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Thinking Nurse

This blog will reflect my interests in learning disabilities, nursing, nursing theory, philosophy and politics and my general interests in the arts and literature. (Nursing is an art as well as a science!) Philosophy and nursing have been intrinsically linked since the days of Socrates, his mother was a midwife, and taught him everything he knew!

Tuesday, February 15, 2005

Theistic and Humanistic Nursing

Theistic and Humanistic Nursing

As an atheist, and a humanist, my view of nursing differs fundamentally from those (perhaps the majority of nurses worldwide) who approach nursing from a theistic perspective. Bringing God into nursing however leads to huge logical and practical problems for nursing thought.

One theistic nurse, for example, writes: “I believe all humans are created in the image of God. For me this provides a rational basis for loving and caring for one another that is stronger than humanism's strongest (which still befuddles me)”

The theistic justification for caring for human beings is thus that they are made in the image of God, and God is more important than anything (including human beings).

The humanistic justification for caring for human beings is that they are human beings – and being human is what ultimately matters.

Theistic nursing is serving God, a spiritual quest expressed through the medium of the people who present as patients. Humanistic nursing is showing solidarity in a human way with other human beings

Putting a divine being above the human race, and arguing that the divine, the spirit, the soul, is higher than the human being has immense dangers. How many wars, massacres, genocides have been justified by claiming that these are spiritual ‘crusades’, with the backing of the divine? This is one consequence of placing the spiritual above the human.

Another danger is this question of the ‘ideal man’ – if we are made in the image of God, and we are all so different, some of us must be closer to the image of God than others. Traditionally religions have argued that men are closer to the image of God than women – one reason why they have resisted the idea of women priests. Presumably they also imagine that non-disabled men are closer to this image than men with disabilities, mentally stable men closer than people suffering from psychosis.

My theistic friend falls into this trap “ Even the mentally ill or deformed are still made in his image”, the words ‘even’, ‘still’ and ‘deformed’ speaking volumes about the theistic attitude to humanity.

A Humanistic view of nursing avoids this pitfall. For humanists, there is no ‘ideal’ human being. Humanity, in all it’s wonderful diversity, is a material fact that we accept. ‘Nothing human is alien to me’ was Terence’s humanistic, accepting and tolerant concept, expressed in 154 BC. If humanity had followed such sentiments think of the wars, witchunts and persecutions that might have been avoided over the last 2000 years, the human beings that might have been accepted instead of being shunned, or actively hunted down, by the theistic majority.

For humanists, nursing at it’s best, is an activity conducted by one human being, in a human way, with another human being. The nurse is attempting to open dialogue with the person in front of them, find a way to connect, as one subjective human being with another. This is all. There is no ‘hidden agenda’ of seeking to find the divine in another human being, or to serve God through that human being – the agenda is simply to find, and be with that person, for who they are. This makes humanistic nursing achievable, realistic, rooted in the material rather than seeking to ask nurses or their clients/patients to rise above or reject their humanity.

Of course this humanistic nursing is frequently not achieved. It is difficult to be human and behave in a human way, it is difficult to reject our programming and accept people rather than judging them, it is difficult to ‘be with’ rather than ‘do to’ in understaffed, bureaucratic, undervalued environments and to reject the social prejudices that divide humanity – even so, it is vital that we struggle toward it, for otherwise we become part of the system of prejudices, theologies, bureaucracies that exclude and oppress so many of the people that nursing serves.


At 10:44 PM, Blogger Ruthie said...


This post is very interesting to me. I'm a newly converted Quaker (although not a theist in the traditional sense of the word) and wannabe clinical psychologist. I also consider myself a humanist.

Like you, I want to enter a caring profession because I value human beings. I value them for who they are - not specifically because God made them or because I believe they are made in God's image. I would be kidding myself if I did not think that my spiritual beliefs played a role in my choice of career and in the way in which I carry out my work.

