Diagnozing Dying: When to Discontinue Oncological Treatment, When There Are More Options?

• In Event: Diagnosing Death: Critical STS Perspectives - II

Abstract

Since Glaser and Strauss published the book Awareness of dying in 1965, it has been considered good practice for clinicians to be forthright with patients about the fact that they are dying (Stacey et al 2019). Clinicians helping patients to ‘open awareness’ is shown to have positive outcomes for both patient and relatives, such as reduced anxiety and improved decision making (ibid.). Currently, however, biomedical advancements have resulted in a rapid increase in the amount of pharmaceuticals marketed for patients at the end of life, providing new treatment opportunities and hope, but also generating challenges in terms of how to interact with patients about their prognosis. Building on an ethnography of a lung cancer clinic, this study explores how oncologists interact with patients with non-curable cancer about treatment decisions, including decisions not to treat anymore. The paper unfolds the piecemeal efforts of diagnosing dying, i.e. of interacting with patients about their fatal disease at different stages of their dying trajectories (Timmermans 1994). From the first consultation when the oncologists inform about the patient’s non-curable disease over several lines of expensive, oncological treatment until, finally, ‘ending’ the patient, i.e. discontinuing the oncological treatment and referring the patient to a palliative unit. The paper contributes to ongoing debates among health economists, clinicians and patient organizations about the use of oncological pharmaceuticals at the end of patients’ lives (Wiersma et al 2018) with empirical insights into what is at stake when oncologists make decisions about treating or not treating non-curable patients.

Author

• Amalie Martinus Hauge, The Danish Center for Social Science Research