudes toward death and dying and increase his knowledge ofthe dying process and its treatment. The physician has a role of primary importance in creating a right situation for dying well. Such a role is contained in the concept of euthanasia. This Greek term refers to a painless and peaceful death and includes the medical art of accomplishing easy dying. The word which was used by Emperor Augustus nearly 2,000years ago retained its original meaning until the end of the nineteenth century, when it began to be used in reference to mercy killing. Many a physician sees little place for himselfbeyond the saving oflives and the curing ofdisease. The incurable threaten his omnipotent view ofhimselfand affront his professional system ofvalues. He wonders ifhis limited time is not best spent with those who are youthful and who hold promise of cure. He wonders if those benefits are lasting which are obtained for dying persons. Several basic questions are worth examining. Of what value is the dying period? What contribution can the physician make to easy dying? Has he any * Assistant professor ofpsychiatry, State Psychopathic Hospital, 500 Newton Road, University ofIowa, Iowa City, Iowa 52240. 432 Russell Noyes,Jr. · The Art ofDying Perspectives in Biology and Medicine · Spring 1971 special competence besides the administering of drugs to apply to this problem? Ifhe is to accept a role which is not only anxiety provoking but also challenging to his personal and professional beliefs, the doctor may gain perspective and knowledge by examining the writings and practices of major historical periods. To die well has been a remarkably uniform objective ofthe dying since ancient times. But though the objective has been unchanging, its precise meaning and the means thought best to achieve it have varied according to the spirit of the times. Changes in emphasis have been reflected in writings on the subject and in the actual practice of dying. The literature ofthe most recent period has largely been medical in character, to which the specialty ofpsychiatry has made notable contributions . In early periods, contributions were made by philosophy and religion, fields which were at the time closely related though slightly peripheral to that ofmedicine. The deaths ofcertain historical figures not only reveal the influence ofthe age in which they lived, but also illustrate the influence ofthe individual personality upon the dying process. Classical Period Among the ancients, concern for the dying rested primarily with the philosophers. In the Phaedo, which contains a description ofthe last days ofSocrates, Plato set down his beliefs with respect to dying and death and described the final hours ofone ofantiquity's most noble and courageous thinkers. He noted the importance of death as a spur to the search for truth and the quest for life's meaning. The true philosopher, he said, made dying his profession. For Plato, the ultimate objective was the attainment ofpure knowledge through a process offreeing the soul from the body. This goal became possible in death. Distress in dying was to be avoided by turning away from distraction and devotion to the body. "Ifyou see anyone distressed at the prospect of dying," said Socrates, "it will be proof enough that he is a lover not ofwisdom but of the body. As a matter of fact, I suppose he is also a lover ofwealth and reputation" [a]. Socrates spent his final day in prison surrounded by and in dialogue with a group ofhis friends. To the...