I think there is another dimension which I have experienced. Unlike your friend who said that even the mentally ill are made in God's image - I would almost go the opposite way and say that if we want to understand God, then we must seek to find him amongst those less fortunate than ourselves.

I draw a lot of inspiration from a particular story Jesus told where he talks about Christ's return and says, "I was hungry and you give me something to eat, I was thirsty and you gave me something to drink, I was naked and you clothed me, I was a stranger and you invited me in, I was sick and you took care of me, in prison and you came to me."

For me, those who suffer represent the divine to us. They represent the rawness of our humanity, that which is worthy of love and compassion not for what we do, but for who we are.


At 9:22 AM, Blogger Seyms said...

Dear Thinking Nurse,

Thank you for leaving a comment on my blog and following it up with this article in yours. I have been wanting to engage with a thoughtful nurse on this whole theistic/humanistic nursing debate. I knew if I exposed my deeper motivations in nursing that they would come in for criticism but I think it is a very positive process especially as you seem happy to discuss rather than shout "bigot" at the top of your voice - as some do.

I agree with Ruthie that in fact the sick and suffering tend to reveal more of the "divine" nature to us, I consider it a privilege to be allowed into their world and appreciate the need to tread very respectfully.

What I was hoping you might be able to explain to me is one more level of "why" humanists value humans for humans sake? What is the rational basis? What underlies that? In my experience, humanists come down to the fundamental that "being human is what ultimately matters". I say why? Why is being human what fundamentally matters? It has an emotional appeal and it answers a deep instinct that we all have for altruism but why do we have that instinct? Is it true that if I ask a humanist nurse "why" enough times the eventual answer is "because being human is what matters"? Whereas if I ask a theistic nurse "why" enough times the eventual answer is "because God" and this even explains why humans matter.

The other thing that bewilders me is why as nurses we are encouraged to think in terms of "holistic" care and told that this includes "spiritual" aspects of a person's being. Even though we are supposed to carry out nursing from an atheistic perspective we are still encouraged to consider "spiritual" aspects of care. How does this work staying within the atheist cosmology? Lately I have come accross a shift in practice since some research has shown that people with some kind of spiritual belief are mentally healthier (I'll find some references for this if you are interested). Off the back of this I have heard practitioners encourage patients in their own spiritual pursuits such as "going to church" even though from the practitioner's point of view the patient is deluded that there is a God at all. Again this seems too strange to me.

I hear your points about "if we are made in the image of God, and we are all so different, some of us must be closer to the image of God than others" but have to disagree that this is my way of seing it although I will certainly admit that some traditional religions have gone down that route. However, you highlighting my use of the words "even" and "deformed" was quite fair enough and this is a point at which I used a certain class of language to communicate something that came out badly. I am quite happy to be challenged on my assumptions there, so thank you. I should have put them in quotation marks myself to show that when I use those words I don't really mean them. You convey a very open attitude towards "neurodiversity" which sounds the death knell for such value laden terms as "deformed" and that's certainly an enterprise I will join you in.

However, I still remain to be convinced, while humanistic approaches may avoid some pitfalls such as witch hunts (which I believe were a frightening twisting of christian doctrine anyway), they are not without their own. I think a crisis is looming over how we view the "criminally insane", for instance. On the one hand the humanist wants to approach the serial rapist with a basic "fellowship" of being and humanity but at the same time has to (surely?) exercise a moral instinct. In practice we don't make the decisions to imprison and punish people and this leaves us free to cultivate therapeutic humanistic relationships but surely the humanistic world view has to hold for society at large - policemen, judges, the public - as well as just for nurses like us. I feel that a theistic understanding enables a more comprehensive working out and grounding for dearly held ideals of justice, compassion, morality, mercy, freedom. I also predict that humanists will ultimately be unable to extend the good altruism of their doctrine towards theists because theism is ultimately seen as the enemy of humanism - there may even be a war; though of course that would be the "theists fault".

Happy to continue discussion online or off. Really appreciate ongoing challenge and thought provoking interaction.


