Since 1950, the Amish population in Lancaster, PA, has almost tripled. Sara is an Amish woman, who is married with four children and residing in Lancaster, amid the productive farmlands called the Pennsylvania Dutch Country. Known as one of the “old-order Plain People,” Sara is devout in the literal application of her faith and her belief in shunning. She adheres to a scripture often quoted in Amish worship: “Be not conformed to this world, but be transformed by the renewing of your mind that ye may prove what is that good and acceptable and perfect will of God” (Romans 12:2). Her home is devoid of electricity, telephone, and television. She travels by horse and buggy. Sara has a strong work ethic and her “family values” are heralded as a model for restoring the family. Because of her religious and cultural beliefs, Sara is excluded from social security and health insurance coverage, and she does not believe in birth control or immunizations. Sara’s rural attitude about health care does not mesh with the current health-care industry.

Sara’s 10-year-old daughter has leukemia, and she and her husband are refusing treatment. As a last resort, Sara took her child to the hospital. Out-of-pocket payment for the hospitalization will come from Sara, her family, and her neighbors. A hospital social worker has been consulted to speak with Sara and her husband in an effort to secure their permission to continue treatment. The social worker showed Sara a news clipping from the USA Today wherein another Amish couple residing in Ohio has also refused chemotherapy to treat their daughter’s lymphoblastic lymphoma--an aggressive form of non-Hodgkin lymphoma that is seemingly curable.

1. Is the social worker’s choice to show the USA Today article to Sara appropriate and ethical? Why or why not?
2. What would be a way for the social worker to share her concerns about Sara daughter’s condition and medical needs while still respecting Sara’s religious and cultural beliefs?
3. How might your own religious and family background influence the way you react to Sara and her family’s situation?