The Art of Dying Reconsidered: A Guide for the Young
Christina Koenes
Psychology & Science
We are blessed—and perhaps cursed—to live in an age where we are faced with endless choices. On balance, we have significantly more choices than any previous generation, and far more than can be realized in a lifetime. In order of increasing difficulty: Which coffee shops in the city should I try? What should I choose to study in college? What profession should I enter? Whom should I marry? Which religion, if any, should I follow?
While it may be possible to try all the coffee shop options, it is certainly not possible to learn every profession or practice all of the world’s faiths. And indeed, with so many options available, there is a possibility of making a significant number of wrong or unfulfilling decisions that lead one away from a happy life—or perhaps cause one to regret his or her choices later on. Of course, one can distinguish between decisions of varying gravity. A wrong decision at a coffee shop is less problematic than a wrong decision regarding a partner or career. The sheer abundance of options, then, is not exclusively a great gift for humans. It is often a burden. For many, it becomes overwhelming sooner or later, especially for young people who have not yet made many consequential decisions, such as choosing a partner, career, or faith practice. In other words, it is my view that many people today are stuck in a semi-permanent “paradox of choice”—options seem endless, so none are chosen with certainty.
In my work as a family physician in a major German city, I often see young people, some of whom are under the age of 20, who are clearly suffering from psychological distress. This distress is often brought about by the inability to make big life decisions, or something like prospective regret: the idea that no matter what they choose, it will be the wrong choice. It manifests in various ways, such as depression, panic disorders, and anxiety disorders; or as a high number of sick leave days due to stress-related symptoms like headaches and stomachaches. My personal observations are consistent with official statistics: In 2024, the average number of cases of work incapacity due to mental illness was 12.2 per 100 insured individuals in the 20- to 24-year-old age group in Germany, which is significantly higher than the national average of 10.4 cases due to mental illness. As part of its Mental Health Surveillance in Germany, the German Robert Koch Institute also shows that the number of young people (aged 18–29) experiencing mental health issues is significantly higher than in other age groups. A similar distribution can be observed worldwide. In 2024, mental health issues accounted for approximately 42 percent of sick leave reports among 18- to 24-year-olds worldwide.
These patients frequently raise the topics of feeling overwhelmed and disoriented during our consultations. Life-changing events, such as starting college, approaching graduation and the associated pressure, or moving out of one’s parents' home, bring the overwhelming number of decisions to the forefront of one’s mind. Well-meaning advice and mottos such as “Follow your heart” and “You only live once” do not provide a helpful framework for making major life decisions. Drawing on the wisdom of partly ancient, partly modern philosophy and modern-day science, I would like to introduce the differentiation principle known as the “deathbed perspective,” which can serve as a guiding principle for navigating complex situations, especially for young people.
The deathbed perspective
This abundance of choices is particularly daunting because the consequences of a decision cannot be fully anticipated, yet are certain to have a far-reaching impact on one’s life. In some sense, it is easier to stay still and keep one’s status quo than to make a big decision that could alter the trajectory of one’s life.
The key factor in making long-term decisions is not whether one can lucidly peer into a crystal ball, so as to see whether the decision will have been worthwhile. On the contrary: most long-term decisions are made by taking the proverbial leap of faith, and then—years down the line—retroactively understanding how one’s decisions, whether they were solid or wrongfooted, made one’s life more meaningful.
Interestingly, though, there is a way to envision this common thread in the present. To do so, a shift in perspective is required so that the present and its abundance of possibilities are no longer a source of paralysis. How can this be done? I advise young people to adopt a mysterious idea: to anticipate life from the perspective of the end of life—which I will refer to as the “deathbed perspective.”
The “deathbed” refers to the place where a person will be able—and indeed need—to look back on their life and consider it in its entirety, with all its good and bad aspects. Decisions and actions are seen in the context of other decisions, actions, and situations and may take on new significance. Short-term concerns and others’ opinions about one’s decisions fade from view. Thus, the "deathbed" still belongs to the realm of life, not death. This place can be anticipated, allowing this perspective on life to be foreseen, at least in part. As Helmut Plessner describes, one of humanity’s core competencies is adopting an eccentric perspective and viewing one’s life from the outside. This enables one to become the object of one’s own reflection and therefore allows the mental anticipation of the future.
From this deathbed perspective, priorities shift suddenly, and the common thread becomes more visible and decisions become clearer. Psychiatrist Viktor Frankl recommends in his famous book Man’s Search for Meaning the following thought experiment to find this common thread in the present: “Imagine first that the present is past and, second, that the past may yet be changed and amended,” and then imagine “[living] as if you were living already for the second time and as if you had acted the first time as wrongly as you are about to act now.”
One can see how this can be done in ordinary life. Sooner or later, partners in a serious relationship will ask themselves if this is the person with whom they can imagine spending the rest of their lives, perhaps building a life together with children. These considerations—whether such a far-reaching decision can be made about this particular person—are challenging because it's impossible to see beyond the present moment. In such situations, the deathbed perspective is extremely useful. By anticipating that point in time, the present moment of decision-making is regarded as having passed. The decision has been made, and one can assess whether one would have wished for a different outcome, depending on the decision taken with or without one's partner. This allows one to avoid potential mistakes that could be made in the moment, such as saying "no" to one's partner out of fear or “yes” while turning a blind eye to irreconcilable differences. Through this mental time travel into the future and back to the present, one can experience the present anew as a second attempt.