At 9:48 AM, Blogger Seyms said...

"Theistic nursing is serving God, a spiritual quest expressed through the medium of the people who present as patients. Humanistic nursing is showing solidarity in a human way with other human beings"

Yes ... I can see how my blog article would lead to this conclusion but protest that it is not the full story. I have a basic humanistic wish to "be with" patient's, too. Most of the time I am not at all conscious that I am on a spiritual quest - I am simply working out of the same basic set of impulses to care that a humanist has. I simply believe that those impulses were downloaded into me from a creator God rather than mysteriously appearing somehow through the evolutionary process.

Thinking aloud and appreciating the chance to develop thoughts.


At 1:39 PM, Blogger Thinking Nurse said...

Thanks Ruthie and Seyms for your comments. I think it is vital that ideas are discussed, and I am glad that this blog is becoming a forum can be a place where ideas like these can be discussed safely, and in a dignified way.

As an atheist I believe strongly in religious freedom, the right of all people with religious beliefs to practice their faith, without suppression. I do not believe in anyone's right to enforce their faith onto everyone else.

I do not see any need for a 'war' between theists and humanists. Humanists justify their ideas through evidence and rational thought. This means that when we are wrong, we consider the evidence, think rationally about it and change our minds. It also means that we can spread our ideas through persuasion and rational argument, rather than force.

Theists have historically justified their ideas through faith. No amount of material evidence would make them change their minds. Historically it can be shown that they have spread their ideas through force, force used against other theists from different groups and sects (The Quakers are particular victims of this), and force used against people who come up with evidence that contradicts their views. (Galileo for example).

Even today people motivated by their religious indoctrination are attempting to prevent children from learning scientific truths about the world, such as the theory of evolution, enforcing the teaching of creationism in a way that will keep a generation of children in ignorance.

There is nothing mysterious about evolution, there is a wealth of evidence for it, it is entirely rational and believable. The story that the world was created in 7 days can only be understood in the sense that it is exactly that - a story (and perhaps an allegory).

Ruthies argument that people with diseases, people with mental illness, people with learning disability, people in poverty and people who are suffering are those that most nearly represent the divine is simply a reversal of the first argument, and risks romanticising illness, mental disorder, poverty and suffering. It is similar to the belief that suffering makes us more holy, that by 'mortifying' the body we can benefit our souls. I have spent several years of unemployment, and can vouch for the fact that there is nothing spiritually uplifting about poverty, and doubt whether it applies to any other kind of suffering.

The division of humanity into 'body' and 'soul' is a dangerous one, from the point of view of health - we are human, we are one, not split into two seperate entities, one worth nothing, one worth everything.

Why do humanists value human beings for their own sake?
We value human beings because we are human beings.

Our species survived because we were able to show solidarity with each other, look after each other in the face of terrible threats. Some call it 'altruism', but it is an entirely self-interested altruism, because by caring for each other, we are caring for ourselves.

You ask about nursing being 'holistic' and considering 'spiritual' aspects of care. The word 'spiritual' is one I do not like, as it implies the existence of a spirit world, separate from the one in which we usually exist.

The people who advocate spirtuality in care say that it does not mean this, that finding a patient's spirituality means finding what is meaningful to them, whether this is a religious belief or not.

A clearer way of expressing this, I think, would be simply to call it 'human care', caring for a person in a human way, recognising their humanity and finding out and respecting what is meaningful to them - whether it is their family, their football team, or their religious faith (or lack of it!).

By calling it 'human care' it makes it possible for all nurses to deliver, whether they believe in a spirit world or not, a method through which they can express their own humanity, in the care of other human beings, and through respecting the uniqueness of other human beings and their meanings.

Evidence that people care, by virtue of being human, rather than because of their religious faith, comes from the fact that caring behaviour is common to all humans, of all faiths, and that convinced atheists (like me) can care about people too...

