On the Concepts of Religion and Confessionality for Pastoral Care and Spiritual Care in Interreligious and Intercultural Contexts: Clarifications with the Help of Religious Education and Systematic Theology

Abstract

According to current consensus definitions in healthcare, religious aspects can be part of ”spirituality” but ”spirituality” is open to non-religious traditions as well. Nevertheless, spiritual care is often provided by theologically trained pastoral caregivers belonging to religious groups and institutional bodies. How, then, do we take “religion(s)” into account when pastoral and spiritual care finds itself within a context of a diversity of religions and religious and non-religious biographies? What function does “confessionality” have—except for the fact that spiritual care professions can also be educated at a theological faculty and thus graduates are familiar with confessional premises of the respective denomination institutions? What significance do these premises have as a basis or a target for research and the fields of action and for the self-understanding of chaplains or spiritual caregivers? Our contribution draws attention to the potential for the reflection on “religion” to inform an understanding of its role in healthcare. In this regard, the term “spirituality” needs some reflection as well. When investing in such clarification, we understand that “religion” and “confessionality” need to be considered with the idea of inherent principles or even as a principle and, thus, are valuable in view of the practice of pastoral and spiritual care. These theoretical reflections are developed on the one hand by comparison with confessional religious education in pluralistic contexts, and on the other hand from systematic theology, specifically with Paul Tillich’s idea of a “Protestant principle” as an open-minded way to bring together pluralistic challenges and the religious identity in pastoral or spiritual care encounters. Preoccupation with these terms as concepts is not only necessary but valuable to encounter the other individual with respect and sincere interest and thus opens up his or her individual access to the world and life and the inherent principles in a resource-building way.

1. Introduction

In our contribution, we want to shed light on the question of what kind of conception of “religion” is needed in the provision of and research on pastoral and spiritual care within diverse contexts of religions, and religious and non-religious biographies. In this regard, an open understanding of “spirituality” has to be reflected in its relation to religion. After this, we go a step further and discuss the concept of “confessionality” as it means more than mere denominational affiliation of pastoral or spiritual care provision. In order to understand these concepts within pastoral care and spiritual care encounters between two individuals in a religiously heterogeneous society, we look at two theological disciplines, i.e., religious education and systematic theology that have been dealing with clarifications of these “big concepts” for some time. Denominational religious education conceptualizes “confessionality” in the horizon of today’s interreligious and secularistic challenges. Systematic theology, furthermore, provides helpful thoughts like Paul Tillich’s concept of the human being as a being always related to an “ultimate concern”. Tillich correlates this to a definition of the Protestant type of religion that can critically examine every shaping of religion, i.e., its claims, its possibilities, and limitations.

2. Theoretical Background

Two observations point to the need for clarification in practical–theological thinking:

2.1. Definitions of Spirituality

“Sometimes, it seems to me as if the concept of religion is not clarified in theories of religious education,” states one of our students in our preparation class for the final exams, “practical theology and religious education”. We discuss this inquiry with the students and encourage everyone to clarify the concept of religion for their own approach to religious education at the time being. Even if we know the limitations of the “stipulative character” (Dieter 2021, p. 37, translated) of definitions of religion, it is nevertheless relevant to work on and discuss the concepts. This student’s inquiry about a “big” concept was not the only one: Our course mainly included students who insisted that we discuss the terms presupposed in theory before we examine specific concepts related to the respective field of practical theological work. Students wanted to know the meaning of “spirituality” in spiritual care and also in the life of a parish congregation. They wanted to understand terms like “secular” and “pluralistic” when practical theology deals with the fact that “we” live in a “pluralistic” or a “secular” society. In order to prevent simplistic statements about secularization or pluralization, terms like these have to be discussed in depth.

Concepts like “spirituality” and or “religion” need clarification even if there are limits to every definition. This is especially true in the theory and practice of pastoral and spiritual care, where individuals and their respective spiritual constitutions are supposed to be taken seriously.

Spirituality in healthcare, for some time now, has been at the center of the consensus-making process, leading to at least two similar consensus definitions. Nolan, Saltmarsh, and Leget published a consensus definition of spirituality that has been used by the European Association of Palliative Care since 2011: “Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred”. (Nolan et al. 2011, p. 88). In 2014, Christina M. Puchalski, Robert Vitillo, Sharon K. Hull, and Nancy Reller reported that within the United States of America, a national and international consensus had been reached in defining spirituality in healthcare: “Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.” (Puchalski et al. 2014, p. 646). Both consensus definitions agree in not explicitly mentioning religion, denomination, or denominational belonging in order to signal openness to both religious and non-religious spirituality, to be applicable to various and heterogeneous healthcare systems, and to enhance interdisciplinary research in spiritual care in healthcare. But, while in the field of palliative care and healthcare as a whole, spirituality may by consensus be used as an “open” concept, we never should stop asking “What is religion?”, like systematic theologian Ulrich Barth (Barth 1996, translated) did in a groundbreaking way years ago and again recently in “Symbole des Christentums” (=symbols of Christianity, Barth 2023). From a practical–theological point of view, it makes sense to problematize and clarify terms that are dealt with as cross-cutting issues in several fields of church-related action. This is the only way to ensure dialogue between fields and to ensure that specific fields do not become disconnected and develop their own logic. Especially in the area of spiritual care in increasingly interreligious and intercultural environments—such as in the healthcare sector—good conceptual work makes sense from a scientific–theoretical point of view and is theologically required. It enables integration and compatibility in the whole of practical theology.

