Paglia's Intervention

By: Archbishop Vincenzo Paglia

Archbishop Vincenzo Paglia: Rediscovering the Role of the Family Doctor Confirms the Right to Healthcare

We publish the speech by Archbishop Vincenzo Paglia, President of the Pontifical Academy for Life, in the video addressed to the participants in the international conference, "Thank You, Doctor!", held in Rome on May 24

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Dear Medical Friends, Welcome to Rome!
I would have liked to greet you in person and shake your hand to thank you for the great service you render to the sick in different parts of the world, but an unforeseen urgent commitment takes me away from Rome today. In this video, therefore, I transmit directly the reflections that I would have liked to share with you, in the hope that I can meet with you tomorrow on the occasion of the audience with the Pope.

But, first, allow me to thank Dr. Tallaj, Dr. Paredes and the entire SOMOS network for the intuition they have had to relaunch the central role of the family doctor by proposing this Declaration. I confess that, as soon as I read it, I had no doubt how necessary it was to subscribe to it, as President of the Pontifical Academy for Life, and to collaborate in its dissemination. Today, I would like to focus my reflection on two passages of this Declaration that seem particularly important to me.

I. I am reading from the Declaration:
1. We are convinced that the rediscovery and necessary recognition of the family doctor’s role and their relationship with the patient can become a decisive factor in the humanization of our societies

The first step concerns being aware of the need to humanize our contemporary societies and the role that the family doctor can play in this humanization process. When we talk about humanization, we refer to what is necessary and appropriate to one’s way of being, the needs and dignity of the human being. All of this, in a very concrete manner, means, above all, guaranteeing the right to care, that is, to the means necessary for prevention, diagnosis, and therapy in the specific situation of the individual patient. The humanization of our societies, from the point of view of medicine, also means guaranteeing access to palliative care and support for the elderly, the seriously ill, or those in the terminal phase of their existence.

Guaranteeing this right to care seems increasingly difficult today, due to increasing health expenditures resulting from demographic and epidemiological changes, the spread of the cult of 'salutism' and the technological revolution. On the other hand, it is also true that although today we live longer and better, we cannot ignore the great vulnerability that continues to accompany humanity, sometimes in ways unknown in the past, as we all experienced with the recent pandemic. Therefore, we are called to ask ourselves how to integrate the virtue of justice into economic or public health choices. In this scenario, for example, we can consider the doctor-patient relationship crucial in its role of limiting the harm from wasting medicines and services through educating patients on health. It is above all the trusted doctor who can help the patient make those lifestyle and health management decisions that are as preventive as possible with respect to diseases and that lead them to assume the consequent duties towards their own health and that of others. On the other hand, we need a very profound ethical and cultural reflection, including within medicine, concerning the inescapable fragility of the human condition, which is further aggravated in illness or old age, and which becomes an occasion for discrimination according to a throwaway culture, so increasingly widespread in our societies.

What if this fragility – never chosen and against which we sometimes fight tenaciously – were a gift?

Within our communities, the family doctor’s role can be crucial in redefining the meaning – or we could say: status – of human fragility. Fragility becomes a gift when, through the dependence it causes, it opens us to the possible beauty of relationships. At birth, we were all naked, crying, and at the mercy of the world. A relationship saved us and allowed us to grow, strengthen ourselves, and create new and beautiful things. However, we realize that this radical dependence can be forgotten, hidden, but never overcome. Once again, it will be relationships that pull us out of non-self-sufficiency, that will save us. To speak of dependence, however, is to only partly describe reality, that is, assuming the unidirectionality of fragility. A more complete description requires, on the other hand, to speak of interdependence. Interdependence reveals the reciprocity of both need and gift, which is realized through relationship. Only by describing the human condition in terms of interdependence – and not just dependence – is it possible to appreciate fragility as a gift. At the same time, interdependence also takes on meaning again, becoming solidarity, fraternity.

We need to broaden our horizons. We need to liberate care from the private and/or domestic sphere or the technical-health sphere; we must restore its social meaning and transform it into a generalized practice, capable of influencing society’s overall balance. It is the memory of the common condition of fragility that constitutes the true basis of the social bond. It is the social bond that transforms the fragility of need into a gift.

