Chapter 32

Dying Well

A Theology for the Christian Approaching Death

Margaret is seventy-eight years old. She has pancreatic cancer. Her oncologist gave her three months in October. It is now late January, and she has outlived the prediction by a few weeks, which surprises no one in her family, because Margaret has always done things on her own schedule.

She is in her own bed. Hospice came in three weeks ago. The hospital bed they brought is in her living room now, near the south window where the afternoon light is best. On the table beside her are three things: her grandmother's Bible, a small wooden cross her son carved when he was nine, and a photograph of her late husband, who died eleven years ago and whom she expects to see soon.

She has done what she could to prepare. She and her estranged sister, who had not spoken in fourteen years over a foolish quarrel about their mother's silverware, sat together one afternoon in November and made things right. She rewrote her will in early December. She wrote letters to each of her grandchildren — twelve letters, each different, each sealed with a name. Her pastor came on Wednesday and prayed with her, read her favorite psalm, gave her communion. Her family takes turns sitting with her now.

She is not unafraid. The dying part itself frightens her — the feeling of leaving, the moment of crossing. But the deeper fear, the one that used to wake her up at night when the diagnosis was new, has quieted. She is going to see the One who loves her. She has known this for fifty years. Now it is becoming real.

That kind of dying — prepared, attended, surrounded, hopeful — used to be ordinary in Christian places. It is not ordinary anymore. This chapter is about how to recover it.

The Lost Art

There is a name for what Margaret is doing. The Latin phrase is ars moriendi — "the art of dying."¹ In the fifteenth century, after the Black Death had killed perhaps a third of Europe and the priest who used to come to every deathbed was sometimes also dead, two small books appeared. The longer one was called Tractatus artis bene moriendi — "treatise on the art of dying well." A shorter, illustrated version followed soon after. Within a generation they had been printed in nearly every European language.

These manuals were short and practical. They named five temptations the dying person would face: loss of faith, despair, impatience with suffering, spiritual pride at one's own goodness, and stubborn attachment to worldly things. Against each temptation they named a consolation: the steadiness of Christ's promises, the immensity of God's mercy, the peace of trusting God's timing, the humility of resting in grace alone, and the freedom of letting go. They taught the dying person what prayers to pray, what passages to recite, what postures to take. They taught the family and friends what to do, what to say, when to be silent.

The tradition did not die with the medieval church. The Reformers kept it. Martin Luther wrote on dying. The Puritan Jeremy Taylor wrote a beloved companion volume in 1651 called The Rule and Exercises of Holy Dying, paired with his earlier Holy Living.² The Eastern Orthodox kept their own dying liturgies, which they keep still. The Catholic tradition kept the last rites. As we saw in Chapter 3, for most of Christian history the deathbed was a known place. Christians knew what to do there.

Then, in the twentieth century, the deathbed moved.

What the Hospital Took

Death moved out of the home. By the 1950s, most Americans were dying in hospitals. By the 1980s, the figure was over eighty percent. The deathbed became a hospital bed. The person at the bedside became, often, a stranger in scrubs holding a clipboard. The ritual structure thinned. The pastor who used to come now sometimes did not even know the person was dying until after the fact.

This shift was not all bad. Modern medicine has eased much suffering, and pain control at the end of life is better now than it has ever been. But something was lost. Stanley Hauerwas has written that the modern church has largely forgotten how to die — and how to help others die — because we have outsourced dying to people whose vocation is curing rather than companioning.³ Allen Verhey put it sharply: the contemporary Christian's deathbed has become a place where things are done to the dying body, but rarely a place where the dying person is met.⁴

The pastoral consequences are real. Many Christians arrive at the end of life having never thought seriously about it. They have no liturgy, no framework, no practiced prayers. The pastor, called late, has little time and few resources. The family is exhausted and afraid. The dying person — sometimes already past clear conversation — gets no help making sense of what is happening.

Signs of Recovery

There are signs of recovery. The hospice movement, which began with Cicely Saunders at St. Christopher's in London in 1967, set out to do something the modern hospital had stopped doing: care for the dying as whole persons.⁵ Saunders was a Christian, a former nurse, a physician, and a thinker who believed that the dying body, the dying mind, and the dying spirit could not be cared for separately. Her phrase "total pain" — the convergence of physical, emotional, social, and spiritual suffering — has shaped end-of-life care ever since.

