Collusion in the Clinic: Constructing Patients' Moral Responsibility to Treat Cancer.

Abstract

American healthcare involves expanding medical technologies and innovations in treatment to improve health outcomes and longevity. Social scientists have argued that this is explained by the moralization of health and cultural attitudes toward imperatives to treat, pointing to the U.S. healthcare system as one that rewards healthy behaviors and "curing" rather than "caring." In this article, we analyze early-stage oncology encounters to understand how patients come to understand what constitutes oncology treatment at the outset of their treatment journey. In these visits (n = 23), we use conversation analysis to identify behaviors used across interactants to frame medically intensive treatment. Ultimately, we find that physicians, patients, and their families orient to patients having a moral responsibility to extend their lives as much as possible through aggressive treatment even when that entails unpleasant side effects, risks, or substantial time investments.