The Euthanasia of Ivan Ilyich: Recovering Good Lives and Deaths in the Age of Assisted Dying

I teach The Death of Ivan Ilyich every December to 18-year-olds. As the semester ends with a rush of final papers, lab reports, and travel plans, I ask them to stop and think about dying. I do so always with the prayer that these students will not face their own death for another sixty years. They are young and flush with life. There is more that lies before them than lies behind them. And yet I ask them to spend time with this dying man and to consider the last thing that will lie before them someday, somewhere, no matter what. 

Why do this? Understand death—inasmuch as any of us can—sheds light on the meaning and goodness of life. Literature has the power to bring to our attention what we cannot experience ahead of time: our death. It thus compels us to ask whether, in the face of death, we have lived or are living a good life. Christ came that we might have “life (zōē) and have it abundantly” (John 10:10). Encountering death through literature and art helps students consider a good life in preparation for their (hopefully) far-off deaths. Perhaps most importantly, Tolstoy presents us with the question of a good death (eu-thanatos) in such a way as to give us a chance to aim for a good life and have it abundantly.

The Universal Need for Palliative Care

Ivan Ilyich, in contrast, is a man who has never had much life in him. He has settled for less, drifted into a kind of non-living life. In his sickness, he is confronted with the question, “What if my life . . . simply was not the real thing?” Around him, he realizes that his friendships were fake, his legal career was centered on neither law nor justice but prestige, and he drifted into marriage with the question, “Well why shouldn’t I get married?” It had not been the real thing. 

If sickness presents Ilyich with the possibility of his not having lived the real thing, it is dying that forces both an answer and a conversion. “All of it was simply not the real thing. But no matter. I can still make it the real thing.” But a conversion to what? “What is the real thing?” he asks. 

My students see it in Ivan’s final moments. Having demanded sympathy for others without ever having given it, he suddenly offers it. Offering compassion, he feels it in return. He puts his hand on the head of his son—“he grieved for him.” He looks to his wife—“he grieved for her.” There was much that was wrong about Ilyich’s life, but what was right about his dying moments was the sudden realization that the real thing was offering care. Ilyich had never committed himself to another, but in dying he finally did. Ilyich has a good death, a eu thanatos. He had this death after both a bad life and bad sickness. Their badness was the product of bad relations. He neither offered nor received care or real love in his life or his sickness. There was only him. He lived with and for, in the words of Iris Murdoch, his “fat relentless ego.” The fakeness of his life was a product of the fakeness of his relationships. Those he lived with also lived only for their own bloated selves. What gave him a eu thanatos was being reborn to compassion, reborn to living for someone besides himself. It was death that gave him this.

What he committed to was helping ease their suffering. He could not end their suffering, but he could lessen it by simply placing a hand on his suffering son. Much of our life is suffering in this vale of tears. Our level of suffering varies but we all do suffer. One of the primary ethical questions of our lives is what we will offer those who are suffering. What we can offer each other in this is palliative care. Pain and suffering will come, but will we be there to lighten each other’s suffering? Tolstoy puts this question before us in the dying of Ivan Ilyich, who in his death finds compassion for others and so faces the light of divine compassion for himself. 

The Death of Ivan Ilyich in the Age of Assisted Dying

But how might we write The Death of Ivan Ilyich in 2025? Ilyich is sick, faced by conflicting treatments that do not work and suffering that grows. He is also faced with growing medical bills and hostile medical providers. Most painfully, no one understands what he is going through, and no one will tell him the truth. No one will tell him the real thing. His wife’s attitude “towards her husband’s illness was that he himself was to blame for it.” He becomes a burden on his friends. He can’t keep up with them playing cards anymore. He spoils their fun but makes them feel guilty when they do not invite him to play. His daughter, exasperated by her father’s selfish suffering, tells her mother, “He acts like we are to blame. I’m sorry for papa, but why should he torture us like this?” He is a bother to his doctors who brush off his questions about how serious things are. He is a burden to himself. 

