Fallen agents: negotiations of patient agency in Norwegian opioid substitution treatment

Abstract

Based on an ethnographic fieldwork, this article explores how patients in a Norwegian heroin-addiction treatment program negotiate their agency, navigating between policies, medical guidelines, and their own lived experiences as they seek what they perceive as appropriate medication. Outlining these patients’ participation in treatment inside and outside the clinic, I illustrate that different types of agency are involved across these domains. I argue that patient agency is not something one has or does not have, but rather involves the institutional interpretations of these mobilised elements: What kind of agency is appropriate to exert in the Norwegian healthcare system? The analysis highlights the social constructions of the “addicted patient” and raises questions of the value of patient subjectivity and the politically tinged ascriptions of agency manifested in patient rights and guidelines for clinical decision-making