"Freelance ritualists! Sports as ritual! What business do these topics have in your journal?" The answer to this question is as complex as it is simple: It's a moral obligation.

Those who study rituals make the obligation plain: ritual actions in the medical setting can promote or undercut healing and human dignity. In this issue of the Bulletin, we highlight routinized healthcare practices — repetitive, unconscious behavior that some theorists term "ritualism." Our interview with Pamela Sankar about her study of informed consent rituals in medical research reveals subtle yet coercive manipulation of desperate patients. Ed DuBose's case study examines hospital infection control policies applied in a nonreflective, ritualistic manner that diminishes healing. Ritualism in the medical setting needs to be recognized and eliminated before it can harm.

Navajo sand painting - Slayer of Alien Gods (detail)

As for a positive obligation for ritual actions — those applied in a reflective manner that some theorists call "ritualization" — this issue of the Bulletin depicts ritual actions that provide order as patients experience loss of meaning, that build community where patients are isolated in suffering, and that transform patient and family hopelessness into hope. In a risky move, this issue also features some freelance ritualists — as they might be called — to make explicit that novel rituals can build community and meaning at an apprehensive time such as childbirth and that rituals can comfort even in the face of the inexplicable loss of a young child.

Rituals can be perceived as just an extra, wholly unaffordable within health care. Worse, offbeat rituals can be dismissed with a conclusion that there is no moral obligation to take them seriously or promote them. Yet the Bulletin's stories disclose that some rituals have palpable, although unquantifiable, health benefits. Even if the connection between rituals and health is not always present, the place of rituals and their contribution to a basic need within all of us gives us reason to pause and explore whether and to what extent society and its institutions should promote practices that span human cultures and beliefs.