2.2. The Concept of Confessionality

In addition to the concepts of “spirituality” and “religion”, there is also a need for clarification of the concept of “confessionality”. We prefer the term “confessionality” to the term “denominationality” because it represents a broader horizon as opposed to institution-oriented denominationality (for the use of the term see Anuleena Kimanen’s article about “Complicated confessionality” in religious education especially in Finland, cf. Kimanen 2015, pp. 130–31). To show the relevance of reflecting on confessionality, we can use an example from German school reality: It is striking that despite the declining number of church members and the mistrust towards the church as an institution, parochial schools are increasingly popular (Abdel Aziz 2023; Amendt 2022). The Evangelische Schulstiftung (=Protestant School Foundation) in Middle Germany states that “more and more parents want” education in Protestant-led facilities (Eberl n.d., translated). What do parents mean? The Schulstiftung tries to explain as follows: “The parents’ wish for an orientation towards Christian values for their children is the top priority. Children should be empowered for a life of self-responsibility in a rapidly changing world.” (ibid., translated). Does this statement clarify the previous assertion? How is Protestant orientation related to religion? Does religious education and schooling merge into a comprehensive concept of Christian value orientation in a similar way as it is sometimes claimed of “religion”/”religiosity” in relation to “spirituality” in the area of spiritual care? These questions show how important clarifications of such “big concepts” are. What applies to school in this example, in our view, applies no less to pastoral and spiritual care: the societal and postmodernism demands are similar.

3. Methodology: Clarification of Concepts as a Theological Task

Even if ultimate clarifications of these big concepts are not possible, it certainly makes sense to at least invest more in working on them in practical theology and in the fields of church action, so that they do not become completely indeterminable “container-concepts” (Baumann 2023). The concepts of “spirituality”, “religion", and “confessionality” for pastoral care and spiritual care, respectively, require such an effort, both in practice and in scholarly development in the context of teaching and research. With regards to practice: As in many countries, denominational providers are major stakeholders in the healthcare market in Germany—every fourth hospital belongs to a non-profit provider of either the Deutscher Evangelischer Krankenhausverband (=German Protestant Hospital Association), DEKV, or the Katholischer Krankenhausverband Deutschland (=Catholic Hospital Association Germany), kkvd (Verband Christlicher Krankenhäuser in Deutschland n.d.). With regards to theory: It is not only students at Münster University who quite rightly demand this disambiguation, but it is also a concern of practical theology as “public theology”, i.e., practical theology, transfers academic theological concepts and puts them into practice in the public sphere—such as the secular healthcare system—to represent and assert these concepts. According to Thomas Schlag—who examines the concept of “public church” (=“Öffentliche Kirche”)—the work on conceptual clarifications, the awareness of complexity in all fields of action, and the systematization of the same in theorizing is first and foremost the task of practical theology (cf. Schlag 2020, pp. 88–89). This explains the close cooperation that exists nowadays between practical and systematic theology, which is mentioned by Schlag (cf. ibid., p. 87). Likewise, our contribution endeavors a theoretical clarification of the terms “religion” and “confessionality” through an intra-theological–interdisciplinary reference between practical theology and systematic theology (which is already laid out due to the theological background of the two authors) among fruitful insights of religious education.

But if we do live “in a pluralistic society”—to take up this term without further explanation—would it not be more necessary to try to understand and deal with the diversity of religions and worldviews common in healthcare in order to develop and practice patient-oriented and thus reality-oriented spiritual care instead of focusing on the explanations of abstract terms? Moreover, one could ask if “confessionality” or denominational affiliation is still relevant in the context of pluralism and contemporaneous individuality of spiritual biographies of religious and non-religious people. Does the denominational status refer primarily to spiritual care providers or is confessionality an issue that regards the patients as well? Even an open and subjective concept of spirituality like “Spirituality is—and only is—what the patient thinks it is” (Roser 2011) becomes identifiable in the pastoral communication process because pastoral care professionals introduce themselves with reference to their denominational background (“I am chaplain N.N. and come from the [e.g., Protestant] church”), which challenges the patient to an analog positioning (“I do not belong to your club, but …”). But does confessionality of the providers mean the explicitly made position in matters of religion and worldview—confessionality as positionality (“Positionalität”, cf. Schambeck 2020)—or is there more to it? These questions, which are increasingly raised in the context of pastoral and spiritual care, have been at the center of discussion within religious education in state schools in Germany, e.g., in the German federal state of Lower Saxony. The implementation of a generalist concept of Christian Religious Education (=Christlicher Religionsunterricht (CRU)) is the center of an ongoing controversy. If successfully implemented, CRU will abolish the previous denominational approach to religious education (Schulreferentinnen 2021) with consequences for academic training of teachers and denomination-specific theological departments in state universities. Similar developments could take place in the context of pastoral care and spiritual care in healthcare. Current developments take place between one extreme to provide only nondenominational spiritual care in public healthcare and the other extreme of strictly re-confessionalizing pastoral care (Straub and Huppenbauer 2021). We advocate for a position that believes that pastoral or spiritual care can be open-minded and heterogeneity-sensitive from a confessional tradition and its premises.

