Abstract
BackgroundAs the range of therapeutic options in the field of oncology increases, so too does the strain on health care budgets. The imbalance between what is medically possible and financially feasible is frequently rendered as an issue of tragic choices, giving rise to public controversies around health care rationing.Main bodyWe analyse the Norwegian media discourse on expensive cancer drugs and identify four underlying premises: (1) Cancer drugs are de facto expensive, and one does not and should not question why. (2) Cancer drugs have an indubitable efficacy. (3) Any lifetime gained for a cancer patient is an absolute good, and (4) cancer patients and doctors own the truth about cancer. Applying a principle-based approach, we argue that these premises should be challenged on moral grounds. Within the Norwegian public discourse, however, the premises largely remain unchallenged due to what we find to be unjustified claims of moral superiority. We therefore explore alternative framings of the issue of expensive cancer drugs and discuss their potential to escape the predicament of tragic choices.ConclusionsIn a media discourse that has seemingly stagnated, awareness of the framings within it is necessary in order to challenge the current tragic choices predicament the discourse finds itself in. In order to allow for a discourse not solely concerned with the issue of tragic choices, the premises that underlie it must be subjected to critical examination. As the field of oncology advances rapidly, we depend on a discussion of its opportunities and challenges that is meaningful, and that soberly addresses the future of cancer care—both its potential and its limits.
Highlights
ConclusionsIn a media discourse that has seemingly stagnated, awareness of the framings within it is necessary in order to challenge the current tragic choices predicament the discourse finds itself in
Setting the scene: public media framings in Norway Material The empirical material for this study was retrieved from the Norwegian newspaper database Atekst
In order to allow for a discourse not solely concerned with the issue of tragic choices, the premises that underlie it must be subjected to critical examination
Summary
If the issue of cancer and expensive cancer drugs is to develop into something more than an issue solely of tragic choices, we argue that each of the premises of the public discourse today as we have characterised it, should be subjected to critical examination, empirically and normatively. The above-mentioned imaginaries are precisely that—imaginaries—and we do not claim to provide solutions to the dilemmas born from expensive cancer drugs. This discussion is not about identifying the ideal future of cancer drugs and cancer treatment. In order to tackle the challenges the future of cancer treatment presents, one needs a public discourse which includes a meaningful discussion on what illness and health is, which health states one should strive for and what one can reasonably expect from standard care. Once the frame of tragic choices is challenged, the public discourse becomes better positioned to explore and discuss these questions
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