Temporal Misalignment and Unequal Agency: What Terminal Cancer Patients Teach Us about Time and Inequality
American Sociological Review · 2026 · Zhuofan Li、Daniel Paul Dohan、Corey M. Abramson
中文摘要
本文考察时间如何通过将能动性分层化，既加剧又动摇既有的不平等。基于在九家癌症诊所为期五年的田野调查，以及对96名在临终前经历晚期癌症诊断的患者进行的196次深度访谈，我们展示了“时间错位”的核心作用——即个体行动所展演的时间性与制度情境所强加的时间性之间的错配，后者结构化了行动在何时以及如何成为可能。民族志数据与多重对应分析（MCA）的结合揭示，资源的有效利用要求癌症患者：（1）对治疗、工作、家庭与官僚日程之间相互冲突的需求进行分诊排序；（2）协调疾病进展与医疗机构之间不匹配的轨迹；（3）将当下不确定的决策锚定于一个可预期的未来。这些管理时间错位的努力不仅再生产了资源差距，还制造出新的、迫近的、且往往内化于身体的能动性约束，随着疾病进展，即便最占优势的患者也发现这些约束耗费资源、偏移目标。将时间重新概念化为能动性与情境之间的一种断裂关系，为资源、制度与文化如何运作并相互交织以塑造医疗及其他领域的不平等提供了重要的社会学洞见。
Abstract
This article examines how time both exacerbates and destabilizes existing inequality by stratifying agency. Drawing on five years of fieldwork in nine cancer clinics and 196 in-depth interviews with 96 patients navigating a terminal cancer diagnosis toward the end of life, we show the centrality of "temporal misalignment"-a mismatch between the temporalities enacted by individual actions and those imposed by institutional contexts structuring when and how action is possible. A combination of ethnographic data and multiple correspondence analysis (MCA) reveals how effective use of resources requires cancer patients to (1) triage conflicting demands of treatment, work, family, and bureaucratic schedules; (2) reconcile mismatched trajectories of disease progression and healthcare institutions; and (3) anchor uncertain decisions at present in an anticipatable future. These efforts to manage temporal misalignment not only reproduce resource disparities, but also create new, imminent, and often embodied constraints on agency that even the most advantaged patients find resource-draining and goal-displacing as the disease progresses. Reconceptualizing time as a ruptured relationship between agency and contexts offers important sociological insights into how resources, institutions, and culture operate and intertwine to shape inequality in healthcare and beyond.