Why Should I Really Consider This? The Rhetoric of Patient Motives in Phase 1 Cancer Clinical Trial Consultations

Abstract

Phase 1 cancer clinical trial consultations are fraught with ethical and rhetorical issues. Phase 1 trials are designed to test the toxicity, and not the efficacy, of therapeutic agents. Fewer than 5% of patients benefit from their participation in a Phase 1 trial, and over 75% of experimental drugs do not become approved cancer medicines. Bioethicists have long debated the ethics of recruitment consultations for Phase 1 trials solely in terms of the need for patients to make a rational decision based upon enough information to avoid what are called therapeutic misconceptions and/or unrealistic optimism as motivations to participate in Phase 1 trials. We argue here, however, that the ethical challenges in Phase 1 consultations go beyond providing information about the (unknown) risks and (unanticipated) benefits of a Phase 1 clinical trial. In this article, we present a rhetorically oriented case study of a Phase 1 consultation, followed by a rhetorically informed critique of the rationality of bioethics. We use Lauren Berlant’s (2011) concept of “cruel optimism” to develop a more complete account of the rhetorical and ethical nexus of patient motivations in Phase 1 consultations by creating a discursive space to explore the concerns, hopes, and motivations of cancer patients considering participation in the earliest phase of clinical research in cancer medicine. The goal of our study is to propose a framework aimed at achieving Lisa Keränen’s (2007) concept of relational integrity applied to Phase 1 consultations.