The case of the lady who risked exploding: A study of multiple consequences and contested values

Abstract

This paper explores the role of value judgements in personal risk management through an in-depth case study involving a woman's treatment for anal cancer. Julia (pseudonym) agreed to have her pre-treatment medical consultation recorded, and participated in two subsequent interviews. Delving into a single case makes it possible to understand why an individual makes decisions in relation to the overall nexus of risks and benefits which they identify even though their choices may seem irrational to others. According to the colorectal nurse research interviewer, Julia ‘risked exploding’ as a result of ‘absconding’ (Julia's term) from hospital in order to have sex shortly after undergoing surgery. Although not to be interpreted literally, the above phrase encapsulates Julia’s risk blindness from a clinical perspective. The article will address the question of how one person came to put herself at unnecessary risk. The question will be considered in relation to non-communication about the interconnected web of issues which troubled Julia, including cosmology, mortality, being left with an unclean, leaky body, loss of economic viability and harm to family members and to close relationships. This analytical framework complements the more usual one in which attitudes towards a particular risk object are compared across cases. The article makes a contribution, within the limits of a single case study, to advancing knowledge about the neglected topic of individual risk consciousness. It will be argued that, in the absence of such analysis, personal decision-making about risks cannot be fully understood, appropriate advice given or sensitive policies developed.

Keywords:

• risk
• risk analysis
• risk communication
• risk management
• risk perception

Notes

1. Risk decision-making algorithms typically require consequences to be listed before their probabilities and values are assessed and expected values added, but the listing process itself relies on unexamined intuitive thought processes.

2. As Shakespeare's Hamlet put it, ‘There is nothing either good or bad, but thinking makes it so' (Hamlet, Act II, Scene ii).

3. Vaccination programmes against HPV may be expected to reverse this trend (Palefsky 2010).

4. This phrase will be used to depict the somewhat uncertain relational status of ‘Donald’ who attended Julia's medical consultation.

5. Research evidence for increasing prevalence of anal cancer at younger ages was cited in the Introduction. Julia would probably not been aware of this trend, and viewed cancer generically as predominantly an older person's disease.

6. Patients with lung cancer have been found to prefer to avoid surgery which would increase their net five year survival chances at the price of an immediate increased risk of death resulting from the operation (McNeil et al. 1978).

7. The specific information on which Julia based her initial belief that she faced a 50% chance of dying from cancer is not known. However, this estimate refers to the generally higher mortality rate for colorectal than for anal cancer. Revised diagnosis from the former to the latter generated a substantial increase in her estimated chance of survival.