Abstract
What a friend we nurses have in Jesus. ‘The blind receive sight, the lame walk, lepers healed, deaf hear, dead are raised, the poor have good news brought to them’ (Matt. 11:2-5). Our Great Physician frequently addresses the fullness of those who come to Him—their spiritual and physical health. The Christian nurse is explained by Alisha Mack and Charles Camosy as more than one who offers care and comfort. She is the hands and feet of Jesus (p. 30), and becomes a way for those who hurt to experience God. It is these profound ideals that call many to the profession of nursing. In this review, I walk through the themes I saw emerge in the book, review the strengths and weaknesses, and discuss the idea/role of the Christian nurse.
Nursing has a religious foundation, beginning with monks and nuns who established centers of healthcare in the ancient and medieval world. Many converted to Christianity during historical plagues due to the expectations of being cared for by the Christian community. In the late 1800s, Sister Mathilde Coskery of the Daughters of Charity of St. Vincent de Paul wrote what is now considered to be the comprehensive document describing the nursing profession (pp. 17–18). Florence Nightingale later had connections to similar groups and is largely credited with founding the profession as we know it.
Mack and Camosy present the first Christian study in bioethics for nurses. Most nurses have some sort of religious background, so it is fitting that this book is introduced to the academy. Their work is rooted in the beautiful picture of Jesus caring for the whole person. Nurses routinely carry out most of the services listed from Matt. 25:35-40: ‘I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me’. Mack and Camosy note the time dedicated to healing in the Gospels. Indeed, a third of the New Testament includes narratives of Jesus’ miraculous healing.
The authors present the Good Samaritan as a bioethical ideal, extending the Christian lens available to nurses beyond Matthew 25. Importantly, the Good Samaritan allowed an interruption in his day, and showed great compassion. Interruptions are inevitable in a nurse's day. And perhaps, as Christians, we should anticipate such interruptions to better address needs in front of us the way Jesus taught us to do. During the pandemic, for example, nurses were called to jeopardize their own health and safety to care for their communities—a display of profound compassion—and interruption—in the healthcare field.
But while many nurses and healthcare workers are religious, wider public discourse commonly questions whether the practice of contemporary medicine ought to be a purely secular enterprise. This is complicated because there is a spiritual component to what nurses do. Nurses do more than fix organic machinery—an almost humorous idea the authors repeat to demonstrate the enormity of nursing duties (pp. 33, 46). Nurses care for patients often in the most vulnerable, significant parts of their lives. Consider final days’ hospice treatment: when death becomes imminent, it is then that medicine fades to the background, and spiritual care takes the foreground. The question of separating one's religious inclinations while at work is a tall order, as discussed in the section beginning page 46.
Even if one was able and willing to leave religious inclinations/moral sympathies at the door, is this a good practice? In chapter 3, Mack and Camosy attribute the origination of the faith vs science debate during middle school science, where young people first consider evolution vs creationism, and develop a feeling that the dichotomy is rational; that there is science, and then there is a superstitious/irrational spirituality they may belong to, but keep hidden in their careers and in their bioethics. This is, of course, problematic. In the end, everyone on a hospital ward, from ‘atheistic anarchists’ to ‘Bible-focused evangelicals’ have their own opinions and definition of ‘good’. There is, then, no way to truly practice a completely ‘secular’ medicine (pp. 48–51). This was a fascinating discussion where the authors surely could have spent more time.
A Christian nursing ethic must also consider what Matthew 25 calls the ‘least of these’. How did the least among us become that in the first place? Mack experienced first-hand how social status, criminal status, and financial status impacted the care patients received. She tells a powerful story of caring that led to a patient saying she was the first nice person he had ever met in his life. Boutique medicine and refusing to take Medicaid patients are evidence of the market rearing its ugly head in medicine. While written from a North American perspective, questions about how our healthcare systems serve the rich and privileged at the expense of the poor and marginalized are increasingly relevant elsewhere, even in the UK.
