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Coronavirus Disease 2019
Avoiding Bad Deaths with an Ounce of Prevention
How might we prevent the disease of death?
Posted July 28, 2021 Reviewed by Gary Drevitch
If the COVID-19 pandemic has brought into focus one truth about modern life, it’s that we are more concerned with the quick fix than slow preventative work. We’ll take that pound of cure any day, so long as we don’t have to contribute an ounce of prevention.
Clinicians know this to be the case with routine ailments. My patients tell me candidly that they are keener to take a weight-loss drug than to exercise, and are happier to swallow a statin than to stop smoking. Everyone wants a magic bullet. And for good reason: They are easier. They require less discipline and forethought.
This “quick fix” phenomenon has played out curiously during the COVID-19 pandemic. It would be easy to point fingers at those who have chosen not to mask or maintain a safe social distance while demanding the proverbial snake oil. But that is not my interest. What I instead find most intriguing about COVID-19 is the expectation that we should all die well without any effort to prevent bad dying. Put another way, if prevention helps to thwart sickness, how then might we prevent the sickness known as death?
The truth is that we cannot prevent death; mortality is 100 percent. It is a uniformly fatal disease we are all destined to catch. But that doesn’t mean we can’t work hard to prevent a bad death. Consider, for example, a person who is genetically predisposed to developing diabetes. I have known such patients. A man is as fit as can be—skinny even—yet suffers from diabetes and high cholesterol. Everyone on both sides of the family has the same. Much as he tries, he develops high sugar and cholesterol. But with good exercise and a healthy diet, he does exceptionally well. Just as there exist better and worse ways to manage disease, there exist better and worse ways to prepare for death. And the worst is when there’s no preparation whatsoever. I’ve cared for such patients, too.
Whether diabetes or death, what’s first required is an acknowledgment of the disease’s reality. We must be willing to concede our finitude. But rarely have pandemic headlines reminded readers of their looming deaths and directed them to anticipate and prepare. Despite more than 4 million deaths from COVID-19 worldwide, we continue to pour energy into thwarting the very idea of death and denying the value of preparation.
This wasn’t always the case. After the Bubonic Plague devastated the population of Western Europe in the mid-fourteenth century, there developed a genre of literature on the preparation for death. Known collectively as the ars moriendi, or “art of dying,” these late medieval handbooks held that in order to die well, one must live well. And living well meant cultivating a life of virtue within the context of one’s community. It was prevention, and it took a parish.
As I write in my book The Lost Art of Dying: Reviving Forgotten Wisdom, the earliest iterations of the ars moriendi described five temptations that the dying commonly faced: impatience, despair, pride, greed, and doubt. Going to the grave in abject despair or miserly greed not only threatened to disrupt the art of dying well, but such a person also failed at the art of living well.
The five temptations, then, needed to be mitigated. Early versions of the ars moriendi offered guidance on cultivating virtues both as individuals and as communities in order to combat habituation to a life of vice. For example, to counteract impatience over the slowness of the dying process, people needed to develop the habit of patience. To protect against despair, communities needed hope. The virtue of generosity mitigated greed; humility counteracted pride; and faith remedied doubt.
Cultivating the virtues wasn’t a simple exercise to be carried out as death drew near. Rather, patience, hope, generosity, humility, and faith were meant to be nurtured in communities over a lifetime. As younger or healthier community members gathered at a deathbed, they rehearsed the same virtues that the dying elder herself had spent a lifetime developing.
When I cared for COVID-19 patients at my hospital in New York City in March and April 2020, I was saddened—but not surprised—by the vast numbers of patients who clung to the illusion of invincibility and rejected consideration of finitude. They did this to their detriment, and my colleagues and I tried when possible to engage them in an ounce of prevention.
We live best when we live with a view to the end. We live best when we live examined lives, lives of virtue, lives characterized by a commitment to the good, the true, and the beautiful. This, too, is how we die best.
First published with Virtues & Vocations, an initiative of the Kenan Institute for Ethics at Duke University.