4. Results from the Theological Conceptual Work—Intra- and Interdisciplinary

(a) Interreligious and intercultural openness is based on educational concepts. Well known, but always to be kept in mind, is the demand that chaplains in the healthcare system continuously improve themselves in interreligious and intercultural issues in order to be able to be considered as competent practitioners, professionally educated contact persons in interprofessional teams and, at the same time, persons of trust for patients. In our opinion, this takes place within the framework of a theological—i.e., denominationally based education. It is a prerequisite to any relationship building with other individuals, in order to be respectful of their religious or non-religious affiliation, that one reflects one’s own spirituality, religiosity, and confessionality in an academically trained and critical manner. Currently, developed courses qualifying for future spiritual caregivers—such as the Master’s program planned at Münster University—will be theologically situated in this sense. In addition, for every interreligious or intercultural encounter, “the study of religions” as well as “the examination of social structures, role and communication patterns” (Wenz 2017, p. 121, translated) are essential. A high degree of specific expertise—i.e., knowledge of religious and cultural constitutions—is therefore equally as important as self-reflection, in various dimensions—like personal motivation, role understanding, and one’s own religious, confessional, or spiritual becoming and the conditions that determine or influence it—whether it follows theological reasons or biographical implications. Georg Wenz emphasizes the examination of biographical narratives that “[…] are central to identity constructs, to the determination of the relationship between individuals and collectives, to social gender and one’s own understanding of roles, to self-assurance, competitions, reservations, as well as to subliminal conflicts” (ibid., p. 123, translated). The intensified examination of these questions is sometimes identified with “spiritual care,” although actually every service in the context of pastoral care faces these challenges: “Interreligious and intercultural opening represents a first response. Spiritual Care is another” (ibid., p. 119, translated). This opening takes place when chaplains in healthcare institutions allow intercultural or interreligious encounters and do not intend re-denominationalization (=Re-Konfessionalisierung), as this not only contradicts the beginnings of pastoral care—as seen in the story of Jesus’ encounter with the Syro-Phoenician woman Mk 7 (cf. ibid., pp. 115–16)—but all pastoral–psychological concepts as well. According to Wenz, it contradicts “the theological horizon of pastoral care as well as its mission” (ibid, p. 123, translated). The interreligious and intercultural opening in the tradition of pastoral psychology not only applies to concepts of Christian pastoral care but also to those of other religions and worldviews. Current developments in Germany, such as the establishment of the first Muslim DITIB hospital chaplaincy training (cf. DITIB Presse 2022) or the established concepts of the Mannheim Institute (cf. Muslimische Seelsorge Baden-Württemberg n.d.), give reason to expect their own profiling, but they are no less related to a religious pluralistic context than Christian chaplaincy training concepts. Also, Wenz mentions Muslim pastoral care as “moving between inwardly oriented goals and intercultural and interreligious demands and tasks” (Wenz 2017, p. 119, translated).

(b) Nowadays, it is to be expected that chaplains should be well versed in the study of religion. But what about an equally competent understanding of the concept of religion itself? It is a task of all theological disciplines to provide students with a thorough understanding of religion that is informed both historically—i.e., regarding the cultures of the ancient Mediterranean or, for instance, from the perspective of the church and history of dogma—as well as sociologically and systematic–theologically in addition to other points of views.

This is all the more important as the concept of spirituality is sometimes used as an avoidance strategy, in order to avoid the “unbeloved” concept of religion, while, nevertheless, the constitution of the human being is determined as “homo religiosus”. Sometimes, chaplains speak about spirituality when working on a ward, even if they focus on religion in research and theological reflection. This shows a too-narrow understanding of religion and is a too-narrow response to the pluralistic contexts and, moreover, contradicts many concepts of spiritual care that decidedly combine the approach of a holistic view of the human being and the corresponding training that deals with different dimensions of the human being with religious, Christian-motivated, or denominationally constituted spiritual care (cf. Peng-Keller 2019; Roser 2019). The problem becomes apparent if an alleged open concept of spirituality is supposed to replace a clear concept of religion: This generates a defensiveness that neither benefits a concept of religion useful in research and teaching nor the overall concept of spirituality. Rather, it brings them into more and unnecessary opposition.

