Two or three decades ago, my sisters and I would meanly poke fun at our mother when Christmas brought with it a swag of greeting cards filled with catalogues of bodily woes. Thirty or forty relatives and friends would get in touch once a year to keep my mother up to date on the colourful details of Lal’s triple bypass, the doctor’s opinion on Marge’s leg, and the nasty turn that Stan had on the train.

Now that we are all in our fifties we no longer think any of this is the least bit funny, and I wish my mother were still with us so I could apologise to her in person. Anyone who has watched the physical decline and death of a beloved parent will find Philip Roth’s new book a painful but compelling read, and those of us now trying not to be too graceless in the management of our own decline are doomed to read Everyman with rapt attention.

It isn’t a happy book, nor does it deploy the humour that is usually Roth’s most endearing trait. Everyman is a powerful meditation on illness and death, shot through with the existentialism that has always characterised Roth’s work and therefore even more cheerless than such meditations usually are, but at the same time – and weirdly, given the subject matter – kicked along in overdrive by the hectoring, bullying vitality of his prose. The funeral of the anonymous and eponymous hero, the Everyman of the title, is the book’s opening scene; what follows is another 170 pages of complex chronology, outlining the lost paradise of an idyllic childhood and tracing the journey from there to a rectangular hole in the New Jersey ground. The emphasis is on his medical history – and, of course, this being a Philip Roth novel, his sexual history as well: “Should he ever write a biography, he’d call it The Life and Death of a Male Body.”

Between bouts of marital fidelity, his sexual life, like that of nearly all Roth’s heroes, is the semi-pornographic stuff of male fantasy. The idea that Nirvana is to be found in the anus of a Danish model half the hero’s age – “If you like that little hole,” she says to him, in the most gobsmacking piece of dialogue I’ve read so far this century, “why don’t you use it?” – appears to be something Roth thinks we’ll all take for granted. Sure, the words “Danish model” have the same effect on a certain kind of man as the word “Ferrari”, but the idea of her or anybody else’s anus as the apotheosis of sexual pleasure gives the reader startled pause in a book by a man whose unrelenting and rampant preoccupation with heterosexual sex has been a major focus of American literature over the last four or so decades.

Roth takes his title from the fifteenth-century morality play in which the allegorical character of Everyman is summoned by Death, whom he unexpectedly meets on the road: “Oh Death, thou comest when I had thee least in mind.” Unlike the medieval Everyman, whose whole point is its religious message, Roth’s Everyman explicitly rejects anything of the kind: “Religion was a lie that he had recognised early in life, and he found all religions offensive, considered their superstitious folderol meaningless, childish, couldn’t stand the complete unadultness …”

This passage is a good illustration of the book’s main difficulty: it’s impossible to tell how much of the protagonist’s views are Roth’s own, whether we are supposed to like this bloke, whether we are meant to sympathise and empathise. The idea of an elderly man railing against the childishness of religion when his own sexuality has remained firmly stuck in the adolescent zone is definitely the stuff of comedy, but I’ve got an awful feeling that Roth doesn’t see his character this way at all and certainly doesn’t intend us to find him funny.

Working your way through a book with no readable moral compass can be a vertiginous experience. The hero is bitterly angry, for example, with the grown sons of his first marriage for having the gall to despise him for abandoning them: whose side should we be on? Roth certainly asks the question at some of the book’s most brilliant moments, such as the younger son’s disintegration at the graveside and the second wife’s virtuoso monologue when infidelities are revealed. But the “everyman” tag seems to indicate that we are indeed meant to like the guy and identify with him, and it’s hard to imagine any real awareness on Roth’s part that “everyman” might not be universally regarded as a synonym for “everyone”.

Everyman positions female readers very strangely: as a woman reading this book I felt emptied out and negated, a zombie voyeur, drawn into unwilling complicity with a world view that constructs women unthinkingly as objects. The female characters exist only in their relation to the hero, and are categorised according to their effect on him: their degree of sexual allure, of usefulness, or of willingness to accommodate and forgive.

And yet there are moments when the hero himself realises, like his medieval counterpart, that the time has come to reap what he’s sown:

… he began striking at his chest with his fist, striking in cadence with his self-admonition, and missing by mere inches his defibrillator … This ordinarily even-tempered man struck furiously at his heart like some fanatic at prayer … assailed by remorse not just for this mistake but for all his mistakes, all the ineradicable, stupid, inescapable mistakes …

Behind the pages of this book you can hear the rustling and jostling of several ghostly textual precursors. The most obvious is Tolstoy’s The Death of Ivan Ilyich, whose structure serves as a model. Other identifiable models include Sartre’s Nausea and Mann’s Death in Venice: clearly there is something about the novella form that lends itself to meditations on mortality and final-paragraph deaths. In its own way Everyman is quite as compelling a read as its luminous Tolstoy ancestor; it’s just that there’s also a lot to take issue with. In the end, it’s the squalling of that unchecked id that starts to get the reader down, even while being invigorated by the energy of Roth’s and his hero’s rage. “Old age isn’t a battle,” says the hero to himself at one point, “it’s a massacre.”

It’s a good line, but what prevents it from being a great one is the fact that it isn’t actually true. If you die of natural causes, then what kills you is your own body. Certainly the pain is real, the debility is real, and the outrageous fact that some things simply cannot be repaired, replaced, restored or healed is more real than anything else. But it’s a sign of arrested development to go on pretending that death is any kind of Other, much less an enemy. The most memorable bits of this book are not about Everyman’s death but about his life: the young man swimming across the bay, watched by the love of his life, or the little boy on the New York bus running errands for his jeweller father, with his pockets full of diamonds.