New book is a detailed Catholic guide to the art of dying well

Death is inevitable and Catholics recognize that it is something that must be done well. But what does it mean to die well? To die poorly?

There are a number of spiritual and moral issues related to death and various end-of-life issues, and a new book from Ignatius Press tackles those questions directly.

Dr. Stephen Doran is the author of To Die Well: A Catholic Neurosurgeon’s Guide to the End of Life (Ignatius Press, 2023). A board-certified neurosurgeon with over twenty-five years of experience, he is also an ordained permanent deacon who serves as the bioethicist for the Archdiocese of Omaha. His writings in bioethics, neurosurgery, and gene therapy for brain disorders have been widely published in national media outlets, academic journals, and neurosurgery textbooks.

Dr. Doran recently spoke with Catholic World Report about his new book, discussing how to take a moral and spiritual approach to end-of-life issues.

Catholic World Report: How did the book come about?

Dr. Stephen Doran: Over the years, I realized that many patients and families had not thought much about the reality of death, and even fewer had contemplated or prayed about it. As a neurosurgeon, I’m often treating patients who have a sudden, severe neurological injury such as a stroke, hemorrhage or traumatic brain injury. Understandably, both the patient and family can be overwhelmed, but are faced with important decision making. Attention is appropriately directed towards the medical problem at hand, but often the spiritual and emotional issues that are simultaneously present are largely ignored.

My hope in writing this book would be that people would take the time to inform themselves about the many complex issues surrounding death and dying, spend some time thinking and praying about the end of life, and then talk with a trusted relative or friend that shares our Catholic Faith.

CWR: What do you mean by dying “well”? And what would it mean to die “poorly”?

Doran: To die well is to let go of the things of this world and to abandon ourselves to love. For some, abandoning themselves into the source of love itself is a simple act of the will. For others, this decision is more difficult.

In his book The Art of Dying Well, Saint Robert Bellarmine wrote: ‘‘We showed, that no one can die a good death, without first dying to the world.” Many of the saints, including Ignatius and John of the Cross, wrote about the necessity of detachment from worldly things. It is not the thing; it is the attachment to the thing that weighs down the soul.

A “poor death” would be the opposite: an inordinate attachment to worldly things that tempts a person to cling to earthly life. It is worth noting that a good death is not necessarily one that is peaceful, pain free, surrounded by loved ones. While, of course, this is desirable, it is not by itself the mark of a good death.

We only have to look to Christ, who died the most perfect death yet suffered so greatly.

CWR: End of life issues are often very complex. Many people find it hard to even know where to start with honest discernment, because it is such an emotional time. What are some basic principles for discerning how to “die well”?

Doran: As St. Robert Bellarmine said so succinctly, “to die well, one must live well.” Living well includes the recognition and acceptance that our time on earth is limited, and that we are all destined to die. This is self-evident, yet so many people are unable to think about, much less pray about the inevitability of death. It is important for us to understand that death is more than the cessation of bodily function: death is the separation of the soul from the body. Yet this should not cause us to despair, but rather fill us with hope. We all long for union with God and death is the necessary way by which our souls join him in heaven. Through the resurrection of Jesus, we have the hope for our own bodily resurrection and the reunion of our bodies and souls.

End of life issues can be complex and it is difficult, if not impossible, to anticipate the circumstances that will occur as death approaches. As such, a living will may not be helpful, and could in fact lead to care that might be contrary to our Catholic Faith. A list of do’s and don’ts when it comes to types of care may not be applicable at the time of serious illness. It is preferable to identify a durable power of attorney for medical care. This person should be someone who loves you and knows you well, and you should have conversations with that person well before you become seriously ill. This person will then be prepared to be your spokesperson in the event you are unable to speak for yourself.

CWR: The book is spilt into two sections: Morality and Spirituality. Are these two facets equally important?

Doran: Both are equally important. Morality without spirituality is just a list of rules. Spirituality without morality would not address the specific concerns that arise during the end of life.

CWR: Can we gain insights into the ars moriendi from the history of Christian practice, or is our modern context too unique for tradition to be helpful?

Doran: Death has become medicalized: illness and death are the enemy, and modern technologies are the weapons to defeat them. In the battle against death, the patient is often reduced to an interested bystander whose humanity or personhood is largely ignored.

Dualism, the separation of the body from the soul—the sacred and the secular—is at the root of the medicalization of death. If we lean into the Christian tradition that we are a unified body and soul, this reorients how we think about death and dying. We see the patient as a whole person with physical, emotional, and spiritual needs. If we neglect any of these, we do so at our peril. The Christian tradition is the antidote to the challenges against the ars moriendi, the art of dying well.

CWR: What do you hope readers will take away from the book?

Doran: My hope is that this book will not only answer questions but also give readers pause, moving them to contemplate, pray about, and prepare for the end of their earthly lives.