Some of the issues in this discussion are touched on in this earlier post:

Thanks again to everyone who has commented on this post. Human beings have a deep need to communicate and think, the more we do it, the more we consider the needs and views of other people, which must ultimately make us better carers, mustn't it?

At 1:39 PM, Blogger Thinking Nurse said...

This comment has been removed by a blog administrator.

At 6:45 PM, Blogger Ruthie said...

Indeed TN - this is a fantasic blog and I'm really enjoying reading some of the dialogue that is going on.

I think we may be more similar than we realise. As a Quaker I also believe strongly in religious freedom, and believe people must make up their own minds and do not seek to influence anyone to follow the same path that I do. There is no need for war, but certainly, I think dialogue (even debate) is very helpful to help us clarify our own thinking and become more understanding towards alternative perspectives.

If you believe that no-one has the right to enforce their beliefs on others - to what extent would you actually want to spread your own ideas through persuasion and rationality? (Some atheists I've met are as evangelical as the fundamentalists :P - but, I don't really get that impression from you!)

I don't think theism automatically leads to forceful proselytisation or to violence against dissenters. It can lead to that - I've witnessed huge amounts of animosity and perseuction within the church - but I don't think the two necessarily go together.

"Ruthies argument ... risks romanticising illness, mental disorder, poverty and suffering."

Perhaps - but a few weeks on the job in any caring profession would be enough to strip you of any romantic notions.

My faith is ultimately very humanistic in seeing the value of each human being and is a source of strength and inspiriation in my work. It is a reminder to see the personhood and dignity in the people I work with.

"It is similar to the belief that suffering makes us more holy, that by 'mortifying' the body we can benefit our souls."

Most certainly not! I do not believe this for a moment and would be very disturbed if I met someone who did. I think what I see in those who suffer is a rawness of life, and it is in the alleviation of that suffering that I find a sense of the divine or ultimate meaning - not in the suffering itself. Suffering happens - it is not holy, it is not good, it is not righteous and it certainly should not be sought out. However, when I am with someone who is suffering it is a reminder, for me, of my own humanity and the value, dignity, fragility and worth of human life which is often easy to forget in the rat race or in my own condition which is currently relatively free of suffering. I consider myself fortunate in this.

I'm currently working in New York City in a big private clinic doing some research. There's a whole lot of money around here and to be honest there are times when I feel very frustrated and uncomfortable with it. My favourite part of the week is on an evening off when I head down to a shelter for homeless young people. Believe me, its not glamourous and I hold no romantic notions about their situations. But the zest for life that they have, the appreciation for the small things and the will to perservere on is something that really challenges me and pushes me to find that which is truly valuable. I am grateful for the relationships I have with them and hope that in some small way my presence with tham and whatever practical help I can offer goes some way to improving their lives.

I agree with you entirely that the division of humanity into body in soul is very unhealthy, and also inaccurate. My faith inspires me to value humans for their own sake. When I refer to the "spiritual" I certainly don't mean some separate plain of existance. For me, the spiritual is the mundane and my faith is my way of affirming the whole of life as being of value and worth - my faith is the whole of my life and my worship is to live fully rather than to pray or perform any specific "spiritual practices". I often say my work is my spiritual practice in that it aims to care for people and the whole of their lives - be that their health, their state of mind, their relationships, their friendships, their personal interests or their chosen faith.

Perhaps this is not a millions miles away from the concept of 'human care' as you have described it.

I'd be interested to hear how you find interacting with patients who have a strong religious faith?


At 4:27 PM, Blogger Seyms said...

I'd like to say another word for the theists but not too much more since this might stray far from nursing and the discussion be more appropriate elsewhere. I agree that sickening atrocities have been done in the name of God but these seem to get more press than the contributions of theists and more specifically christians in history. I could name the invention of both nursing and social work, the abolition of slavery and the invention of empirical sciences for instance, as well as a strong influence in the foundation of the education system and the welfare state.

