Author:
Anthony Ughetti, MHA
December 2018
Proposing a Contemporary Ars Moriendi
This blog is an outgrowth of my recent MHA Capstone Project with Saint Joseph’s College. This author contends that significant confusion, inefficiency, and rancor exist in the current state of end-of-life care. In response, the author proposes a contemporary ars moriendi that can serve as a framework for standardization of end-of-life-care. This can help resolve existing barriers and lead to a “holier” death and dying process for patients, families, and providers.
Thesis and Call to Action
Although hospice and palliative care services have existed for decades, there remains confusion and contention about what the services entail, when they should be initiated, and what benefits flow from them. Such confusion negatively impacts the patient and family experience of the dying process and leads to inefficiencies in the delivery process. This author proposes a solution in the form of a contemporary ars moriendi - a set of rules and guides that can help clinicians, patients, and society better understand end-of-life services. Moreover, it can promote service delivery in a way that leads to efficiency, cost-savings, and a happy, holy death for the patient.
Ars moriendi? What does that mean?
This blogger contends that the last time society and the medical profession achieved consensus about the “right way” to pursue the death and dying process was in the 14th century, concurrent with the Black Death plagues and the concomitant explosion in the number of deaths. Theologians, philosophers, clergy, and caregivers codified a series of edicts and social mores into a coherent document termed ars moriendi, which in English translates to “the art of dying.” Thus, at that time, and for about the next two centuries, a common framework for death and dying was promulgated amongst professionals, laity, providers, patients, and families. In the views of this writer, contemporary society could significantly benefit by returning to a contemporary ars to guide current death-and-dying ministry.
End-of-Life Care in the U.S.: State of the Art
In contemporary society and medical practice, there is no consensus about ways to achieve a “holy” or “happy” death:
· Some (Gawande, 2014) contend there is no way to control the end-of-life process: “I am leery of suggesting that endings are controllable”.
· Others (Brescia, 2017) appear to foster confusion about the difference between hospice and palliative care, as well as when they should be initiated: “Hospice care is more associated more frequently with home care.” “Palliative care requires continuous presence of doctors and staff”.
· Still others argue that in contemporary times, “we are able to choose the rituals we perform with our dead, nor do we have to believe what our parents believed” (Order of the Good Death, 2018).
Which view is “right”? Which is “wrong”? Who decides? Can consensus be reached?
My proposal: An Ars with a Triple Goal
To clear the confusion and promote consensus, the author proposes a contemporary ars moriendi that promotes three primary goals:
· Uniform naming, branding, and terminology regarding the terms “hospice” and “palliative care”;
· Promotion of election of the appropriate end-of-life service early in the disease process;
· Cost savings and improved utilization of medical services in the terminal phase.
Achieving these three goals will substantially improve the death and dying process for patients, families, providers, and society as a whole.
Implications for Health Administrators
I contend that a contemporary ars would impart significant benefits, including the following:
· Better understanding of the dying process, better symptom control and a greater sense of community and support of all throughout the death and dying process;
· With the demographics of an aging American population, society will need more efficient and standardized methods to manage the wave of dying older adults;
· Any efforts that seek to reduce confusion (such as agreeing upon standard nomenclature) and contain costs (such as reducing futile high-cost curative efforts when death is imminent) will benefit the medical industry and society as well;
· Ultimately, the death process may become more peaceful and “holier” for all if the triple aim of the contemporary ars is realized.
Limitations of this proposal:
The key limitation of this proposal is that it represents only the author’s perspectives. It is not intended to be a definitive answer. However, it is hoped that this work will advance the dialogue, generate additional discussion, and further refine and advance the goals proposed by the contemporary ars.
The author is hopeful that such discussions may generate even more new, novel ways of refining the death and dying process - ultimately improving the experience for patients, families, and providers.
Selected Resources/References
Berry, L., Castellani, R., & Stuart, B. (2016). The branding of palliative care. Journal of
Oncology Practice. Doi: 10.1200/JOP.2015.008686.
Brescia, M. (2018). The nature and treatment of human suffering. Health Progress July-August
2018: 9-13.
Gawande, A. (2014). Being mortal: Illness, medicine, and what matters in the end. London,
England: Wellcome Collection.
Order of the good death website (2018). About. Retrieved from