This mental time travel makes it easier to view life as a whole, allowing one to analyze the potential consequences of a decision on one’s entire life—and at an early stage. As such, the deathbed perspective becomes an existential reduction tool that simplifies our approach to the freedom offered by an overwhelming abundance of choices modern life provides. Engaging with the question of which decision will lead to significantly more inner peace in the long run frees people from their fixation on others' opinions, overemphasis of positive or negative feelings, and instant gratification—all of which often prevent them from making good, long-term decisions.
This deathbed perspective may be foreign to many people, especially young people. Unlike in the past, some of them have never seen a dying person or corpse, or have only seen one rarely. In my experience, for example, more than half of my classmates had never seen a corpse before the anatomy course in medical school, in which we had to perform dissections. (Indeed, many medical programs use the first dissection class not as a gradual introduction to medical practices, but as a gradual introduction to seeing a corpse. In my experience, many classmates had to leave the room temporarily.)
Small wonder, then, that death is generally not a welcome topic of conversation. If it comes up at all, it is usually in discussions about the “alchemical” question of our time: Longevity, or as Ernest Becker calls it: “Immortality projects,” that is, how to avoid death for as long as possible. Thus, young people have few opportunities to learn from older, wiser people who have grappled more with the subject, and are rarely forced by circumstances to reflect on dying themselves.
But to develop a shared understanding of the “deathbed” and what is crucial for a peaceful death, we must turn to philosophy: The concept of an ars moriendi, or art of dying.
Ars moriendi
Ars moriendi can refer to the immediate moment of death and what is crucial at that time, as well as to the early practice of preparing for a good death. But to understand this concept, we must also explore the philosophical underpinnings of death’s opposite: life.
Every human being is given and entrusted with their own life at the moment of coming into being. One cannot create oneself; one does not “possess” their own existence. This means they have no ultimate power over it—just as it is given to them, it can be taken away. Life, therefore, is less a possession than a gift. Human beings are affected and impressed by life and cannot be reduced to the sum of their parts like machines. Indeed, this can be best seen by the fact that an individual person cannot be adequately described through words, as some philosophers have argued that the mere presence of human beings transcends any conceptual or categorical grasp. From my own perspective, describing another person leaves me with a sense of not knowing them, only knowing about them. And even if I know them and have experienced their presence, a mysterious residue always remains—I can always know them more.
The same applies to life. From a scientific, observational, third-person perspective, life itself is invisible and indescribable. One can only observe a living being, not reduce it to a description. According to the French philosopher Michel Henry, life does not actively come to a person, nor do they create themselves as a living being. Rather, life is given to or imposed upon them, and they endure it. The moment a person attempts to possess life, they necessarily take their own life, because seizing a gift means it solidifies into an object. Taking possession of life means it loses its liveliness because it becomes a rigid object and ceases to exist. In other words, humans can deny the gift-like nature of life by refusing to accept it as such, which means—in some real sense—taking their own lives.
What are the implications of life's gift-like nature for dying? Dying means relinquishing life in the sense of voluntarily sacrificing one's life, or giving back what does not ultimately belong to us. It means letting go and allowing life to be what it is—a gift that cannot be held onto. A good death becomes a personal sacrifice: the voluntary return of the gift to the giver of life. Dying well means perceiving oneself as a recipient of the gift of life, which allows one to let go and return the gift to the one who gave it first when the time comes. This often involves recognizing that there is something greater than one's own life—something or someone for whom it may be worth sacrificing one's life for. This includes but is certainly not limited to martyrdom. Rather, it means having lived life in a way that pursues what is considered more valuable than one's own life. For example, for many people this more valuable phenomenon may be God, one's career in service to others, a spouse, or children—the very things young people today are not choosing. The common thread among these items is love, because love itself shifts one’s focus and center from oneself to others, transcending us, consequently allowing us to give our lives as well. Gabriel Marcel sums it up as follows: “To love someone is to say: you shall not die.” Put differently: I would rather give my life for you.
Meanwhile, the opposite of a gift is an exchange. An exchange means: I give something I possess on the condition that I receive something of equal value from someone else—something that is often objectively equal but subjectively more valuable to me. Through this process, we earn the object in question that belongs to another. After the exchange it becomes our possession. We perform this action frequently in daily life.
What does this imply for the process of dying? If dying is not an unconditional surrender of life but rather a clinging to it, then the logic of exchange comes into play. The dying person tries to exchange his life's work and achievements for his life, thereby trying to buy immortality through what the person already earned. Alternatively, when it becomes apparent that his accomplishments are insufficient, the dying person attempts to take out a time loan—time in which he can accomplish enough to make the exchange effective and bring a work as valuable as life itself to the table. It is the attempt to free oneself, to redeem oneself from the shackles of one's limitations and mortality.
