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Philosophy Of Medicine Essay, Research Paper

The book, the Spirit Catches You and You Fall Down by Anne Fadiman is an

objective look into the world of two different cultures and their belief

systems. The viewpoints of the Hmong and of the American doctors represent Hmong

culture and the root of Western medicine. The book takes into account how two

cultures, rather, two completely opposite worlds are ?collided? and their

impact on each other (Fadiman 1997). The book uncovers the underlying meaning of

how different Western medicine can be from different cultures and its challenges

and consequences. In addition, Fadiman questions the very basics of philosophy

by taking into account the simple metaphysics and moral ethics that face Lia?s

doctors and parents and what role society plays. The book questions the belief

system of Western medicine as well as the Hmong beliefs and cultural practices.

Fadiman encourages us to think of the root of Western culture and medicine as

well as learning about the Hmong?s beliefs. Which is more relevant? When a

patient is in a life or death situation, whose opinion and expertise on medicine

holds higher ground? In the case of Lia Lee, this was the problem. Why was Hmong

culture and practice irrelevant in the eyes of the many doctors and nurses that

cared for Lia? Reading this book, it is obvious to see the philosophy of western

medicine versus the Hmong culture. This book helps clearly define western

culture and its biomedical system by contrasting it to the Hmong?s. The book,

more than anything, else analyzes the epistemological, metaphysical, and moral

viewpoints of both western medicine and that of the Hmong culture and questions

their validity and effectiveness. Epistemology is the theory of knowledge(Tauber).

In this book, the theory of knowledge can be posed by one question. How did Lea

get sick? This question leads to two different viewpoints ? Western medicine

and culture and the Hmong. The root of Western medicine is biomedicine. What

makes biomedicine unique and sets it apart from other cultures is the idea that

there is only one answer and one truth behind that. Simply stated, it is a

matter of facts and the question of what, not how(Tauber). This is the primary

difference between Hmong culture and Western medicine. In the book, Lia?s

doctors wanted to know the one problem that was causing Lia to have severe

seizures. They neglected to ask how Lia got sick. The view of Lia?s parents

was the complete opposite. They wanted to know how Lia got sick and if this

meant Lia was blessed with a gift and would become a ?txiv neeb(Fadiman).?

To understand the epistemological perspective of the Hmong, we must first take

into account their cultural identity and how they practiced it. The Hmong were

adamant in their belief system and were wary of the doctors in Merced in there

care of Lia. Under their care, they believed; Lia would have been healed. The

Hmong cultures to cure an illness, in Lia?s case the quag dab peg, there were

animal sacrifices made. Lia?s parents say that Lia?s soul had left her when

her sister had unintentionally slammed the door. This rationalization that the

door frightened Lia and was the cause of the series of medical problems she

would face, is an example of the epistemological view of Lia?s parents. It was

interesting to read in the book, as Faddiman recounts, the way the doctors

treated Lia?s parents. Because of the cultural barrier, communication problems

pertained to everything from signing a document to administration of medication

for Lia. Because of the cultural barrier, there were problems of moral ethics as

well. Did the doctors ever take into account the parents wishes for their child?

Lia?s parents believed that the only medication they were willing to give Lia

would be the kind that would be fast and preferably in a pill. The Hmong culture

is against shots and blood being taken in large quantities as well as anything

that could affect the dab and cause evil spirits to enter her soul(Fadiman).

Epistemologically speaking, the doctors had a completely different viewpoint of

what happened to Lia than her parents. From the doctor?s point of view, their

main concern was not primarily how Lia got sick but rather where the existence

of the illness came from. There main goal as Lia?s doctors was to stop the

seizures that were taking control of Lia?s body and to do that they needed to

know where the problem was located. Was the uncontrollable epilepsy caused by a

neurological deficit in Lia?s brain? On the other hand, was there something

microscopic that the doctors could not see that caused Lia to have a unique

disease that had nothing to do with normal standard epileptic patients? This is

where the Hmong perspective and the view of Western medicine take different

paths. One could question if they were ever on the same path to begin with. The

doctors questioned where the illness came from while the Lia?s parents asked

how. Epistemology is derived from the Greek episteme, meaning

"knowledge," and logos, which has several meanings, including "theory.(www.comptons.com)?.

