Confronted by his terminal condition, Ivan attempts every remedy he can to cure it until the pain grows so intense that he is forced to cease working and spend his days in bed.

In 1984, philosopher Merold Westphal said that the story depicts "death as an enemy which: (1) leads us to deceive ourselves, (2) robs us of the meaning of life, and (3) puts us in solitary confinement.

"[3] In 1997, psychologist Mark Freeman wrote: Tolstoy's book is about many things: the tyranny of bourgeois niceties, the terrible weak spots of the human heart, the primacy and elision of death.

But more than anything, I would offer, it is about the consequences of living without meaning, that is, without a true and abiding connection to one's life[4]Indeed, the mundane portrayal of Ivan's life coupled with the dramatization of his long and grueling battle with death seems to directly reflect Tolstoy's theories about moral living, which he largely derived during his sabbatical from personal and professional duties in 1877.

In his lectures on Russian literature, Russian-born novelist and critic Vladimir Nabokov argues that, for Tolstoy, a sinful life such as Ivan's is moral death.

[6] In his book A Confession, Tolstoy writes: No matter how often I may be told, "You cannot understand the meaning of life so do not think about it, but live," I can no longer do it: I have already done it too long.

[7]This epiphany caused significant spiritual upheaval in Tolstoy's life, prompting him to question the Russian Orthodox Church, sexuality, education, serfdom, etc.

[8] The literature Tolstoy composed during this period is some of his most controversial and philosophical, including The Death of Ivan Ilyich and short stories such as The Kreutzer Sonata and The Devil.