Ethical Issues: Merced Community Medical Center

Ethical issues

The Hmong first settled in Merced, California in the mid-1970’s which gave the medical domain years to become aware and comfortable with the cultural differences with this population. When Lia entered Merced Community Medical Center (MCMC) for the first time it was understandable to not have a translator available. However, after repeated admittance it was apparent that the Hmong utilized a hospital that practiced Eastern medicine. Therefore, a translator not being present regarding any medical matters is an ethical issue. More importantly, as Fadiman noted, both of Lia’s parents were illiterate, therefore reiterating that an interpreter was necessary and not solely a translation of documents. Often the Lee’s consented to procedures

and agreed to administer specific regimens without understanding what it was they were consenting to. This inability to understand what was occurring around them intensified extensively when the Lee’s were under scrutiny for Child Endangerment. Not understanding what was at stake, the Lee’s unknowingly surrendered Lia. The Lee’s and the medical personnel were on two different levels of understanding even nearly four years later, when Lia was admitted during her most detrimental seizure yet. This highlights the value of the ethical issue of not providing informed consent so that the family could make an informed decision.
Lia’s family had multiple interactions with medical personnel where confusion occurred.

From one of these interactions another ethical issue emerged. During Lia’s worst seizure, the Lee’s were told that she needed to be transferred to a specialized unit at another hospital. As the doctor, Neil, explained this to the Lee family, he mentioned that he was leaving town. This was an ethical issue. Expressing his personal plans with a patient’s parents is crossing professional boundaries. This was expounded when the Lee’s indicated that the reason Lia had to be transferred was because her primary doctor was going on vacation. This was a fine line that every individual walked when working with the Hmong. When the doctors introduced themselves by their first name, they disassociated with their professional self. This gave them the opportunity to have less status, as Sukey Walker, a psychologist described as critical to becoming accepted within the Hmong population. However, it also looked poorly on the doctor if they lessened their status according to the American way, as in wearing blue jeans under their white jackets. This was an ethical dilemma at its finest. The doctor either sought acceptance from the Hmong family by initiating a partnership to facilitate better care the patient, or clung to their beliefs to maintain what they thought were professional

boundaries.
Another ethical issue that seemed to be persistent during interactions with medical personnel was the use of family members as interpreters. For example, during the same hospital admittance during which Neil voiced his family arrangements, the hospital staff used the Lee’s nephew as an interpreter. A separate instance was during a hospital stay when Lia was having a grand mal seizure. A cousin of the Lee’s had to describe to the resident on staff that Lia was not on her medication for a week while stating that the Lee’s hadn’t refilled the prescription. During this instance the resident transcribed that the client history was unreliable. Not only is the interpreter unintentionally bias, therefore creating the potential for misrepresentation of information but puts the family member in an unnecessary bind of having to interpret, console and communicate
What I learned
I learned a few things from these ethical issue examples. While reading some of the interactions that the Lee’s had, I started to think of what it would be like to be in their position. The best way for me to think about it was how I feel when I watch a foreign film without subtitles during a climactic scene. No matter where I search there is no one around who can explain to me what is going on while the scene continues to unravel. I have to take it all in with confusion. The Lee’s, disoriented, are expected to make critical decisions while being characters of a foreign production.
I can see the medical personnel point of view and the Lee perspective.

That being said, I do not agree with how the ethical issues carried out. To begin with, it’s important to understand the value of culture. My culture is as valuable as any other individual’s. However, when working in the medical field, it is my duty to provide and facilitate the best care possible while working with clients. To be client-centered, the client being the essence of the helping profession, one must be willing to respond to their client’s culture. Contained within this willingness is an ethical issue; by abiding by the cultural requests of the client I may be unable to provide the best care possible because of conflicting beliefs. As a therapist I would need to have the self-awareness to step aside and facilitate an opportunity for the client to receive the best

care.
Reaction of Hmong culture
I’ve enjoyed reading about Hmong culture thus far. As I went the book I kept thinking about one critical component though. Each time I read an anecdote about the culture I associated the group of people with that anecdote. In other words, began to form stereotypes. I understand the point of creating a heuristic, especially when engaging in cultural competency. It allows for quicker decision making. At the same time, I contemplate whether this form of learning, through generalized beliefs, values and rituals, moves toward cultural competency and client-centeredness.
I found it fascinating to hear that the culture of the Hmong base many of their perceptions on ideals I do not even consider. For example, who the visitor was sent by makes a significant difference by the Hmong individuals. By being aware of this cultural belief, I can be prepared to understand why a client of any culture may communicate with a visitor with apprehension or enthusiasm.