Can we rediscover the bonds of solidarity between us, even among people seemingly distant or different from each other? Can we get involved in a societal project that includes the elderly, poor, sick, disabled, and also foreigners, prisoners, ... that reminds us of our common fragility and the urgency to care for one another? On the other hand, we will only be able to survive in this world within the framework of a new social pact between peoples. This is something that politics - increasingly oppositional - struggle to understand. This is the idea that Pope Francis has repeatedly pronounced: a new future is only possible if we move towards the unity of the human family that responsibly inhabits the planet as the ‘common home’ for all.

Caring means a compassionate way of living our relationships with others, being aware of their fragility and dignity. This way of relating differs from domination and contract. It is the sense of making a gesture of overcoming utilitarian logic. Are we ready to say goodbye to individualism and indifference, to the delusion of omnipotence so that we can reopen the horizon of a civilization of compassion?

How can we react to the realization of our constitutive fragility, of our common vulnerability?

Should we persist in denial, denying this dark side and focusing even more on increasing our power, our dominion over life and reality? Or is it a matter of opening our eyes and hearts, taking another path? Removing fragility from sight and abandoning it to the margins is not a solution. The abandonment and weakening of ties, starting with family ties, are the hallmarks of the social model that we have built in recent decades, a model promoted by a hyper-individualistic and hyper-capitalist culture. A cultural and social model that is increasingly distant from the Aristotelian philia that has inspired and shaped our Western civilization for many centuries, and even before Christianity nourished our relationship with each man, our brother, with mercy and compassion. A cultural and social model that gives rise to a fast-paced world in which we are accustomed to following protocols and procedures and where we no longer know wisdom and prudence; in which desire is reduced to consumption; in which we struggle to transform events into experience. We do many things, most of the time in a distanced and superficial manner, without being truly present, close to each other. The reality is that we are becoming incapable of even seeing the helplessness, fragility, failure, illness and death that surround us, of letting ourselves be touched by them, of letting them move us. Pope Francis wisely warns: “God exhorts us to face the great disease of our time: indifference. It is a virus that paralyzes, renders inert and insensitive, a disease that attacks the very core of religiosity, provoking a new and sad paganism: the paganism of indifference” (Assisi, September 20, 2016). Again: “Evil is contagious [...] The wave of evil always swells like this: it starts with standing apart, watching without doing anything, being unconcerned; then we think only of what has to do with us and we grow used to turning aside. It is also a danger for our faith, which withers if it remains merely a theory and is not put into practice, if we remain detached, aloof and uninvolved” (Homily on the Solemnity of Christ the King, November 20, 2022).

Faced with the contradictions of our time, we only have one corrective left: to counteract the culture of waste with one of care, to initiate a policy of care and to abandon that of waste. A care that extends to the whole of life, both in its temporal dimension and in that of the meaning, of the meaning of existence. A care that, therefore, goes beyond, and, in a certain sense, precedes, the dimension of health or the health sector. Care always concerns both the level of interpersonal relationships and their structuring at the social level.

The care that sustains all social life, restricted or extended, is therefore a value that each of us is called to cultivate until it becomes a virtuous disposition, an excellent action. These words are probably superfluous in this room, since for the health professionals present here, “caring” is not just an ordinary human dynamic, but the origin of a professional vocation and the model of a lifestyle.

II. The second passage of his Declaration on which I would like to focus concerns the social dimension of care, i.e., the priority given to the doctor-patient relationship, an ethical core so strongly felt and represented by you, but unfortunately often ignored elsewhere in medicine.
The text reads as follows:
2. The doctor-patient relationship also forms the foundation of a healthcare system that prioritizes prevention and a holistic view of health

Medicine has an intrinsic social dimension through the doctor-patient relationship on which clinical activity is based. This relationship has become “technified” and bureaucratized at the cost of the ethical value and human density of clinical action. This should probably be seen as a limitation and not as a necessity of contemporary medicine. His Declaration again calls our attention to a fundamental human element: our relationships with each other. And you see this relationship not in a merely pragmatic-utilitarian sense (i.e., instrumental in the attainment of goals and regulated by procedures), but in an ethical sense, i.e., as a privileged and inalienable place for the fulfilment of individuals, for all people who are actors in each relationship. It is in the patient relationship, ethically lived, where we realize the professionalism of a healthcare professional. It is in the relationship with the healthcare professional, ethically lived, where the dignity of the patient finds an important moment of recognition. It is in the relationship with the family that the healthcare professional begins to weave the network of social solidarity. It is in the medical community that they exercise those relational virtues that cannot fail to find expression in the other spheres of their human and social life.

