Among all living beings, we humans are the only ones who know that we must die, and who can view our end with calm. For most of us, however, that is a difficult position for two main reasons. First, we have lost our immortality: only a very few still have an unqualified belief in the resurrection from the dead and in eternal life. Second, our demise in this world is made even more problematic because the number of our descendants has so dramatically shrunk and many of us do not have any children at all. How then can we live on, at least for a time, in their memories?
In general, we are very proud of the fact that our average life expectancy has doubled, even tripled within a few generations. If something happens to one of us prematurely, he or she can usually be promptly repaired. We believe it is our right to feel nearly immortal during our "best years". A slew of prevention campaigns often insinuate that we may indeed soon attain immortality: with a little more jogging, no more smoking, rigorous stair climbing, consumption of low-fat milk, regular "check-ups", it might be possible to put death off altogether. Once upon a time illnesses carried meaning with them. They were taken as a benign hint from God to stop our sinful ways in time. What sense, if any, do health problems make nowadays? They certainly no longer have their old meaning. And yet they often provide the only chance in our hectic lives to turn inward and reflect. Are we afraid, we will not find anything in there, within ourselves?
Paradoxically, death's permanent presence in the media contributes to its sterility. The media show deaths, but only those who occur under unusual circumstances, which we find easy to discover as irrelevant to our situation. Few of us will die a newsworthy death in a plane crash, during an earthquake, the collapse of a skyscraper or a mine, or during a terrorist attack. But even if our own deaths in all likelihood will be banal, we should not ignore death or consider it insignificant. Who among us would want to trade a quiet death for one of those millions of horrible deaths inflicted by human hands during two world wars, in concentration and prison camps, in bombings and firestorms? Today, at least most of us die a natural death.
Death in our time has become a more modest presence, leaving most of us in peace for decades, even if it ultimately prevails. Yet even under these totally new conditions, we find it hard to achieve a balance in our lives, for living means to accept the tension of becoming, being, and decaying that is in us from the start. Balance means not only to accept and endure this tension but to give it meaning and shape. Moreover, for laymen and health professionals alike it means to accept a natural death at the right moment, and not to prevent it, which, technically, has become possible to do temporarily. The old dream of a fulfilled and completed life goes back in our culture to the philosophers of antiquity. That this dream is now suddenly becoming true for more and more people is something totally new. No wonder that many still have problems with it.
If, as they say, the one life we have is our finest possession, and it used to last thirty or forty years, what shall we do with the additional thirty or forty years we now have? Not everyone seems to know. Certainly there is suicide at all stages of life. But suicide grows more common in people over seventy or so, as suicide researchers and gerontologists confirm. Gained years are not necessarily fulfilled years. We have to fill them with meaning. If people spend their lives interested only in physical activity but not in spiritual-cultural matters, they should not be surprised to find themselves confronting a great spiritual emptiness when their physical powers wane in old age and they do not know how to fill the extra days, months, and years. But this need not be so: the situation could be prevented with a lifelong cultivation of spiritual and artistic interests.
Our dilemma is this: the doubling, even tripling of our life expectancy is only one side of the coin. The other side is that along with the increase of our earthly life expectancy there has been a totally different, countervailing development. The result is that over the last generations our lives have by no means become longer, but have - because of the loss of faith in the Beyond - become infinitely shorter. Doesn't the doubling of our earthly years mean little in relation to the loss of faith in an eternity?
Against this background we need not be astonished that most of us go through life in reverse, as it were, with our backs turned on old age and dying. We worship youth because it is at the furthest remove from the final exit. One can understand why the body as the only guarantee of our remaining earthly life is being valued so highly once an afterlife has been rationalized away. When our body is no more, we are no more. Therefore we watch our bodies incessantly, cultivate and pamper them, do bodybuilding and everything else to ensure a smooth functioning.
Even if most of us live the full extent of our natural lifespan, we remain mortal, and that is not a medical problem. It is not a problem at all, but a part of our humanity. Who are we, among all living beings, to alone claim immortality? If medical science attempted to prevent death, that would be inhuman. The problem is that many of us think that medical science should continue to be in charge even when nothing more can be done and nothing more should be done. Death is not a medical teaching subject, and dying right is not part of medical studies. Here a vacuum exists both with professionals and lay people, because instruction in dying right is not required for anybody, in whatever discipline. We are all alone in that regard. Although all of us will die, hardly anyone is prepared, or is preparing to die right. It used to be quite different!