And in our time what do we do with people who are burdens? Unborn burdens are not to be born. Elderly burdens are to be dispatched. The disabled who cannot carry themselves are not to carry on. And what else is Ilyich but a burden? One can imagine the novel rewritten. The wife gently nudges him towards the needle because she blames him for the illness. His daughter is no longer tortured by his torture. Friends—those who do not want to feel guilty for not inviting him anymore—invite him to exit this life. Doctors uncertain of treatment can find a treatment whose outcome is certain. And poor Ilyich himself could be relieved of thinking about whether his life was fake by just ending it. No closing confrontation with grief, and therefore no conversion to care for others. It would all be so much neater, which was a value as dear to Ilyich as it is to our antiseptic time. 

An updated Ivan Ilyich would conclude about twenty pages earlier with euthanasia or assisted dying. It would offer a good death that is as fake as the life that Ilyich lived. The fakeness is the fakeness of the “assistance.” To live an ethical life is “to bear one another’s burdens” (Galatians 6:2). It is to offer real assistance for those who suffer. All around us are only people who suffer. The question is, will we bear them up, will we offer them the palliative care of love? Or will we dispatch them as our human nature inclines us to do? A culture that euthanizes our old, our sick, and our disabled is a culture that increasingly forgets what it means to care for each other.

Ilyich cannot name this, but he lives it in the last minutes of his life. Bearing the burden of his son’s pain, he offers comfort. He has learned to do this from his own pain but also from the faithful care of his servant Gerasim. It was Gerasim alone who spoke honestly of death and who alone offered palliative care. He did not do this by smothering Ilyich, but by easing his pain, by carting away his refuse, and by holding him when he was lonely. Ilyich had failed to live the “real thing” in his life. In Gerasim, he gets a glimpse of what the real looks like. It looks like care and compassion. It is not easy, and it does not smell good. But it is real. 

What Ilyich faces in the final moment is grace. He is graced with the realization that he needs to offer care. Knowing that the real is compassion is not his accomplishment but is the gift of his son’s presence. We, who would so quickly assist him out of this life, would do so because we can bear with neither grace nor compassion. They ask too much of us for another. 

Because death is not taken from him by “assistance” that offers no real help, Ilyich is graced with realization that death is no more. “Instead of death there was light.” He sees this light and realizes that “death is over . . . there is no more death.” Ilyich’s realization echoes Revelation 21:4 that “death will be no more.” Only a culture that can see death and care for those who are dying can be a culture open to the One who bore all our burdens. Christ’s dying offers us abundant life even in our deaths if we are willing to face them. In his Good Death, death itself dies. Euthanasia denies us a good death because it is the denial of care, the denial of facing death authentically, and the denial of the goodness of life. It is thus the denial of the Author of Life—or of any possible spiritual breakthrough at all.

Salvaging Good Deaths and Good Lives

Each fall for many more years, my students and I will read a novella about a dying, loveless lawyer from Tsarist Russia. We will ask what the real life is and wonder if we are living it. We will consider what love and care look like and whether we live in a culture in which we bear each other’s burdens. To bear those burdens is to face our deaths together. The direction of our culture is increasingly toward “death pods” where we will die alone, because we, like Ivan, have refused to really live together. Resisting such a culture of solitary and uncared for assisted dying will take legislation, but it will also require that we spend some time with Ilyich and try to recover the goodness of a good life and of a good death. Someday I will face death. Someday my students will face it as well. Will we do so in a world detached from reality or attached to it? A culture that dispatches the burdensome or bears their burdens? A culture that offers care or that offers death? The euthanasia of Ilyich would have made impossible his eu thanatos. Our society’s growing practice of euthanasia may well prove to be the denial not only of our good deaths but also of the only real thing, a good life.

Image by sudok1 and licensed via Adobe Stock.