A patient with a myocardial infarction is given a standardized concoction of aspirin, oxygen, nitroglycerine, and pain medication. While a doctor prescribes and a nurse administers, the nurse is at the bedside, performing the art of nursing that this book so wonderfully portrays. It is these moments where the patients are so very different from each other, their families, their individualized needs. It is the nurse at the bedside who notices the tearful wife to the side and provides comfort—an act that is unpaid for by the business of the medical establishment, but a moment all of society will expect and appreciate from the nurse. It is the spiritual act of compassion, of being the hands and feet of Jesus, of caring for the least of these, in their moment of sickness. Nurses care for the least of these, who sometimes aren’t the patients at all—they are the families.
A thread throughout this book is the role of the nurse (and subsequently, the ethics involved) (see, for example, pp. 26–33, 64–65, 74–78, 101, 127, 144, 158). One role the nurse has is communication with caregivers/family members. This is a fluid role and requires constant reassessing, such as how end-of-life situations require more communication with family and less with the patient. The nurse must be trusted by the patient and caregivers to be an effective part of the healthcare team, and the dissemination of information demands time, administration, and the emotional energy required to do this cannot be underestimated. Nurses also play the role of advocate through their communication. Receiving unanticipated news is often laced with deep emotions, requiring time and processing to work through. Perhaps the patient is weighing options of potential treatment, and chooses to discuss these with the nurse. In these moments, the nurse may be asked their own informed and educated input, or may be a listening ear—either way, this is a way for the Christian nurse to inhabit the Christian ethic in their work. Questions about a procedure or diagnosis often come during evenings and weekends, or when the physician is not on their rounds, which rightly so, is most of the time. Nurses, then, require such a framework to guide their words and actions. This may be the decision to perform, or not perform, an ethically questionable procedure.
An issue highlighted throughout the book is the difficult position whereby a nurse is tasked with following the doctor's orders, and has their own personal thoughts and beliefs that may contradict said orders. The authors touch on the concept of ‘opting out’ (pp. 162, 171) if a nurse feels a procedure goes against their religious conscience. Physician-assisted suicide is one of several examples discussed (pp. 65–66, 172). The authors ought to be mindful here of the fine line they balance. The hope of avoiding a violent death through means such as physician-assisted suicide is widely supported. However, as recent developments in Canada remind us, this is a slippery slope, and the book would have been stronger with more detailed discussion on physician-assisted suicide. What the authors propose, in contrast, is the idea of ‘accepting death but never killing’ (pp. 64, 98–103). This may be the idea I struggled with the most in the book: that a decision not to pursue treatment may end in death, and it seems that sometimes that is seen as violent, and other times, that is seen as honorable. That said, the book ends with a fascinating idea that, if no one can be found to do an elective abortion because nurses or others are refusing, that is in fact a good thing.
Returning to the reality that nurses carry out orders written by physicians is the example of Baby Doe (pp. 78–84). In this situation, nurses were at the bedside caring for a dying child after parents refused treatment. Because carrying out a physician's order is still a large part of nursing, and the patient has the right to their own decisions in their care, the case study of Baby Doe ultimately leaves the reader feeling powerless and is ultimately unhelpful. The dilemma remains that nurses are caught in the middle, performing care they may disagree with, or feel moral distress about, caught between the family and the physician. Still, the example is a practical way to teach Christian nurses how to inhabit a Christian ethic at work—the nurse was there to act as communicator and advocate in the Baby Doe situation. Another role of a nurse is the difficult conversations with patients and families when doctors are not present. The nurse once again is the unsung hero, the one at the bedside as the infant draws its last breath, long after the other members of the family and healthcare team have gone home or returned to their offices.
Predictably, a weakness of the book was that certain sections read like two separate books, one written by a healthcare leader and the other by a theologian. The book jumps between medicine and theology, and did not always accomplish marrying the two.
And yet this is an academic book which at times brought me to tears. It is informative in a technical sense in terms of bioethics, but what I appreciated most was how it explored the difference that Christian faith can bring to nursing in a practical sense. Thus, bioethical principles like the Imago Dei are embodied through the book's explorations. More books like this, co-written between theologians and practitioners, would be valuable. What is true for nursing is surely true for so many professional vocations: We care for the whole person in front of us, made in the image of God.