With regard to the clarification of “religion,” there are sometimes purposeful approaches that consider both the value of empirically observable religion, religiosity, and the concept of religion itself. For example, it has been Annette Haußmann’s merit in her dissertation “Ambivalenz and Dynamik: Eine empirische Studie zu Religion in der häuslichen Pflege” (Haußmann 2019) to not only describe how religion presents itself in the everyday lives of people caring for their spouses but also to draw important conclusions about the concept of religion itself. Religion presents or manifests itself in diverse ways, religion is “ambivalent” and can become a resource or enable the identification of resources, but it also includes or reveals chasms, hope and suffering, as already pointed out by Henning Luther (cf. ibid., pp. 474–77). Religion does not only have positive connotations; it cannot only be identified with positive “meaning”. The experience of meaninglessness cannot be excluded from religion. In any case, religion cannot be described without inherent processes: “Religion is itself in a state of flux and does not represent a static variable [=Größe].” Haußmann ably showed this “on various levels from cognitive attitudes to religious practices” (ibid., p. 470, translated). We share the conviction that complexity is to be emphasized: processes include experiences that are intrapersonal and interpersonal and can be observed psychologically as well as sociologically in religion and in the church. This takes place in and as religion. Certainly, such observable dynamics are known, but according to Haußmann, the concept of spirituality is often used instead of considering religion itself as a process (cf. ibid. pp. 469–72). Characteristics of its dynamic nature are often acknowledged in the larger sociological context and in the horizon of individualization and pluralization of religions. However, there is a lack of awareness of “[t]he inner-psychic component of changeable religiosity, which underly temporal change and developments […]” (ibid., p. 470, translated). According to Haußmann, one can refer to Wilhelm Gräb and Kenneth Pargament who represent a dynamic concept of religion. Gräb links religion and biography, whereby religion is to be thought of as flexible meaning making and interpretation of life (cf. ibid., pp. 470–72); Pargament describes a functional concept of religion in the context of “religious coping” as the dynamical process of adaptation with “search for meaning” as its content (cf. ibid., p. 470, translated).

Haußmann’s study shows that it is fruitful to critically examine the parameters of the use of religion, religiosity, religious affiliation, and religious practice within qualitative studies or with quantitative measurement instruments in the context of healthcare. However, when such studies are undertaken without the participation of theologians as is often the case, they run the risk of being oversimplified. However, in recent years along with empirical surveys on the efficacy (“Wirksamkeit” in German) of pastoral care and spiritual care, the terms “religion”, “religiosity,” or “spirituality” and their relationship to one another have also been sharpened (cf., for example, Höfler 2022; Bettenbrock et al. 2020). For many, “spirituality”, as mentioned above, is still more accessible than “religion” since spirituality has already been established as a relevant variable by other actors in healthcare, and the “spiritual dimension” of being human has been empirically underpinned and provided with corresponding implications for action (cf. the plea of Balboni et al. 2022). Additionally, the definition of spirituality should be expanded constantly; otherwise, the term becomes what is sometimes called a “container term” in a derogatory way. But “container term” may even have some potential as it leaves ample room for ambiguity, definition work, and consensus processes.

In our view, it is worthwhile to work with the well-informed knowledge of religious education since religion and religious development have already been intensively empirically researched there for years. Therefore, the results can be taken as a basis for conception (cf. Domsgen 2019, especially chp. 3). In our view, the pioneering results and elaborated concepts should not be reserved for the field of religious education. Again, we oppose the idea of a strict separation of the fields of practical theology. To give an example, we think that researching “theologizing with children” (in German, the term is “Theologisieren mit Kindern”, cf. Büttner et al. 2014) can also be helpful to grasp religious imprints more precisely, for example, with regard to images of God and religious practices. Existing studies can be applied to a practically relevant concept of religion in other fields. In addition, as Maike Schult points out, the critical examination of the images of God that were formed and developed is a lifelong task for professionals in the pastoral field. Only by reflecting on one’s own images of God among other “hidden influences” (translated) can the power or misuse in a pastoral encounter be critically examined. Supervision and collegial case consultations for instance are helpful in her view (cf. Schult 2021, p. 225).

The academic understanding of other religions or worldview options is, therefore, to be intensified, but at the same time, we have to keep in mind the above-described processual and changeable nature of religion itself and conduct research accordingly. Qualifications of religion such as “orientation”, “search for meaning”, or “overcoming contingency” have to be considered provisional if the “inner-psychic component of the changeable religiosity” plays a role. If, therefore, a “homo religiosus” can be ascertained, then it can be used with an empirical and theoretical understanding of “religion” as proviso. Nevertheless, let us tackle the task even if there is a prominent vote that advises against defining religion “in the singular” (cf. Theodor Dieter (Dieter 2021, p. 38), who refers to Carl Heinz Ratschow’s claim that emphasizes the reality of religion in the variety of religions).

