VI. `You Get on a Rollercoaster Where you Can't Get Off': Treatment Decision Making and `Choice' in the Context of Infertility after Breast Cancer

Abstract

Individual ‘choice’ is currently a pervasive and powerful concept in medical research and practice (Wilkinson and Kitzinger, 2000: 801). In breast cancer research, in connection with responsibility for one’s own health, it is often defined as avoiding certain ‘risk factors’ and having a healthy ‘lifestyle’ (Simpson, 2000). While most of these ‘risk factors’ are actually inherently social, such as the number of children a woman has, her diet or exposure to environmental pollution (Potts, 2000), a discourse of ‘lifestyle’ and individual ‘choice’ shifts what should be social and political responsibilities onto the individual woman in a prime example of ‘victim-blaming’ (Wilkinson and Kitzinger, 2000). And ‘choice’ is a popular term not only in the aetiology of breast cancer, but also in its management. The UK Department of Health (DoH) has in recent years published several documents concerned with increasing patient involvement and ‘choice’ in treatment decision making (Department of Health, 2001, 2003: 76, 2006: 24). However, the notion of treatment choice in breast cancer practice has been criticized for several reasons. Due to space limitations, I will focus here on only one aspect: following arguments made in other fields such as HIV/Aids (O’Manique, 2004), I will problematize the utilization of the neoliberal conceptualization of ‘choice’ as the internal, psychological process of an autonomous individual making a rational decision based on factual information by the DoH. Using a particular case from my current PhD research on young women’s experiences of breast cancer, I will argue that, first, using this construction in