Chapter 32

Dying Well

Recovering an Ancient Wisdom for the Christian Approaching Death

Margaret was seventy-eight when the oncologist told her, with that careful softness oncologists learn, that the chemotherapy was no longer working. She had been a schoolteacher for forty years in a small Nebraska town. She had buried her husband nine years before. She had three grown children and seven grandchildren and a small white house with a garden she could no longer tend. She listened to the doctor without crying. When he finished, she nodded once and said, “All right. Tell me what comes next.”

What came next was hospice. Margaret enrolled the same week. She had two months, possibly three. She did not waste any of them.

In the first week she finished her will. In the second she wrote letters — one to each of her children, one to each of her grandchildren, two to old friends, one to the man who had taught her algebra in 1962 and shaped the trajectory of her teaching life. In the third week she asked her pastor to come and bring communion. He came with bread and a small silver cup he used for hospital visits, and the two of them sat in the morning light of her front room, and they ate and drank, and he prayed, and she wept quietly, not from grief but from something nearer to joy.¹

In the fourth week she began rereading the Psalms. She started at Psalm 1 and read three or four each morning. She told her daughter she wanted to die having Psalm 23 fresh in her ears. By the sixth week the cancer was in her bones and the morphine made her drowsy, and the reading slowed. But she kept on. She got to Psalm 130 the day before she lost the strength to hold the book.

Her daughter slept on the couch beside her in those last days. Her son flew in from Denver. Her grandchildren came in twos and threes, hugged her gently, said the things grandchildren say when they do not know what to say. The pastor came twice more. The hospice nurse, a Catholic woman with steady hands, came every day.

On the last morning Margaret was awake before dawn. She asked her daughter to open the window. She asked her to read Psalm 23. Her daughter read it in a voice that broke twice. Margaret listened with her eyes closed, and when it was finished she said, very clearly, “Surely.” She said it like a person agreeing with something. Then she said, “He is here.” Her daughter could not tell whether she meant the pastor (who was not in the house yet that morning) or someone else. Margaret smiled a small smile, and her breathing changed, and within an hour she was gone.²

I tell you Margaret’s story not because it is unusual but because, by historic Christian standards, it is exactly normal. For most of the last two thousand years, this is what a Christian death was supposed to look like. The dying knew they were dying. They had time and they used it. They reconciled what could be reconciled. They received the sacraments. They listened for the voice of the Lord. Their families gathered. The pastor came. The Psalms were read. The dying person spoke their last words and then went, by faith, to meet the Christ they had been following all their lives.

This used to be common. Now it is rare. Most Americans — the majority of them Christians — die in hospitals or nursing facilities, surrounded by professionals rather than by family and clergy, often unconscious, often surprised, often without the rituals their forebears would have considered absolutely essential.³ The contemporary church has, in large measure, lost the art of dying. The tradition that for centuries shaped how Christians prepared for death has thinned to the point of near-invisibility in most congregations. Pastors are not trained in deathbed ministry. Families do not know what to do. The dying themselves have rarely been taught how to think about their own deaths.

This chapter is an attempt to begin recovering what we have lost. I want to walk through the historic Christian art of dying — the Ars Moriendi tradition that shaped fifteen hundred years of Christian deathbeds — and then ask what a contemporary version would look like, particularly in the light of what we have learned from fifty years of careful research into near-death experiences. Margaret’s death was not an accident of personality. It was the fruit of a tradition. That tradition is recoverable, and it is, I believe, urgently needed.

The Question We Have Stopped Asking

For most of human history, dying well was a question Christians asked one another. They asked it before they were dying, with the seriousness that another generation might have given to choosing a profession or building a marriage. They asked it during their last illness, when they could still ask. And they asked it on each other’s behalf, after a death, measuring the dying they had just witnessed against the standard the church had taught them.

Lydia Dugdale, a physician at Columbia who has written the most important recent recovery of the tradition, puts it bluntly: in the medieval and early modern world, “everyone knew that a good death was a possibility, and a bad death a possibility, and that the difference between them was not a matter of luck.”⁴ A good death was something a person worked toward over the whole of their life. A bad death was something the church and the family and the dying person himself fought against, with every spiritual resource at their disposal.

Today most Christians, if they think about their own deaths at all, think about them in terms borrowed from somewhere else — from the medical system, with its conversations about “quality of life” and “goals of care”; from the broader culture, with its mix of denial and morbid fascination; from the funeral industry, which has its own logic and its own incentives. Few Christians today know the historic categories. Fewer still have been trained to use them.

This is a problem. It is a problem because dying is hard, and people who have to do hard things benefit enormously from the accumulated wisdom of those who have done them well before. It is a problem because the contemporary church’s pastoral capacity at the bedside has thinned along with the tradition. Most pastors I know — and I know many — will tell you privately that they feel inadequate to deathbed ministry. They were not trained for it in seminary. They learned what they know from doing it, and from the painful experience of doing it badly the first several times. We have professionalized so much of dying that we have, in the process, deskilled the church.

Dugdale calls her book The Lost Art of Dying, and the title is exact. It is an art. It can be learned. It used to be taught. We have stopped teaching it, and we are paying the price.⁵

What I want to do in this chapter is begin teaching it again. Not in any complete way — that would take a book, and several have already been written.⁶ But I want to give you, the reader, the basic shape of the tradition, the place it has come from, the resources it offers, and the way the empirical evidence we have looked at across the last thirty-one chapters of this book bears on the practical question of how to die.

I will assume, for most of this chapter, that you may be the dying person. Perhaps you are not yet, but you will be one day. Most of what I will say applies as readily to a person five years from death as to a person five days. The art of dying, as the tradition understood it, is not something you learn at the deathbed. It is something you learn before you reach the deathbed, so that when you reach it, the work is already largely done.

