Send message to Author

Paper short abstract

This article explores how institutional care navigates moralities of care in rural Shanxi, China. By improvising moral performances beyond healthcare, primary hospitals mitigate tensions between moral requirements and unmet care needs to maintain family intimacy and uphold social welfare provision.

Paper long abstract

In China, anti-cancer treatment resources are so polarised between urban and rural areas that it leads to massive intra-national therapeutic mobility to major cities. Primary hospitals surrounding rural areas, such as county-level hospitals and county-level traditional Chinese medicine hospitals, could only provide fundamental anti-cancer treatments. Following the logic of cure, receiving local treatment becomes a last resort during clinical decision-making processes, while following the logic of access, most studies associate the utilisation of local primary hospitals with limited family care resources and financial constraints. However, the complexity of healthcare modes that primary hospitals employ is largely overlooked in both logics.

Instead, I suggest we might better understand primary hospitals as significant care infrastructures embedded in local social contexts. Based on ethnographic research in the oncology ward of a county-level hospital in Shanxi province, China, this study reconfigures what care means to institutional health providers beyond healthcare. Inspired by Julie Livingston’s framework of improvising medicine, I develop the notion of ‘improvising morality’ to describe the autonomy of doctors in a primary hospital where they actively navigate the morality of care from both family and social perspectives. Through a balance of constraint and capacity, the improvising moral performances of doctors mitigate tensions between unmet care needs and moral requirements to maintain family intimacy and uphold social welfare provision.