People have an illogical preoccupation with death, death frightens and intimidates, it is something to avoid in all forms and when faced with death turn aside and let it pass. This is also the cause of apathy with regards to the suffering of the dying. It is far more pleasant to think that Tolstoy’s characters were just unfeeling and unkind in general (which they were) than to consider the fact that an unfortunate majority of people behave the same way in similar situations. In my personal experience as a child I watched a great-great-aunt waste away from lung cancer and at the same time watched my great aunt and uncle treat her horribly. To take care of her before she died was a chore, a responsibility, an obligation, and nothing more to them. It would be nice to believe that this was an isolated incident but unfortunately the dieing are rarely treated as equals, instead they are treated as a burden, a wasted life that will be swept aside when the end finally comes. Of course this is not to say that everyone is wrong in feeling this way, it is natural because it allows the person to distance themselves from the death, and at the same time prepare for the persons death. There are shades of grey in this situation however; distancing oneself from a dieing person and treating them slightly differently is not the same treating them as a worthless responsibility.
As a more global issue this explains how people can hear things like 70,000 deaths and not blink. As long as the at-least-it-isn’t-me feeling exists there is little concern. However events like the recent Tsunami and Katrina though show a different side of humanity at large, this humanity is the part that all help each other to help others. Unlike personally helping a person as they die, events like tsunamis are able to make people feel better because although there is death it is preventable by a little money or time. This evidences that a major cause of the apathy many feel is a result of the hopelessness of the cause.
Hopelessness is the second major cause of apathy towards the dieing; a hopeless cause is seen in one of two ways, either as a heroic struggle or a waste of time. Unfortunately helping the dieing to be comfortable is not a heroic struggle, so it ends up being a waste of time. Once something has been designated as a waste it is designated as unimportant, and once things become unimportant it becomes a chores. And no one likes chores…
Tolstoy displays this in all of its incarnations ranging from the butler assistant who was concerned with Ilych’s wellbeing both physical and mental, to the wife who showed little concern for him, to the “specialists” (quacks by modern standards) who treated him as nothing and even referred to him as “the sick.”