I should also say, before going further, what this chapter is not. It is not a manual for grief. It is not a guide for those who care for the dying — that is the next chapter, on companioning the dying. It is not a treatment of the harder pastoral case of the dying unbeliever — that is Chapter 34. This chapter is for the Christian, or the Christian-curious, who is approaching their own death and wants resources for thinking about how to do it well.

The Tradition: A Brief History of the Christian Art of Dying

The phrase Ars Moriendi — Latin for “the art of dying” — refers most narrowly to a particular set of fifteenth-century manuals that took their place in late-medieval Christendom as the standard pastoral guides for the deathbed.⁷ But the tradition the manuals codify reaches back to the first Christian centuries and forward, in modified forms, into the present. To recover the art of dying is to recover something the church has been doing, in one form or another, since Polycarp and Perpetua walked toward their executions in the second century.

The earliest Christians faced death frequently and publicly. The martyr accounts that survive from the first three centuries of the church are, among other things, instruction manuals on how to die. Polycarp, the bishop of Smyrna, was burned at the stake around AD 155. His account, preserved in a letter from his church, presents him as having no fear, refusing to deny Christ, praying as the fire was lit, and entering death with a confidence that astonished the pagan crowd.⁸ Perpetua, a young Christian noblewoman martyred in Carthage in 203, kept a diary in prison that survives as one of the earliest pieces of Christian devotional literature written by a woman. She faces her death with the same composure, undergirded by visions she records of Christ’s presence and of the heavenly home awaiting her.⁹

The point of these accounts is not that every Christian should aspire to martyrdom. The point is that early Christians believed dying well was possible, and that the church passed down stories of those who had done it as patterns for those who were yet to die. The genre we now call hagiography — the lives of the saints — functioned partly as a school of dying. The death of the saint was often the climax of the account, written with care because the church believed Christians who had not yet died had something to learn from the way the saints had.

By the high medieval period, this concern had taken liturgical form. The dying Christian, in twelfth- and thirteenth-century Europe, would normally receive what the tradition called the “last rites” — confession, communion (the viaticum, “food for the journey”), and anointing with oil. Prayers were said over the dying body. The Psalter was read. The dying person was encouraged to speak final words of faith. Family and clergy gathered. The deathbed was a public event, attended by the church.

The fifteenth-century manuals systematized what had been a long oral and liturgical tradition. The earliest version, the long Tractatus artis bene moriendi (“Treatise on the Art of Dying Well”), seems to have emerged from the Council of Constance around 1415, possibly in connection with the pastoral concerns raised by the Black Death and the prolonged crises of late medieval Christendom.¹⁰ A shorter, illustrated version appeared by the 1450s and circulated widely in the new medium of woodblock printing. By the time Gutenberg’s presses were moving books across Europe, the Ars Moriendi was one of the most widely printed Christian texts in the world. There were editions in Latin, German, French, Dutch, Italian, English, and several other languages. The standard scholarly estimate is that over 100 separate editions were printed before 1500.¹¹ Few books in history can claim that kind of saturation.

The manuals follow a remarkably consistent structure. The dying person, the manuals teach, faces five characteristic temptations as death approaches. Each temptation has a corresponding consolation by which it can be overcome. The dying person, with the help of those gathered at the bedside, is invited to recognize each temptation, recognize the lie within it, and lay hold of the consoling truth.

The Five Temptations of the Dying

The first temptation is against faith. The dying person is tempted to doubt — to wonder whether any of it is true, whether God exists, whether Christ has really redeemed, whether the gospel will hold at the boundary of death. The manuals are realistic about this. They do not pretend that faithful Christians are immune. They simply say: when the temptation comes, hold to the creed. Recite it. Speak it aloud if you can. Let those at the bedside say it for you. The church has confessed this faith for two thousand years; it is not undone by your last confusion.¹²

The second temptation is despair. The dying person looks back over a life and sees the sins, the failures, the ways they fell short, the people they hurt. The voice that comes is the voice of the accuser: you are not forgiven; this is too much; this is not coverable. The manuals respond with the gospel. The blood of Christ, they say, is sufficient. The thief on the cross was forgiven in his last hour. The prodigal was met by the father while he was still a long way off. There is no sin too great for the cross to cover. The dying believer holds to the cross.

The third temptation is impatience. The dying person, suffering, is tempted to anger — at God, at the disease, at the family, at the slowness of dying or the speed of it. The manuals recognize that suffering is real and do not minimize it. They simply remind the dying person that Christ Himself suffered, that the dying are joined to His sufferings, that patience in dying is itself a participation in the gospel. This is not a denial of pain. It is a frame within which pain can be borne.

The fourth temptation is spiritual pride — the deceptively pious version. The dying person, looking back over a life of relative faithfulness, is tempted to take credit. Look at all I did for the Lord. Look at how I served. The manuals are remarkably alert to this. They say: you did nothing apart from Christ. Whatever good was in your life, He did. Cast yourself on Him alone. Do not let pride sneak in at the last moment and disguise itself as gratitude.

The fifth temptation is attachment to the world — to one’s family, possessions, plans, projects. This is the most poignant of the five. The dying person does not want to leave. The manuals, again, are realistic. They do not say one should not love one’s family, or that one should be cold to what one is leaving. They say: hold these in their proper place. The Christian’s deepest attachment is to Christ. The lesser loves are sustained within the greater. To die well is to release the lesser loves into the keeping of the One who loves them more than you do.¹³

The manuals do more than identify temptations. They prescribe practices. The dying person is to confess. To receive communion. To be anointed. To pray the prayers the church has prayed at deathbeds for centuries — the litanies of the saints, the Psalter, the commendation of the soul. Family and clergy are not bystanders. They have specific roles — reading aloud, praying, holding the dying person’s hand, speaking the responses when the dying person can no longer speak. The deathbed is a liturgical event. The church is present.

