An Amish Paradox: Diversity and Change in the World's Largest Amish Community

Chapter 7 Health along the Life Cycle

a฀฀chapter 7฀฀a Health along the Life Cycle They don’t come in every time they sneeze. —A local physician A s Amish individuals confront health decisions throughout their lives, they, like everyone else, are guided by a variety of considerations . Among the most important are moral values and beliefs, cost, knowledge, and accessibility. Whether the person is a member of a New Order, Old Order, or Swartzentruber church can also make a difference . All these factors enter into decisions about how and where to give birth, how to address physical illnesses and injuries during adulthood, what to do about psychological problems and issues of well-being, and how to deal with fatal diseases and near-death dilemmas. In this chapter we explore how these considerations affect health decisions of the Amish at different stages of the life cycle. Overviews of Amish health care attitudes and practices are already available,1 but we hope to add to those discussions by focusing more thoroughly on the health care dilemmas faced by the Amish because of (a) new knowledge about alternative techniques, (b) variations in practices of the several orders, (c) pressures exerted by the state and by health care professionals, and (d) increasing health care costs. We also discuss Amish health care from both internal and external vantage points, that is, from the points of view of Amish respondents as well as the various professionals who treat them. In addition, we explore end-of-life issues more com- pletely than previous studies have done and look at the lessons that might be learned from the Amish approach to health care. It should not be surprising that the distinctiveness and insularity of the Amish community are reflected in their perspective on health care. The differences from English society in Amish cultural beliefs and history and the structural arrangements in the Amish community create “culture care diversities” that are distinctive in some ways when compared to dominant care preferences in English society and also vary within the Holmes County Settlement itself.2 These factors make it crucial for the health care professional to possess a sympathetic understanding of Amish culture. As members of a “high-context” culture, Amish individuals are deeply connected to each other socially, culturally, and historically. There are mutual understandings that are often unspoken and taken for granted, and nuanced behaviors and language connotations of which outsiders are usually not aware. Being a tight-knit community, the Amish carry a heavy concern for the care of others; they consider themselves first of all members of a close community to which they are accountable.3 This cultural context and the diversities within the Holmes County Settlement inform health care approaches throughout the life cycle. Giving Birth Pregnancy,thoughafrequentoccurrenceamongtheAmish,isnotanevent that is baldly advertised in local media like the Budget. Rather, the subject of giving birth is handled in a more guarded, toned-down fashion. The Budget, a newspaper that serves the Amish population and has a national edition with a circulation of about twenty thousand, is made up mostly of letters from Amish people about events in their families. Letters are a major form of communication in the Amish community, and those in the Budget come from Amish all over the world, including the nearby population . The editors told us that the term pregnancy would not be used in letters ; a phrase like with child is considered more appropriate. This caution is especially prominent among Old Order and Swartzentruber Amish and appears to be tied to concerns about modesty and privacy. Discussions on the nature of a birth (for example, a Caesarean section) are also frowned upon, as are advertisements of products considered highly personal, such as underwear. ฀ a฀health along the life cycle a฀ 221 222฀ a฀an amish paradox a฀ The Amish guardedness in discussing pregnancy is suggested by a story related by a Holmes County chiropractor who has many Amish patients . A “lower” (i.e., Swartzentruber) order Amish woman who was six to seven months pregnant came in to see him, “And she had also brought her 14–15-year-old son in with her. So I had been talking to her about him, and then I turned to her, how’s your pregnancy going? She sent him out of the room. She said: ‘We don’t talk about things like that in front of the children.’ I took the opportunity and said: ‘What age...