Let us look back to the second half of the fifteenth century. By then printmaking techniques permitted the relatively inexpensive production of woodcuts in large editions that could be distributed cheaply. It had long been the task of priests to help the dying through their last hours. The problem, however, was that during the frequent epidemics many people died at the same time, and there were not enough priests to assist everyone. The priests also knew from experience, just like the "loved ones" of the sick, that contagious diseases were extremely dangerous. Whoever could flee did so, and the farther the better. In short, nobody could be certain of not having to die alone.
What did our forebears do? They learned to die, everyone for him- or herself, even when they were still young. Even if they could not read, they could look at woodcuts. In the view of that time, a soul's fate was often decided during the last hour on earth. It was thought that the devil's forces would try everything to get hold of the soul about to depart. People of those times could imagine what these final temptations would be: tempting of the faith, tempting into despair, and tempting into impatience, pride and arrogance, and earthly materialism. Whoever succumbed to one of these hellish temptations in that last hour was certain to forfeit the heavenly splendours and suffer in eternal hell.
A typical small educational brochure consisted of eleven woodcuts. In each picture the dying person was shown in bed, an Everyman of about forty, with whom all could identify. Five woodcuts illustrated the five great temptations already mentioned. Terrible devils' faces bear down on the moribundus from all sides. They show him his register of sins and let all his life's misdeeds parade by. As perjuror, adulterer, miser, drunkard, glutton, thief, and murderer he would stand no chance of God's mercy. The woodcuts would appeal also to his vanity, would flatter him, remind him of his life's accomplishments, the honors, heroic deeds, and fame. They would mention all his possessions, to distract him from concentrating on dying in a way that would please God.
The corresponding images on another five woodcuts, however, showed the heavenly forces hurrying to his side: angels, saints, and the Trinity. They supported the dying person in his struggle for the soul. Five times he would resist with their help. Then he died. The eleventh woodcut would show the happy end: an angel ready to receive the expired soul in the shape of a small naked child and lead it into God's heavenly splendor.
Dying, the right way of dying, could be learned. If one had absorbed this Ars bene moriendi, this "art of dying right" at a young age, one did no longer have to fear dying, not even dying alone. One knew what the last hour would hold in store, and one only had to copy the Everyman on the woodcuts to be assured eternal bliss.
As a historian, I am always tempted to look how our forebears dealt with problems like ours today. Just as in the past, nobody can be sure that he or she will not have to spend the last hour without spiritual help and die alone. But who teaches us to die?
No one is so naive as to suggest republishing the old Ars Moriendi and distributing it on large numbers to people to help them relearn the "art of dying right". But if we agree that even in our time once again we need an ars moriendi - and I believe we do - there are some good lessons to be learned from the old.
First, an ars moriendi should be rooted in its time. Half a millenium ago it was based, as a matter of course, in the Christian world view and its belief in a Beyond, in resurrection and eternal life. It prepared one for the struggle for the soul in the last hour and guaranteed a successful outcome to those who followed its precepts. For most of us today, life consists only of its earthly part. The process of dying rings in the final chapter.
Second, a decisive factor in the success of the earlier ars moriendi was its concentration on the essential. Eleven expressive, understandable woodcuts sufficed to make the point. A contemporary new ars moriendi must also be concise and poignant, as well as generally accessible. It must speak to everyone today, just like long ago, for once again nobody can be sure of not dying alone.
Third, the "art of dying alone" addressed everyone, even in their early years, for nobody could be certain about not having to die alone the very next day. Thus, the ars moriendi was also an ars vivendi, an "art of living right". Living such a fulfilled earthly life means that at its natural end we are willing to let go even without the prospect of any continuation.
To begin this learning process only with the loss of health and the prospect of death is usually much too late. Just like five hundred years ago, the practise has to begin in youth. Thus, this new ars moriendi is not a manual for the intensive care units, hospice, or the bedroom at home. The motto of this ars is to "live fulfilled", to do so all one's life and as a result "to die in peace." The last weeks, days, or hours may turn out to be whatever and wherever no matter what illness leads to my end or whether I die without help in a hospital, a nursing home, or at home. I have lived my life and did not just grow older. Fulfilled by life, and not just tired of it, I can give it up.