It is hard to overstate how thoroughly this tradition shaped Christian dying for several centuries. From roughly 1400 to 1900, in most of Europe and most of Christianized Europe’s extensions, this is roughly how Christians died. Not all of it was good — the tradition picked up theological accretions some of which the Reformation rightly questioned — but the basic shape of the deathbed was stable across confessional differences and across centuries.

The Reformation and the Tradition

The Reformation modified the tradition without destroying it. Luther wrote his famous “Sermon on Preparing to Die” in 1519, before the formal break with Rome was complete. It is a stunning piece of pastoral theology. Luther tells the dying believer to fix his eyes on three images: the image of death (which he should look at squarely, not in denial); the image of sin (which he should also look at squarely); and the image of Christ on the cross (which displaces both, because Christ has taken death and sin into Himself). The dying Christian, Luther says, should look at Christ until death and sin recede into the background, and Christ alone fills the field of vision.¹⁵

The Anglican tradition produced its own classic in Jeremy Taylor’s The Rule and Exercises of Holy Dying (1651). Taylor, a Caroline divine writing during the upheavals of the English Civil War, argued that holy dying was the natural fruit of holy living — that the way one died was largely determined by the way one had lived. He wrote with extraordinary literary elegance about the practical disciplines of dying: examination of conscience, the use of Scripture, the role of the family, the proper attitudes toward physical suffering, the management of fear. Taylor’s book, paired with his earlier Holy Living, was the standard Anglican manual for dying for two centuries. John Wesley distilled it for Methodist use. It still repays reading.¹⁶

The Reformed tradition’s great catechetical statement on dying is the first question of the Heidelberg Catechism (1563): “What is your only comfort in life and in death?” The answer:

That I, with body and soul, both in life and death, am not my own, but belong to my faithful Savior Jesus Christ, who, with His precious blood, has fully satisfied for all my sins, and delivered me from all the power of the devil; and so preserves me, that without the will of my heavenly Father, not a hair can fall from my head; yea, that all things must be subservient to my salvation, and therefore, by His Holy Spirit, He also assures me of eternal life, and makes me sincerely willing and ready, henceforth, to live unto Him.¹⁷ —Heidelberg Catechism, Q. 1

This is not a rite. It is a confession to be carried in the heart, recited in life and recited again in dying. Reformed Christians for four centuries memorized this answer as children and rehearsed it as they grew old. The catechetical tradition assumed that the comfort one needed in dying had to be put into the bones long before dying began.

The Eastern Orthodox tradition has its own deep resources. The Orthodox dying liturgy — the “Canon for the Dying” — is a series of prayers said over the dying person, often by family or by a priest, drawn from the Psalter and from the church’s long memory of dying saints. The Orthodox memory holds, more strongly than most Western traditions, the conviction that the dying person is not merely passing into private experience but is being received by Christ and the communion of saints — that the church on earth and the church in heaven are simultaneously present at the deathbed, accompanying the soul.¹⁸ This is, I think, exactly right, and we will see in a moment that the NDE evidence corroborates it in striking ways.

One folk-theological development in the Orthodox tradition deserves a brief mention because contemporary readers sometimes encounter it: the doctrine of the “tollhouses” or teloniai, in which the soul of the dying Christian is said to pass through a series of demonic interrogations on its way to Christ. This is a developed iconography rather than mainstream Orthodox dogma, and the more careful Orthodox theologians have always been ambivalent about it.¹⁹ I mention it only to note that the historic tradition has had its eccentric versions and that recovering the tradition does not require recovering all of them.

How We Lost It

The historic Christian art of dying did not die from being discredited. It died from being relocated. Specifically, it died from the medicalization of dying in the twentieth century — the long, gradual movement of the deathbed from the home to the hospital.

Atul Gawande, the surgeon and writer, has documented this transformation with extraordinary care in Being Mortal. As recently as 1945, the great majority of Americans died at home. By 1980, that proportion had inverted — about 80 percent died in institutions, mostly hospitals. The deathbed, which for centuries had been the family’s and the church’s territory, became the medical system’s territory. The dying person was attended by doctors and nurses rather than by spouses, children, and clergy. The cause of death became a matter of clinical interest more than spiritual significance. The rituals thinned and, in many cases, vanished altogether.²⁰

I want to be careful here. The medicalization of dying brought real gains. People who would once have died in agony now have access to effective pain control. People who would once have died of treatable conditions now survive them. The hospital is not the enemy. Modern medicine is, in the right places, a profound blessing.

But something was lost in the transition, and we have not yet figured out how to recover it. Gawande, who is not writing as a Christian, sees the loss with great clarity. He notes that contemporary Western dying often has the structure of a kind of denial — that the dying person and their family and their physicians collude in pretending, often until the very last hours, that death is not approaching. Aggressive treatment continues past the point at which it can offer any real benefit. Conversations about goals of care happen too late or do not happen at all. The dying person ends up tethered to machines in an intensive-care unit, often unconscious, often in pain, often with no opportunity for the kinds of farewells and reconciliations that dying well requires.²¹

For the church, the medicalization of dying has had two specific consequences. First, the deathbed is no longer a Christian space. The hospital is a wonderful institution, but it is not designed around the spiritual needs of the dying. The lighting is wrong; the noise is wrong; the privacy is wrong; the presence of strangers is constant; the rhythms of the place are governed by clinical protocols rather than by liturgical time. It is genuinely difficult to die a recognizably Christian death in most hospital settings. The hospice movement, which we will come to in a moment, has done much to remedy this, but the basic problem remains.

Second, the church has, in many cases, deferred to the medical system rather than complementing it. Pastors and priests are typically not in the room. Chaplains, where they exist, are often stretched too thin to spend the kind of time the historic tradition would have demanded. Families, having outsourced dying to professionals, have lost the practical knowledge of how to be present at a deathbed. Many Christians have never seen anyone die. The skills, the prayers, the practices, the knowledge of what to say and what to do — all of this has thinned to the point where the average congregation has only a handful of members who could competently sit with a dying believer through the last days.

