Choosing Whom to Trust: Autonomy Versus Reliance on Others in Medical Decision Making Among Plain Anabaptists
Michael Sauder, MD, MPH, MA, St. Louis University, St. Louis, MO, Penn Medicine Lancaster General Health, Lancaster, PA
The idea of patients as autonomous agents dominates bioethics literature in America. But Plain Anabaptists, for example Amish and Conservative Mennonites, allow their communities to influence medical therapy decisions more than the typical American does. They choose differently whom to trust. In this paper, an Anabaptist physician presents insights gained from experience working with such Anabaptists. Sharing of medical expenses, emphasis on family input, and acceptance of authority results in a different approach to decision-making. They choose differently whom to trust. This is relevant to medical professionals interacting with them, especially when Plain Anabaptists make decisions at variance with a medical recommendation. How can one heal [in] the spaces between? I suggest that the typical American doctor often mistakes the area of disagreement, assuming that the presentation of more facts will sway the patient. It may be true that a patient with limited formal schooling does not have all relevant data. Yet often Plain Anabaptists come to a different decision because of a different value system. They are making their own decision about whom or what to trust. In some cases, Plain Anabaptists may sense an undercurrent of disapproval about their choice. This paper concludes by examining if there is some inconsistency in such a critique. After all, in one reading of the dominant ethic, one’s value system is radically personal. Respect for autonomy is key. Patients reference their personal morals when making medical decisions. On what basis may a clinician critique a decision, if that decision springs from a personal value system? Examining the subculture of Plain Anabaptists is a way into exploring medical decision-making in general, especially when religious commitments are at stake.