(c) The variety of religions is reality and the processual, dynamic character of religion is reality as well; therefore, in this respect, we claim that it would be far too simple to emphasize “neutrality“ in the pastoral and spiritual care field, which is not plausible in terms of scientific theory. Even if many do not want to label existential questions, hopes, and suffering with the attribute “religious”—understandably due to the real danger of religious overpowering (=“Überwältigung”)—the pursuit of the clarification of these terms and their examination assists in understanding human beings. In this sense, we understand Bernd Beuscher’s plea, who—as an expert on religious education—emphasizes the need for “spiritual competence” (translated) for those working in palliative care. Religion and spirituality have to be dealt with in end-of-life care. Beuscher speaks of the “X-factor” that becomes repeatedly tenacious in palliative care. He describes the “X-factor” as the “variable that does not let the respect for the dignity of questioning [=“Frag-Würde”] of human life get lost” (Beuscher 2014, p. 560, translated). Beuscher claims “neutrality is not an option” (ibid., 561, translated), considering the relevance of dealing with the existential questions posed by human beings, which on the one hand are present in every conversation—i.e., one’s own inherited “worldview” (translated)—and on the other hand are imposed in conversation because existence frightens individuals (cf. ibid., pp. 561–62, translated). One cannot speak “neutrally” about fear and death or about existential conditions. Therefore, “professional relational work cannot do without reflected basic assumptions about the human being, God and the world and a reflection on the human existential basic position” (“eine Reflexion der humanen existenziellen Ausgangssituation,” ibid., p. 561, translated). The human being, God, the world—such relationship work can thus never be done without what we could probably link to the term “religion”; Beuscher himself speaks of “spiritual competence” and demands the acquisition of this competence, thus revealing theological underpinnings in the field of palliative care. Furthermore, according to Beuscher and others, the demand for religious and ideological “neutrality” in palliative care reveals misunderstanding in several ways: Caregivers and physicians will not be able to escape the “theological–philosophical problem” because of “existential anxiety” (“existenzielle Grundangst”, ibid., p. 562, translated) if they are interested in a relationship with the patient that is based on trust. This, in turn, is due to the fact that, according to Beuscher, these kinds of questions concern every human being and not only persons who are afraid of the physicality of being (“Leiblichkeit”) for instance (cf. ibid., p. 568). Beuscher clarifies as follows: “The spiritual competence pursued here, however, does not establish irrationality as a private pleasure, but a radicalization of rationality for the sake of the human condition” (ibid., translated). Beuscher, as we have seen, wants to advocate for an understanding of spirituality and thus stands up for “spiritual competence”. In our opinion, this simultaneously addresses another aspect significant for the relationship between “spirituality” and “religion” and is equally important for the relationship between pastoral care and spiritual care: Can “religious” content—“X-factor”, “God”, “the transcendent”, “the sacred”—be abstracted from a “spiritual” dimension? Can the topics—often decidedly associated with spiritual care—such as “values”, “meaning”, “Inner Peace” (a central factor of the Spiritual Need Questionnaire (SpNQ) by Arndt Büssing, cf. e.g., (Büssing 2019)) or “holistic view of man” be contrasted with the topics of religion, especially when the latter is to be understood as a dynamic and ambivalent variable? Does not “rationality for the sake of the human condition” even include the concretization that humans will eventually turn out to be “homines religiosi”? This is at least to be discussed and not immediately discredited as an attribution that is asserted by “religious people” only. To put it quite pointedly, and especially with an open understanding of spirituality, it does always come down to the question: “What is religion?”

In our view, not only can manifold, individual, and collective forms of “spirituality” be understood as central variables in pastoral care and spiritual care in pluralistic contexts, but also the multidimensionality of religiosity and “religion”, which need not be contrasted with the former. Empirical research—both in the health sector and in others, i.e., religious pedagogical fields—can enrich the discourse. Likewise, it is important to draw on theorizing in systematic theology. The complexity of the task is not only increased by “pluralization” and “individualization”; the processes are also complex, which are systemically, socially, and interpersonally different (for example, in the relationship between pastoral caregiver and the person who suffers) and need to be understood as internal processes as well. “Spirituality”, “religiosity”, and “religion” are the valid terms for this discussion—providing of course that they are determined. The complex and processual character applies no less to the horizon in which religion itself takes place. It is very helpful that the late Christian Polke emphasizes the “collective term” of pluralism (Polke 2016, p. 297, translated). If one talks about pluralism, one has to mention that it is a term that underlies processes as well (cf. ibid.). “Pluralism means nothing else than the way we catch hold of plurality because we live it out in each case” (ibid., translated). As a basic “social phenomenon” (ibid., p. 309, translated), its various—both positive and negative—forms express “lived sociality” (ibid., p. 310). Pluralism includes elements or dimensions like functions or interests (ibid., p. 301, translated) and thus it is important to consider these categories by talking about pluralism or a pluralistic society. It is a complex category because it includes “cognitive” and “ethical challenges” at the same time (ibid., 302, translated). The dynamics of the concepts take place in dynamic conditions.

