Patient Autonomy Analysis

Anne Fadiman’s novel, The Spirit Catches You and You Fall Down, addresses key concerns regarding health and medicinal relationships with cultural beliefs. She challenges readers to consider what is known about western medicinal practices and beliefs, based on science, and recognize its effectiveness when paired with cultural understanding. This novel portrays some of the greatest medicinal and health challenges and cultural failures of western societies. There were several cultural competency themes integrated throughout the book, however, it surprised me at how distant western practices and the Hmong’s healing methods were at the beginning. It seemed as if it would be a stretch to form a connection between these two extremities,

The concept of autonomy in the medical practice brings many different views. Autonomy is the ability individuals have to be self-governing. In these different views there exist two schools of thought, one is the belief that people are born with the ability to do what they want their body and no organization can tell them what to do with their body, like the government. On the other hand, some people believe that it is more complicated and conditional on mental competency so that person can make rational decisions. However, the majority of people seem to advocate for autonomy. A particular largely uncontroversial discussion arises with the case of Dax Cowart, who had his right to autonomy taken from him in a tragic accident and is

“Medicine was religion. Religion was society. Society was medicine” (Fadiman, 1997). To the Hmong’s, this is a way of life. Everything in their culture is interrelated and represents a holistic view. As Americans, we try to incorporate the holistic approach into our health care system, but heavily rely on medications and science to treat illness.

When parents apply religious or cultural beliefs concerning spiritual healing, faith healing, or preference for prayer over traditional health care for children, concerns develop. This dilemma is unraveled in Anne Fadiman 's true story, The Spirit Catches You and You Fall Down, where the study of cross cultural medicine holds a significant value in all profession. The book chronicles the vast cultural differences between mainstream Americans and the Hmong, and how language and cultural barriers affected Lia 's treatment. To understand the Lees we really need to understand the Hmong culture.

Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed

On the other hand, western medicine doctors diagnose the problem by observing the physical symptoms, screening the blood, and perform various other medical techniques that rely on advanced medical education and training. Doctors are concerned with the physical symptoms and disregard the “soul” which in turn conflicts with the Hmong culture because they believe in souls and higher mental processes. Fadiman’s proved that the central argument was the collision between the Hmong culture and the physical disease treatment of western medicine.

In Anne Fadiman’s book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (1997), a Hmong family was faced with having to deal with westernized practices. Foua and Nao Kao, parents of Lia Lee, are forced to take Lia to Merced Community Medical Center, (MCMC), when she has a seizure. Lia’s parents believe that her seizure was the result of her soul being scared from the door slamming, thus escaped and became lost. MCMC has no Hmong interpreters to offer the Lees, so

The Spirit Catches You and You Fall Down: A Hmong child, Her American Doctors, and the Collision of Two Cultures written by Anne Fadmin writes “As William Osler once said – or is said to have said – ‘Ask not what disease the person has, but rather what person the disease has” (p. 275). This statement has significant meaning throughout this book especially when it came to the story of Lia. Lia was a young Hmong girl who suffered from Epilepsy. Due the Hmong culture playing a significant role in Lia's care, it caused communication barriers between Lia's parents and the health care professionals dealing this family that led to heartbreaking decisions.

In The Spirit Catches You and You Fall Down, Lia’s health complications could have been prevented or alleviated if the doctors had taken the cultural differences, cultural belief and practices of the Hmong community into account. While doctors in this book had received a Western type of foundation in terms of their medical preparation, this book demonstrated that how the life of a patient could have been improved when he/she is examined holistically.

“In the Spirit Catches You and You Fall Down”, Anne Fadiman explores the subject of cross cultural misunderstanding. This she effectively portrays using Lia, a Hmong, her medical history, the misunderstandings created by obstacles of communication, the religious background, the battle with modernized medical science and cultural anachronisms. Handling an epileptic child, in a strange land in a manner very unlike the shamanistic animism they were accustomed to, generated many problems for her parents. The author dwells on the radically different cultures to highlight the necessity for medical communities to have an understanding of the immigrants when treating them.

