Résumés
Abstract
Alcohol-related liver disease (ARLD) is a common indication for liver transplantation yet it is considered ethically controversial in academic, clinical and public discourses. Various social groups consider people with ARLD as personally responsible for their condition and question whether they should have access to a scarce resource. How the news media constructs responsibility for ARLD may influence public opinions toward those who are ill as well as related healthcare policies. Since the organ transplantation system relies on the willingness of individuals to donate organs, understanding how the media portrays controversial issues is a matter of vital importance for public health and health policy. We investigated how responsibility for ARLD requiring liver transplantation is presented for public consumption in the news media. Using a keyword search of two online news databases, we selected 81 articles from the United Kingdom, Canada and the United States. We analyzed the articles using a discursive psychological approach. We found that the news media ascribed responsibility for ARLD to three main actors: individuals with ARLD, biological predisposition, and policy and industry representatives. How responsibility for ARLD requiring liver transplantation is presented in the news media may have implications for people diagnosed with other substance-related disorders who present for transplant candidacy or are on the transplant waiting list. Investigating how responsibility for ARLD is constructed in news media may provide insights into how responsibility is understood in other stigmatized health conditions and its potential implications for population health equity.
Keywords:
- alcohol related liver disease,
- liver transplantation,
- responsibility,
- media analysis,
- bioethics,
- stigma
Résumé
Les maladies hépatiques liées à l’alcool (MHLA) sont une indication courante pour la transplantation du foie, mais elles sont considérées comme éthiquement controversées dans les discours universitaires, cliniques et publics. Divers groupes sociaux considèrent les personnes atteintes d’une MHLA comme personnellement responsables de leur état et se demandent alors si elles devraient avoir accès à une ressource rare. La manière dont les médias d’information établissent la responsabilité de la MHLA peut influencer l’opinion publique à l’égard des personnes malades ainsi que les politiques de santé qui s’y rapportent. Étant donné que le système de transplantation d’organes repose sur la volonté des individus à donner leurs organes, comprendre comment les médias présentent les questions controversées est une question d’importance vitale pour la santé publique et les politiques de santé. Nous avons donc étudié la manière dont la responsabilité des personnes souffrant de MHLA nécessitant une transplantation de foie est présentée au grand public dans les médias d’information. En utilisant une recherche par mot-clé dans deux bases de données d’information en ligne, nous avons sélectionné 81 articles du Royaume-Uni, du Canada et des États-Unis. Nous avons analysé les articles en utilisant une approche psychologique discursive. Notre analyse révèle que les médias d’information attribuent la responsabilité des MHLA à trois acteurs principaux : les individus ayant une MHLA, les prédispositions biologiques et les représentants des politiques et de l’industrie. Elle révèle également que la manière dont la responsabilité des MHLA nécessitant une transplantation de foie est présentée dans les médias peut avoir des implications pour les personnes diagnostiquées avec d’autres troubles liés à la consommation qui se présentent pour une candidature à une transplantation ou qui sont sur la liste d’attente de transplantation. Enfin, cette étude peut aussi nous donner une idée sur la manière dont le concept de responsabilité est compris pour d’autres maladies stigmatisées ainsi que ses implications potentielles sur l’équité en matière de santé des populations.
Mots-clés :
- maladie du foie liée à l’alcool,
- transplantation du foie,
- responsabilité,
- analyse des médias,
- bioéthique,
- stigmate
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Acknowledgements / Remerciements
We are grateful for the audience discussion on this paper at the 2018 Canadian Bioethics Society Conference in Halifax, Nova Scotia. We also wish to thank Dr Kieran O’Doherty, Jed Gross and Dr Josée Lynch for helpful feedback on earlier versions of this manuscript. Kristie Serota received funding from a summer research stipend at the University of Toronto; Grace Bannerman was funded by the Multi-Organ Transplant Summer Research Program; Daniel Z Buchman receives salary support from the University Health Network.
Nous sommes reconnaissants de la discussion publique sur ce document lors de la conférence de la Société canadienne de bioéthique de 2018 à Halifax, en Nouvelle-Écosse. Nous souhaitons également remercier le Dr Kieran O’Doherty, Jed Gross et le Dr Josée Lynch pour leurs commentaires utiles sur les versions antérieures de ce manuscrit. Kristie Serota a bénéficié d’une allocation de recherche d’été à l’Université de Toronto; Grace Bannerman a été financée par le programme de recherche d’été sur les transplantations multi-organismes; Daniel Z Buchman reçoit une aide salariale de l’University Health Network.
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