Critical Analysis of a Literary Work
By Debbie Cresta
Submitted to, Brian Foxworth, in partial fulfillment of
HCE604 Ethics for Nurse Leaders
Regis University
December 5, 2013

Critical Analysis of a Literary Work When looking over the topics of choice, one book stood out among the rest. The ethical dilemma was clearly spelled out for anyone to see. Things are not always what they seem to be, they are not often black and white and at times require that we take our time to really examine our choices and how we come to reach them. Although there are many ethical dilemmas within the content of the story and some may be very hard to pin down, finding just one specific health care ethical issue to talk about can be considered a daunting task. First we must understand that the word ethics means different things to different people and that in reality its very definition can describe their own version of moral philosophy. It is conceivably much harder to understand the issues between what is right and what is wrong, the problems that may exist between ethics and morality, one’s integrity and the many existing belief systems. It is not as simple as black or white or what constitutes good behavior as oppose to bad. We must remember that one man’s poison may be another’s choice of practicing healing methods. We must remember that we live in world that has vast cultural belief systems, ethical values, and religious beliefs, therefore we must practice our western medicine without inflicting any due harm on our patients. It is with mindset that choosing the one correct health care ethical dilemma becomes almost impossible when choosing to tell the story of young Lia Lee. There are ethical dilemmas the force us to consider the moral consequences of our moral actions especially when it may involve a life or death situation and what occurred during the life of Lia Lee a descendent of the Hmong tribe that now reside Merced, California is text book example. This case depicted what happens when we as professionals don’t understand something, how we tend to disregard the ideals, beliefs, or practices of others from foreign nations as ignorance and may attributed it to lack of education or miscommunication. All the time failing to acknowledge our own shortcomings and narrow minded views or beliefs and placing a great significance in our so call superiority. When we as medical professional fail to accept others moral, ethical or religious beliefs we fail our patient in many significant ways. The moral obligations we have toward our fellow humans, act as guides to the often cloudy actions of life, but there are occasions luckily not on many, when life strikes back and creates situations, where the fine line between right and wrong is irretrievably distorted and one must make a choice, or be lost forever after (Halfon, 2011). In the case of Lia Lee, these lines where continuously crossed breaking the one most important ethical dilemma of all, and that is doing no harm.
Principle of Non-Maleficence
This particular term non-maleficence is common in laws of many countries. It literally means non harmful, in Latin. The ethical principle of Non-Maleficence says that whatever a doctor does for treating a patient, with the best interests in heart, he cannot harm the patient, and this is standard practice for all medical professionals (Johnson, 2012). In the legal terms, it should be interpreted as 'should not.' Expanding on this idea further, as professionals we would like to inform that a doctor is supposed to 'not do any harm' to his patients more than 'treating' and curing him for his suffering. The medical ethical principle of Non-Maleficence was clearly violated in the case of young Lia Lee whether it was intentional or not.
The Spirit Catches You and You Fall Down by Anne Fadiman This is a story of when two totally different cultures conflicted in their beliefs on what was causing the seizures in a 3-month old girl and the trials and tribulations each went through to fight for the life of Lia Lee. This story is about sadness, misunderstandings, prejudices, and at times violence all surrounding the care of an infant child that belong to Foua Yang and Nao Kao Lee, Hmong refugees that had made their new home in Merced California. To understand the clashes in cultures the author paints a vivid picture of how the Hmong were people whose history depicted them as simple but fierce people. Living in the outskirts of Laos, having once been chase out of China because they would not submit to the Chinese way of life. They were proud people that never depended on outsiders. They had their own ways, they have their ethical beliefs, their cultural beliefs, and their moral ethics. Things were done with a purpose and each incident were attributed to spirits bad or good. During the Vietnam War the Hmong were chase out of their home, their way of life was change forever. They found themselves fighting for the Americans to earn a living. Once the Americans left Vietnam many Hmong follow suit and fled Laos, many ending in Thailand refugee camps, this is where the Lee’s story really begins. After years in the Thailand refugee camp the Lees where granted asylum in the United States, the ended up in California. It is here where the clash of cultures set the battle for life of little girl, who was the first of the Lee’s children that were born in the United States. Normal customs for the Lees were to have the child at home in silence, sometimes the husband was present sometimes not but because the Lees mistakenly believe if their child was born at home and not at the hospital it could not retain American citizenship they decided to have their child at MCMC hospital in Merced, CA. This the first time the Lees have ever entered any medical facility and it was here where their dilemma would begin. In accordance with Hmong tradition children aren’t given their names until three days after birth