The stereotype of the Amish is that they are Luddites, unsophisticated rustics resolutely refusing to use technology because they perceive it as evil. However, if anything, their approach to technology is more sophisticated than the surrounding culture’s, and we could learn much from their approach, especially in medicine.
Contrary to the stereotype, the Amish do not categorically refuse to use technology; it only appears that way in contrast to those of us around them who avidly and unreflectingly adopt new technologies as soon as they are advertised. To the Amish, technology is not sinful or immoral, just potentially dangerous: like a knife, which can be used to cut bread or inflict mortal injury. They are also keenly aware that often, when we adopt new technologies to serve some purpose of ours, the technology insidiously becomes the master and we its servant. Therefore, they have consciously and collectively tried to tame and domesticate technology so that its brute force does not overwhelm their culture and values. They understand that technology requires careful evaluation before it is adopted (this necessarily involves selectivity and sometimes rejection!), and careful limit-setting once it is adopted. This has led them to be scrupulous about what technologies they adopt, and how they adopt them. They “modify and adapt technology in creative ways to fit their cultural values and shared goals.”* The Amish default mode towards technology, in contrast to ours, is to go slow, be careful, and check with the community. They remember the truth that we seem to forget (despite innumerable and painful examples): technology has the potential to change and destroy in ways that we may not realize until it is too late to undo the damage. How many times have we suffered this, without learning? From the antibiotic resistance resulting from the inordinate and thoughtless prescribing of antibiotics for anything that even looks like an infection, to the deforming of the patient-physician relationship by the interposition of the computer, to the cancers caused by excessive and knee-jerk CT scans, we find too late the damage done by the technology we have embraced with such ardor and haste, seeing only the good that it promised without taking thought for its potential to undermine the ends of medicine it was supposed to serve.
The Amish ask, as should we, “Can humans tame technology, or does it control our destiny? Has the enormity and cleverness of our creation overwhelmed our ability to control or guide it?”* This question is important as we evaluate existing technologies (as is happening, for example, albeit belatedly, in the Choosing Wisely campaign); it will be even more important as we approach technologies whose power to act upon humans dwarfs anything we have seen yet, such as nanotechnology and gene therapy. Will we, like the Amish, be willing to go slow, be careful, and check with the community? Or will we find that our technology has taken control, overwhelming our ability to control or guide it?
* These quotes, and much of the background information for this post, come from The Amish, a fascinating study by Kraybill, Johnson-Weiner and Nolt, published last year by The Johns Hopkins University Press. Other information for the post came from discussions with several of my own Amish patients.