Parents heatlh and responsibility

The incident

“I was working the night shift in out-of-hours service in the province of Agrigento, in Sicily, in January 2015, when a 20-year-old came to me to get his head medicated. He told me that he had had a seizure (from epilepsy) and he had fallen on the ground, thereby hurting his head.

Whilst I was attending to him, he kept drinking from a bottle of beer. I realised that the wound was worse than it seemed at a first glance, therefore I told him that he should go to the emergency room of a hospital instead, with an ambulance.

But he answered that he didn’t want to go to the hospital and that he’d rather go back to the pub and have another beer. I kept insisting on his need for emergency care, and he kept answering that he did not want to go. Then I suggested he called his family. But he replied his phone balance credit was zero. So I offered to call his family and managed to get hold of his father and explained the emergency of the situation. The father scolded me for waking him up in the middle of the night. He told me that since his son was a grown-up man he wouldn’t need to call his parents for further assistance. As an adult, his son should be able to go to the hospital with an ambulance by himself and, furthermore, he should only go by his own free will.

Consequently, when the medication was finished, the young man signed a declaration stating that he refused to go to the emergency ward. Then he left.”

1. Identities of the actors in the situation

The narrator is a woman and female doctor, working in an out-of-hours healthcare service in the province of Agrigento, Sicily, at the time of the incident. The narrator recently graduated as a doctor. She has an Italian background; she is 28 years old.

From a socio-cultural and gender-cultural perspective, she is strongly focused on health, and she describes herself as very passionate about her work. Thus, she values the knowledge about health.

However, from a social-cultural perspective, she also considers family as a main value and reference point. As a doctor, she has worked in different socio-economical and socio-cultural environments, characterised by low educational and cultural level from many points of view, especially related to the low socio-educational level.

Two people caused the culture shock for the narrator in this incident:

  • A young Italian man, 20 years old arriving at hospital for head problems.
  • The young man´s father (and mother in the background)

Apparently, the young man and his parents are characterised by a low socio-educational level. This seems to include that they also have a superficial conception of health and the importance of keeping a good health.

The relationship between the actors is a relationship between a person providing a health service and one other person who has the right to use this service.

2. Context of the situation

The incident takes place in a out-of-hours healthcare service, a small healthcare facility equipped for first aid mostly, in the province of Agrigento, Sicily, January 2015.

At the time of the incident, the narrator is working the night shift, when a young man, 20 years old, arrived to have his head attended to.

The healthcare facility was frequented by people at the time, all of them with different cultural backgrounds. At that time of the night, the only people present were the doctor (recently graduated) who is very willing to serve, and the patient who requires assistance but who also has some resistance.

3. Emotional reaction

The narrator was shocked and could not believe what had just happened. She was really stunned that parents could remain so indifferent and careless to their son, when confronted with such a severe health situation. The narrator was especially shocked by the fathers  “couldn’t-care-less” attitude.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

1) Family:

The female doctor considers family as a main value and reference point regarding every aspect of human and everyday life. Family members should be available for each other and support each other, and they should certainly care for each other in all emergency situations, where a family member is in need of help, support and guidance.

2) Parental responsibility:

Linked with the value of family, responsibility is also at stake as a basic value in the incident, according to the doctor. From the doctor´s point of view, parents are always responsible for the wellbeing of their children, no matter the child’s age and conditions.

As a parent, you maintain a responsibility towards whoever you bring into this world.

3) Self-responsibility:

Furthermore, the value of being responsible isrepresented in the incident. From the doctor´s point of view, the young man is showing very poor self-respect, when he pretends to be careless about his injuries and continues to drink beer during the treatment. It may be seen as an attitude of recklessness and male brawn. But usually, it is also a way of hiding a lack of self-confidence, self-esteem and self-awareness. Therefore, in the eyes of the doctor, the young man is gambling with his own life as if his life and health is worth nothing. This may also be confirmed by his father’s carelessness, probably not a new experience to the son.

4) Healthcare and physical integrity:

In her position as a doctor but also as human being, the value of protection of health is fundamental. Health should be given precedence over everything. This is strictly linked with the idea of bodily integrity, which is highly valued by the doctor. The wound in the head of the patient should, in her view, receive immediate care, and she cannot accept the attitude of the patient in relation to his health. From her professional point of view especially, treating, curing and healing are necessary to maintain the integrity of the human body, which is what she has decided to commit her life to.

In addition to this position the Doctor has the responsibility of not letting the patient go if he is a risk. Also her professional identity could be threatened by the fact that the patient refuses to follow her recommendation and also from the lack of responsibility of the parents.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The impression is negative – partly because of the young man´s carelessness and lack of responsibility and accountability to his own health – and partly because of the carelessness, indifference and refusal of help shown to the son by the parents.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

1) Rebellion, resourcefulness and autonomy:

By avoiding further medical examination and by showing no interest to call his parents for help, he also demonstrates his autonomy and right to control his own health, illness and life. It is a classic ideological part of the “wild young man”, going back to the fifties and images of disturbed young men at odds with the established societal norms and values.

In the situation, the female doctor represents a real counter-image.

Supporting this hypothesis, the mere fact that he went to the hospital can be seen as a solution to his need for medical attention and as a sign of his autonomy in finding solutions to problems.  From his point of view, there is no need to involve his parents in the situation because they cannot help him anymore than he already helped himself by seeking medical attention.

Another hypothesis is that the young man is used to being rejected by his father/parents, and has therefore learned that he should take care of himself. At the same time, he may be imitating the value of masculine coolness and naivety that he may have learned from his father/other masculine models in his life.

2) The importance of health:

Health is not a value that should be given precedence over others in his point of view. Perhaps, we can also make the hypothesis that going to the hospital was already conceived as a good-enough reaction to the situation, and that nothing more is required of him, as doctors can take care of his health from that point on.

3) Substance Influenced

As the narrator describes the incident we can also think that the young man could be under the effects of alcohol which could lead him to refuse the advice of the doctor. Drinking alcohol in high quantitycould have an anaesthetic effect on the body. The patient might then feel less pain and consider his wounds as less serious as they actually were.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

In this case, it is possible to identify poor/lack of family values. The young person is perhaps too proud and ready to react in any way to the deficiencies they have had.  This can lead to a reaction that would risk endangering some fundamental aspect such as health. Probably you should be ready to accept different views towards the family value. Although it is difficult to explain to a young man the importance of health from the point of view of the narrator. It is therefore essential not to give up: it is important to enhance health even in the face to those who are reluctant.

However, an issue arises when the need for medical attention is confronted with freedom of choice of patients to refuse treatments. Until they are not in a life-threatening situation, the practice in most Western societies is to give the right to patients to refuse medical care if they are considered able to make a decision. The role of the doctor in these cases is confined to the communication of the dangers of refusing the care and informing the patients, so that they can make informed decisions.