Precision patients: Selection practices and moral pathfinding in experimental oncology
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Precision patients : Selection practices and moral pathfinding in experimental oncology. / Dam, Mie S.; Green, Sara; Bogicevic, Ivana; Hillersdal, Line; Spanggaard, Iben; Rohrberg, Kristoffer S.; Svendsen, Mette N.
I: Sociology of Health and Illness, Bind 44, Nr. 2, 2022, s. 345-359.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Precision patients
T2 - Selection practices and moral pathfinding in experimental oncology
AU - Dam, Mie S.
AU - Green, Sara
AU - Bogicevic, Ivana
AU - Hillersdal, Line
AU - Spanggaard, Iben
AU - Rohrberg, Kristoffer S.
AU - Svendsen, Mette N.
N1 - Publisher Copyright: © 2022 Foundation for the Sociology of Health & Illness
PY - 2022
Y1 - 2022
N2 - This paper addresses selection practices in a Danish phase 1 unit specialised in precision medicine in the field of oncology. Where precision medicine holds the ambition of selecting genetically fit medicine for the patient, we find that precision medicine in the early trial setting is oriented towards selecting clinically and genetically fit patients for available treatment protocols. Investigating how phase 1 oncologists experience and respond to the moral challenges of selecting patients for early clinical trials, we show that inclusion criteria and patient categories are not always transparent to patients. Lack of transparency about inclusion criteria has been interpreted as morally problematic. Yet drawing on social science studies of ‘unknowing’, we argue that silence and non-transparency in interactions between oncologists and patients are crucial to respect the moral agency of patients at the edge of life and recognise them as belonging to the public of Danish health care. In the discussion, we consider the practice of placing ‘unfit’ patients on a waiting list for trial participation. Rather than representing an ethical and political problem, we argue, the waiting list can act as a valve enabling oncologists to navigate the scientific and as well as the moral uncertainties in phase 1 oncology.
AB - This paper addresses selection practices in a Danish phase 1 unit specialised in precision medicine in the field of oncology. Where precision medicine holds the ambition of selecting genetically fit medicine for the patient, we find that precision medicine in the early trial setting is oriented towards selecting clinically and genetically fit patients for available treatment protocols. Investigating how phase 1 oncologists experience and respond to the moral challenges of selecting patients for early clinical trials, we show that inclusion criteria and patient categories are not always transparent to patients. Lack of transparency about inclusion criteria has been interpreted as morally problematic. Yet drawing on social science studies of ‘unknowing’, we argue that silence and non-transparency in interactions between oncologists and patients are crucial to respect the moral agency of patients at the edge of life and recognise them as belonging to the public of Danish health care. In the discussion, we consider the practice of placing ‘unfit’ patients on a waiting list for trial participation. Rather than representing an ethical and political problem, we argue, the waiting list can act as a valve enabling oncologists to navigate the scientific and as well as the moral uncertainties in phase 1 oncology.
U2 - 10.1111/1467-9566.13424
DO - 10.1111/1467-9566.13424
M3 - Journal article
C2 - 34993996
AN - SCOPUS:85122366704
VL - 44
SP - 345
EP - 359
JO - Sociology of Health and Illness
JF - Sociology of Health and Illness
SN - 0141-9889
IS - 2
ER -
ID: 290034301