Being a Christian involves metaphysical, epistemological, and social commitments that set Christians at variance with the dominant secular culture. Because Christianity is not syncretical, but proclaims the unique truth of its revelations, Christians will inevitably be placed in some degree of conflict with secular health care institutions. Because being Christian involves a life of holiness, not merely living justly or morally, Christians will also be in conflict with the ethos of many contemporary Christian health care institutions which have abandoned a commitment to Christian spirituality. In this regard, managed care raises the special question of how Christian institutions can act morally under financial constraints and maintain their character while under the control of secular managers. This question itself raises the further question as to why health care institutions need even pose this query when there are Christian physicians and nurses who could work for less, or Christian men and women who could become sisters and brothers and work for nothing. Contemporary challenges to Christians to maintain their integrity in a post-Christian world have much of their force because Christians have failed to maintain traditional Christian sprituality. In the face of that failure, Christian physicans and nurses will find themselves in greater conflict with health care institutions, because few will any longer understand the requirements of traditional Christianity. In its place, they will have put a generic spirituality, a value-neutral understanding of the role of the health professional, and an anonymous commitment to social justice.