Elaine M. Drew Department of Family and Community Medicine Medical College of Wisconsin Nancy E. Schoenberg College of Medicine University of Kentucky Deconstructing Fatalism: Ethnographic Perspectives on Women’s Decision Making about Cancer Prevention and Treatment Researchers have long held that fatalism (the belief in a lack of personal power or control over destiny or fate) constitutes a major barrier to participation in posi- tive health behaviors and, subsequently, adversely affects health outcomes. In this article, we present two in-depth, ethnographic studies of rural women’s health decisions surrounding cancer treatments to illustrate the complexity and contesta- bility of the long-established fatalism construct. Narrative analyses suggest that for these women, numerous and complex factors—including inadequate access to health services, a legacy of self-reliance, insufficient privacy, combined with a culturally acceptable idiom of fatalism—foster the use of, but not necessarily a rigid convic- tion in, the notion of fatalism. [fatalism, Appalachia, cancer, prevention, health decisions] Fatalism has been defined as “a philosophical doctrine holding that all events are predetermined in advance for all time and human beings are powerless to change them” (Webster’s Dictionary 2010). The construct has been used in a variety of re- search areas, including accounting for adolescent unemployment and psychological distress, approaches to coping with food safety, and numerous studies on health behavior and decision making. In the health sciences, the fatalism construct increasingly has been applied to account for health behavior and even health outcomes. Investigators classify as fatalistic those individuals who believe that health is “a matter of fate or luck and beyond an individual’s control” (Straugham and Seow 1998). For example, when an individual decides to engage in risky sexual practices without the use of a condom or opts out of getting an HIV/AIDS diagnostic test when pregnant, re- searchers have evoked fatalism or other related psychosocial constructs to help explain such decisions. Constructs related to fatalism include locus of control (Rotter et al. 1962), optimism (Steginga and Occhipinti 2006), and expectancy 164 MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 25, Issue 2, pp. 164–182, ISSN 0745- 5194, online ISSN 1548-1387. C  2011 by the American Anthropological Association. All rights reserved. DOI: 10.1111/j.1548-1387.2010.01136.x