By Donna Lu
If you were diagnosed with terminal cancer, would you prefer to know about it, or to continuing living in blissful ignorance as if you were perfectly healthy? This question is at the heart of the film The Farewell, written and directed by Lulu Wang.
In the film, a Chinese family decides not to tell their grandmother, Nai Nai (Shuzhen Zhao), that she has stage-four lung cancer. The film’s title gives away its premise: under the pretence of a cousin’s wedding, the family stage a long-overdue reunion in China to give everyone a chance to say goodbye.
The Farewell, billed as being “based on a true lie”, originates from Wang’s life. Her grandmother was diagnosed with lung cancer in 2013 and given three months to live. Like the film’s protagonist, the Chinese-American granddaughter Billi (Awkwafina), Wang was troubled by her family’s decision to withhold the diagnosis from her Nai Nai.
The prevailing narrative of “battling cancer” in Western society has its own issues, with its discourse of personal triumph that values individual responsibility and determination. But the alternative – to lie outright – might seem inconceivable, particularly to those accustomed to the norms of Western culture. It is, however, a common practice in China, rooted in the belief that telling a person about their diagnosis can make their condition deteriorate quicker.
“Chinese people have a saying: when people get cancer, they die. But it’s not the cancer that kills them, it’s the fear,” says Billi’s mother (Diana Lin).
The plot line of The Farewell is familiar to me. Like Billi’s Nai Nai, my aunt was diagnosed with metatastic lung cancer. Nobody in the family told her – nor did the doctors when she later underwent surgery to remove a tumour. The last time I saw her was in north-eastern China a few years ago. Her once-plump figure had shrunk to a wiry frame. She was in her early 70s, in good spirits, but a far cry from the feisty matriarch who used to dominate conversations.
The Farewell is a heartfelt film, punctuated by moments of unexpected – and unexpectedly uplifting – humour. In a darkly comical scene in a printing shop, Nai Nai’s younger sister demands that the results of a medical report be doctored to edit out references to cancerous nodules and replaced with the nebulous term “benign shadows”.
For the most part, doctors in China comply with the wishes of family members. A 2018 survey of Chinese doctors found that 98 per cent would tell relatives about a cancer diagnosis first, and of these, 82 per cent wouldn’t tell the patient if the family asked the doctor not to. Of 180 doctors surveyed, nearly half said that they would similarly want to withhold a diagnosis from their own relative.
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It wasn’t so long ago that medical professionals in Western countries had similar attitudes: in a 1961 study in Chicago, 90 per cent of doctors said they wouldn’t inform the patient of a cancer diagnosis – many even reported that they deliberately changed the diagnosis to avoid mentioning cancer.
While disclosure is now mandated in many countries, resulting from a shift towards personal autonomy, Chinese doctors are legally obligated to try to avoid any adverse effects that may result from informing a patient or their family about a diagnosis. The truth hurts – perhaps too much, is the rationale.
In the film, Billi has a conversation with a UK-educated doctor in front of Nai Nai, who doesn’t understand English. “Isn’t it wrong to lie?” asks Billi. “If it’s for good, it’s not really a lie,” the doctor replies. “I mean, it’s still a lie,” says Billi. “It’s a good lie,” says the doctor.
Billi struggles to reconcile her family’s dishonesty with a personal sense of guilt. This conflict generates the film’s narrative tension, and boils down to differing views of morality. There’s a dichotomy between Western individualism and Eastern collectivism, a dilemma of Kantian versus consequentialist ethics.
But it also depends on the aforementioned hypothetical – a subjective judgement about whether knowing you have terminal cancer would be better or worse, and by what measures.
Some cultures similarly view disclosure as being worse. Doctors often withhold diagnoses in Singapore, Japan and Lebanon, for example. Interestingly, a US study of attitudes to cancer disclosure in elderly people found that Korean-American and Mexican-American respondents were more likely to view truth-telling as cruel and even harmful. European-American and African-American respondents were more likely, on the other hand, to view it as empowering – knowledge that gives individuals the agency to make informed decisions.
Quality of life
Then there is the question of whether awareness of a cancer diagnosis might worsen life expectancy or likelihood of survival. On this point, the research is conflicting. Studies suggest that the fact of knowing about a terminal diagnosis doesn’t seem to shorten a person’s lifespan, and that being told directly causes less emotional distress than if a person guesses it from their own deteriorating condition. But an Iranian study of people with gastrointestinal cancer found that ignorance about the diagnosis was associated with a better physical, social and emotional quality of life.
Regardless of the science, while watching the film it was hard to shake an uneasy sense of complicity in my aunt’s situation, and the feeling that someone should have told her that she had lung cancer. Billi expresses this idea to a female relative at one point in The Farewell.
“Tell her? Why would we do that?” is the reply. In case Nai Nai has things she wants to do, says Billi, or to give her the chance to say goodbye.
The Farewell, like the decision the family ultimately makes, is complex and nuanced. There is no easy way to say goodbye, no absolute prescription on how best to live and let live, or die.