The theology of imago Dei is frequently presented as a reason to value humans equally, but there are different theological views of what this image entails, and Scripture alone does not necessarily address when in the development process human beings begin to reflect God’s image. This essay proposes that the primary aspect of being in God’s image involves a relationship with Him, and the other theological views of imago Dei require this relationship to properly reflect God’s image. To contrast this view of humanity with that of a medical/evolutionary perspective, it is essential to discuss how “disease” is defined and manifested. Bird’s four theological views of imago Dei will be briefly reviewed. Finally, an analysis of and extrapolation from Psalm 139:13-16 provides insight into the core of what it means to be a relational human in God’s image, where the focus is more on being in relationship than the modern focus on capacity for doing. The vital essence of a person’s being—including their wisdom, emotions, and conscience—is created and embroidered by God and consecrated to Him for the purpose of having a sacred, sacrificial intimate relationship with Him. God’s design for families is intertwined with humanity’s relational purpose. When combined with current scientific knowledge, this passage affirms the image of God is present in humans from conception to natural death. God’s ability to have a relationship with individual persons is not affected by impairments. Other Scripture supports this Psalm 139-based vision of human identity and worth.