Conscious of these challenges, we nevertheless go a step further and work on the basis of the preceding considerations on “confessionality” as a principle; however, we start with the idea of inherent principles of the Christian religion relevant to spiritual and pastoral care. The following discussion will take the form of three theses.

5. Theses for a Discussion

Thesis 1: First of all, let us state that “Neutrality is not an option.” In order to deal with existential questions in healthcare institutions one needs “spiritual competence”. Therefore, in our view, “religion” remains an important topic. We go one step further if we now speak of concrete manifestation of religion both in interreligious and intercultural encounters as well as in interreligious cooperation. The specific religion is significant not only because its traditions, teachings, and rituals can function as “offers” but also because—if experienced as a familiar or foreign religion—they can generate a potentially salutary effect, leading to a change in perspective. It is also significant because they are determined by principles that, when reflecting on them, make actions in the healthcare sector more fruitful: Simon Peng-Keller understands spiritual care—which he characterizes as a professionalized form of pastoral care for a specific context, i.e., the healthcare sector—as a necessary consequence of the Christian “healing mission”; therefore, “Christian pastoral care in healthcare […] is to be understood in this horizon” (Peng-Keller 2021, pp. 70–71, translated). The horizon is described by God who unconditionally turns to humankind and comes close to Jesus. The multidimensional salvific action of Jesus is recognizable so that “healing action” is the only consistent response of Christians and corresponds to the God revealed in Christ. This understanding substantiates the mandate for pastoral care in clinical pastoral care. Peng-Keller demonstrates that the development of spiritual care is Christian-motivated (cf. ibid., pp. 21–36); it is, without Peng-Keller using the term, essentially a principle that can be applied to the “new” challenges in the clinical field and to the demands for a holistic view of the human being. It also includes the spiritual dimension as stated by the WHO (cf. ibid., pp. 33–35). Peng-Keller refers to the “profile” of Jesus’ salvation work (ibid., p. 79, translated) as “therapeutic work”, a well-documented and not a negligible aspect of his ministry, which shows that God comes close to people; the profile is moreover universal and provided with the mission to the disciples and thus to the church. It is complex and situational; it shows “curative, rehabilitative, and palliative” (ibid., p. 80, translated) approaches that correspond to the different dimensions of humans and human suffering, which are granted by the Holy Spirit (cf. ibid.). Furthermore, the important triad of cure, care, and healing is recognizable in the New Testament (cf. ibid., p. 83). This triad further opens up approaches for Peng-Keller—and also in our view—through the interaction of the aspects that—together with the acquisition of expertise regarding the corresponding contexts as field competences—ensure patient-oriented therapeutic measures and ways of interprofessional cooperation that make healthcare better. This Christian foundation understood as a principle is valid and open to any perspective on being human and any perspective on the world.

Thesis 2: The idea of “principle” can be taken further and even be related to confessionality, which leads to our proposal in this article: That “confessionality” can be grasped as a principle at all has been demonstrated by religious education for quite some time. It has had to be re-examined not only because of current challenges—heterogeneity in the classroom, multi-optionality, and non-denominational students—but also for denominational religious education itself. Antonia Lüdtke and Uta Pohl-Patalong shed light on the major trends and conceptualizations on the topic of “confessionality” from a religious education perspective (Lüdtke and Pohl-Patalong 2018). Along with this, “the concept of confessionality is no longer primarily materially determined […]” (ibid., 87, translated). It is a principle and therefore not to be determined by its specific doctrine or form (cf. ibid.). If confessionality is reflected in this way, it can be concretized in the following ways: It can stand, for example, for “transparency” or “transparent ‘commitment’” in teaching to show ways “in which perspective religion is taught” (ibid., p. 88, translated), or it can also be claimed for subject orientation when confessionality indicates that the “searching” (=“Suchbewegungen”) of subjects can take place “within the horizon of a certain religious tradition” (ibid., translated). Furthermore, confessionality is considered a principle when “religious judgment formation” is made possible with it, whereby the teacher also functions as a “structural role model” (ibid., p. 89, translated). Other religious educators take the view that the ability of plurality is ensured via the “principle of confessionality”, if “religious dialogue competence” is practiced in dealing with different religions or alternative worldviews, with the emphasis on the relevant “simultaneity of religious identity formation and ability of plurality” (“Identitätsbildung und Pluralitätsfähigkeit”, ibid., 89). Lüdtke and Pohl-Patalong understand confessionality accordingly as a search process in the discourse on religious education (cf. ibid., pp. 89–90, translated). If, as a consequence, the ability to act in plurality takes place pragmatically in the form of teamwork (e.g., team teaching) and coordination of work processes and concepts between those responsible for the denominations and religions involved and, additionally, if this happens in cooperative forms of action and if all those involved work “at eye level”, the potential for the discourse of pastoral care and spiritual care in healthcare becomes apparent. It is challenging but it is possible. Pastoral care, at least in the period after World War II, began to cooperate with human and social sciences, eliminated rigid and confining dogmatic principles, and began to meet human beings with respect, practicing empathy or compassion (cf. Burbach 2014, pp. 218–23). Similar to the discussions on religious education, it is challenging to analyze the limits of working with confessionality: What about the use of rituals in an interreligious encounter? What kind of rituals? For Georg Wenz, this marks a boundary not to be crossed (cf. Wenz 2017, pp. 124–25). He emphasizes that “No Buddhist can distribute the Lord’s Supper, no Muslim can perform the Catholic anointing of the sick, no Christian can pray the Kaddish, no Hindu can recite the Koran. Where pastoral care includes transcending liturgical acts, it will have to remain confessional” (ibid. p. 125, translated). It is important to discuss forms of confessionality in the various fields of practical theology.