The diagnostic testing that MCMC professional deemed necessary to assess Lia’s progress was continually challenged throughout her care. Foua Yang and Nao Kao believed most of the procedures were unnecessary and did not understand the importance of the testing. A challenge for healthcare professionals when dealing with disapproved medical procedures and methods in Lia’s situation is the repetitive testing needed to review Lia’s progress. The blood sampling that occurred at every medical visit was viewed as unnecessary and threatening to Foua Yang and Nao Kao because, “Most Hmong believe that the body contains a finite amount of blood that it is unable to replenish, so repeated blood sampling, especially from small children, may be fatal” (Fadima, 33). Medical professionals overlooked a very important aspect of the Hmong culture, which is the soul, and the wisdom of shaman Txiv. Prayer is often used in the United States as a healer and according to the Hmong culture,  “Txiv neebs knew that to treat the body without treating the soul was an act of patent folly” (Fadima,

In this case study on cross cultural medicinal beliefs and practices, Anne Fadiman addresses the rift between Hmong spiritual and medicinal customs and the culture of American biomedicine by telling the story of a young Hmong child, Lia Lee. Lia’s journey started when she was three months old and she suffered her first of many epileptic seizures. Over the next few months she continued to suffer from her seizures and made at least three emergency room visits. Like most cases of epilepsy, the cause of her grand mal seizures was unknown, however, her parents, Nao Kao and Foua Lee, believed it to be the result of her elder sister slamming the door and scaring Lia awake, allowing a dab, or evil spirit, to steal her soul. After her first visit to the Merced Community Medical Center, it became clear that the language barrier would not allow for an accurate patient history to be recorded. As Lia’s condition worsened, this barrier would further prevent the Lee’s from understanding exactly what was happening to their daughter as well as follow the treatment the doctors were implementing. This eventually lead to the doctor’s believing that Nao Kao and Foua

Traditionally, a common Hmong’s custom is that a soul can separate from its body and a shaman possesses power to control spiritual forces. Therefore, a shaman is capable of healing illnesses at the spiritual level. The Hmong have a belief that ancestral spirits, including the spirits of shamans are reincarnated into the same family tree. The Hmong’s believe in their Shaman more than western doctors. They prefer to perform their treatment by hosting their rituals to save and cure their sicknesses. Unfortunately, the major problem that Hmong refugees encounter upon arrival to this country is conflict with the US medical system. This conflict arises from misunderstanding and mistrust from both health professionals and refugees patients. As a

Nursing is an all encompassing profession in which practitioners are not only proficient in technical medical functionality, they also have the obligation to remain compassionate and respectful of patients and as such are expected to adhere to pre established codes of ethics. Of these ethics, autonomy is of extreme importance as it offers patients a sense of personal authority during a time where they may feel as if their lives, or at the very least their health, is no longer under their control. Autonomy in the context of nursing allocates the patient and often their family with the final word on the course of treatment. The concept of patient autonomy is a highly variable subject in all fields of health care. It is a universal concept that varies widely in its meaning and interpretation. Autonomy in its simplest form can be defined as a state of independence or self governing (Atkins, 2006). Patient autonomy can also be defined as the ability to make once own decisions, based on one’s sound judgment. It is defined by the American Nurses Association (ANA, 2011) as the "agreement to respect another 's right to self determine a course of action; support of independent decision making." This seemingly straight forward ethical concept is rife with difficulties when one considers potential disagreements that may arise even when informed consent is provided, particularly among children or vulnerable people. Relevant research and

This week I have learned how important it is to perform self evaluation and constantly refreshing the knowledge of professional behavior. As one of our discussion subjects, patient autonomy was discussed this week. We take great measures not to violate out patient’s autonomy. However, I learned the hard way how one can unintentionally violate patient’s autonomy, and what are the consequences to do so. I was temping in our other office, and I was running behind because my patient had a hyperglycemic episode. My days usually going smooth, so this time, I got thrown of my game. The next patient who was already waiting 20 minutes, finally got into the treatment room, and after checking probing records, medical history and asking about any current