The Art of Living and Dying During COVID-19 / Lydia Dugdale, MD

For the Life of the World / Yale Center for Faith & Culture

For the Life of the World is produced by the Yale Center for Faith & Culture. For more info, visit faith.yale.edu

Dr. Lydia Dugdale, MD is a New York City internal medicine primary care doctor and medical ethicist. She is Associate Professor of Medicine and Director of the Center for Clinical Medical Ethics at Columbia University. Prior to her 2019 move to Columbia, she was the Associate Director of the Program for Biomedical Ethics and founding Co-Director of the Program for Medicine, Spirituality, and Religion at Yale School of Medicine. She edited Dying in the Twenty-First Century, a volume that articulates a bioethical framework for a contemporary art of dying, and is author of The Lost Art of Dying: Reviving Forgotten Wisdom (forthcoming from HarperCollins Summer 2020), a book about a mostly forgotten ethical tradition and text that emerged in response to the Black Plague in the late middle ages: Ars Moriendi, “the art of dying.”

-1:10 Drew Collins: introduction to the episode.

-1:15 Do Not Go Gentle into that Good Night by Dylan Thomas; hear it read by the author here.

-2:05 Drew’s introduction of Dr. Lydia Dugdale.

-3:18 Beginning of their conversation.

-4:00 Lydia’s experience of the current pandemic: "Every face is a new face ... we’re starting from scratch with everyone... What’s different right now, is that we’re managing sick people without the opportunity to get to know them or their families … we are largely monitoring by computer screens, so we’re really missing out on the human connection.”

-5:35 The impact of the lack of human connection on healthcare providers: the situation is dehumanizing for patients and the doctor-patient relationship.

-7:34 The meaning of moral injury and the impact of COVID-19 on doctors and healthcare workers’ mental health: comparing military front lines to healthcare front lines.

-8:05 Lydia: “But what we’ve experienced in New York is actually far less than what we anticipated.”

-8:32 “When you are working really hard to save people’s lives but they aren’t really human in the way that we usually think of doctor’s relating to patients. And I don’t want to suggest that the doctors are dehumanizing the patients but the situation is so dehumanizing.”

-9:45 Explication of the term “moral injury”.

-13:10 The unsung heroism of essential workers in NYC, already living at the brink of economic peril.

-14:20 Lydia describes her own personal fears:

-15:05 The non-stop nature of the pandemic impact in NYC. Never-ending ambulance sirens, refrigerated mobile morgues around the city; lack of attention on public school children and the educational impact and the importance of public schools. "We have children who are going hungry because they are dependent on school to eat”; shuttering small businesses, because closing doors for a month is impossible.

-17:20 Lydia on the macro-picture of the health-effects of the economic downturn; human flourishing.

-18:19 Lydia shares an unpopular, but important view: How the current moment of covid-19 could change the conversation about human finitude, acceptance of our mortality, and the need to prepare for our deaths.

-21:25 Ars Moriendi—the art of dying, which has been lost in modern America.

-22:26 Lydia explains how her interests in Ars Moriendi were sparked--Lydia’s grandfather’s brushes with death, her family’s frank conversations about the reality of death, and her experiences of other people dying while completing her medical residency.

-25:39 “What struck me about the Ars Moriendi (art of dying) is that it was developed in the aftermath of the Bubonic plague outbreak that struck western Europe in the mid-1300s. And was a pastoral response, if you will, to the concerns of the laity--the laypeople--who said ‘look our priests are dying or they’re skipping town; there’s no one to perform burials or last rites; for all we know, this can be damning to our souls; we need some help preparing for death.’”

- 27:30 The Ars Moriendi was given to all of the community, including children. It grew out of the pre-Reformation Catholic Church, but eventually was adopted much more broadly, and ended up not being tied to a particular denomination or religion.

-29:11 "In order to die well, you’ve got to live well.” Understanding our finitude and working out questions of death in a community.

-29:27 In her book she makes the case that, of course, the art of dying is broad, but it should include the constant acknowledgement of one’s finitude that is carried out in a community that helps the person figure out these questions.

-31:09 Fear of death, grief, and tapping into the wisdom on ultimate questions about the art of dying.

-31:40 See Christian Wiman, My Bright Abyss

-33:00 "There is a way in which the thought of death or threat of death brings into relief that which we most value."

-33:31 A view to our death helps us to answer very important questions about human life and flourishing.

-34:01 Practical and personal aspects to the reality of sickness and death during a pandemic, and its implications for personal family life.

-37:01 “It took at the very beginning [of the pandemic] an acknowledgement of our finitude. We had to be willing to having those tricky conversations with little kids from the beginning."

-37:50 The importance of community for dying well; "Right now, dying from covid-19 in the hospital means dying apart from family...the relational piece is really being challenged..."

-38:35 Some doctors have to call patients before they come to inform them of the sad reality that if they pass, they would likely be alone.

-39:50 Lydia: “Dying alone is not the same as lonely dying.”

-41:34 “The challenges of dying well during covid-19 are surmountable if we are "attended to the tasks of preparing to die well over the course of a lifetime."

-42:00 Conclusion.