Thesis 3: The potential of this specific discourse on religious education to address the challenges of pastoral and spiritual care in pluralistic contexts should be obvious, but finally we want to ask whether the idea of principle cannot be considered with what might essentially constitute a confession. We consult Paul Tillich who has defined in different contexts and in several contributions principles of Protestantism and the Protestant as a principle (cf. for example, Tillich’s contributions: Tillich 1962). For him, it is a principle that did not simply begin with the Reformation, during which time it was formed as a denomination. It already existed before since it describes a process that must be inherent in the formation of religion:

“Religion, Christianity and Protestantism share an ambiguity of meaning which is rooted in the nature of the idea of God. Religion deals with God, whatever ‘God’ may signify in a special religion. But God, according to the message of religion transcends every human possibility including the religious possibility itself. Therefore religion, in order to deal with God, must always negate itself in the name of the God whom it affirms. Religion must understand the infinite distance between all its symbols, rites, acts and commands from the reality of the Infinite to which they point. If religion fails to do so it becomes superstitious and arrogant” (Tillich [1942] 1992, p. 248).

The history of religion as a whole is to be understood exactly within the handling of this challenge: the reality-oriented negation of any religious claim is repeatedly forgotten and religion constantly runs the risk of setting that which is taught and practiced absolutely. This happens although the Christian religion nevertheless came into being with the one, who, while becoming the founder of the religion at the same time emphasized the “end of religion” (ibid., p. 248) when he proclaimed the Kingdom of God (cf. ibid., pp. 248–49). This understanding, however, could not be sustained, and over time the nascent church developed the idea of “unbroken religious self-affirmation” (ibid., p. 249). However, protest rises: “prophetic” criticism against the hubris that does justice neither to religion nor to humankind. Protest rises, not only and decidedly in the Reformation period (cf. ibid., p. 249). Certainly, even this denomination is in danger of undermining the principle—the Protestant principle—and moreover, “negation” can be driven so far that nothing is said anymore. There have been instances when symbols and whole traditions were marginalized as a consequence (cf. ibid., p. 250): “The emphasis on the distance between God and religion can lead and has led to the loss of religion” (ibid.).

As is well known, Tillich represents a broad concept of religion (“Wherever an ultimate concern is expressed, there religion is expressed. Being religious is being concerned in an ultimate, unconditioned way” ibid., p. 248) as well as a broad concept of God, so that the concepts can also be applied in contemporary pastoral contexts in interreligious and intercultural encounters without imposing a particular God or belief in this God on people. This is possibly to be understood analogously to the “X-factor” considered by Beuscher. As it is there, one may want to justify it—or not. The fact that this concept of God is finally grounded in a God who, as “Being-Itself”—Tillich’s central term for God—determines the whole of reality and thus advocates ontological grounding—anthropologically and objectively, which we leave aside for the moment. It should only be clarified here that Tillich describes the Protestant principle as a principle which—if valid—will critically reflect religion and likewise one’s own acting in it. This principle can certainly be further differentiated, e.g., as Tillich speaks in this article of seven principles with which he characterizes in detail the relationship to the other areas of our life—such as art, science, but also politics—and thus emphasizes that all areas enter into a relationship with the divine and, therefore, secular areas do not need to be degraded. There is not such a clear distinction from a sacred area. (cf. ibid., pp. 249–53). Christian Polke emphasizes that Protestantism of course is not more capable of pluralism than other denominations, but historically and socio-culturally it has always had to face the thrusts of plurality and with its own different movements has been a plural phenomenon (cf. Polke 2016, pp. 299–301). Polke also works with Tillich’s Protestant principle to present his own concept of “pluralism as a Protestant principle”. We agree with Polke that Tillich’s approach to dynamic pluralism remains helpful (ibid., cf., pp. 305–9) and that a Protestant principle can promote an “open ethos of plurality” (ibid., p. 316, translated) through its inherent self-reflection and self-limitation. Empathic action is a consequence of taking the limits seriously (Polke uses Tillich’s notion of “fragmentarity” (=Fragmentarität) here, ibid. translated).