Atul Gawande's 2014 book Being Mortal brought a similar message to a wide secular audience.⁶ Gawande, a surgeon, watched his own father die and discovered that what dying patients most needed was almost the opposite of what hospitals were giving them. They needed presence, conversation, the right to choose, time. Lydia Dugdale, a physician and ethicist, wrote The Lost Art of Dying in 2020 — an explicit attempt to recover the ars moriendi tradition for our day.⁷ Dugdale puts the medieval manuals back on the bedside table and asks what they still have to teach.

These are signs of life. The Christian community can build on them. The recovery, though, asks something of us — a willingness to think about our own death before it arrives.

The Shape of Dying Well

Preparation

Christian preparation for death does not begin in the hospice room. It begins decades before. It begins when a Christian first takes seriously the fact that they are mortal. The medieval ars moriendi assumed that the soul is being shaped, all through life, for the moment when it will leave the body. The way you live shapes the way you die.

This means small daily practices. It means living within the rhythm of confession and forgiveness, so that broken relationships do not pile up like unpaid bills. It means making peace with your own life — your failures, your regrets, the things you wish you had done differently. It means setting your affairs in order well before the deadline, so that the last days are not consumed with paperwork. It means cultivating the habits of prayer that, when the dying time comes, will rise to meet you because you have practiced them long.

The Deathbed Disciplines

When death is near, the church has practices that do real work. Confession, where the dying person can speak what they need to speak — to God, often through a pastor or trusted Christian — and be released. Communion, where the body and blood of the Christ who has gone before through death are received. Anointing with oil, which is biblical (James 5:14). Prayers of commendation — the ancient prayers in which the church speaks the dying soul into God's hands. The recitation of the psalms, especially Psalm 23 and Psalm 121, which the dying have been holding for three thousand years. The reading of beloved Scripture passages. Familiar hymns sung quietly at the bedside.

These are not magic. They do not earn anything. They open the dying person, and the dying person's family, to the presence of God who is already there.

The Encounter

Here the NDE evidence joins the older tradition with surprising specificity. What the ars moriendi manuals taught — that the dying soul is met by Christ, sometimes by angels, sometimes by deceased Christian loved ones who have gone ahead — turns out to match what tens of thousands of NDErs report.⁸ The encounter is real. It is personal. It is loving. The dying believer is not disappearing into a void; they are walking into the presence of a Person.

I want to be careful here. The basis of Christian hope is not the NDE evidence. The basis is Christ — His death, His resurrection, His promises. The NDE evidence is corroboration; it is not foundation. But corroboration matters when the dying person is afraid. The pastor at the bedside can say, with full Christian confidence and now with empirical support, "Christ will meet you. The crossing is into His arms." Chapter 21 developed the case for that identification at length.

The Church at the Bedside

Christian dying is communal. The dying person should not be isolated. The family should be there. The pastor should be there. The Christian friends, the small group, the people who have prayed with this person and broken bread with this person — they should be there if at all possible.⁹

This requires intentional effort. Modern hospitals are not naturally hospitable to gathered Christian community at the bedside. But it can be done. A pastor and a few friends can sit and pray, can sing softly, can read Scripture, can simply be present. The dying person — even when no longer obviously responsive — often perceives this presence. The next chapter will give specific reasons, drawn from the NDE literature, to believe so.

What About Fear?

Christian dying is not necessarily without fear. Fear is a human reaction to a great unknown, and dying is the great unknown. Even Jesus, in Gethsemane, sweated blood. The dying believer should not be told to feel no fear, as if fear were a failure of faith. Fear is held within faith, not erased by it.

The good news is that the encounter overcomes fear. NDErs who report fear at the early stages — and many do — uniformly report that the fear dissolves in the presence of the light, in the presence of love, in the presence of the One who meets them.¹⁰ The believer can therefore say to the dying, "If you are afraid, that is human; the fear will not be the last word; what meets you on the other side is love."

