In these chapters, Fadiman discusses how the Hmong are a large portion of the Merced city population, yet are not a visible force in the city’s day-to-day life. This highlights their insularity and strong ties to their own community. Although Lia’s condition has stabilized since her big seizure earlier in the story, it becomes apparent that she has sustained serious permanent brain damage. Nao Kao, Lia’s father, continues to practice Hmong medicine as he has in the past, and sees those he cares for return to health. He sees a direct contrast between this and Lia’s experiences with American medicine, which did not immediately help Lia return to health.
One of the core reasons for the clash between the Lee family and Lia’s American physicians is that the two sides differed in their purpose. The central aim of American medicine is different from the central aim of Hmong medicine. American medicine seeks to prolong life, while Hmong medicine seeks spiritual welfare. Had Lia’s family never left Laos, Lia would likely have died in infancy from one of her epileptic seizures. Her family’s move to the States prolonged her life, but Fadiman questions if this prolongation was ultimately for the best. Western medicine prolonged her life (compromising it in some instances), yet it was the source of much suffering and hurt for the Lee family.
We may think it is strange for the Hmong to attribute all illness to spiritual causes, yet the Hmong think it strange that American medicine does not seem to concern itself at all with the spiritual. An American physician would never inquire about a patient’s “spiritual” health. I would find it pretty strange if my doctor asked me about the state of my soul, yet for the Hmong, that would be the central question. The Spirit (much like the Christian conception of the soul) is transcendent, and exists beyond the physical body. It affect the body’s physical health in life, and lives on after the body’s earthly life has ended. I can certainly understand the Hmong emphasis on spirituality in medical practice. The soul, thought to belong to God, takes precedence over the physical body, but we do not consider it in Western medicine.
Yet a patient’s spirituality routinely plays into their return to health. It is widely documented that patients who feel at peace before a surgery suffer fewer complications in surgery, fewer post-operative complications, and experience shorter recovery periods. Medicine cannot not quantify this trend or predict the length of the recovery period, because it belongs to an intangible realm that medicine, with its empirical evidence and predictive power, cannot exert control over. Patient experience is influenced by an individual’s values and spirituality, all of which belong to the intangible realm outside the direct reach of medicine.
Ethical considerations for Christian physicians, then, center on how to incorporate Christian spirituality into healthcare while respecting the patient’s own spirituality or value system. Christian physicians have their ethics shaped by the Christian narrative, so their ethical system will undoubtedly be a part of their medical practice. The question becomes: how can a Christian physician practice medicine in a way that honors his or her own spirituality while also respecting their patient’s spirituality, regardless of whether they are Christian?
Alas, that’s a question for next time.
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