Following theologian Raimon Panikkar, I argue that healthcare chaplaincy is authentic in regard to religious pluralism only when it is dialogical. In examples of pastoral problems of sacramental ministry and prayer that challenge the aims of denominational and multi-faith chaplaincy, I show how professional healthcare chaplains may enter into communion with patients in authentic relationships while maintaining a sense of alterity necessary for dialogue and effective ministry. I explore also the role of embodied alterity in the creative tension of intrapersonal rela-tionships. In response to the theological challenge of religious pluralism, I conclude that by experiencing dialogical pluralism in the reflective practice of ministry, healthcare chaplains can offer unique insights to pastoral theology.