This is not the church’s fault, exactly. The medicalization of dying happened to us; we did not choose it. But it is now the church’s problem, and the church will have to take it up if dying-well is to be recovered for contemporary Christians.

The Contemporary Recovery

The recovery is already underway, in fits and starts, on several fronts at once. The most important is the hospice movement.

The modern hospice movement traces its origins largely to one woman: Cicely Saunders, an English nurse and physician who founded St. Christopher’s Hospice in London in 1967. Saunders was a serious Christian who saw the medicalization of dying for what it was and dedicated her professional life to recovering a different way of caring for the terminally ill. Her achievement was twofold. She demonstrated that good pain control was possible — that no one needed to die in unmanaged physical agony. And she insisted that physical pain was only one dimension of suffering. The dying, she taught, also have emotional, social, and spiritual pain. Hospice care, in her vision, addressed all four.²³

Saunders coined the phrase “total pain” for this multi-dimensional view of suffering. It was not a soft phrase; it was a clinical category. A patient’s “total pain” could be reduced by morphine, but it could also be reduced by visits from family, by reconciliation with an estranged child, by prayer, by the assurance of God’s love. In Saunders’s hospice, all of these were considered legitimate clinical interventions. The dying person was a whole person, not a body to be managed.

The hospice movement she founded has spread worldwide. In the United States, hospice services are now available in every state, mostly funded through Medicare since 1982. About half of all Americans who die now spend at least some time under hospice care.²⁴ This is a real recovery. It is not yet complete — many people enroll in hospice only in the last few days of life, far too late to receive its full benefit — but the trajectory is in the right direction.

Alongside hospice, a smaller but theologically significant body of recent writing has begun to recover the explicitly Christian art of dying. Three works in particular deserve attention.

Stanley Hauerwas, the Methodist theologian, has been writing about dying for decades. His Naming the Silences: God, Medicine, and the Problem of Suffering (1990) was an early and influential argument that the church had outsourced its responsibility for the dying to the medical system, and that this was both a theological and a pastoral failure. Hauerwas has long argued that the church needs to recover its own practices — its prayers, its sacraments, its presence — as the primary frame within which Christian dying happens, with medicine as a useful servant but not the master.²⁵

Allen Verhey’s The Christian Art of Dying: Learning from Jesus (Eerdmans, 2011) is the major recent theological treatment. Verhey, a Reformed ethicist who himself died in 2014, traced the historic tradition with great care and showed how it could be recovered for contemporary Christians. His distinctive move was to read the historic Ars Moriendi tradition through the lens of Jesus’s own dying. Christ, Verhey argued, is the original master of the art. His own death — with its trust, its prayer, its commendation of His mother into the disciple’s care, its forgiveness of His executioners, its final “into your hands I commend my spirit” — is the pattern. The Christian dying well dies into the pattern Christ has already traced.²⁶

Lydia Dugdale’s The Lost Art of Dying: Reviving Forgotten Wisdom (HarperOne, 2020) is the most recent and the most accessible of the three. Dugdale, a physician at Columbia and a Catholic, surveyed the historic Ars Moriendi tradition and asked what it would look like to live it out as a contemporary believer. Her book is structured around the temptations and consolations of the medieval manuals, applied to the realities of twenty-first-century medicine, work, family, and faith. It is the book I most often hand to dying Christians and to the families of dying Christians, because it is rigorous and humane and genuinely useful.²⁷

To these I would add the work of Christopher Kerr, a hospice physician whose Death Is But a Dream documents the deathbed visions he has observed across decades of practice; Kathryn Greene-McCreight, an Episcopal priest who has written movingly about Christian dying in light of her own theological work; and Joel Shuman and Brian Volck, whose Reclaiming the Body articulates the broader Christian frame within which dying-well needs to be situated.²⁸

I have referenced these works extensively in the dissertation that underwrites this book, and I draw on them again here. What I want to do for the rest of this chapter is offer my own constructive synthesis — what a contemporary Christian art of dying might look like, drawing on the historic tradition, the contemporary recoveries, and the empirical evidence we have surveyed across the rest of this book. I will offer this in six sections, each of which addresses one dimension of the art.

A Contemporary Christian Art of Dying

1. Preparation

The first thing to say about dying well is that it begins long before the deathbed. Jeremy Taylor was right: holy dying is the fruit of holy living. The Christian who has spent their life learning to trust Christ does not have to learn to trust Him for the first time at age 76 with a metastatic diagnosis. They have been practicing for decades.

This is not to say that a faithful life makes dying easy. It does not. Dying is hard for everyone. But the Christian who has been formed in faith brings to dying a set of practices, attitudes, and relationships that make the work, if not easy, then at least possible.

Concrete preparation looks like several things. It looks like living in awareness of one’s mortality. The medieval Christian remembered death — memento mori, “remember that you will die” — not because they were morbid but because they understood that life lived without that awareness drifts into a kind of unreality. Their meditations on death, their visual reminders, their daily prayers acknowledging mortality — all of this was meant to keep life rightly proportioned. Modern Western culture has lost most of this, and the loss has costs. We avoid thinking about our deaths until we cannot avoid it any longer, and then we have not done the work.²⁹

Preparation also looks like making peace with one’s life. This is not the same as having lived a perfect life. None of us has. It is the work of looking honestly at one’s life, owning what needs to be owned, asking forgiveness where forgiveness is needed, extending forgiveness where it has been withheld. Dying with major unresolved relational wounds is harder than dying without them. The work of reconciliation is best done before the deathbed, when there is energy and time. The medieval tradition called this preparing your soul, and it was understood to be a years-long process, not a deathbed scramble.

