Defend or reject: Buchanan and Brock would rightly defend the decision of the court to remove Lia Lee from the custody of her parents and place her in a foster home Deciding for others: competency

This essay involves defending or rejecting the statement that Buchanan and Brock (2008) would rightly defend the decision of the court to remove Lia Lee from the custody of her parents and place her in a foster home. Although the statement might seem clear, the term "rightly" introduces an ethical twist to the whole discussion and the need to have an ethical theory to qualify right and wrong within the decision.

Plan for the Essay

The essay first defines the incidents surrounding the circumstances of Lia Lee and the verdict of the court. The dispute of competency follows next and the essay analyzes the issues at hand incorporating the views of Buchanan and Brock (2008). All these concerns interconnect with the philosophy of utilitarianism, and contemporary beliefs as well as primary principles in medical ethics. Despite ultimately defending the decision to remove Lia from her family, I will raise objections to the decisions and behaviors of all parties involved with Lia Lee given the cultural incompetency on display.

Interpretation of the Text / Argument

The Hmong are people with a long history of defiance, freedom, pride, and survival in Asia (Fadiman, 1998). They have a history of maintaining their culture and defying external influence, which makes their culture and the way of life ancient in light of the modern advances in technology and science. Their perception of medicine is reminiscent of the precursor to science: mysticism. The Hmong community that immigrated into the United States found a culture that is a sharp contrast to their own. Furthermore, there was the drawback of a language barrier and illiteracy among members of the Hmong community.

Anne Fadiman, in her celebrated work, The Spirit Catches You and You Fall Down, reports the struggles of a Hmong family with a child, Lia Lee, who is diagnosed with a severe condition of epilepsy. It is essential to note that, although the family had seven other children, they adored Lia the most out of the seven children. However, the parents' perception of the character of epilepsy, their interpretation of the western medical system, and their reaction to a physician's instruction are the source of conflict between the Lees, the medical staff, and the judicial system (Fadiman, 1998). The conduct and attitude of the Lee family does not absolve the medical staff at Merced from the consequences of their narrow minded conceptualization of the main sources of conflict and attrition with the family.

The perceived incompetence of the Hmong family arises because the family does not follow through with medication and appear to be endangering the child (Fadiman, 1998). Consequently, the doctor calls in Child Protection Services (CPS), who promptly initiates court litigation for transferring the child to foster care. The court laid out their verdict that the parents were incompetent, and without delay, they transferred the child to foster care.

Buchanan and Brock (2008), in Deciding for others: competency, make a case for surrogate decision-making in cases where the competency of the patient, or the patient's blood relation, is questionable. Competency is a medical-legal concept that implies autonomy, an essential principle. Competency is a confluence of issues such as the right of the parents to self-determination, the well-being of the state, and those of the parents. The concern here is that the court deemed the parents of Lia Lee incompetent and, therefore, removed the child from their care.

The concept of competence has several properties, according to Buchanan and Brock (2008). First, a competent individual must be able to communicate choices to the persons involved in healthcare. Secondly, the competent individual must understand the health situation in which his or her decision counts, as well as the consequences of those decisions. The third aspect is that a competent person must be able to reason and deliberate since the medical staff may engage him or her in a discussion of the problem. Finally, the competent individual must act from a consistent set of values. If any of these aspects lacks, then the competence of the decision maker in health situation is questionable.

Medical situations present many dilemmas and gray areas that require specialized knowledge. The decision maker will be under the influence of several factors such as the way a medical practitioner presents the case or question. A majority of decision makers have no information about the cases...

These decision makers must rely on the medical practitioner to elucidate the finer points. Therefore, even a competent individual may be subject to influences that reduce autonomy. This shows that competence is also not an open and shut case. Therefore, the parties concerned in a medical case should respect the decision of a competent individual.
Exploring the parents of Lia Lee in light of Buchanan and Brock's concept of competency, I find them to be ineffectual and incapable of caring for special needs of the child thereby putting her in mortal danger. They were unable to communicate effectively with the medical team due to cultural and language barriers. The Lees do not understand the medical situation of their daughter and they do not appear to make rational decisions concerning Lia's medication. These claims I can substantiate from the fact that they do not follow prescription and sometimes throw away medication. Furthermore, they view the disease from a mystical point-of-view that contradicts medical practice (Beauchamp, 2003).

I must state that the position in the foregoing paragraph is a strictly western point-of-view and has inbuilt biases that characterize western thinking. Biases are in every culture. The Hmong cannot understand why the doctor does not treat the soul, and the doctor does not understand why the Hmong will bring amulets and chickens to the hospital. The paternalistic doctor imposes regimes on the Hmong expecting compliance and gratitude and meets with resistance or indifference. In spite of these biases, the Lees were not acting from a consistent set of values because they would take the child to the medical center for treatment but would discontinue the prescribed medication. They distrust the medical system.

Ethics is a matter of right and wrong in the day-to-day life and professional functions. In this matter, would it be right to support the decision of the court to place Lia Lee in foster care? Would Buchanan and Brock (2008) support the decision? The answer to the latter question is that they would support the decision. This is purely a matter of competence which the law defines elaborately. Furthermore, the interests of Lia Lee and those of the State outweigh the rights of her parents. However, the answer to whether Buchanan and Brock would be correct to defend as ethical the decision to place Lia in foster care is not that straightforward. It will, therefore, require some discussion of the ethical theories in this regard.

Utilitarian theory focuses on the purpose of an action. Utilitarian theory uses the thesis that a practice is right if it has the greatest possible balance of good consequences (Beauchamp, 2003, p10). The goal here is maximizing of benefits and ensuring the least possible harm. The Lees could not take care of the Lia thereby endangering her health by failing to give the drugs consistently. They could not give the drugs consistently. Lia's condition necessitated care in a consistent manner and the action of placing her in foster care would provide an opportunity for her to get it. In putting Lia in foster care, the court was minimizing any harm that would result from incompetence.

Utilitarian theory supports the action of the court action to seek greater good. In fact, the only requirement for Lia to go back to her parent was that they demonstrate the ability to follow the treatment regimen. The court even accepted to pay the foster family because of the hardships of taking care of Lia.

Objection

Utility implies the outcome of actions. The action of placing Lia in foster care resulted in more seizures and seemed to make the child's condition worse. Furthermore, the Lees misunderstood the motive of this action since they construed it as the result of hatred of the doctors. The court and doctors should have considered alternative action since the actions of the Lees were the result of a cultural misunderstanding. Further, it was not their fault that they did not conceptualize western medical practice as the westerners did. The resulting loss of autonomy was stigmatizing to the parents. In fact, the parents fulfill their part of their responsibility by loving the child.

Reply to Objection

The Lees demonstrated their unwillingness to cooperate in alternative actions by refusing to sign the social services plan. They also failed to live up to expectations during Lia's week long visits. Furthermore, the incompetence of the Lees is inexcusable since they are within a larger system that charges parents with the obligation of watching over their child's health, and they should discharge this responsibility. The Lee's actions of love seem negligible in…