Whereas metaphysics is concerned with the underlying nature of reality,

epistemology deals with the possibilities and limits of human knowledge. It

tries to arrive at a knowledge of knowledge itself(www.md.com). It is also a

speculative branch of philosophy and tries to answer such questions as: Is the

world as people perceive it the basic reality, or do people perceive only

appearances (or phenomena) that conceal basic reality? What are the boundaries

between reason and knowledge, on the one hand, and what some thinkers call the

illusions deriving from metaphysics? What is the basis for knowledge? Is it

observation, experience, intuition, or inspiration? On the other hand, is there

some other basis?(www.comptons.com) In Lia?s case, the basis for knowledge

stemmed from two completely different cultures. The belief and basis for

knowledge that the Hmong had believed for years centered on the sprit and the

dab. Western medicine was far more narrow and straightforward dismissing any

idea that the practices and rituals of the Hmong would be of any help. Knowledge

may be regarded as having two parts. There is, first, what one sees, hears

touches, tastes, and smells. Next there is the way these perceptions are

organized by the mind to form ideas or concepts. The problem of epistemology is

based on how philosophers have understood the relationship of the mind to the

rest of reality(Tauber). The Hmong believed in animal sacrifice and treating the

body with herbs and liquids rather than injecting the patient with needles and

drawing blood. This process harms the individual according to the Hmong, and

damages it so the soul will have a harder time coming back. One of the primary

concerns with the treatment of Lia was the medication she was on. Since doctors

did not know for certain what Lia had and what was causing her seizures,

numerous combinations and doses of medicine were given. From the doctors

perspective it was all they could do at the time(Fadiman 97)). Lia?s parents

believed that the administration of so many drugs was the problem. In addition,

the cultural barrier led to frustration and anger when medication was not given

properly and when Lia?s parents decided against western medicine. Since the

Vietnam War ended in 1975, approximately 150,000 Vietnamese refugees have begun

their lives in the United States in Westminster, Calif., and a community south

of Los Angeles in Orange County(Fadiman 97). Similarly, ethnic communities of

Laotians and Cambodians sprang up in such states as Texas, Louisiana, Illinois,

Washington, Oregon, Virginia, Minnesota, Florida, and Pennsylvania. California

had the largest concentration of all Indo-Chinese groups, except for the

Indo-Chinese Hmong, formerly a mountain-dwelling people of Vietnam and Laos,

whose largest community was in Minnesota(www.comptons.com). Each group had its

own language and culture and preferred to live isolated from the others. The

refugee problem in Southeast Asia had been escalating ever since large-scale

bombing attacks were launched on North Vietnam in the mid-1960s. By the end of

the conflict thousands were homeless and thousands more sought refuge from the

victorious Communists. American military forces evacuated many of the Vietnamese

(among who were large numbers of ethnic Chinese). As repression and genocide

followed the Communist takeover, still more refugees fled. Among them were vast

numbers of boat people, who used any sea vessel at their disposal to escape

Indochina. Many were first sheltered in refugee camps throughout Southeast Asia

before reaching the United States(www.comptons.com). While these immigrants were

allowed into the United States under various refugee laws, the government sought

the help of volunteer agencies to find American sponsors and to arrange for jobs

and housing. The immigrants were then sent to various parts of the country to

begin new lives. The government’s purpose in this program was to scatter them

and thus prevent the growth of ethnic colonies such as the one that developed in

Westminster(www.comptons.com). The plan failed quickly. Not long after their

original settlement, the refugee families, driven by loneliness, began to

relocate to ethnic communities. Thus, the present settlement of the Indo-Chinese

refugees developed from this second migration. These resettled immigrants found

life difficult. While most of the first Indo-Chinese refugees had been

well-educated city dwellers, the later arrivals came from rural backgrounds and

had limited, if any, schooling. (The Hmong, for example, were subsistence

peasants without a written language.) They did not speak English, and their few

skills were useless in an urban, industrialized society. Many suffered from

physical and psychological traumas that they had experienced before fleeing

Indochina(Fadiman 97). Desperate for money and humiliated by their oppressed

situation, a few turned to criminal activities, but most worked hard to become

less dependent upon public aid. Members of large families usually helped one

another with living expenses and education costs. The origin of Hmong, I felt,

was an important component in understanding where the Hmong came from and why,

in America, they secluded to themselves far more than any other race. Fadiman

