University of Colorado, Denver, United States.
University of Colorado, Denver, United States.
Soc Sci Med. 2018 Mar;200:107-113. doi: 10.1016/j.socscimed.2018.01.033. Epub 2018 Jan 28.
A growing body of social science literature is devoted to describing processes of biomedicalization. The issue of biomedicalization is especially relevant for individuals suffering from end-stage cancer and hoping that aggressive end-of-life interventions, which are riddled with uncertainty around quantity or quality of life, will produce a 'cure'. To examine hospice underutilization among end-stage cancer patients, we apply the anthropological concept 'political economy of hope,' which describes how personal and collective 'hope' is associated with the political and economic structures that produce biomedicalization processes. Previous studies have examined hospice underutilization among end-stage cancer patients and have identified barriers stemming from patient and physician characteristics or health insurance reimbursement policies. Yet, these studies do not provide an organized synthesis of how barriers articulate, how they are part of the longitudinal decision-making process, or describe the sociocultural context surrounding hospice care enrollment decisions. This paper focuses on US-specific mechanisms and is based on qualitative, in-depth, interviews with physicians at an academic hospital (N = 24). We find that hospice underutilization results from a web of interconnected constraints surrounding end-stage cancer patients. Our research reveals how hospice care contradicts the political and economic structures associated with end-stage cancer care and illustrates how end-stage cancer patients are transformed into a form of biovalue, a fundamental commodity sustaining the political economy of hope.
越来越多的社会科学文献致力于描述生物医学化的过程。对于患有晚期癌症并希望通过充满不确定性的积极临终干预措施来“治愈”疾病的患者来说,生物医学化问题尤为重要。为了研究晚期癌症患者中临终关怀利用不足的问题,我们应用了人类学的“希望的政治经济学”概念,该概念描述了个人和集体“希望”如何与产生生物医学化过程的政治和经济结构相关联。先前的研究已经考察了晚期癌症患者中临终关怀利用不足的问题,并确定了源于患者和医生特征或医疗保险报销政策的障碍。然而,这些研究并没有提供一个有组织的综合分析,说明这些障碍是如何相互关联的,它们如何成为纵向决策过程的一部分,或者描述围绕临终关怀登记决策的社会文化背景。本文侧重于美国特有的机制,并基于对一家学术医院的医生进行的定性、深入访谈(N=24)。我们发现,临终关怀利用不足是由晚期癌症患者周围相互关联的一系列限制因素造成的。我们的研究揭示了临终关怀如何与晚期癌症护理相关的政治和经济结构相矛盾,并说明了晚期癌症患者如何转变为一种生物价值形式,这种生物价值是维持希望的政治经济学的基本商品。