because the fear that an evil spirit called the “Dab” would be able to steal the soul of the child if they knew it. The Hmong traditions were many but this one was especially important to them because the Hmong cherish the family dynamics and they especially cherished their children. Little Lia birth was normal and uneventful, although Lia’s mother had no prenatal check-ups. The biggest problem they face was the disdain shown by most of the western medical professional and the lack of cultural understanding and communication efforts by the hospital staff. On the third day the littlest Lee received her named in the Hmong ceremony where the soul is believed to binded to child forever. The Hmong believe that a child is not a whole person until he or she receive their name because this when the soul unites with child and the binding string keeps them together until death. At three months little Lia experienced her first seizure, although it was misdiagnosis because the parents could not communicate with the doctors and by the time they got to the hospital the seizures had stop. Once Lia was truly diagnosis the clash of culture and beliefs would take center stage in the proper treatment of her care. To the Lees. Lia’s disease was cause by the “Dab” that took advantage of the baby reaction to a slam door to snatch her soul, they call her seizures “The Spirit catches you, and you fall down, the doctors call it Grand Mal and Petit Mal Seizures. The Lees believed in sacrificing chickens and pigs and inviting the Hmong Shaman to chant and retrieve the soul from the “dab” to bind it back to little Lia. The doctors felt that placing Lia on anticonvulsive medication was the best treatment for her. The Lees did not want the seizures to go away, they wanted to control the episodes not stop them because they saw the seizures as a sign the little Lia was a future shaman for their people. No one could communicate with each other. As the years progress Lia’s seizures got worst, the parent felt the medicine was causing the child’s illness, the communicate their want and fears and once again the doctors thought them uncooperative, uneducated, and lacking in understanding. No one doctors felt that the parents were not following the medication protocol set up for little Lia. Again the Lees could not think to examine the Lees cultural beliefs or find a way to communicate with them on their level. There were those occasional members of the medical community that tried to understand the culture and fought for their rights of the parents but these were few and far in between. Nothing was ever resolved the Lees grew to distrust the American medical community and everyone at MCMC hospital saw the Lees as stubborn unyielding Hmong people. As a resulted Lia was the one to suffer and the medical community did not meet the expectation of Non-Maleficence. Could have they? I am sure had they taken the time and use all resources to investigate and get to really know the Lees they would have found some middle ground. As it went, at nearly four years of age, after the medical community had taken Lia away from the Lees for non-compliance of medication administration and made them suffer beyond belief, Lia had the worst seizure of little life, it is here where she became a vegetable, where her parents said that her soul was lost forever.
Analysis
The author felt after much research and meeting the Lees, the Doctors, and all others involve in this tragedy that no one meant to do Lia any harm but in the end that is what had exactly happened. If someone would had put the effort in to ask the Lees the correct questions during those rare times when there was a Hmong interpreter available maybe they would have come to a different conclusion, the problem is no one will ever really know if understanding the Lees or the Lees understanding the doctors may have turn out differently but they should have tried. The problem here was that the medical community saw the Lees as uneducated stubborn Hmong, who would not follow their directions when it came to the treatment of their daughter and the Lees saw a community of doctors that did not care to learn the ways of the Hmong and treated them like lowlifes and uneducated. The author work so fastidiously in finding reason for all these factors and presented them without discrimination. The medical community fail to find interpreters, they fail to take the Lees cultural background into consideration, they fail to understand the cultural differences in the practice medicine and spiritually, they fail to gain the trust of the Lees, and above they fail little Lia in providing her care and respecting her parents’ wishes. Although this occurred before the training on cultural diversity and respect of cultural differences, the fact still remain that the medical community fail to meet the needs of the Lees and their daughter Lia. The author saw this when doing her research, her analysis of the situation show that the medical community did not set out to intentionally hurt the Lees and Lia but the acts of superiority, thinking they knew what was best for Lia, and acting with disregard to her family fears, show they failed even to initiate a dialogue with Lees that may have open doors and gain their trust. Something could say for the caring attitude because in their professional opinion they were trying to save Lia’s life, it was just the way they went around getting it done that became the focal point of this case. They fail in gaining the trust and respect of the Lees and they fail Lia because in the end the child lived out the rest of her life in a vegetative state, although be it in the care of the family that love her. The most important biological and social structure in the Hmong community is the Hmong kinship, often defined by blood relationship. In the end the Lees’ daughter was returned to them and their care with only occasional medical visits.