Science is an endeavour originally grounded in the theistic assumption that there are laws that govern the universe and that they can be measured and discovered. It is a process by which hypotheses are formulated and tested by empirical methods in order to come up with a theory.

Evolution is a theory that is not empirically testable because it is not possible to devise experiments that last for millenia. It is a good theory that I largely accept because it fits the known evidence very well but it cannot be called "scientific truth" and on its own is not a sufficient explanation of the diversity of life.

Having studied physical anthropolgy, primate evolution and specialised in primate behavioural ecology at university (this last bit was great I followed a group of monkeys in the wild for five weeks in order to glean some data that might shed light on early humanoid social behaviour), I learned one thing more clearly than anything else. "Nobody knows for sure" - this month, papers will be published that tear down much of what was assumed last month. While this is the case we need a bit of humility about calling evolution a "truth".

I don't have a problem with it as a theory but it is contrary to the spirit of enquiry, that must prevail in all true science, to speak of it as dogmatic truth. To believe in it requires faith, too, because it is not observable. Scientists working at the cutting edge are still divided as to how speciation occurs, for instance. We just have to trust that it does ... somehow.

I guess we have come a long way from nursing but this is probably the proof in the eating that as you say, "Nursing is an incredibly diverse and exciting sphere of activity. Nursing penetrates into every aspect of life, every social sphere."

Keep up the good blogging :-)

At 8:55 PM, Blogger OMF Serge said...

Hi Thinking Nurse,

You do not have trackbacks, so I wanted to know I posted a response to this post on my blog, Imago Dei.
Best of luck in your training.



At 9:45 AM, Blogger Thinking Nurse said...

Here is my reply to Serge's criticism of my post:The kindest thing that could be said about your criticism of my arguments is that it is intellectually lazy. A more unkind interpretation would be that it is downright dishonest - a dishonesty perhaps justified because it is perpetrated 'in the service of God'.

What you do, rather than answering my arguments, is to make a false amalgam between my viewpoint and that of Singer. You have tied my argument by the ankle to a straw man, then knocked down the straw man in the hope that my arguments will fall with them.

You associating my ideas with Singer's, on the grounds 'they are both varieties of humanism', is just as ridiculous as me associating your ideas with satanism, on the grounds 'they are both varieties of theism'. It is quite clear that Singer's ideas are the precise antithesis of my own, as you would have learned if you had bothered to read my original post properly, or to read some of the other posts in my blog, particularly those that criticise eugenic arguments - I.e. the posts on Margaret Sanger, the post on the Gassing of Aloisia V, the post on neurodiversity.

Eugenics and Singer are the antithesis of humanism - rather than accepting humanity for what it is, which is what humanism advocates, it divides humans into 'fit' and 'unfit' - just as some christians divide humans into 'saved' and 'damned' - in many ways perhaps it these christians who are closer to Singer than me.

At 3:00 PM, Blogger OMF Serge said...

Thinking Nurse,

Thanks for your reponse. You seem to have misunderstood a few of my points - which is probably more a function of my unclear writing than anything else.

I believe your personal view, in which you have decided to dedicate a major portion of your life and talents to human beings that are not as abled as some of us - is an example of what is right, good, and beautiful in this world (I hope that is clear). I wholeheartedly agree with you that human beings are valuable based on the fact that they are human beings, and not on their abilities. I've called that intrinsic value, and it is the basis that human rights are grounded. I believe we are in complete agreement on that. I suppose we agree on the epistemology of human value (we agree they have intrinsic value), just not on the ontology (where we derive that value). (If I have these terms wrong, someone please correct me)

I agree that your views and Singer's are in direct opposition to each other. I am not arguing based on guilt by association. However, Singer is held by humanistic organizations as an exemplar of their beliefs. Another example is the British Humanist Association (I wonder if you are a member), which states:

Humanist professors today include Antony Flew, Peter Singer (perhaps the most widely read current writer on ethics), Richard Norman (philosophy) and Sheila McLean (medical ethics and law).Although Singer's beliefs are not compatable with yours, they appear to quite compatable with humanism. You have made the opposite claim (his views are not compatable with humanism). Why is he listed there? Is it you or I who have misunderstood humanistic ideology? Your comparison of Singer to Christianity would be very offensive - to Singer. In his book "Rethinking Life and Death", he clearly states that his ethical beliefs are completely antithetical to the Judeo-Christian idea of ethics. His book states that notions like intrinsic value of human beings are remnents of the past and need to be rejected.