Preparation also looks like ordering one’s practical affairs. A will. Advance directives. Powers of attorney. Conversations with one’s family about wishes. The historic tradition had no embarrassment about practical matters — the medieval will-making was itself a spiritual discipline, often undertaken with the priest present, framed within prayer. Contemporary Christians sometimes act as if attending to practical matters is somehow unspiritual. It is not. It is a gift to those you will leave behind. Dying without a will is, among other things, a final imposition on the family that has loved you.

Preparation finally looks like the long cultivation of the soul. The sacraments, the Scriptures, prayer, the worship of the church, the practices of repentance and faith — these are the disciplines that shape a Christian into someone who can die well. None of them is a deathbed practice in the narrow sense. All of them are practices for life. But they bear their final fruit in the way a Christian dies. The dying believer who has prayed Psalm 23 weekly for fifty years brings something to the deathbed that the dying believer who hears it for the first time at age 80 cannot bring. The Psalter has gotten into them.

2. The Deathbed Disciplines

When death is near — the last weeks, the last days, the last hours — the historic tradition prescribed specific practices. These are worth recovering, though they will look different in different traditions.

Confession. Whether sacramental (in Catholic and Orthodox practice) or non-sacramental (in most Protestant practice), the dying Christian benefits from speaking out loud, to a pastor or priest or trusted believer, the sins they are aware of and the burdens they carry. The point is not absolution-as-magic. The point is the relief that comes from honest confession into the ear of someone who can speak the gospel back. James 5:16 is exactly right: “Confess your sins to one another, and pray for one another, that you may be healed.” Healing here includes the healing of dying.

Communion. The dying Christian who is able should receive the Lord’s Supper. The Western tradition called this the viaticum — food for the journey. It is exactly that. The body and blood of Christ given to a believer at the threshold of death is the most concrete expression possible of the truth that He is going with them, that He is in them, that the body broken for them is the body that will receive them.

Anointing. The biblical practice of anointing the sick with oil (James 5:14) has an honored place in the historic tradition. Both Catholic and Orthodox communions have specific liturgical forms for the anointing of the dying; many Protestant traditions have recovered the practice in recent decades. The point is not magic. The point is the embodied prayer of the church over the dying body, marking it with oil, naming it as belonging to Christ, asking for healing or grace as the Spirit wills.

The Psalms. The Psalter has been the prayerbook of the dying for as long as there has been a church. Psalm 23 is the obvious one, but the dying Christian benefits from many: Psalm 27 (“The Lord is my light and my salvation”), Psalm 31 (“Into your hands I commit my spirit” — the words Jesus prayed at His own death), Psalm 90 (“Lord, you have been our dwelling place”), Psalm 103, Psalm 121, Psalm 130, Psalm 139. Family or pastor reading these aloud, slowly, with the dying person, is one of the great gifts the historic church has left us. The Psalms are written in language a dying person can pray when they cannot construct their own prayers.

The commendation. The historic Christian deathbed always included, in some form, a commendation — the entrustment of the dying soul to God. Many Christian traditions have specific liturgical forms for this. The basic shape is simple: the dying person, or the pastor or family on their behalf, speaks the dying soul into God’s hands. Christ’s own words from the cross, “Father, into your hands I commend my spirit” (Luke 23:46), have always been the model. Many traditions echo Stephen’s parallel words at his death: “Lord Jesus, receive my spirit” (Acts 7:59).

The presence of the church. The historic deathbed was attended — by family, by clergy, by the gathered church in some form. The Christian was not meant to die alone. There are circumstances in which solitary dying is the only option, and we will come to those in a moment. But where it is possible, the dying Christian should be surrounded by the visible body of Christ. The deathbed is a place where the communion of saints becomes thick.

3. The Encounter

This is where the central argument of the rest of this book comes to bear on the practical question of dying.

The historic Christian tradition has always taught that the dying Christian, at the moment of death, is met. Met by Christ, who has gone before. Met by the angels, who escort the soul. Met by the deceased loved ones, who welcome it. Met by the communion of saints, into which the soul is being received. This is not metaphorical language — or rather, it is metaphorical only in the sense that any language about realities beyond ordinary experience is metaphorical. The tradition is making a claim about what is actually happening: the dying soul is met.

For most of Christian history, this claim rested on theological grounds — on Scripture (Luke 23:43, Philippians 1:23, 2 Corinthians 5:8, Revelation 6:9–11), on the testimony of the saints, on the inner witness of the Spirit. It was, the tradition acknowledged, a claim of faith.

Over the past fifty years, however, an unexpected body of evidence has accumulated that bears on the claim. NDE research, as we have seen across this book, has produced thousands of cases in which persons who died — whose hearts stopped, whose breathing ceased, whose brains went silent — reported being met. The phenomenology is remarkably consistent across cases, across cultures, across decades of careful study. They report leaving the body. They report a transition. They report a being of light, often identified as Christ, particularly by Christian experiencers. They report deceased loved ones, sometimes including loved ones they did not know were deceased — the “Peak in Darien” cases. They report being known, loved, welcomed.³⁰

The dissertation that underwrites this book analyzed 5,278 NDE cases — 832 from peer-reviewed scholarly sources, 4,446 from large open databases. Of these, 1,618 cases (30.7 percent) met the threshold for “Exceptional” or “Strong” evidential quality on a three-dimensional scoring system. 1,114 cases involved accurate distant observation during clinical death — that is, the dying person reported information they could not have obtained through ordinary sensory means. 87 percent of qualitative NDE accounts showed high or moderate compatibility with biblical anthropology and eschatology.³¹ The numbers behind these phrases represent decades of careful clinical work by physicians, psychologists, and chaplains in dozens of countries. They are the closest thing humans have ever had to empirical data on what happens at the boundary of death.

