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Would you tell a loved one they’re dying?


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The first trailer for “The Farewell” shows a side of Awkwafina you’ve never seen before.
A24

Imagine finding out your loved one was dying, but you had to keep it a secret. 

That’s the moral conundrum Chinese-American director/writer Lulu Wang found herself in six years ago, when she learned her beloved grandmother was diagnosed with stage 4 lung cancer. Keeping with a long-standing Chinese tradition of not disclosing terminal illness to the elderly, Wang’s family chose not to tell her grandma, nicknamed “Nai Nai,” that she had three months to live. Instead, they fast-tracked her cousin’s wedding in Nai Nai’s native Changchun, China, so everyone could gather to say goodbye. 

It’s an emotional story that Wang delicately explores in her sweetly funny and profoundly moving drama “The Farewell,” a critics’ and audience favorite with 99% positive reviews on Rotten Tomatoes and $17.1 million at the summer box office (off a modest reported $3 million budget). It’s already expected to be a major Oscar player, with many prognosticators on awards site GoldDerby.com predicting nominations for best picture and best actress for star Awkwafina, who makes her dramatic debut as Billi, a fictionalized version of Wang. 

Billi (Awkwafina, right) struggles to keep her grandma’s (Zhao Shuzhen) terminal diagnosis a secret in “The Farewell.” (Photo: A24)

Given her upbringing in the USA, the practice was “completely new” to Wang: “I didn’t know it was this common cultural thing – I thought it was specific to my family.” But after sharing her story on an episode of “This American Life” in 2016, “I learned how prevalent it was, because I started getting emails and messages on social media from people all over the world.”

According to a 2017 study published in the medical journal Supportive Care in Cancer, withholding information about a terminal diagnosis is common in Asian countries such as China, Japan and Singapore, as well as some Western countries, including Spain, Italy and Greece.

In cultures that put a greater emphasis on family as the primary social unit, it is frequently family members – not patients – who receive diagnoses from doctors and therefore decide what to do with that information, says Anita Hannig, an associate professor of anthropology at Brandeis University who focuses on birth and death. 

More: Awkwafina opens up about loss: ‘The Farewell’ is ‘a very personal story for me’

“There’s this idea of ‘filial debt,’ that you owe your mother and father for taking care of you all your life, so when that person gets sick, the family steps up to take care of them,” Hannig says. “These decisions (about health care) then become distributed among the family, and this idea of autonomy gets shifted over to the relatives.”

Billi is initially disgusted by the lie. But she starts to come around after a heartbreaking discussion with her uncle (Jiang Yongbo), who says it falls on the family to shoulder the emotional burden for Nai Nai (Zhao Shuzhen), who doesn’t need the added fear of death as her physical health deteriorates. 

That thoughtful consideration for a person’s mental well-being stems from a Chinese philosophy known as “chongxi,” the belief that you can essentially wash away misfortune with joy.

Billi (Awkwafina, second from left) flies to China for a wedding as a means to say goodbye to her ailing grandma, Nai Nia (Zhao Shuzhen). (Photo: A24)

“In many cultures, there’s this notion that if you tell someone their diagnosis, it may lead them to giving up,” Hannig says. “It’s basically this idea that bad news heralds a bad outcome, and goes back to the power of the spoken word to harm or to heal, and that words can literally kill you. Of course, that goes totally against this idea we have in Western medicine, where the agenda in biomedicine is all about open discussion of disease, diagnosis and prognosis.” 

“America is rather unique in terms of it is really not comfortable with the topic of death,” says Jon Radulovic, vice president of communications for the National Hospice and Palliative Care Organization. “We have access to greater medical technology than a lot of other countries in the world, so people continue to treat and treat and treat as long as there’s a medical intervention available. We don’t think about the quality of life.”

But as more people turn to holistic medicine, “we’re seeing more baby boomers who are interested in the options available to them,” Radulovic says. ” ‘What are the benefits of chemotherapy? Will this surgery really make a difference for me?’ There was a survey done in (2017) that at end of life, those who opted for hospice care live an average of 28 days longer than those who continued with curative treatments. It’s just an important lesson that sometimes approaching your illness with a holistic, person-centered approach might actually have benefits that being in the hospital wouldn’t necessarily offer.”

Wang’s family took sometimes extreme measures to shield Nai Nai’s diagnosis from her, passing off cancer medications as vitamins, and altering test results with Wite-Out to describe her tumors as fictitious “benign shadows.” Nai Nai’s doctors even became complicit in the lie, at the request of her family. 

“If she was coughing and wanted to go see the doctor, they would tell her, ‘Oh, it’s just an infection’ and give her some antibiotics,” Wang says. 

“The Farewell” filmmaker Lulu Wang, left, and actress Awkwafina, who plays a version of her in the semi-autobiographical film. (Photo: VIVIEN KILLILEA/GETTY IMAGES)

To Radulovic’s knowledge, there are no laws in the U.S. barring families from lying to their loved ones about disease, although falsifying medical reports gets into thorny legal territory, especially if a doctor is aware of it.

“And if the patient themselves asked the physician to tell them what’s going on, I think the physician would need to do that,” Radulovic says. “But they would certainly try to understand where the family members are coming from (in lying), and there are certainly a lot of factors. How old (is the patient)? Are they suffering from a degree of dementia or Alzheimer’s, where explaining things might not be understood?”

There are also more personal quandaries at play that go beyond end-of-life care: If someone continues to live their life ignorant of an underlying medical condition, are you robbing them of the chance to say a “proper” goodbye to the ones they love, or fulfill any last wishes of things they wanted to do or see? 

“Every individual has the basic right to deal with his or her impending death the way they choose, so hiding the existence of a terminal illness is doing a great disservice to the dying person,” says Larry Samuel, an American cultural historian who has written about the psychology of death. “Finding closure, saying goodbyes, or otherwise ‘getting our house in order’ are essential ways we can complete our last chapter of life and at the same time help bring death and dying into ordinary conversation.”

On an ethical level, “I do not think people should be lied to about their health,” Wang says. “I still feel very morally conflicted about this lie, and whether it’s right or wrong.”

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Awkwafina describes her culture shock in making “The Farewell” in China, where she learned to speak Mandarin “for survival.”
USA TODAY

But personally, she sees the lie as a mixed blessing: At the end of “Farewell,” a title card reveals that the real Nai Nai is still very much alive. There’s no medical explanation for why she has long outlived that grim 2013 prognosis, but her diagnosis was indeed accurate. 

“She’s 86 and she’s ill, so you can imagine (her health is) up and down,” Wang says. “We’re always on edge about it, and I try to talk to her as much as I can and make time to see her whenever I can. I’m not taking any of the time we have for granted.”

Nai Nai FaceTimes with Wang regularly and visited the set of “Farewell” while it was shooting last year, although to this day, she still doesn’t know the film’s title or what it’s actually about. Wang told Nai Nai it was a family wedding comedy, “so technically, we didn’t lie to her (about that),” she says with a laugh.

“The lie has enabled me to spend more time with my grandmother than I have since I was 6 years old, and getting to see me be a director and put this whole production together was really significant for her,” Wang says. And yet, “she knows that it’s out in the States and has asked, ‘When can I see it?’ So my family is in the midst of dealing with all of that, and there are still different opinions within the family about whether we should show her.”

Even now, Wang wonders, “Did it really work? Was the lie an essential part – or the main reason – why she has lived this long? And if we were to tell her the truth (now) and she saw the movie and something happened, would I feel guilt and a sense of responsibility, that somehow revealing the truth has now had a negative impact on her?

“They’re not questions I’ll ever really be able to answer, but they are things that I continue to grapple with.”

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