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

Abstract

Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late‐stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their disease. The seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day‐to‐day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms.

A dimensional analysis of inner strength in people ageing with serious illness

“…The context of the tension between being human and being viewed through a medical lens in this model speaks to medicalization of illness and death. Medicalization shifts normal developmental markers, such as birth and death, into the realm of medical concern (Mohammed, Peter, Gastaldo, & Howell, 2020). When knowledge of medicine is privileged, an imbalance in power between patient and provider is created (Mohammed et al., 2020).…”

“…Medicalization shifts normal developmental markers, such as birth and death, into the realm of medical concern (Mohammed, Peter, Gastaldo, & Howell, 2020). When knowledge of medicine is privileged, an imbalance in power between patient and provider is created (Mohammed et al., 2020). However, for some, medicalized language and knowledge can be internalized into a person's identity leading to greater ownership of their illness (Mohammed et al., 2020).…”

“…When knowledge of medicine is privileged, an imbalance in power between patient and provider is created (Mohammed et al., 2020). However, for some, medicalized language and knowledge can be internalized into a person's identity leading to greater ownership of their illness (Mohammed et al., 2020). The reciprocal nature of medicalization is well represented in this model in way that has not been previously conceptualized.…”

La medicalización de la muerte y el valor de la conversación hospitalaria sobre el buen morir

“…83). Gracias a las nuevas tecnologías médicas que surgieron en los siglos XIX y XX, la medicina pudo intervenir directamente en los procesos de la 'muerte natural' y conseguir por primera vez, postergarla (Mohammed et al, 2020). La inevitabilidad que antes caracterizaba la muerte y la dejaba por fuera del arte médico empezó entonces a ser cuestionada.…”

“…El concepto de 'medicalización' fue introducido en las décadas de 1960 y 1970 por pensadores y críticos sociales como Michel Foucault, Ivan Illich y Thomas Szasz, entre otros, para describir el proceso a través del cual diversos problemas humanos (típicamente no-médicos) llegan a ser definidos y tratados como problemas médicos (Sadler et al, 2009). La noción ha sido utilizada para explorar el modo en el que la racionalidad médica ha absorbido identidades sociales (como género y orientación sexual) y experiencias humanas en otro tiempo 'normales' (como la locura, el envejecimiento y la muerte), incorporándolas en su lenguaje técnico como condiciones fisiológicas tratables mediante terapias médicas o farmacéuticas (Mohammed et al, 2020). La 'medicalización' también señala el proceso cultural a través del cual las personas del común internalizan racionalidades y vocabulario médico desde donde interpretan y viven sus conductas, cuerpos e identidades (Mohammed et al, 2020).…”