For the dying Christian, the relevance is direct. The encounter at death is not a matter of theological speculation only. It is, in addition, what the empirical evidence shows. The dying believer can approach death with empirically grounded hope. NDEs are not the basis for hope — the basis is Christ — but NDEs provide phenomenological confirmation of what Christ has promised.

Let me say this carefully, because it is important not to overclaim. NDEs are evidence about the early phase of postmortem consciousness, not the full eschatological future. Every NDEr returned. Their experiences cover the first minutes to perhaps an hour of consciousness after clinical death. They do not, on their own, settle the questions about the long-term intermediate state, the resurrection, or the final judgment. Those are theological questions, answered from Scripture, on which I have written elsewhere.³²

What NDEs show is that the moment of death — that specific transition the dying believer is approaching — is not a falling into emptiness. It is not the lights going out. It is, on the consistent testimony of those who have crossed and returned, a being met. The dying Christian, on the consistent witness of the tradition and the consistent finding of the empirical research, will not face annihilation in the moment of dying. They will face a Person.

The full development of this argument is in Chapter 21 on the encounter with the Being of Light, in Chapter 24 on the conscious intermediate state, and in Chapter 25 on Christ’s descent. I will not repeat those arguments here. I want only to say what they imply for the dying believer: hope is empirically reasonable. The promise that Christ will be there is not a sentiment offered in the absence of evidence. It is, in 2026, a promise the evidence remarkably supports.

4. The Role of the Church

The church’s role at the deathbed is irreducible. Christ has chosen to use the body of Christ — the visible, embodied, particular church — as His ordinary means of presence to the dying. This means that pastors, family members who are believers, and the gathered church matter, not as sentimental decoration on a private medical event, but as agents of Christ’s own ministry to the dying.

What does this look like? It looks like the pastor showing up. Not just for funerals — though those matter — but for the dying. It looks like the elders organizing meals and visits over the weeks of decline. It looks like the friends from small group sitting through the long afternoons. It looks like the children of the congregation knowing it is normal to visit the dying, because their parents have brought them to do so. It looks like the church building rooms in its life and rhythm for the slow work of accompanying members through their last weeks.

None of this is exotic. It is the basic practice of any healthy congregation. But many contemporary congregations have, in fact, lost it — not from any decision but from the slow drift of professionalization. The hospital handles dying. The funeral home handles death. The church handles funerals. Everything in between is uncovered. The recovery of the art of dying is partly a recovery of the church’s confidence that the in-between is its territory.³³

I will say more about the specifics of pastoral care at the bedside in the next chapter on companioning the dying. Here I only want to register the basic point: dying-well is not a private spiritual achievement of the dying believer. It is the work of the dying believer and the church together. The historic tradition assumed this without needing to argue for it. The contemporary recovery has to argue for it, because we have forgotten.

5. The Role of Fear

I want to say something direct about fear, because I have noticed that contemporary Christian writing on dying often skirts it. The Christian dying, we are sometimes told, should be unafraid. The faithful believer faces death with serene composure. Anything else is a failure of faith.

This is, I think, both unrealistic and unbiblical. Unrealistic because most dying Christians are afraid, at least sometimes. Unbiblical because Christ Himself, in Gethsemane, on the night before His death, sweat what Luke describes as something like blood, and prayed that the cup might pass from Him. The Author of our salvation did not approach His death in unruffled calm. He approached it in agony — and yet trusting.³⁴

This is the right model. Fear is not the opposite of faith. The opposite of faith is despair. Fear is human; faith is the trust that holds even when fear is present. The dying Christian who is afraid is not failing. They are simply human. The work is not to suppress the fear but to hold it within the larger reality of Christ’s love.

What helps with fear? Several things. The presence of others — fear is multiplied by isolation, reduced by company. Concrete prayer, especially prayer that has been practiced for years and can be reached for in distress — the Lord’s Prayer, the Apostles’ Creed, beloved hymns, the Psalms. The reminder that one is not alone — that Christ has gone before, that the saints go with us, that the church is praying. And, increasingly, the empirical hope that what NDEs show is what Christ has promised: that the encounter is loving, that the transition is peaceful for those received in faith, that the being of light is not a stranger.

I have sat with several Christians who were intellectually persuaded by the cumulative evidence for the encounter at death and who told me, as they were dying, that the evidence had helped them. One was a retired engineer with pancreatic cancer who had read the dissertation that underwrites this book. He told me, with a small smile, that he had never thought he would be grateful for footnotes. The footnotes, he said, made it concrete. The case was not just somebody’s comforting story. It was, on the evidence, what was about to happen. He was still afraid. But the fear had a frame.³⁵

6. The Role of Unfinished Business

Dying well includes attending, where possible, to what is unfinished. There are relationships to mend. Words to speak. Things to set in order. Last gifts to give to those who remain.

Hospice nurses will tell you that many dying patients seem to be holding on for something specific. A son driving in from across the country. A grandchild’s graduation. The arrival of a particular person. The completion of some specific task. Sometimes the dying person announces what it is. Sometimes they do not, and only afterward, looking back, can we see what they were waiting for.

The pastoral wisdom is to take this seriously and to help where help is possible. If there is an estranged child, see if reconciliation can be arranged. If there are words the dying person wants to say, make sure there is a chance to say them. If there are practical matters that need closing, help close them. The aim is not to manufacture closure where none can honestly be had — some unfinished business is unfinishable, and dying with that genuine grief is itself a form of trust — but to remove avoidable burdens from the dying soul.

The historic tradition was practical about this. The medieval will-making liturgy is one example: a formal occasion, often with the priest present, in which the dying person ordered their goods, arranged for masses or prayers for their soul, made provision for the poor, and named the recipients of bequests. It was a practical act and a spiritual one at once, undertaken in prayer. Most Christians today have no equivalent. Many die intestate, leaving their families to sort out matters that should have been sorted in advance. This is not a minor thing. It is part of dying well.