Unfinished Business

Dying well includes attending to what is not yet finished. There are relationships to mend. There are words to say — words like "I love you," "I am sorry," "I forgive you," "Thank you," "Goodbye." There are blessings to give the children and grandchildren. There are letters to write, possessions to assign, last conversations to have.

This is real work, and it is sacred work. Sometimes the dying person has the energy to do it. Sometimes they do not, and the family must do as much as they can on their behalf. Either way, the unfinished business should not be ignored. Death is not the end of the relationship — but it is the end of certain things that can only be done before death.

What the NDE Evidence Adds

What does the NDE evidence add to all this? Four things, briefly.

First, the encounter at death is real. The dying soul is not being met by emptiness. As we saw earlier, what NDErs almost universally describe is a Person of overwhelming love. Christian readers have good reason to believe this Person is the Christ of the New Testament.

Second, the transition is peaceful for the prepared. The out-of-body phase, when reported by Christians who have spent decades in faith, is often described in terms of quietness and clarity rather than panic. The body's dying is one event; the soul's experience is another.

Third, deceased Christian loved ones may welcome the dying. Chapter 13 showed that NDErs sometimes encounter deceased relatives whose deaths they did not yet know about — a finding that resists easy psychological explanation. The traditional Christian image of the saints awaiting the dying is, on this evidence, more than poetic.

Fourth, consciousness during apparent unconsciousness is the rule rather than the exception. The dying person who has stopped responding may still be experiencing. The conscious intermediate state begins, if the NDE evidence is right, somewhere very near the moment of bodily death.

What the Dying Ask

Now to the questions the dying actually ask.

"What if I die in pain?" The pain is real. Modern palliative medicine has reduced it greatly, and the dying believer should accept whatever pain control fits their conscience and conviction. But pain does not negate the encounter. Christ on the cross died in pain. He met His Father through it, not after it. NDErs who suffered greatly in their dying often report that the moment of crossing relieved the pain at once.

"What if I die afraid?" Fear is human. The encounter overcomes it. The presence that meets the dying does not condemn the frightened.

"What if I die alone?" No Christian dies alone. Christ is there. The communion of saints is there.¹¹ When the human family cannot be present — and sometimes they cannot — the divine family is.

"What if I die unconscious?" The empirical evidence is that consciousness during clinical "unconsciousness" is real. Cardiac arrest patients have reported detailed accurate observations of their resuscitation, with eyes closed and heart stopped.¹² The dying person who appears unresponsive may be experiencing the encounter already. The pastoral implication: speak as if the dying person hears you, because they may.

The Art of Dying Is the Art of Living

There is a deeper truth at the bottom of all this. Knowing how to die teaches how to live. The medieval phrase ars moriendi has a sister phrase — ars bene vivendi, the art of living well. They are the same art.

A Christian who has sat with mortality will rank things differently. The grudges look smaller. The relationships look bigger. The work gets done with a steadier hand because it does not need to be everything. The prayer deepens because it is for real things rather than worried things. The grace of God becomes more obvious because we have stopped pretending we don't need it.

A word about suffering, briefly. Some Christians die slowly. Some die in great suffering. The Christian tradition has resources for this. The cross is not a slogan; it is the truth that God has been, in His own person, where the dying body now is. To die with Christ is, in some real sense, to die into the life of God.¹³ None of this makes the suffering less. It makes the suffering meaningful.

Margaret

Margaret died on a Tuesday afternoon, in February, around three o'clock. Her son was holding her hand. Her daughter was on the other side of the bed. Her pastor had been there in the morning and had read her Psalm 23 and prayed the old prayers of commendation. The hospice nurse said her breathing changed and then, very gently, stopped.

Her family does not know what she saw in her last moments. She had not been speaking by then. But they know what the Christian tradition has taught for two thousand years, and they know now what tens of thousands of NDE accounts confirm. She was met. She was loved. She was welcomed. The crossing was into a Person.

Dying well is possible. The Christian tradition still has its resources. The empirical evidence supports what faith has long believed. The dying believer is not facing the void. They are facing a Person who is waiting, who has loved them all their lives, who has died Himself to draw them home.

The next chapter turns from the dying believer to those who sit beside them — the pastors, family, friends, and chaplains who carry the ministry of presence at the bedside.