Mr. Chang is a 60-year-old man living in New Haven, Connecticut. He lives in a relatively small Hmong community with his wife. He has two adult children, a son and a daughter, who are 28 and 32, respectively, along with three grandchildren ages 1, 2, and 4. He works as a math teacher at a local high school. His wife does not work outside the home. For the past couple of weeks, he has been complaining of pain in his lower abdomen. He has not received treatment for his pain at a hospital or clinic because he has been receiving care at home from his clan’s Shaman. The Hmong people view illness as having either physical or spiritual causes, physical being related to environmental factors, and spiritual being related to evil spirits unhappy with the ill individual. Spiritual healing rituals with a Shaman are common as good health depends on the souls living in each person, and it is believed that any invasive procedures can cause soul loss in the individual. However, one day, Mr. Chang’s pain is so severe that his children rush him to the hospital against his wishes. It is more common for younger Hmong people to visit the hospital than for older generations because they are more familiar with Western medicine. Upon being admitted to the hospital, the doctors perform a scan to see what is causing his abdominal pain. While waiting for his results, Mr. Chang gets up to use the restroom. He experiences a sharp pain in his abdomen that causes him to double over and hit his head on the railing next to the toilet, which causes him to lose consciousness. The results of the scan showed a large mass. The doctors indicate that it will be relatively easy to remove the mass, but they must act quickly. Due to the delay in Western medical care, the mass has grown significantly and must be treated immediately. As Mr. Chang is a member of the Hmong community, he indicated prior to his fall that he does not believe in surgical procedures and would not want any invasive action to be taken. Upon hearing the diagnosis and possible next steps, his children are adamant that the doctors provide the surgery as they know it will be a simple fix. With this surgery, Mr. Chang would live, continue providing for his wife, and be able to see his grandchildren grow up. His wife, however, is completely against it, citing that any surgical procedure would cause soul loss in her husband. Time is of the essence here. The physician handling this case brings this up to you, the hospital administrator, as you are her good friend, and she needs advice. Furthermore, she tells you that Mr. Chang’s children are threatening to sue the hospital if their father does not receive the surgery, claiming that the hospital denied him medically necessary treatment to save his life. Knowing the hospital’s financial position, you understand that the hospital does not have the capacity for a major lawsuit. Though Mr. Chang voiced concerns about surgical procedures prior to his fall, he is currently not in a sound state of mind to make any treatment decisions for himself. There are two options: (1) proceed with surgery or (2) do not proceed with surgery. What do you advise your friend to do?

CASE STUDY Discussion Questions

How do you balance cultural practices with providing care to people and managing changing dynamics within generations (e.g., immigrant versus first-generation American)?

Discuss whether the wishes of the wife should be considered more heavily than those of the children, even though the children are threatening to sue.

Discuss possible preventative measures that the hospital can take to circumvent difficult situations like this in the future.

Please answer these 3 questions in 1-2 pages.