Unfinished business also includes the quieter things: writing letters to grandchildren, recording a final blessing for the family, telling adult children what one wants them to know, expressing gratitude to those who have shaped one’s life. Margaret, in the vignette that opened this chapter, used her early hospice weeks to write letters. Many dying Christians find that this kind of work brings deep peace. It is the gift of one’s remaining time, given carefully, while one still has it.³⁶

Some Honest Pastoral Questions

I want to take up, briefly, four questions I am asked again and again by Christians who are facing their own deaths. These are not abstract questions. They come from real people in real distress, and they deserve direct answers.

“What if I die in pain?”

This is the question I am asked most often, and I think it is the question most Christians are most afraid of. Let me say several things.

First: in 2026, in the developed world, no one needs to die in unmanaged physical agony. Modern palliative medicine has effective tools for managing the pain of dying. If you are dying and your pain is not adequately controlled, you have a right to ask for better treatment, including referral to a palliative-care specialist or hospice. The historic tradition was not naive about pain — the medieval Christians knew exactly how much it could hurt to die — but the resources we have for managing pain today are dramatically better than anything our forebears had. The fear of dying in agony is, for most contemporary patients in the developed world, a manageable fear.³⁷

Second: even where some pain remains, the pain does not negate the encounter. The Christian theology of suffering — which I will say more about in a moment — holds that suffering is real and can be borne. The dying Christ, on the cross, was in pain. He was also, on the historic Christian account, doing the most important work of His life and the most important work in human history. Pain and faithful dying are not mutually exclusive.

Third: NDE accounts — and here I am drawing on the dissertation’s analysis — are remarkably consistent in reporting that the pain of dying recedes at the moment of the transition. The OBE phase begins, and the body’s pain is left behind. This is not a promise. It is what the cases consistently report. If the pattern of NDE phenomenology bears on what the dying experience, then the pain you fear may not be the last thing you feel. The last thing many NDErs report feeling is peace.³⁸

“What if I die afraid?”

You may. Many do. Christ Himself approached His death in distress. Fear in dying is not a failure of faith.

What I would say is that fear in dying does not get the last word. The encounter at death, on the consistent witness of NDErs, overcomes fear. The being of light is loving. The deceased loved ones are warm. The transition itself is peaceful for those who have approached it in faith. Many distressing NDE reports — we engaged these in Chapter 28 — involve initial fear that gives way, often through the experiencer’s cry to Christ, to the same loving encounter the larger NDE literature documents.³⁹

If you are a Christian in fear, do not condemn yourself for it. Speak the fear honestly to those at the bedside. Pray the prayers you can pray, even short ones — Lord Jesus, help me. The fear may stay with you to the end. The encounter is bigger than the fear.

“What if I die alone?”

This is one of the deep contemporary fears, and it is heightened by the medicalization of dying. Many Americans now die in hospital rooms with strangers passing by, family unable to be present at the moment of transition. Some die in nursing facilities at three in the morning, with no one in the room.

Let me say two things. First, no Christian dies alone. The promise of Romans 8 — that nothing in death or life can separate us from the love of God in Christ Jesus — is not poetic exaggeration. Christ is there. The communion of saints is there. The angels are there. The empirical evidence we have surveyed in this book corroborates what the tradition has always taught: the dying Christian is, in fact, met. Even when human company is absent, divine company is not.⁴⁰

Second, where it is possible, we should not let fellow Christians die alone. This is, again, the church’s work. If you are reading this as a member of a congregation, ask your pastor whether your church has any organized ministry to the dying. If it does not, perhaps you could help start one. The dying Christian who needs a hand to hold for the long afternoons should be able to find one.

“What if I die unconscious?”

This is the question that the empirical evidence we have surveyed answers most directly.

The conventional assumption — held by many medical professionals and by most lay Christians — is that the unconscious dying patient is essentially absent. They cannot hear. They cannot perceive. Whatever interior experience they may be having is gone with consciousness.

The NDE evidence makes this assumption look badly mistaken. NDErs — people who were medically unconscious by every clinical measure, often during cardiac arrest with documented absence of brain activity — routinely report having heard, seen, and understood what was happening in the room around them. They report conversations of family members and clinicians. They report whether the room was peaceful or anxious. They report the prayers of those at the bedside. They report which family members had arrived and which had not.⁴¹

The implications for the unconscious dying are direct. Speak as if heard, because they may be. Pray over them. Read Scripture aloud. Tell them you love them. Tell them it is all right to go. Sing the hymns they have loved their whole lives. Whatever is happening to them clinically, the empirical evidence suggests that the interior person may be more present than the body’s responsiveness suggests. The next chapter will say much more about this. For now, let it be a comfort: the unconscious dying believer is not absent from what is happening at their own death.

The Question of Suffering

No serious treatment of dying well can avoid the problem of suffering. Dying often involves suffering — sometimes severe and prolonged. The Christian who is dying may ask, with full theological seriousness, why God is permitting it. Why this disease. Why now. Why so long. Why this much pain.

I will not pretend to a fully adequate answer. I do not have one. The Christian tradition’s most honest treatments of suffering have always acknowledged that there is a remainder — a portion of the pain we cannot rationalize, a question we cannot finally answer. Job’s comforters were rebuked by God for explaining too much.

