Commentary on Paley J (2009) Religion and the secularisation of health care. <i>Journal of Clinical Nursing</i> 18, 1963–1974

All propaganda or popularization involves a putting of the complex into the simple, but such a move is instantly not constructive. For if the complex can be put into the simple, then it cannot be as complex as it seemed in the first place; and if the simple can be an adequate medium of such complexity, then it cannot after all be as simple as all that. Had we written what was attributed to us in the article ‘Religion and the secularisation of health care’ (Paley 2009), we should indeed be concerned. However, to the extent that our arguments were misrepresented (or perhaps simply misunderstood), we felt it important to clarify what we are arguing for and the ‘precise nature of our ambitions’ (p. 1965). Few would resist the claim that religion, or at least political forces or personal ambition shrouded in religion, have perpetrated untold evil and oppression. However, the temptation in our current day is to adopt a binary whereby religion becomes the vessel blamed for all evil in the world, and some other idea, whether that be secularism, humanism or something other, becomes the shining representation of equality, compassion and social justice. Simplistically demonizing certain locations, while idealistically portraying others, fails to represent adequately the competing tensions of justices/injustices and compassions/disinterests that characterise individual and collective human endeavours. In the specific case of religion, both the power for social exclusion and inclusion (and all variations thereof) need to be accounted for. Rather than resorting to inaccurate binaries, there is a compelling need to engage the implications of ideas, particularly those ideas that have captured the popular interest, such as the idea of spirituality in nursing. Critical thinking must co-exist with ideas rooted in specific claims, whether theological or otherwise, within a professional practice discipline such as nursing. Patterns of religion, sacralisation and secularism are complex. One can begin from a secular or religious location and argue for a global resurgence in religion or a global progress of secularisation. The literature one uses, the way in which secularisation is defined and, perhaps most importantly, the particular social context informing one can build a convincing argument either way. However, that is not the fundamental argument from our perspective. Whether the world is primarily religious or secular is irrelevant when we are called to care for a patient for whom religion and/or spirituality (R/S) is an important part of their identity. Indeed, the very complexities that cause scholars to argue for or against a global resurgence of religion are often mirrored at the individual level where R/S values and beliefs can be both a source of comfort and pain in the midst of illness. Inevitably, these beliefs affect how patients construct, cope with and make decisions in their healthcare experiences. A deeper understanding of and engagement with this complexity is the basis for individualized, respectful care. Further, the R/S views that healthcare providers bring to the discipline add another layer of complexity. As a discipline with a public trust, nurses need to account for the various ways in which R/S influence health and healthcare provision, and we need to do so from a multiple of perspectives, including, but not limited to, secularity. To assume that secularity can provide a single viewpoint out of which to address R/S is overly simplistic and is characteristic of the propaganda and popularization that Engleton addresses in the quote cited above. In the face of the complexity of R/S in a pluralistic world, we agree that it is essential to ground theorising and practice in all that can enrich our understanding. In light of the limited space available in a single publication, we chose to highlight theology and philosophy both because of our positions as scholars influenced by the tradition we know best, Christianity, but further because these disciplines have extensively engaged the ideas operating in the spirituality in nursing discourse. Likewise, sociology of religion provides the key insight into social trends in relation to the influence (or lack of influence) of religion, and lived religion and spirituality in relation to health and illness. However, this in no way discounts the valuable contributions from those of other disciplines or other religious traditions who may not identify with the term ‘theology’. Our main point is that it is impoverishing to leave behind centuries of thinking that have enriched understandings around R/S. Indeed, in the evolution of human thought, our understandings are not only enriched by ‘good’ thinking, but sometimes even more so by ‘bad’ thinking that propels and motivates us forward to realize a new vision. Finally to the precise nature of our ambitions: our intention is not to argue for a Christian theological perspective, nor do we intend to argue against any other perspectives (such as secularism). Rather, we argue from one Christian theological perspective while inviting further dialogue from a variety of other perspectives so as to enrich the dialogue. We aspire to move beyond partisanism or sectarianism to engage with the range of ideas that contribute to understanding the complexities of R/S. We engage from a location we know best, Christian theological understandings, but we welcome, indeed feel it is essential in a pluralistic society, to particularise and reflect from multiple traditions. Our hope is that, collectively, we will thoughtfully and creatively provide a place within health care where individuals can draw upon and express their full range of identity, including the diversity represented by gender, ethnicity, sexual orientation and religion/spirituality.

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