Kalanithi’s ars moriendi

Ars moriendi or the “art of dying” was originally a specific religious essay composed as a comfort during the Black Plague of the late middle ages. Today, the term may be applied to a religious or philosophical essay on the subject. Because life is overshadowed by the “letting go” of inevitable death, the genre is not only addressing conscious last days of life but may today be aplied to the entire art of living, of living well, wisely, and consciously, in the face of inevitability.

Ars moriendi is universal. From stoics in the West to Japanese death poets in the East, classics on dying with the understanding that living correctly is always an urgency do share important insights without divisive metaphysics or speculation.

The genre may today, by analogy, be authored by wise physicians, even if the weight of how to livee well is only offered as an opportunity to the wise reader. How We Die, the influencial 1994 book by surgeon Sherwin B. Nuland, described the process of aging and death as a natural phenomenon versus the catalog of diseases gleefully assigned to each symptom of decline by the medical and pharmaceutical establishments. Not that dying has even been the happily painless ideal of going to sleep without awakening, as Nuland notes. The impulse to arrest and frustrate a natural course even when the prospects of reversal are nil commonly delineates medical discourse, even now when palliative philosophies and practical methods of palliative care have emerged. Death “with dignity” is an older negative mindset, but even palliative care still requires insight about time, space, quality of life, consciousness, and suffering — no easier to understand as science. But any death carries the urgency to embrace the expression of ars moriendi.

Ars moriendi cannot be an art taken up too late for comprehending what happens in the long or short course of time. This urgency is illustrated by the fate of the brilliant young neuro-surgeon Paul Kalanithi, who was also thoroughly familiar with literature and the ars moriendi genre. He died very young, barely finishing his medical residency, but managed to wrie an autobiographical manuscript When Breath Becomes Air (2016), describing his days from lung cancer diagnosis through reacting, coping, then eking out life to the end.

This memoir can be readily added to the repertoire of arts moriendi, made special because the author is a physician. Like Being Mortal by Atul Gawande — which, however, addresses as third-person research the life and death of patients, plus the life and death of his father — Kalanithi’s book fits this new expression of the ars moriendi genre. In Kalanithi’s book the modern jugernaut of technological and pharmaceutical progress is contrasted with tenuous quality of life prospects. No better person for composing such a book is Kalanithi because the author is both a terminal cancer patient and an informed physician and scientist who can both recount his careful medical decisions as a practicing neuro-surgeon while assessing the signs of impending death more professionally and philosophically than other people in this life stage, and, perhaps, better than other writers of ars moriendi.

The value of the art of dying, considered when in health and vitality, is to practice a clear mindset long before consciousness is swayed by fear and suffering. Kalanithi was originally a formal student of literature because of its clear psychological insights, but eventually he pursued the study of medicine and neuroscience for their physical and descriptive insights, for knowledge about the mechanical and biological aspects of the unitary body/mind that constitutes our identity. Science is the priveleged knowledge afforded by modern times, but as Kalanithi wrote in his final year, literature uplifts the burdens of the self. Poetic passages classical and modern sprinkle the author’s pages, and one sees a divergent contrast of art versus science gradually unified in fact and elevated in spirit.

In the end, said Joseph Conrad, we live as we die — alone. Or, rather, we die as we live. To each personality is alotted an art of dying, an extension of the art of living, providing a perfect continuity if we learn the art well.