Being open-minded about our situation today makes it easier to find solutions. To be open-minded means to not only take note of the following facts, but also draw conclusions from them. For example, we can read that the average life expectancy in Germany was 37.2 years in 1855, whereas it was 74.6 years in 1985, an exact doubling. Further, not only do we have twice as many years, we also have twice as many good years. Our nutrition is more assured and better than ever before. Infectious diseases are largely under control. We work half as long as our ancestors and generally under better conditions. Economically, with some exceptions, we can afford many more things. Information of all kinds, obtained through numerous television and radio channels, an overabundance of print media, museums, libraries, concert halls, and unversities all over the world is available to all of us as never before.
Are all these advantages worth nothing to us? Dozens of generations before us have striven for a long life. We have it. We are living a dream come true for humankind. And yet we are insatiable - we want more years, better years, and if possible, all of eternity as well.
To be sure, the current control over "plague, hunger, and war" and the resulting increase in life span to an age never before achieved are not guaranteed forever. New plagues threaten us, such as AIDS or wars in different parts of the world. How long this unusual state will last depends in large measure on our vigilance and all of our willingness to contribute. The historian knows plenty of examples of stagnating, even regressive life expectancy. I don't want to paint images of horror - for some, such images qualify the change from an insecure to a secure lifetime and bring about a free-floating anxiety that is hard to conquer. It is a mistake to let fear paralyze you.
The fact is that of today's 80 million or so Germans, more than half were born after 1950. Thus for the first time a large stratum of German society has not experienced the immediate threats of "plague, hunger, and war" that reigned for millenia. For the first time the majority of the German population has been given the astounding opportunity of living and shaping their lives in terms of a quasi-calculable end. This offers an amazing chance to realize a life plan. For the first time we can weigh and coordinate the strengths and weaknesses of each phase of our lives. It no longer makes sense to live just from one day to the next. Given the already mentioned weakening of our physical abilities, it is important to cultivate from early youth not only physical but also intellectual and cultural interests, both in oneself and in others, so that one finds pleasure in each phase of life and makes the last years worth living.
Even for those who still die early, as victims of accidents or incurable diseases, the realization of a life plan makes sense, I think, even if it is cut short. Everything happened for them, too, at the right time. Dying young or old, nobody should berate him- or herself on the deathbed for having missed something. There should be no last-minute, panicky attempt to catch up on what cannot be recouped. The goal should be "to live fulfilled - to die serenely", at whatever age.
Have we been assuming that the change from an uncertain to a certain life expectancy will bring with it an earthly paradise? Only naive people ignore the two sides on a coin.
Let's weigh the facts. Developments since World War II have brought us much that is positive, particulary the shift from an uncertain to the certain life span. We have twice as many years, we have twice as many good years, we can afford more things than ever, and we have more access to the world than ever before. But the same developments have brought us gravely negative changes: the widespread loss of faith in eternity, the possibility of prolonged illness, and the decay of our communal structures, to name just a few.
I doubt that anyone would like to rescind these negative developments by returning to the bad old days of "plague, hunger, and war". We are free to do so. The old infectious diseases have not disappeared from the face of the earth. Hunger and war still exist. Everybody is free to travel without prophylaxis into malaria-infested areas, to go without preserved foodstuffs into the African or Asian hunger zones, or to visit theaters of war. He or she would find the desired premature death and would never have to think about life plans or a new ars moriendi.
Most of us, however, embrace the long life that has finally become possible, and we must accept its concomitant negatives. Let us make the best of the long life we have wished so hard for and that we are now privileged to have. Let us transform every one of the years gained into fulfilled ones, taking advantage of our immense technical, economic, and cultural resources, and then let us die a natural death.
As I wrote at the beginning of this chapter, to be human is to accept and meaningfully endure the tension within us from the beginning - the tension between becoming and being, between being and perishing. Is that so hard to comprehend? Concise and brief, like the old ars moriendi, this is an essential truth for all of us.
Re-Introducing Doctors and Nurses to Death
Under this title, an Ars Moriendi-Conference was held at Yale University on April 15-16, 1994. It was sponsored by the Program for Humanities in Medicine at Yale (Director Professor Howard M. Spiro, M.D.) and the Goethe-Institute Boston (Director Dr. Peter Schmitt). The present article is the revised contribution to that event. The complete conference proceedings are published by Yale University Press (Facing Death, ed. by Howard M. Spiro, Mary G. McCrea Curnen, Lee Palmer Wandel; New Haven - London, 1996; 212 pp).
Last revision: Friday, 30. August 1996 - 16:23:37