Ivan a judge in the high court with a child and a wife is found to be living a good and simple life, or so he thought. He begins to feel sick and finds out that he is terminal. It is at this point that he is forced to contemplate his mortality and the life he has led up to this point.

It is through the process of dying that Ivan suffers greatly both with pain and with the fact that he feels his suffering is so undeserved based on the life he believes he has led. He believes to be suffering wrongly because he has done nothing wrong in life and so he concludes that pain, suffering, and death are simply useless and arbitrary. He is frustrated with his wife and son for not acknowledging the fact that he is dying and so he turns to a servant boy who shows him compassion. It is the boy's compassion that open Ivan's eyes to examine the life he has actually led.

As death is fast approaching Ivan makes a distinction between what he believes to be artificial life and authentic life. He thinks that Gerasim is leading an authentic life because he has compassion and depth. Ivan then deduces that he has led an artificial life consumed with his own self-interest.

At the moment of his death his final transformation of character takes place as he sees a bright light, perhaps of truth, and learns to feel empathy for his wife and son and compassion for their artificial lives. He finally dies living the joy of the authentic life. There are several interpretation of the end of the novella.