Temporal Misalignment and Unequal Agency: What Terminal Cancer Patients Teach Us about Time and Inequality

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.