The potential of such a thought for the pastoral activities to be considered here becomes apparent in several respects, for example, when we remind ourselves of the unfortunate oscillation between confessional pastoral care and—in some way different, even if characterized as “neutral”—spiritual care; whether the latter is the “better option” actually reveals a completely misleading questioning. What does require consideration is what spirituality, what religion, and what confessionality can be, as well as what they contribute and what their limits are. In the end, it is a concern of affirmation of religion that arises from the impression of an “ultimate concern” and the value of its forms of expression and essential criticism in one. Pastoral care in the sense of a Protestant principle would, in our view, entail the recognition and appreciation of individual spirituality and religiosity as a resource and, at the same time, its critical questioning—for example, in the question of needs, hardships, stressful life events, or tendencies toward functionalization. And this does not need to be an assertion without content as there is a long tradition of practicing and acting with empathy and compassion. But a theological- and religious-studies-informed understanding of either empathy or compassion is anything but trivial. If empathy means “to accompany the process of self-exploration of the other and to be in resonance with it. Empathic understanding as a pastoral attitude wants to contribute to the interlocutors getting to know themselves better in order to find solutions together for the questions at hand” (Burbach 2014, p. 223, translated). This is also true concerning the interreligious and pluralistic situations today. Compassion is a central concept for Buddhist chaplaincy and Buddhist spiritual care (cf. e.g., Lee and Oh 2019), but also for the Catholic theologian Johann Baptist Metz and his concept of Christian world ethics (cf. Metz et al. 2000).

Neutrality as a forward-looking claim for the plurality of human constitutions, worldviews, and concepts of reality is neither a topic nor a program. “Religion” is then not to be relativized, even when it comes to conversations with non-religious people because the pastoral care person who has dealt extensively with “religion” will be able to talk about existential questions of any kind in a professional pastoral conversation characterized by trust. Analogously, but at the same time in a different way, this applies to confessionality, not only in order to make the affiliation of the chaplain transparent and thus to be able to be regarded as an “authentic” person who challenges the others to form their own judgments—or also to find their own resources in dealing with suffering—but also because one can discern principles that apply in every encounter. Whether pastoral and spiritual care declare and practice cross-disciplinary compassion as a principle, Christianity is accompanied by the principle of healing or the Protestant creed with its doctrine of justification serves as a principle, which does justice to the individual existence of every human being, or the Protestant principle is seen in its genuine way as the necessary protest that critically reflects on religion and denies absolute claims. In this case, the question of truth does not have to be avoided, as certainly one or the other religious educator associates with their own concept of confessionality, as do some systematic theologians, thus viewing religious processes from subjective concern without asking for justification. Paul Tillich, who pursues the search for truth, wants to combine healthy self-negation with the claim that the principles are true and still valid. This was helpful during Tillich’s time (cf. ibid., p. 252) and is equally helpful in the present as well as the specific question posed in this paper. In Tillich’s seventh principle—in reference to the rejection of “any definitive or final system of Christian ethics or politics”—we are told what should probably always be the case: Protestantism “applies the Christian message to every historical situation as the principle of criticism and demand” (ibid., p. 253). Therefore, our task is to apply this to the context—pastoral care and spiritual care in pluralistic societies—and thus to adapt the expertise in each case without relativizing the principles. After all, Tillich is also a good example of someone who decisively dealt intensively with the interdisciplinary knowledge of his time in order to pursue theological questions. This becomes especially clear in his concept of anxiety as a category of awareness, which incorporates quite different interdisciplinary insights into anxiety (from psychology, philosophy, and sociology) in his theological system with its anthropological premises. Even contemporary findings—e.g., on neuroscientific insights into anxiety—can still integrate this system with its ontological approach as part of an interdisciplinary process, just as in Tillich’s day (cf. Ihben-Bahl 2020). Tillich’s approach tries to open up the view to not only the threatening existence perceived by anxiety and thus the finite but also to the infinite and thus a God who embraces the mortal human, a human who can also become aware of this transcendent reality, therefore understanding oneself as a part of the infinite in contingent moments and thus able to walk the world with courage: the courage to be (cf. Tillich [1952] 2000). This approach can be taken up and work on the concepts can be carried out, which should then, in turn, interact with the (empirically based) findings from practice. Today, there are new results from more disciplines and more interdisciplinary work to carry out; moreover, the societal conditions will change because there is not a fixed situation of pluralism.

6. Conclusions

Pastoral care does not have to become more neutral—this may not even be possible in consideration of the “conditio humana”. Also, spiritual care is not inherently more neutral than pastoral care—whether it is anchored in a specific denomination or arises from other contexts. Contemporary challenges are addressed when the fundamental concepts are reflected upon; they need to be studied empirically and their guiding principles should be recognized and made transparent but also filled with content without being doctrinal or absolute. Intensive conceptual work is not to be preferred over intercultural and interreligious knowledge: the two must go together in order to engage with depth and do justice to every pastoral encounter.