Pandemic, Aging, and Agency

How preparing for death empowers the elderly.

Posted Jun 25, 2020

Coronavirus has consumed more lives in a short period than does seasonal influenza and has proven itself especially vicious toward the elderly. The virus has magnified pre-pandemic concerns that those living in Western society care little for their oldest members. Headlines such as “Why Are We OK with Old People Dying?” or “Why Are So Many People Ready to Let the Elderly Die?” reinforce this point.

The writer Jean Améry doubtless would have agreed that in today’s world, the young are more concerned with their own lives than with the lives of the elderly. Born in Austria in 1911, Améry had a particularly complicated relationship with growing old. The title of his book, On Aging: Revolt and Resignation, sums up his feelings on the matter—he would both rebel against and resign himself to the inexorable.

Améry’s third chapter, “The Look of Others,” focuses on how elders come to feel invisible. They go unnoticed by the younger and more robust. He opens with reference to Jean-Louis Curtis’ book La Quarantaine—“not a great book,” he says, but “reflectively beautiful.” Published in the 1960s, La Quarantaine tells the story of two married couples at the prime of life—notably, their forties—whose relevance is challenged by time itself.

Améry applauds the use of the word quarantine in the book’s title. On the one hand, quarantine refers to “the decade of aging between forty and fifty,” Améry writes. “[O]n the other the hygienic isolation imposed upon human beings, no longer young: their quarantine.” There we have it: quarantine as both the fifth decade’s plateau between ascent and descent, as well as the social isolation imposed on the old by the young. The former is a state of being, neither sought nor received. The latter is compulsory, rendering the aged passive, bereft of their agency.

Of course, the word quarantine takes on heightened significance during a pandemic that has disproportionately targeted the old. In recent months all people, old and young, have been quarantined. We all have been hygienically isolated, to borrow from Améry. Halting human contact thwarts spread of disease, logic tells us. And if the elderly are especially vulnerable, they must be especially quarantined.

Everyone has well-intentioned guidance for society’s oldest members. The Centers for Disease Control offers “COVID-19 Guidance for Older Adults.” Medical centers and even mainstream newspapers have published their own recommendations. The guidelines tend to converge on the need for methods that are principally protective. Perhaps rightly so. But less commonly do we read advice to societal elders that bolsters their sense of agency.

In fact, Améry says that the look of others condemns the elderly. It judges them as “creatures without potential.” He continues: “No one asks [the aged] any longer, ‘What do you want to do?’ All declare, dispassionately and unflinching, ‘That you've already done.’” Society thus moves to protect and confine the vulnerable, robbing them of agency and targeting them for certain death. Had he still been living, COVID-19 would have reified Jean Améry’s most dystopic fears.

Since certain death of the elderly is not something new, ushered in for the first time by COVID-19, it is worth considering how previous generations have sought to bolster the agency of the aged.

For more than 500 years a body of literature known as the ars moriendi—or art of dying—was widely popular in the West. It developed not in response to the novel coronavirus but during the aftermath of a particularly devastating outbreak of bubonic plague. Historians estimate that the 1350s plague epidemic took the lives of one-third to two-thirds of Western Europeans. Survivors feared for the souls of the dead, many of whom had been buried improperly and without ritual. They wanted to prepare themselves should death swiftly return.

No one knows who wrote the first version, but by 1415, a handbook on the art of dying began to circulate throughout Europe. Immediately it gained traction. Although the initial text had a Catholic subtext, it was translated into multiple languages and modified for other religious and even non-religious communities. This ars moriendi offered advice for all members of a community in care of the dying and preparing for death. It also advised the dying themselves on how best to prepare for death. The ars moriendi were fundamentally empowering texts, for the young as well as the old.

How did the ars moriendi affirm the agency particularly of the aged? It did so in many ways, but I highlight three.

First, the ars moriendi placed the elderly squarely within the bounds of community. They were central to the family, not sidelined. Second, the art of dying literature taught that in order to die well, one had to live well. Attending to questions of what it meant to live well, of corporate beliefs and values, were central to community life. And they were meant to be worked out over a lifetime. Third, the ars moriendi described prayers and practices in which community members—young and old—could participate. This might take the form of a catechism “Q&A,” or it might mean a prescribed prayer or reading. Regardless of form, these practices were rehearsed by communities in states of sickness and health. Elderly who practiced the art of dying, then, would have been well-equipped to face their deaths. They would not have been caught off guard. And when their faculties waned, family members would have known to continue the exercise of such practices in their stead. Lifelong participation in community-based preparation for death offers the ultimate exercise in agency.

Améry feared growing old. He despised the quarantine—“the hygienic isolation”—that society imposed on the aged. A revival of the ars moriendi would empower the elderly to exercise their agency, and it would also empower their communities to carry that torch forward.