What the tradition does offer is several frames within which suffering can be borne. The cross is the central one. The dying Christian shares in the sufferings of Christ — not as a meritorious act, but as a real participation. Paul speaks in Colossians 1:24 of “filling up” what is lacking in Christ’s afflictions for the sake of His body, the church. This is not a claim that Christ’s atoning work is incomplete. It is a claim that the suffering of Christians in this life is taken up into Christ’s own ongoing presence with His people. The dying Christian’s pain is not pain in isolation. It is pain held within the cross.⁴²

The eschatological hope is another frame. The pain of dying is finite. Whatever follows, on the Christian account, is not more pain. The patristic writers spoke of the suffering of dying as a kind of birth pang — intense, but ordered toward something. The new self being delivered into the new life. The biblical image is Christ’s own — in John 16, He compares the disciples’ impending grief to the labor of childbirth, intense in the moment, transformed by what comes after.

I do not say any of this to minimize what dying believers actually go through. I have sat with people in unimaginable pain. The frames do not make the pain go away. They simply give it a place — somewhere to belong — that bare neurological pain does not have. Christian suffering is suffering with company, suffering with hope, suffering with a Person who Himself suffered.

The Art of Living in the Light of Dying

The historic tradition was very clear on this point: the art of dying is not separable from the art of living. Jeremy Taylor wrote two books, Holy Living and Holy Dying, and meant them to be read together. The contemporary Ars Moriendi tradition has the same conviction. Lydia Dugdale puts it this way: “The way you die is the way you live, only more so.”⁴³

This means that thinking about how to die well is not morbid. It is not even unusual. It is what Christians used to do all the time, and what humans of nearly every culture before the modern West used to do. Living in awareness of one’s mortality clarifies things. It tells you which loves are deepest, which ambitions are real, which uses of time are wise. It chastens the petty. It elevates the genuine. The ancient prayer asks God to teach us to number our days, that we may apply our hearts unto wisdom (Psalm 90:12). It is exactly right. The numbering of days is itself the school of wisdom.

What the recovery of the art of dying offers, then, is not just a different way to die. It is a different way to live. The Christian who is honestly aware of their mortality lives differently. They invest in different things. They make different choices about time and money and attention. They are not anxious about petty things in the way one is anxious when one has forgotten one is going to die. They are also, often, more joyful — because the things that genuinely matter are seen more clearly when held against the horizon of one’s ending.

The contemporary church, if it is to recover the art of dying, will have to recover, with it, the art of living mortality-aware. This is a long pastoral project. It involves catechesis, preaching, the recovery of practices, the modeling by elders, the formation of children. It is the work of generations, not single sermons. But the work is worth doing. The Christian life shaped from its beginning by mortality-awareness is the life that, at its end, can die with composure. The two are one piece.

Resources for the Journey

I have referenced several books and resources throughout this chapter. Let me gather them briefly. For the Christian preparing for their own death — whether near or far — I would recommend:

Lydia Dugdale, The Lost Art of Dying (HarperOne, 2020), as the most accessible recent recovery of the historic tradition. Allen Verhey, The Christian Art of Dying: Learning from Jesus (Eerdmans, 2011), as the major theological treatment. Jeremy Taylor, The Rule and Exercises of Holy Dying (1651), still in print and still rich, for those who can sit with seventeenth-century English. Atul Gawande, Being Mortal (Metropolitan, 2014), as the sober medical-cultural diagnosis of where we are now. Christopher Kerr, Death Is But a Dream (Avery, 2020), for the deathbed-vision testimony from a contemporary palliative-care physician. The historic Ars Moriendi manuals themselves, in modern English translations, remain remarkably useful for those willing to do the work.⁴⁴

For the family or congregation that wants to recover the practical practices of deathbed ministry, the next chapter on companioning the dying goes into the specifics. The point I want to make here is simple: the resources exist. The tradition has not been entirely lost. There are books to read, prayers to learn, practices to recover. What is required is the decision to recover them.

What the Dying Believer Faces

Let me close where I began — with the dying believer.

If you are reading this and approaching your own death, here is what I want to say. You are not facing the void. You are not falling out of existence. You are not walking into the unknown alone.

You are walking, as twenty centuries of believers have walked before you, toward Christ. He has gone before you. He has died Himself. He has descended into death and risen again. He has promised, with explicit words, to come for those who trust Him. The historic tradition has held this promise out to dying Christians for two thousand years. The empirical evidence we have surveyed in this book — the careful clinical research of physicians and psychologists across half a century — corroborates it. What you face, on the joint witness of theology and the data, is a Person.

The Person is loving. The encounter, on the consistent testimony of those who have crossed the boundary and returned, is not terrifying for those received in faith. It is, in the language of the experiencers themselves, the most loving experience they have ever had — love beyond what the ordinary categories can hold. This is what the Christian tradition has always said the encounter with the risen Christ would be. The cases agree.

You will not be alone in the moment of dying. Even if no human is in the room. Even if you are unconscious by every clinical measure. Even if you are afraid, and even if the pain has been long. The promise of God is that He is with you. The witness of the cases is that the dying are met.

Use whatever time you have. Make peace with the people you need to make peace with. Receive the sacraments your tradition offers. Pray the Psalms. Let the church be present to you. Speak the words you need to speak to your family. Forgive what you can forgive. Trust what you can trust. And then, when the moment comes — whether you see it coming or whether it surprises you — let go.

Christ is waiting.

Margaret’s last word was “Surely.” She was answering the Psalm. Surely goodness and mercy shall follow me all the days of my life, and I will dwell in the house of the Lord forever. She was confirming, with her last breath, what she had spent her whole life confessing. The historic tradition would have called her death a good death. A holy death. An ars moriendi in the literal sense — an artful dying, the visible fruit of a long obedience.

Margaret’s death is possible for any of us. It is not a matter of personality. It is a matter of preparation, of practice, of the slow formation that the Spirit does in those who give themselves to Him over time. The art is recoverable. The tradition is alive. The encounter is real. And the One who has gone before us — who endured the cross, despising the shame — is, by every account theological and empirical, exactly there at the threshold, waiting.

That is what the dying believer faces. That is what dying well comes to. That is, in the deepest possible sense, the art of dying.