The writer did a good job of explaining the varied viewpoints of the different people who were players in this heartbreaking drama. More than that, the book provides a lot of researched information about the Hmong history as well as the Hmong experience in the United States. The saddest part here was that it took a crisis of Lia’s magnitude to bring attention to the lack of cultural sensitivity in this medical community (Fadiman, 1997). Unfortunately, the differing perspectives of Western doctors and Hmong patients led to tragedy in the case of Lia Lee. Her parents did not understand or care to administer the complicated regimen of anti-convulsants that Lia’s doctors had prescribed; they were more interested in the ability of shamanistic rituals and sacrificial offerings to keep away evil spirits. Her doctors did not even attempt to appreciate the Hmong perspective on health and spiritual healings (Fadiman, 1997). We all know by now that western medicine save lives but in the case of little Lia an understanding of the Hmong cultural practices would had gone a long way in bridging the differences between the two cultures.
Personal Position
It hard to put yourself in the position of either of these cultures. As a nurse you understand the medical community because they wanted what they thought was best for Lia but they forgot the number one rule “do no harm” and whether intentional or not the damage they caused Lia and her parents was irrefutable. On the other hand, when I was reading the book I found myself siding with the Lees because I could see them as caring loving parents, the medical side of me saw how frustrating the situation could be when they failed to properly follow the medical regime assigned to Lia’s care. In all fairness the book provided the answers to all my questions and I had a firsthand look at way the parents acted and did the things they did. This made me wonder if the author had decided to keep all the pertinent information about the Hmong culture to very end, not explaining the things they did or way they did it would I felt the same way about them or would I sided with medical community in labeling them as uneducated and non-complaint? Would I have felt like the nurses did exasperated because I felt they couldn’t or wouldn’t do what was required of them to help their daughter? Would I feel like the doctors that treated her tire and misunderstood, wanting only the best care possible for Lia and angry because her parent refuse to acknowledge the millions dollars of health care and time that went in the care of Lia? And What if the author only presented the side of the Hmong and their beliefs, the customs, their practices, and their culture, would I have been unable justified just what the medical community call help? Would I dare to trust them over and over again, when everything they did for my child came with ominous consequences? Could I trust them? Should I believe them? Or would I do what the Lees did and acted out of love to protect my child? Thinking about what this is supposed to represented shows the author wrote this book with compassion for all involve. My personal assessment of this situation is that it is one full of culture differences, misunderstandings, and standoffs where no one really examined the real consequences behind the cultural clashes. Although tried as I might I saw no real answer for this dilemma? The only thing I see is that with or without intent the doctors at MCMC hospital failed to do their job and do no harm to a sweet innocent child and because of they did not acknowledge the cultural differences, they failed to comprehend the bigger picture. When it came to what constituted the care in every facet in little Lia’s treatment they failed to protect her. I only leave with thought in mine, if were my child and I believe like Hmong did, would I had done like the Lees did? I think I would because so many people discount spiritually as medicine and I see it as medicine for the soul and if you can repair the soul you can heal the body. As for the doctors at MCMC hospital I felt they did what they thought was right for Lia but fail in meeting the expectations of the Hmong culture, in the end the result was the same, Lia was the one that suffered the consequences of their culture clash.

References
Fadiman, A. (1997). The Spirit Catches You And You Fall Down. New York City
Farrar, Straus and Giroux.
Halfon, N. (2011). Addressing health inequalities in the US: A life course health development. Social Science & Medicine, 671 - 673.
Johnson, C. E. (2012). Meeting the Ethical Challenges of Leadership. Casting Light or Shadow. Los Angeles, CA: SAGE Publications Ltd.