The Death of Ivan Ilych begins at the chronological end of the story. A group of judges are gathered together in a private room of the courthouse when Peter Ivanovich, a judge and close friend of Ivan Ilych, announces that Ivan has died. Consoled by the thought that it is Ivan who has died and not them, the men in the room cannot help but think of the promotions and transfers that Ivan's death will occasion. That evening, Peter drives to Ivan's house to attend his funeral. But while looking at Ivan's corpse, Peter is bothered by an expression of disapproval and warning on Ivan's face. Ivan's wife Praskovya quizzes Peter about possible strategies to maximize her dead husband's government pension. On his way out, Peter encounters Gerasim, Ivan's sick nurse. Peter mentions that Ivan's death and funeral are a sad affair, and Gerasim surprises Peter with the observation that everyone dies some day.

The story then shifts more than thirty years into the past and picks up with a description of Ivan's life. Ivan is the second of three sons, and in all respects is an average and commonplace person. Around the age of thirteen he attends the School of Law where he assimilates the values and behavior of those with high social standing. Ivan becomes an examining magistrate in the reformed judicial institutions and moves to a new province. Ivan marries and things progress smoothly until Praskovya becomes pregnant. As Praskovya's behavior begins to disrupt the proper and decorous lifestyle cherished by Ivan and approved by society, Ivan increasingly absorbs himself in his official work and distances himself from his family. At work he prides himself on removing all personal concerns from his consideration, and at home he adopts a formal attitude toward his family. Time passes and Ivan moves up in the ranks. He expects to be awarded the post of presiding judge in a University town, but is passed over for promotion. Infuriated and struck by a keen sense of injustice, Ivan obtains a leave of absence and moves with his family to his brother-in-law's house in the country. Conscious that his salary cannot cover his family's living expenses, Ivan travels to St. Petersburg to look for a higher paying job. He learns that due to a change in the administration of the Ministry of Justice, a close friend has landed a position of great authority. Ivan is awarded a higher paying position in the city, and informing his family of the good news, Ivan departs alone to buy and furnish a house in preparation for the family's arrival. One day as he is mounting a step-ladder to hang some drapes, he makes a false step and slips, banging his side against the window frame. The injury is not serious, however, and Ivan is quite pleased with the final appearance of the house. He settles into his new life and acquires a love of bridge.

Ivan begins to experience some discomfort in his left side and an unusual taste in his mouth. The discomfort gradually increases and soon Ivan is both irritable and quarrelsome. The doctors Ivan visits all disagree on the nature of the illness, and Ivan becomes depressed and fearful. Even cards lose their appeal. Ivan's physical condition degenerates rapidly. One night while lying alone in the dark, he is visited by his first thoughts of mortality, and they terrify him. He realizes that his illness is not a question of health or disease, but of life or death. Praskovya does not understand nor wish to understand her husband's plight, and Ivan can barely suppress his hatred for her. Ivan knows that he is dying, but he is unable to grasp the full implications of his mortality. He tries to erect screens to block the thought of death from his mind, but death haunts him ceaselessly. In the midst of this suffering, Gerasim, Ivan's peasant servant, enters the scene. Assigned the task of helping Ivan with his excretions, Gerasim soon begins passing the entire night with the dying man. To ease his pain, Gerasim supports Ivan's legs on his shoulders. More than any other living person, Gerasim provides Ivan with the compassion and honesty that he needs. Ivan's daily routine is monotonous and maddening. As those around him continue to pretend that he is only sick and not dying, Ivan feels that he is surrounded by artificiality. No one wants to confront the fact of Ivan's imminent death. Ivan becomes silently enraged, and seeing his little son Vasya, Ivan realizes that Vasya is the only one besides Gerasim who understands him. That night Ivan dreams of a deep black sack. He is being violently pushed into the sack, but cannot fall through. And he both fears and desires to fall into it. Awaking from his dream, Ivan sends Gerasim away, and for the first time he hears the inner voice of his soul speaking to him. Twelve more days pass, and Ivan is no longer able to leave the sofa. He lies pondering death and questioning the rationale behind his suffering. As he examines his life, Ivan realizes that the further back he looks, the more joy there is. He finds that just as the pain grew worse and worse, so too did his life. He knows that an explanation for the suffering would be possible if he had not lived rightly, but recalling the propriety of his life, he resigns himself to the senselessness of death. Then, one night while looking at Gerasim's face, Ivan begins to doubt whether he has lived his life correctly. He imagines the black sack again, and the immense agony he experiences stems partly from his being thrust into the sack, and partly from not being able to get right into it. The conviction that his life was a good one prevents him from entering the sack, but for some reason he is unwilling to relinquish that belief. Suddenly, "some force" strikes Ivan in the chest and side. It pushes him through the sack and into the presence of a bright light. At that very moment his hand falls on his sons head and he feels sorry for him. His wife approaches his bed, her face wet with tears, and he feels sorry for her too. He realizes that his official life and his family and social relations were all artificial. And he experiences a sense of extreme joy. In the middle of a sigh, Ivan stretches out and dies.