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Don GrantMay 07, 2024
A young female doctor in blue scrubs holds hands with an older female patient, both sitting on a couch. (iStock/BongkarnThanyakij)Many health care professionals report that they are actively involved in reminding patients of their sacred selves in an otherwise dehumanizing environment. (iStock/BongkarnThanyakij)

Pandemics, police brutality, deportations, evictions, hate crimes and other threats to marginalized groups have rekindled discussion within religious circles about the sanctity and care of vulnerable strangers.

Unfortunately, such conversations often do not include the perspectives of public servants who directly care for strangers, including nurses, therapists, educators and social workers. Many of these professionals are trained in scientific methods that can be indifferent, if not hostile, to the spiritual qualities that make human beings special. At the same time, society expects them to deliver care with a “human touch” that affirms individuals’ ultimate worth. They are not religious workers, but they still play a pivotal role in incorporating the imago Dei, the notion that all people are made in the image and likeness of God,into public life.

The sociologist Max Weber foreshadowed this tension over a century ago in his writings on the place of religion in modern society. He noted that for most of human history, care was restricted to family and friends. It was not until the Axial Age (800-200 B.C.) that communities first began to recognize all humans, including foreigners and other strangers, as spiritual beings deserving of protection. This spiritual revolution greatly expanded the reach of care and inspired the creation of public facilities that use impartial criteria to ensure (at least in theory) that all people can have their needs met.

Weber predicted, however, that as scientific authorities assumed greater responsibility for individuals’ well-being, members of the clergy and others might object, insisting that care be left to churches, charities and families. Weber understood this objection, fearing that as bureaucracies and advanced technology permeated and further rationalized Western society, they could extinguish human qualities, like the spiritual, that care workers had previously nurtured to help them recognize the dignity of vulnerable strangers—and thus dissipate those workers’ passion to care for others.

Ironically, Weber never inquired into the experiences of frontline helping professionals. Perhaps this is because care has traditionally been provided by some of the least powerful people in a society—slaves, servants, members of lower castes and especially women—and thus devalued. Or perhaps Weber, like many academics, assumed that care workers merely follow the rules of their institutions and exercise little, if any, agency.

The reality is that precisely because they interact with the most vulnerable populations, frontline helping professionals must constantly balance rationalistic understandings advocated by science and more humanistic or religious ones like the imago Dei. Indeed, in response to clients’ growing complaints about the impersonal nature of modern bureaucracies, hospitals and other institutions have begun to advertise their commitment to holistic care that recognizes individuals as biologically, psychologically, socially and spiritually constituted. These efforts to legitimate themselves in the eyes of potential customers effectively make it the duty of care professionals to coordinate science and spirituality.

And as responsibility for the care of the human species has shifted from family and friends to large, science-based institutions, care workers increasingly function as surrogates for loved ones. This was most obvious during the Covid-19 pandemic in hospitals and nursing homes, when patients were not allowed to receive visitors and care workers were the only people available to compensate for their absence. But responsibility for care of the human spirit falls on frontline staff whenever we assign responsibility for at-risk groups—the young, the old, the poor, the sick—to public systems run by scientific authorities who demand that others not interfere with their dispassionate methods and procedures. To counterbalance these organizations’ cold nature, staff members who directly interact with the public are expected to exhibit empathy and act as moral stand-ins.

My study of a public teaching hospital’s nursing staff found that, contrary to the conventional belief that spiritual care is the domain of chaplains, nearly half of nurses say they provide more spiritual care than these religious authorities. A large majority of nurses also said they were quite comfortable discussing spiritual questions about the meaning of life, illness and death; and they reported experiences at work that had a profound impact on their understanding of spirituality. These stories—about how nurses tried to help patients cope, for example, with disturbing test results—were often crafted in ways that not only made the spiritual plausible, but also suggested how science and spirituality can coexist.

Especially important, nurses who considered their work a calling interpreted a wide range of situations as warranting spiritual intervention and deployed a large set of practices, from prayer to simply being present, to care for patients’ needs. Thus, they were actively involved in reminding patients of their sacred selves in an otherwise dehumanizing environment.

To appreciate why care workers are so important to promoting the imago Dei, consider what the political scientist Joan Tronto identifies as the four phases of care: caring about (recognizing that care is needed), taking care of (determining who should administer care), caregiving (directly meeting needs) and care-receiving (how care is experienced by recipients).

In discussions about how to put the imago Dei into practice, it is tempting to focus on where care is needed (caring about) and who should provide care (taking care of). But this focus can exclude those who provide immediate help (caregiving) and are entrusted with dignifying the vulnerable (thus improving the experience of care-receiving). Sadly, this omission mirrors how care work tends to be distributed in the wider society: The easiest and most recognized tasks of care are performed by powerful actors, whereas the most challenging and invisible tasks are relegated to those with less authority.

Professional care work offers myriad opportunities to honor the sanctity of vulnerable strangers. It also requires applying protocols and techniques that can do the opposite. If people of faith wish to defend imago Dei, they need to let those who perform this balancing act on a daily basis into the conversation. Better yet, guardians of this ethic should immerse themselves in the world of care. There they can begin to fully appreciate the creativity and commitment required to implement a transcendent, universal ethic in a real-world setting. They may come to realize that if vulnerable strangers are to be revered during a time of religious decline, it will likely depend on secular workers who are charged with the sacred duty of caring for all.

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