Writing Away Responsibility: How Physicians and Ghostwriting Agencies Legitimise Academic Misconduct in China's Healthcare System

Abstract

This paper examines how physicians and ghostwriting agencies in China's healthcare system legitimise academic misconduct through strategic discourse. Integrating governmentality and accounts theories, it analyzes how participation in ghostwriting is constructed as an inevitable response to contradictory institutional demands. Critical discourse analysis of social media posts reveals three dynamics: parties position services in a grey zone between professional assistance and misconduct through boundary-drawing techniques; frame involvement as unavoidable rather than voluntary; and create complementary discourses enabling institutional requirements to be met without challenging contradictions. The study extends accounts theory by showing how neutralisation techniques serve as identity-protective mechanisms in professional contexts. It introduces ‘mediated responsibility displacement’ to explain how market actors, as intermediaries, partially assume responsibility while redirecting moral blame to systemic factors, showing how professionals navigate impossible requirements through market solutions rather than resistance.