goes into detail about the history of the Hmong and their culture struggle to

keep their identity. What I found interesting was that even in America where the

Hmong attained their freedom, they were still unhappy. The cultural barrier was

never broken partially because the Hmong did not want to assimilate and lose

themselves. Consequently, they often secluded themselves and did not bother

learning English and finding jobs. What they wanted most of all was a piece of

land where they could grow food and livestock to survive and practice their

beliefs. Ironically, they fled their country to be free and came to America,

only to feel the opposite. In Lia?s case, there was an underlying question to

Lia?s sickness. The main question was why did Lia get sick? The doctors

questioned the existence of Lia?s sickness while her parents questioned why

there ever was an illness. Lia?s doctors looked to rationalism and logic while

her parents took this as a sign to mean that her symptoms made her special. They

said that Lia?s condition was because she possessed a special trait that the

txiv neeb also possessed. Her parents thought she was blessed in a way.

Metaphysics is a word coined almost accidentally. It is the title given to a

book written by Aristotle after he had completed his ‘Physics’, and it was

placed immediately afterward in the body of his writings(www.askjeeves.com).

Whereas ‘Physics’ deals with the observable world and its laws, ‘Metaphysics’ is

concerned with the principles, structures, and meanings that underlie all

observable reality. It is the investigation, by means of pure speculation, of

the nature of being–of the cause, substance, and purpose of everything.

Metaphysics asks: What are space and time? What is a thing and how does it

differ from an idea? Are humans free to decide their fate? Is there a first

cause, or God, that has made everything and put it in motion?(www.comptons.com)

The view of Western beliefs and ideology are reinforced in the book that the

doctors of Merced knew more about Lia?s sickness and medicine in general based

on their knowledge of Western medicine. The doctors of Merced felt that the

medicine they practiced held a higher ground, in their eyes, and most believed

that the Hmong?s ritual practices of animalism and sacrifice were a waste of

time. Because observation, experience, or experiment cannot arrive at the

answers to such questions, they must be products of the reasoning mind(Tauber).

Such matters are very close, in fact, to the province of religion and in Asia,

the answers to these questions are normally put in a strictly religious

framework. In much 20th-century Western philosophy, metaphysics has been

dismissed as pointless speculation that can never achieve positive

results(Tauber). Nevertheless, metaphysics has many defenders who still explore

notions put forward by Plato and Aristotle(www.comptons.com). For the average

person, common sense says that there is a real world of perceivable objects.

These objects can be analyzed and understood with a high degree of accuracy.

Philosophers have not been able to let the matter rest there. In the case of

Lia?s health, her parents felt that less medication, and less hospitalization

would make Lia better. They felt that their touch and healing power alone could

cure their beloved child. The doctors felt otherwise and based this on the

assumption that they were right and that Western medicine was the only accurate

and trustworthy method to treat a patient. In Western culture, being sick ?is

technical not moral (Tauber).? The underlying question was how much of the

illness was technical and how much of it was part of the social commune (Tauber).

Finally, the question that both the doctors at Merced as well as Lia?s parents

ask themselves is if the problem could have been avoided. This leads us to

question both their value systems. The main concern for Lia was her health and

the doctors of Merced made sure that they did everything they could despite

irreconcilable differences regarding Lia?s medication with her parents as well

as the notion that Lia would be better if she stayed at home without the

treatment of doctors. While reading the book, Faddiman questions whether the

choice to put Lia in a foster home was a moral one. Would she have been better

off in the care of her parents whom neglected to give her the numerous

combinations of drugs because they believed it would harm her? This brings in

the role of ethics and moral, and what they mean in Western culture. Another

name for ethics is morality. One word is derived from the Greek ethos, meaning

"character," and the other from the Latin mores, meaning

custom.(www.compton.com)" Because both words suggest customary ways of

behavior, they are somewhat misleading. The Greek philosopher Aristotle had a

better term–practical wisdom. It was called practical because it was concerned

with action, both on the part of the individual and on the part of society. It

had to do with what should or should not be done(www.askjeeves.com). Aristotle

divided practical wisdom into two parts: moral philosophy and political

philosophy. He defined them together as a "true and reasoned state of

capacity to act with regard to the things that are good or bad for

man.(www.comptons.com)? The field of ethics has several subdivisions.

