Stephen E. Doran

(San Francisco: Ignatius Press, 2023, paperback, 219 pp.)

Reviewed by John M. Grondelski

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Writing about how people died alone during the Covid pandemic, Stephen E. Doran cites Ars Moriendi (The Art of Dying), a 15th-century work intended to help people in the age of bubonic plague “die well,” alerting them to life’s temptations and traps as they head down the path toward death: the defining moment of their existence.

That death defines the person hardly seems to be in dispute. Euthanasia advocates, even those who are agnostic or flat-out deny that an afterlife exists, call for “death with dignity,” assuming that a person’s “autonomy” is encapsulated in the final moment of life. The Judeo-Christian tradition, while affirming “life is changed, not ended,” nevertheless holds that post-mortem life is fixed by what a person was at death. So the “art of dying” remains a vital proposition, even if our culture generally surrounds death with an evasive silence.

Doran’s To Die Well could be considered an Ars Moriendi for our day. Though written for a popular Catholic audience, confessional considerations should not limit this book’s reach, which is broadly Christian. It has something for all people of good will, since much of Doran’s discussion about ethical issues connected with dying is rooted in natural law principles accessible to all.

The breadth of this book—encompassing bioethics, medicine, theological anthropology, spirituality, sacraments and liturgy—defies pigeonholes, while matching the scope of its author’s expertise. Stephen Doran is a Nebraska-based neurosurgeon with almost 30 years of medical experience who writes about bioethical issues. He is also a deacon of the Catholic Church.

To Die Well is divided into two parts, “Morality” and “Spirituality.” The first lucidly explains circumstances imposed on death by modern medicine: medically assisted nutrition, withdrawing care, palliative and hospice care, pain control at the end of life, advance directives, brain death, perinatal death, euthanasia, how people died during Covid, and what he calls “deaths of despair.”

While each of these topics could be a book, Doran sticks to the essentials within the grasp of a non-technical audience. A chapter on “Medically Assisted Nutrition” explains why nourishment and hydration, even if a feeding tube is necessary, is not an “extraordinary” means of prolonging life. “Withdrawing Care” explores the ordinary/extraordinary care distinction, stressing that an individual’s medical circumstances may make the same treatment “ordinary” for John but not for Joe.

Another important chapter deals with “palliative” and “hospice care,” along with “pain control at the end of life.” Fears about “unbearable suffering” are stoked by proponents of euthanasia to justify medical interventions designed to cause death. That modern medicine can ameliorate, or at least “manage” pain reveals many of their arguments to be less fact-based than ideological.

Doran distinguishes among “advance directives,” “living wills,” and “POLSTs” (Physician Orders for Life Sustaining Treatment). He is inclined to favor “advance directives,” coupled with a durable power-of-attorney that designates a delegate to make medical decisions for an incapacitated person. Of course, he wants that delegate to be someone with whom the patient has shared his concerns and who shares an ethical commitment to Catholic teaching. He prefers the delegate over living wills and POLSTs (or even a simple advance directive) because ethical medical decisions must be made when there is a concrete medical situation, something about which an a priori document may either be ambiguous or cannot countenance.

“Brain Death” explains how this definition of death emerged and how it differs from the traditional one involving cardiovascular cessation. Doran also notes the wildcard that causes some (like this reviewer) to be suspicious of “brain death” definitions: organ transplantation. Organ donation can be a noble act, but sometimes it seems our technological mindset may be ready to declare John dead before his time in order to harvest fresher organs to help Jim. “Perinatal Care,” which discusses the whole complexus of medical care involving mother and child during pregnancy, is extremely timely, given the effort to portray post-Dobbs pro-life laws as threats to maternal life. The chapter covers a variety of prenatal issues, typically addressing them through the Double Effect Principle. I would have liked to see the argument here expanded, though, because it presupposes two patients, while pro-abortionists insist there is only one.

“Euthanasia” tackles the two forms it assumes in today’s world: “physician-assisted suicide,” where a medical worker simply provides lethal drugs, and “active euthanasia,” where the worker administers death. Doran argues that, in the end, they are indistinguishable: Both are tarred by a common intention: effecting someone’s death.

Doran’s chapter on Covid focuses on how people died—socially and medically isolated—during the pandemic. It’s his opportunity to introduce discussion of Ars Moriendi, preparing for death. It’s also the chapter I was least satisfied with, as I would have welcomed some post-pandemic assessment of whether the inhumane protocols (you can guess where I stand) then put into place around the dying were really justified.

“Deaths of Despair” addresses an underdiscussed contemporary phenomenon: the high number of people dying from addiction or taking their own lives due to an underlying sense of meaninglessness or loneliness. The spike in suicide among young people, the rise in opioid-connected overdoses (fentanyl), and the stubborn persistence of slow death by alcohol all point to a public health and spiritual crisis among our contemporaries.

Part II (“Spirituality”) of To Die Well focuses on more explicitly Catholic (though in many respects also broadly Christian) aspects of approaching death. Topics addressed include “dying well,” “dying to the world,” the last things (death, judgment, heaven, hell), the meaning of suffering, the last sacraments, the celebration of Christian death, and cremation.

This is where Doran lays his spiritual cards on the table. In contrast to the worldly view that dying well means choosing the manner of one’s death, Doran writes this:

As the end of life approached, family was once again allowed to visit. Periods of smiling wakefulness were increasingly replaced by sleep. Judicious doses of morphine helped ease her pain but precipitated even more somnolence. Once she was no longer able to eat or drink, death was imminent. Small groups of family huddled at her bedside, whispering decade after decade of the Rosary. With family beside her, she literally breathed her last seconds after the final decade of the Glorious Mysteries were recited. A good death indeed. (pp. 140-41)

In a society where the inevitability of death is rarely acknowledged let alone discussed, this book fills a real niche, specifically for Catholics but also for everyone concerned with “dying well.”

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Original Bio:

John M. Grondelski (Ph.D., Fordham) was former associate dean of the School of Theology, Seton Hall University, South Orange, New Jersey. All views herein are exclusively his.