Courageous Truth-Telling in the Care of the Dying
Micah Rojo, BSN, MTS, Duke Divinity School, Durham, NC
As Mr. J’s nurse, I observed him over two months growing increasingly frail, agitated, and delirious—ultimately requiring chemical and physical restraint just to perform clinical care. Despite the clear signs of decline, Mr. J was not on hospice, nor designated DNAR; instead, he was full code, with his care directed toward recovery. What I was tasked with felt far from true care—it was participation in perpetuating a lie, not in honestly tending to his imminent death.
This paper offers a cultural and philosophical exploration of the structures that dictated my care of Mr. J, proposing parrhesia, or courageous truth-telling, as a way for nurses to authentically care for the dying. First, using Sharon Kaufman’s ethnography on dying in American hospitals, I argue that medicine and technology often obscure death and its inevitability, leading to care that defaults to life-preservation. Second, I address the medical hierarchies that determine access to truth, exploring how the nurse’s insights about imminent death may be dismissed by others in the healthcare hierarchy, such as when my assessment was disqualified by the attending physician.
The core of this paper argues for parrhesia, particularly as modeled by early Christian ascetics, as a vital tool for nurses to provide appropriate and compassionate care in end-of-life contexts. Parrhesia is a direct and frank verbal act where the speaker, compelled by duty, risks personal consequences to express the truth for another’s benefit. Ascetic parrhesiastes achieved this by dying to themselves each day, accessing a truth grounded in the other world, which transcends the present world’s fears, conventions, and hierarchies. Guided by a commitment to this order, the nurse parrhesiast could thus act as a witness to a different way of being—one that faces death with openness and courage. In life and speech, the parrhesiast reflects the values of this eternal order, challenging the denial of death so embedded in medical institutions.
The nurse parrhesiast lives this calling with humility and moral courage, consciously positioning themselves as a truth-teller within the constraints of a system that resists acknowledging mortality. Drawing on Foucault’s framing of parrhesia, this paper shows how nurses, by embracing parrhesia, might critique the game of truth in hospitals that marginalizes nursing voices and sustains the illusion of indefinite life. With the ascetic’s resolve to die to themselves daily, the nurse parrhesiast bears witness to the finite nature of life and confronts the barriers to dying well. By encouraging both patients and fellow clinicians to accept mortality, the nurse parrhesiast can help restore honesty and compassion to the dying process, helping patients like Mr. J prepare for death.
This paper offers a cultural and philosophical exploration of the structures that dictated my care of Mr. J, proposing parrhesia, or courageous truth-telling, as a way for nurses to authentically care for the dying. First, using Sharon Kaufman’s ethnography on dying in American hospitals, I argue that medicine and technology often obscure death and its inevitability, leading to care that defaults to life-preservation. Second, I address the medical hierarchies that determine access to truth, exploring how the nurse’s insights about imminent death may be dismissed by others in the healthcare hierarchy, such as when my assessment was disqualified by the attending physician.
The core of this paper argues for parrhesia, particularly as modeled by early Christian ascetics, as a vital tool for nurses to provide appropriate and compassionate care in end-of-life contexts. Parrhesia is a direct and frank verbal act where the speaker, compelled by duty, risks personal consequences to express the truth for another’s benefit. Ascetic parrhesiastes achieved this by dying to themselves each day, accessing a truth grounded in the other world, which transcends the present world’s fears, conventions, and hierarchies. Guided by a commitment to this order, the nurse parrhesiast could thus act as a witness to a different way of being—one that faces death with openness and courage. In life and speech, the parrhesiast reflects the values of this eternal order, challenging the denial of death so embedded in medical institutions.
The nurse parrhesiast lives this calling with humility and moral courage, consciously positioning themselves as a truth-teller within the constraints of a system that resists acknowledging mortality. Drawing on Foucault’s framing of parrhesia, this paper shows how nurses, by embracing parrhesia, might critique the game of truth in hospitals that marginalizes nursing voices and sustains the illusion of indefinite life. With the ascetic’s resolve to die to themselves daily, the nurse parrhesiast bears witness to the finite nature of life and confronts the barriers to dying well. By encouraging both patients and fellow clinicians to accept mortality, the nurse parrhesiast can help restore honesty and compassion to the dying process, helping patients like Mr. J prepare for death.