Descriptive ethics, as its name suggests, examines and evaluates ethical

behavior of different peoples or social groups. ?Normative, or

prescriptive?, ethics is concerned with examining and applying the judgments

of what is morally right or wrong, good or bad(Blais 93). It examines the

question of whether there are standards for ethical conduct and, if so, what

those standards are. Comparative ethics is the ?study of differing ethical

systems to learn their similarities and contrasts?(Blais 93). In modern

developed societies, the systems of law and public justice are closely related

to ethics in that they determine and enforce definite rights and duties. They

also attempt to repress and punish deviations from these standards. Most

societies have set standards, whether by custom or by law, to enable those in a

society to live together without undo disruption(ww.comptons.com). It is

possible for law to be neutral in moral issues, or it can be used to enforce

morality. The prologue to the United States Constitution says that insuring

domestic tranquility is an object of government. This statement is morally

neutral. Such laws as those passed to enforce civil rights, however, promote a

moral as well as legal commitment(Blais 93). So much human activity is simply a

matter of custom or habit that little thought may be given to many actions. When

an individual in Western society gets up in the morning, it is normal to get

dressed and to put on shoes before going out. However, in doing so, one does not

usually bother thinking ?This is a good and necessary thing that I?m

doing.? There is a great deal of behavior, however, in which people are

conscious of why they act in a certain way. They are confronted with the need to

make choices. At the basis of choice two questions arise: "What good do I

seek?" and "What is my obligation in this circumstance?(Blais

93)" Ethics is primarily concerned with attempting to define what is good

for the individual and for society(Tauber). It also tries to establish the

nature of obligations, or duties, that people owe themselves and each other.

Philosophers have said for thousands of years that people do not willingly do

what is bad for themselves but may do what is bad for others if it appears that

good for themselves will result. It has always been difficult to define what is

good and how one should act to achieve it(www.askjeeves.com). Some teachers have

said that pleasure is the greatest good. Others have pointed to knowledge,

personal virtue, or service to one’s fellow human being. Individuals, and whole

societies, have performed outrageous criminal acts on people, and they have

found ways to justify doing so based on some greater "good.(Blais 93)"

The difficulty in deciding what good and obligation are has led moral

philosophers to divide into two camps. One camp says that there are no definite,

objective standards that apply to everyone(Blais 93). People must decide what

their duties are in each new situation. Others have said that there are

standards that apply to everyone, that what is good can generally be known. If

the good is known, the obligation to pursue it becomes clear. The position that

insists there are ethical standards is called ?ethical absolutism?, and the

one that insists there are no such norms is called ethical relativity(Blais 93).

One of the clearest and most useful statements of ethical absolutism came from

Aristotle in his ‘Nichomachean Ethics (Blais 93)’. He realized that what people

desire they regard as good. Nevertheless, to say no more than this means that

all desires are good no matter how much that they conflict with one another.

Consequently, there can be no standards at all. Aristotle solved this problem by

delineating between two types of desire–natural and acquired(www.comptons.com).

Natural desires are those needs that are common to all human beings such as food

and shelter. Beyond these, people also have a desire for health, knowledge, and

a measure of prosperity. By being natural, these desire, or needs, are good for

everyone. Since there can be no wrong basic needs, there can be no wrong desire

for these needs(www.comptons.com). However, there are other desires as well.

