Watching “The Farewell” from a Nurses’ Perspective with Dr. Katreena Merrill

By Alex Coleman

This week, BYU College of Nursing’s social media team is kicking off our new “Movie of the Week” campaign. In a recent email from President Worthen, students at BYU were strongly encouraged to stay home as much as possible. For both students and alumni alike, our team wanted to provide a service which will both entertain and give you something to think about– and “Movie of the Week” was born!

To kick off our campaign we chose the critically acclaimed, “The Farewell.” Scoring a whopping 98% on Rotten Tomatoes, we admire this film for its raw treatment of the ethical questions surrounding the intersection between terminal diagnoses and family culture. Plus, it is sure to make you laugh. 

The Farewell is a heartwarming, hilarious story that follows “Billi,” the daughter of a Chinese-American family who grew up in New York. Billi’s grandmother, who still lives in China, is diagnosed with terminal lung cancer. However, everyone in the entire family, including the doctor who diagnosed her, decide it is best to keep her diagnosis a secret from the matriarch herself. The film follows Billi’s struggle to grapple with the morality of everyone being deliberately dishonest to the grandmother. In a poignant scene, Billi’s uncle explains that “the lie allows the family to bear the emotional burden of the diagnosis, rather than Nai Nai herself– a practice of collectivism that [Billi’s uncle] acknowledges to Billi differs from the individualistic values common in Western culture” (wikipedia).

Apparently, lying to family members about their terminal diagnoses is not totally uncommon in Chinese culture. As the doctor in the movie puts it, it is a “good lie,” spun to spare the patient pain and suffering in their final months. Associate professor Dr. Katreena Merrill, who teaches an ethics course at BYU College of Nursing, says of the movie, “I thought it was a great example of how ethics is different culturally, and how people want to be involved or not in their own ethical decision making.” 

“The Farewell” really confronts how nuanced healthcare is by cultural and sociological factors. It looks at the differences in Billi’s “Americanized” worldview that tends towards the more individualized and autonomous experience, versus her family members who are still in China. They view their decision to withhold information from the grandmother as a sacrifice they are making on her behalf. In their more Eastern culture, a person’s life is not simply one’s own, but they are part of a collective. Billi’s angst about not allowing her grandmother the freedom to decide what to do with her last months is confronted when she learns that her grandmother kept the same secret when her husband was diagnosed with a fatal illness. Not until he was on his deathbed did she tell him what was happening. 

“You can’t make assumptions about people’s feelings about healthcare and death and dying. You have to understand them from a cultural standpoint and an individual standpoint.” Dr. Katreena Merrill

In short, the movie presents us with a seemingly simple ethical question– the right versus wrong of being honest. It then asks us to reconsider that question through a different cultural lens. Dr. Merrill comments that there were several things that the movie invited her to consider about nursing ethics and even practice in general. For example, she commented on a scene in the movie where the doctor and Billi have a full on conversation about the grandmother’s fatal diagnoses right in front of her, but the grandmother cannot understand a word. It made Dr. Merrill think about an experience she’d had going to the doctor’s office with her mother-in-law. After the doctor rattled off about how the visit went, he asked his patient if she had any questions. She replied that no, she didn’t, and he left the room. Immediately she turned to Dr. Merrill and asks, “What did he say?” Dr. Merrill comments, “I think that we forget that we speak a foreign language, just as in this movie, when the doctor actually literally spoke a foreign language. When we do not translate our medical jargon into what the patient can understand, we might as well be speaking Chinese to an American or English to a Chinese person.”

The movie also created a space for Dr. Merrill to think about the culture of patients she’s treated throughout the years. Even in the United States, there is a vast array of family culture. “When some people have children, it’s just the woman in labor and her husband there. But sometimes, it’s a whole todo– aunts, cousins, grandparents, siblings.” She goes on to say, “People do not separate healthcare from the rest of their lives. It is part of their life. If you have a family that is just generally in your business, that the way your healthcare is also going to be. You have to understand that when you’re working with people.” 

As nurses, there is so much we have to consider when we think of the question of how do we treat people. This is not just what techniques or medicines will we use in treatment. It extends to the realm of approaching our patients in manner and in process in a way that reflects how unique every individual is. It’s a tough balance, for sure. Dr. Merrill gives these poignant closing words, “I think the thing the movie really brings forward is that you can’t make assumptions about people’s feelings about healthcare and death and dying. You have to understand them from a cultural standpoint and an individual standpoint.”

Here’s some thoughtful questions you can consider as you watch the movie:

  1. Is there such a thing as a “good lie”?
  2. How much of a healthcare professional’s responsibility is it to dictate/guide how a family will approach the death of a family member?
  3. How can a healthcare professional be sensitive in approaching different cultural aspects that might be unfamiliar?
  4. What can healthcare professionals do in their practice to help preserve quality of life as a patient approaches death? 

For additional reading about treating patients cross-culturally, check out Lynn Callister’s BYU Devotional, “”They That Wait Upon the Lord”: Metaphor and Meaning.”

Film poster from A24 productions website https://a24films.com/films/the-farewell

Published by BYU Nursing

Guided by the truths of the gospel of Jesus Christ, we exemplify the Healer’s art by: leading with faith and integrity; advancing the science of nursing and healthcare; promoting health and wellness; alleviating suffering; and serving individuals, families, and communities. The mission of the College of Nursing at Brigham Young University is to learn the Healer’s art and go forth to serve.

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