Christian theology, especially the doctrine of Imago Dei, states clearly that all human beings have intrinsic value regardless of their abilities. I tried to make this clear. I would agree with you that some who claim to be Christian do not treat other humans in this way. I would also agree that the way you have chosen to live your life may be more consistent with this belief (intrinsic value) than many theists that you know. I question whether it is consistent with humanism as defined by humanistic groups.

Maybe you could point me to some humanistic writings that would support your idea of intrinsic value of all human beings. I would be interested in that.

Thanks for the interaction, I'd love to have it continue.


(crossposted at Imago Dei)

At 12:03 PM, Blogger Thinking Nurse said...

I would argue that Singer can fairly be described as an atheist, as atheism is simply an acknowledgement that there is no God, rather than a developed belief system grounded in human values. However, because Singer argues that human beings cannot be valued simply by virtue of their humanity, this would disqualify him from any claim to be a 'humanist', as valuing the (real) human rather than the(fictional) divine is a key part of any definition of humanism.

The Humanist magazine, for example defines humanism thus: "Humanism is a rational philosophy informed by science, inspired by art, and motivated by compassion. Affirming the dignity of each human being, it supports the maximization of individual liberty and opportunity consonant with social and planetary responsibility. It advocates the extension of participatory democracy and the expansion of the open society, standing for human rights and social justice. Free of supernaturalism, it recognizes human beings as a part of nature and holds that values—be they religious, ethical, social, or political—have their source in human experience and culture. Humanism thus derives the goals of life from human need and interest rather than from theological or ideological abstractions, and asserts that humanity must take responsibility for its own destiny."

Humanistic values thus come from 'the dignity of each human being', 'human rights','social justice','human experience' and 'human needs and interests'.

Humanism is a thread that goes right back through philosophy - Cicero for example argued that human beings were caring simply by virtue of their humanity well before the birth of Christ.

If you want to debate whether humanism or theism is the best grounding for nursing, I would suggest that you address yourself to these ideas, rather than thinkers like Singer, who reject the value base of humanism, for their own reasons.

I discuss some of these ideas further, and apply them to modern nursing in my post "A Charter for Human Caring in Nursing"

At 9:53 AM, Blogger Thinking Nurse said...

In the news this morning that the US and African wings of the Anglican Church are about to split away from the CofE over the issue of Gay clergy.

It seems christians themselves cannot accept the point that imago dei is trying to make that all humans are made equally in God's image - if they were, they would all be equally capable of administering his sacraments - wouldn't they?

At 2:00 AM, Anonymous Steve said...

Dear Thinking Nurse,

You wrote,

It seems christians themselves cannot accept the point that imago dei is trying to make that all humans are made equally in God's image - if they were, they would all be equally capable of administering his sacraments - wouldn't they?Clearly, the question comes down to the church's position on homosexuality. Those who openly go against the teaching of the church on the doctrine of marriage (and human sexuality broadly) should not expect to participate.

That's equally true of corporations, though. Employees who deviate from company policy should not expect to have leadership positions given to them. Yet this in no way implies that anyone is less human.

Furthermore, there are a number of secular thinkers who oppose gay marriage, and if such people formed an organization whose goal was to promote traditional marriage, no openly gay individual should expect to play a significant role in that group, either. This would not mean that homosexuals were of any less significance in their eyes.

Thanks for your thoughts,


(cross-posted on Imago Dei)

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