These are not needs but wants. It is at the level of wants that the nature of

good becomes clouded. Individuals may want something they desire as a good, but

it may be bad for them. People with sound judgment should be able to decide what

is good for them, in contrast to what is only an apparent good(Blais 93). This

sound judgment comes with experience. Young children have little experience of

what is good or bad for them, so they must be guided by parents and other

adults. Mature adults, however, should be able to decide what is good for them,

though history demonstrates that this is not always the case. People must decide

what is good for others as well as for themselves(Fadiman 97). That is, they

expect that goods for them apply equally to other people. To be able to treat

others in the same way one treats oneself, Aristotle said it is necessary to

have the three virtues of practical wisdom: temperance, courage, and

justice(www.comptons.com). Relativists do not believe that there are

self-evident moral principles that are true for everyone. They say that people’s

moral judgments are determined by the customs and traditions of the society in

which they live(Blais 93). This is a clear example of why the Hmong?s views

differed from Western culture. These may have been handed down for centuries,

but their age does not mean they are true standards. They are simply norms that

a certain society has developed for itself. What is right is what society says

is right, and whatever is considered good for society must be right. If this

were the case, did Lia?s doctors do everything they could? Were they clouded

by the mentality that Western medicines was superior to the Hmong culture and

disregard the practices that Lia?s parents strongly believed would save their

child? If the doctors had taken a different approach from the beginning and

hired interpreters and had not been one-sided in their beliefs, would Lia?s

fate be changed? As with life, all choices involve risk. There are no principles

or standards that are right for all people at all time. New situations demand

new approaches. What was once valid may be inappropriate now. In the world of

the 20th century–with its rapid changes, endless wars, and moral upheaval–the

ideas of existentialism have seemed correct to many people in the

world(www.comptons .com). Some existentialists base their position on

religion(Blais 93). Even here they say it is impossible to fall back on moral

laws or principles in making decisions. Choices must be made on faith, often in

conflict with traditional moral guidelines. Individuals trust that what they are

doing is right, but they can be entirely wrong. They commit themselves to the

unknown, and the decision can often be an agonizing problem. The Hmong?s

beliefs were based on their faith in the healing power of their medicine. Before

Lia became severely ill, Hmong did not entirely dismiss Western medicine. They

did, however, believe that a combination of the two would be more effective than

just Western medicine. Students of comparative ethics have found that most

societies–from the ancient to the modern period–share certain features in

their ethical codes(Blais 93). Some of these have applied only within a society,

while others have been universal. Most societies have had customs or laws

forbidding murder, bodily injury, or attacks on personal honor and reputation.

Societies rely on rules that define elementary duties of doing good and

furthering the welfare of the group. In societies where the major

religions–Judaism, Christianity, Islam, and Buddhism–are predominant, the duty

of helping the needy and the distressed has been implanted(www.comptons.com).

These obligations extend beyond family to acquaintances and even strangers.

Telling the truth and keeping promises are also widely regarded as duties. When

Lia was taken away to a temporary foster home, the doctors promised Lia?s

parents that she would return to them in six months. When their promise fell

through and Lia was not returned as promised, Lia?s parents began to

disbelieve the system, which was intended to protect the individual. The United

States represents a series of ideals. For most of those who have come to its

shores, it means the ideal of freedom–the right to worship as one chooses, to

seek a job appropriate to one’s skills and interests, to be judged equally

before the law. It means the ideal of the frontier, of overcoming obstacles–

taming the West, curing diseases, voyaging to the planets(Fadiman). It means the

ideal of progress–that personal life and political, social, and economic

institutions will improve through hard work, fair play, and honest endeavor. It

means the ideal of democracy–the right to be heard as an individual, the right

to cast a ballot in a free election, the right to dream of a better life and to

work toward one’s goals(Fadiman). The Hmong did not have this voice, nor felt

their opinions mattered in the case of Lia?s health. In America they felt like

foreigners, in their homeland they felt the same. The fate of Lia Lee may have

been different if not for ignorance, superiority in Western medicine, and a

cultural barrier that still continues today.

www.md.health www.comptons.com Blais, Debbie. The ethics of specialization.

Unpublished paper. University of Alberta (1993). Fadiman, Anne. The Spirit

Catches You and You Fall Down. Noonday Press. Canada, (1997).


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