The “Conflicted Dying”

Abstract

Using a poststructural perspective, we examine the subjectivities that are produced when advanced cancer patients seek life extension through biomedical treatments. Seven case studies were developed that included 20 interviews with patients, family, nurses, and physicians recruited from a tertiary hospital in Canada, 30 documents, and 5 hours of participant observation. We identify seven types of subjectivity: (a) the Desperate Subject, (b) the Cancer Expert Subject, (c) the Proactive Subject, (d) the Productive Subject, (e) the Mistrusting Subject, (f) the Model Patient Subject, and (g) the Suffering Subject. We characterize the "conflicted dying," a contemporary figure who holds multiple perspectives about seeking curative treatment despite the acknowledgment of death. Using active strategies to gain access to treatment, this figure resists traditional arrangements of power/knowledge established by health care providers. We suggest that the search for life extension is a process of shaping the self to fit certain aesthetical traits associated with surviving cancer.

Palliative care in the context of immune and targeted therapies: A qualitative study of bereaved carers’ experiences in metastatic melanoma

“…To assist patients/carers to navigate these options, while mediating the closeness of end of life, clinicians must have respectful and honest conversations about end of life alongside the provision of curative treatments. 57 Clinicians can support patients and families in giving them choice about how to spend the last phase of life.…”

The medicalisation of the dying self: The search for life extension in advanced cancer

“…This manifestation of medicalisation may be emblematic of what Williams andCalnan described as lay 'reskilling' (1996, p. 1616) or the public re-appropriation of expert knowledge in response to modern abstract systems like experimental medicine. By forcibly reconstituting the clinical encounter as a space where self-obtained data and their own treatment priorities could be introduced, participants resisted the traditional hierarchies of power and knowledge relations set forth by medical paternalism (Mohammed et al, 2016).…”

“…We obscured identifying details by omitting or changing non-essential identifiers of participants to prevent them from being identified. For a more complete description of the methodological work that guided this study, see Mohammed et al (2015), Mohammed et al (2016).…”

“…In an earlier publication (Mohammed, Peter, Gastaldo, & Howell, 2016), we reported on the multiple kinds of subjectivities that are generated when people with advanced cancer seek life extension through medical treatments. We suggested that the pursuit of curative treatment is supported by certain active, mistrusting, assertive and expert subjectivities taken up by people to gain access to medical treatment.…”