Yet no matter how many achievements one attains in the world, it is never possible to exchange them for life itself. Human beings are always limited both spatially and temporally, as well as by the weaknesses of their bodies. They cannot overcome these limitations without relinquishing their humanity and becoming machines, which would impose different limitations. This exchange can never be carried out validly. Despite the attempt, the dying person will have to give up his life. He will do so in a struggle because letting go would mean admitting that all his previous actions were futile and without any reward. To the dying person, it is not a good death; he loses the final battle. Any attempt to retain control until the very end, whether through assisted dying, suicide, or trying every therapy until the last moment, will not resolve this tension because life is a gift and cannot be altered according to our will.
Consequently, the key to preparing for a good death does not lie in self-empowerment, but in the simplicity of dying as an act of voluntary self-sacrifice. Therefore, to die well means not clinging to my possessions or achievements in order to exchange them. Rather, it means living in the knowledge that I live for something more meaningful and can thus prepare to give my life for it.
The gift perspective allows one to make the best possible decisions in life because it shows that an individual has lived such a rich life that they are prepared to let it go rather than cling to it. While inner voices—driven by fear of losing face, control, or happiness—paralyze individuals who face daunting decisions with long-term consequences, the gift perspective shifts the focus to what is essential for the individual. The image of one’s “deathbed” and the anticipated reflection on one's life helps one recognize the turning points at which one can practice letting go of life and living towards what is meaningful. It is crucial to voluntarily adopt this perspective and set out in search of one's own life's meaning, which death itself calls into question.
The question of one's significance
Contemplating one’s mortality in the above manner undoubtedly presents challenges. After all, according to the Catholic philosopher Hanna-Barbara Gerl-Falkovitz, “dying is such a manifest shattering of identity that this process demands an answer.” The concept of mortality confronts individuals with the question of whether their lives have meaning and significance and whether their existence makes a difference in the world. As Gerl-Falkovitz goes on to say, “Human beings have been pulled too far from their roots on Earth [by death] not to seek meaning in the incomprehensible. Meaning implies direction beyond factual causality.” Put differently, one cannot know with rigid certainty the significance of their life—but lives filled with meaning are ones that grapple with this question.
Unfortunately, many studies show that young people, in particular, are experiencing a crisis of meaning—often, the significance of their lives is not apparent to them. This is partly due to the fact that many have settled into a semi-permanent state of non-commitment. This state paralyzes them in the face of the overwhelming abundance of options, where it seems as though only the wrong choice can be made. This state of limbo prevents them from establishing deep relationships with the world or other people because doing so would entail commitment. Consequently, they remain trapped in a perception of their own insignificance. Without deep commitments—such as making long-term decisions about a career, partner, or faith—their lives feel meaningless. Committing to choices gives us a sense of responsibility and the possibility to change things for the better. It also moves us towards love for others. And this is precisely what young people are missing out on today.
But finding one’s significance is often less heroic than many initially assume—it is rarely the superhuman, single-handed rescue of the world. In my experience working in palliative care units, the question of deep personal relationships almost always comes to the forefront at the end of life. At this time, one’s own limitations are keenly felt, and the question of meaning takes center stage. Many describe that it's not only important to have been loved during their lifetime, but also to have taken the time to love somebody deeply. Numerous studies support that description, suggesting that forming deep relationships makes life more meaningful. In one widely cited meta-analysis, a strong correlation exists between the meaning of life and a sense of belonging. We do not live in isolation. Instead, our immediate environment has a significant influence on us and can deeply impact the meaning of our lives.
The question of one’s significance concerns the imprint one leaves on the world and on another person’s heart, which outlasts one’s departure from this world. It is the personal, irreplaceable fingerprint, with its unique ridges and lines, that leaves a mark on others. This mark is not made through achievement, but through generous love that gives part of oneself to another and allows the other person to enter one's own heart. Martin Buber summarizes this concept as follows: “Through the Thou a man becomes I,” meaning a person only becomes an “I,” an identifiable subject, through a counterpart who treats them as an equal and is capable of loving them. And as many philosophers and scholars have long argued, every person has a unique spatial, temporal, and metaphysical place in the world that becomes intelligible in relation to other persons. Therefore, relationships with loved ones or even with a divine being who loves you unconditionally are crucial for perceiving one’s own significance.
The significance of one’s life only becomes apparent in retrospect when one reflects on the many decisions, both big and small, that led to one's deathbed. Even then, one may have regrets about how things turned out. Through the “deathbed perspective”—that is, by mentally anticipating one's ultimate end, which is usually far away for young people—each individual can make better present-day decisions that make life more meaningful right now: a decision rooted in love and directed toward others, which can be significant for oneself and others. On a small scale, this could be an act of service at work. On a larger scale, it could be deciding to choose a partner, have children, or pursue a career.
The ultimate goal of life, in my view, is to answer the question: What is worth living for and dying for? For whom? Practicing answering this question on a small scale clarifies our priorities in life and diminishes the intimidating power of the overwhelming abundance of freedom and choices. The deathbed perspective can therefore serve as a yardstick in life, offering us orientation as an existential tool for simplification through preemptive prioritization in situations where we are overwhelmed by choices.
Christina Koenes
August 2026