The major idea that Tolstoy presents through this short story is the way that humans avoid confronting the realities of death and even go as far as to ignore their own mortality whilst anticipating how they can profit from the death of others. This is shown in the start of this story through the former work colleagues of Ivan Illyich reading about his death in the newspaper. Although some are unsettled by the news, others are not, and all think happily of the promotions they will receive as a result and look forward to paying their respects to Ivan Illyich's family. Such views are summarised by Peter Ivanovich's visit to Ivan Illyich's widow, and how he responds when he hears about his last three days of suffering. Although initially he thinks of how terrible that would be and how his own mortal condition means something like that could happen to him, he is quick to shrug off these morbid thoughts:
...the customary reflection at once occurred to him that this hd happened to Ivan Illyich and not to him, and that it should not and could not happen to him, and that to think that it could would be yielding to depression which he ought not to do...
What is interesting about responses such as these is how they are shown to be felt by the upper class relatives and friends of Ivan Illyich. The one lower class character in the story, Gerasim, has a very different approach to death, as he summarises to Peter Ivanovich: "It is God's will. We shall all come to it some day." It is Gerasim's unpretentious acceptance of death as an intrinsic part of life that allows him to be of such consolation to Ivan Illyich in his last few weeks.
Following this introduction, the main story begins by describing Ivan Illyich's life, and his rise through the social ranks and how he begins to feel a pain that gradually becomes worse and worse. Ivan Illyich struggles with both accepting the failing nature of his health but also the way in which he is treated as a result by his wife and children, and their attempt to avoid the enormity of what he is going through. He is haunted by philosophical questions of what his life meant and how it can be valued. As his condition worsens, he is finally able to accept that his death is inevitable. It is only in the last three days of his life, which are full of unremitting pain and agony, that he is able to accept the value of his life and finally die. This only comes when his son kisses his hand and weeps over his father. When Ivan Illyich is able to express sympathy towards his wife and son and tries to apologise, he is able to see the "light" and finally die in peace.