Medical problem

- Symptoms:
o Severe hypoxic brain damage
o Septic shock
o Severe seizures
o Blood unable to clot
o Comatose and brain-dead
- Extensive medical history, dim prognosis by physicians
o By Terry Hutchinsons orders, life-sustaining measures (e.g. double volume
exchange transfusion, succession of antibiotics, etc.) were discontinued; taken off
anticonvulsives following abnormal EEG (no brain activity due to prolonged
asphyxiation) and yielded to parents/Peggy and Neil
- Acute and critical
- Goals of treatment get rid of symptoms and keep seizures at bay via Depakene
- Contingency plan none, but eventually hired interpreters

Lia can benefit by medical care by receiving medicine to prevent her seizures, and harm can be
avoided by building a trusting relationship between her parents and the American health system.
To do this, physicians and medical staff should assume a culturally relativistic manner and be
patient and sympathetic despite cultural differences. Interpreters should be present when there is
any uncertainty over whether the patient and family might not understand medical directives.
Most important, though, is that medical staff visibly demonstrate intentions of not only
beneficence and nonmaleficence, but also willingness to compromise to accommodate the
patients cultural/religious background when making clinical decisions. However, Lias parents had
a deep mistrust for American healthcare except for select individuals to some extent, including
Neil and Peggy stemming from their initial negatively prejudiced treatment by the doctors and
medical staff at the Merced hospital. This impression was reinforced by the discriminatory
experienced reported by other members of their ethnic community.

Patient preferences
- The patient is underage, and beyond basic signs of physical suffering, would not
demonstrate any capacity to make decisions regarding her own course of treatment
- The surrogates are Lias parents, who - because of their callous treatment by medical staff,
prejudice (their own and the establishments), and cultural/religious background were
not always well-informed, or gave consent to, Lias various treatments
o Misunderstanding of Neils decision to send Lia to MCMC for advanced pediatric
care
o Initial non-compliance with Lias prescribed medications
o Uninformed about MCMC spinal tap procedure
- Parents were unwilling to cooperate
 o Felt that American medical care infringed on and disregarded their
cultural/religious beliefs, and thus developed antagonistic attitude towards
Western medicine in response to their callous treatment
Without explanation = Lias treatments, prohibition/dismissal of parents
desires or opinions
Not allowed to sacrifice animals, or bring in local shaman/neeb
Not allowed to bring Lia traditional food

Overall, Lias case was handled very poorly in terms of respect for her and her parents autonomy.
Although the parents wished for Lia to survive, and this goal aligned with Western medicines
desire to prolong and protect life for as long as practically possible, the clinical staff demonstrated
callous disregard for the patients cultural/ethnic/religious background, instead treating Lia via a
clinically ethnocentric approach. Their relationship was improved due to the unassuming
professionalism demonstrated by Neil and Peggy, who were more sincere and tolerant than many
of their peers, but damage had already been done, not only to Lias family, but also to the entire
Hmong community.

Between patient autonomy and beneficence/nonmaleficence, doctors prioritized the latter in this
case. The parents wishes/values/desires/preferences were ignored, not/poorly understood, or
inadequately expressed. Clinical staff made culturally insensitive decisions that strained their
relationship with Lias parents, and thus had a negative effect on the parents willingness to
comply/agree with the doctors prescribed course of treatment. Furthermore, there was little
expression from the establishment overall of any intention to understand the Lees beyond Lias
medical history and symptom presentation.
- Here was American medicine at its worst and its best: the patient was reduced from a girl
to an analyzable collection of symptoms, and the physician, thereby able to husband his
energies, succeeded in keeping her alive.

Neither Hmong community/Lias parents nor medical staff trusted the other party:
- those bad parents, those bad doctors
- Confirmed the Hmong communitys worst prejudices about the medical profession
Following the Grand Mal incident, the Lees lost all trust for American medicine, exempting Neil
and Peggy
Clinical staff frustrated with Lees ungratefulness despite staggering financial cost of Lias
treatments; blamed Lias condition on the worst sin the parents noncompliance. Angry at
parents desire to do things their way.
- On the other hand, Neil and Peggy admitted defeat, renounced extravagant claims
noncompliance had nothing to do with it
o Septic shock caused the seizures, not the other way around
Depakene administration may have compromised immune system, raising
risk for septic shock
 o Too invested in prejudgements Neil would have normally done a septic
workupBut this was Lia. No one at MCMC would have noticed anything but her
seizures. Lia was her seizures and thus blinded themselves to anything besides
o You have to give up total control[when there is a very dense cultural barrier.
Parents left confused and uninformed until the end, when it was too late. Also frustrated, not only
due to inability to effectively communicate with Lias caregivers, but also because felt like victims
of circumstance unable to do anything to help Lia themselves
- But this happened here in the US, and Americans have done this to her, and our medicine
cannot fix that.
- American medicine had both preserved her life and compromised it. I was unsure which
had hurt her family more.
Nothing more Cartesian than Western medicine, yet Hmong cultural beliefs are deeply spiritual
and metaphysical little attempt to bridge incompatibility and make culturally accommodating
decisions, only made prescriptions and did procedures when needed, and left parents on their
own without much follow-up (asking for their input/feedback, informing them on rationale of
procedures, emotional support). Reduced Lia to symptoms not a single one [of medical charts]
dealt with Lees perception of their daughters illness.

The issue of compliance is that it implies moral hegemony: Western medicine is omnipotent, so
any other system is morally (anyone who practices it to treat others/self is committing a sin by
inflicting harm) and intellectually (breeds condescending attitude towards other systems) inferior.
Use a model of mediation (show willingness to compromise) instead of coercion.

Physicians must oppose traditional culture of emotional dissociation, and stay attuned to their
own humanity, conducting themselves and viewing patients as whole individuals ask not what
disease the patient has, but what patient the disease has. Acknowledge patient realities
understand their perception of the disease: how they got it, what do they call it, how would they
prefer it to be treated, and what they think will happen because of it. Piecing together patients
conceptualization of disease enables physicians to better establish a healthy, working relationship
with their patients and their families.