Nursing Inquiry. 2020;27:e12316. wileyonlinelibrary.com/journal/nin
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https://doi.org/10.1111/nin.12316
© 2019 John Wiley & Sons Ltd
1 | INTRODUCTION
The concept of medicalisation has been utilised to explore the ways
medical thinking has encroached into a number of physiological con‐
ditions, pharmaceutical and medical therapies, social identities and
normal human experiences such as ageing and death (Conrad, 2005).
An ongoing social and cultural process, medicalisation, also occurs
when people participate in the medical appropriation of their be‐
haviours, bodies and identities through a variety of ways, including
the internalisation of medical rationales (Nye, 2003). It is also associ‐
ated with the increased prevalence and potency of medical vocabu‐
laries, definitions and models in the personal practices and identities
of lay people (Halfmann, 2011). Medicalisation has been applied to
the examination of genetic testing for breast cancer (Frank, 2012),
mammography screening (Griffiths, Bendelow, Green, & Palmer,
2010) and vaccination for cervical cancer (Vardeman‐Winter, 2012).
Although the medicalisation of dying has been well examined
(Burgess, 1993; Field, 1994; Seale, 2000), no study to date has con‐
sidered the medicalisation of dying from advanced cancer, and how
it is approached as an incurable illness that is the leading cause of
premature death in Canada (Canadian Cancer Society, 2013).
People are living longer with advanced and incurable cancers
(Lage & Crombet, 2011), thereby rewriting the possibilities of medi‐
calisation. The cultural perception of cancer as an acute illness that
Received: 18 October 2018
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Revised: 5 July 2019
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Accepted: 9 July 2019
DOI: 10.1111/nin.12316
FEATURE
The medicalisation of the dying self: The search for life
extension in advanced cancer
Shan Mohammed
1
| Elizabeth Peter
1,2,3
| Denise Gastaldo
1,2,4
| Doris Howell
1,5
1
Lawrence S. Bloomberg Faculty of
Nursing, University of Toronto, Toronto, ON,
Canada
2
Centre for Critical Qualitative Health
Research (CQ), Toronto, ON, Canada
3
Joint Centre for Bioethics, University of
Toronto, Toronto, ON, Canada
4
Dalla Lana School of Public
Health, University of Toronto, Toronto, ON,
Canada
5
Princess Margaret Cancer
Centre, University Health Network, Toronto,
ON, Canada
Correspondence
Shan Mohammed, Lawrence S. Bloomberg
Faculty of Nursing, University of Toronto,
155 College Street, Suite 130, Toronto, ON
M5T1P8, Canada.
Email: shan.mohammed@utoronto.ca
Funding information
The project was funded by a doctoral
fellowship from the Social Science and
Humanities Research Council of Canada and
the University of Toronto.
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 ex‐
amine 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 analy‐
sis of 30 documents and 5 hr of field observation. A poststructural perspective in‐
formed our study. We propose that searching for life extension enacts medicalisation
by shaping the dying person afflicted with terminal cancer into new medical sub‐
jectivities 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 generat‐
ing 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.
KEYWORDS
cancer, case studies, death and dying, electronic patient record, end of life, medicalisation,
palliative care, poststructuralism