By appreciating the social dimension of care, you, as family doctors, can support, when possible, the home environment, in contrast to the logic of hospitalization. As we know, hospitalization results from the attempt to make technological and expensive medicine effective (bringing all patients together in place of increasingly articulated and complex medical equipment and care). However, hospitalization is very often a source of discomfort for the patient and their family, in addition to that already imposed by the disease, especially if it is severe or disabling. You, as family doctors, develop models of home care that allow you not to uproot the patient from their environment. In many realities, these models are complemented by the active and voluntary participation of the local community, feeding the social cement that makes it possible to support the most seriously ill.

The impoverishment of the social dimension is not unique to medicine. We see it in contemporary culture when it manifests itself in many other human contexts. All human communities - the family, the company, the university and education in general, the neighborhood, etc. – are articulated today in a technical and contractual sense, where the most frequent jargon is that of law and privacy (which goes far beyond the legitimate respect and protection of the privacy of the person, of the family). Privacy today means individualism and self-referentiality, an absolute impenetrability and incommunicability that often translates into isolation and abandonment. In the name of protecting privacy, the doctor does not interfere in the patient’s decisions. What really happens, however, is that the patient is left alone, without that support, wise advice, and point of reference that every healthcare professional represents for their patient, as parents are for their children, siblings among themselves, and as we see among friends, neighbors and all human communities. This does not mean returning the doctor-patient relationship to the paternalism so contested in recent decades, but it does mean reaffirming the existence of our social responsibility, which is, above all, a duty of mutual care. We are called to care for one another. Others are not obstacles or tools. They, whoever they may be, are not only a means, but also an end for each of us. What is at stake is the deeper vision of the human being, of society as a whole, and only secondarily of medicine as a place of human action.

The social dimension of medicine leads us, almost as a corollary, to issues of justice and inequalities, with the recent pandemic being a test case and, we hope, also a moment of reflection and learning. The Covid-19 pandemic demonstrated that, in all countries, the common good of public health must be balanced with economic interests. During the early phases of the pandemic, many countries focused on saving as many lives as possible. Hospitals and, above all, intensive care services were insufficient and were only strengthened after enormous efforts. Significantly, healthcare services survived, thanks to the impressive sacrifices of doctors, nurses and other health professionals, rather than technological investments. However, the attention given to hospital care diverted attention from other care institutions. Nursing homes, for example, were hit hard by the pandemic, and personal protective equipment and testing were only available in sufficient quantities at a late stage. Ethical debates about resource allocation were based primarily on utilitarian considerations, with no attention paid to those most vulnerable and exposed to the greatest risks. In most countries, the role of family doctors has been ignored, when, for many, they are the first point of contact with the healthcare system. The result has been an increase in deaths and disabilities brought on by causes other than Covid-19. Common vulnerability also requires international cooperation and coordination, knowing that it is not possible to deal with a pandemic without an adequate healthcare infrastructure that is accessible to all on a global scale.

The Church has always paid attention to the aspects of justice and human rights, including common brotherhood, as the Apostle Paul writes: “There is neither Jew nor Greek, neither slave nor free person, neither male nor female; for you are all one in Christ Jesus." (Gal. 3:28). It is a Gospel that sounds like the Good News for our time. And it is closely linked to the Gospel words of Matthew: “For I was hungry, and you gave me food, I was thirsty and you gave me drink, a stranger and you welcomed me … whatever you did for one of these least brothers of mine, you did for me” (Mt 25:35, 40). The fraternity we see in the Gospel can be multiplied by many other passages and direct messages from Jesus. But it is time for us to take a step forward: we are interconnected. The world is interconnected and the sooner we understand this, the sooner we will be a true global community united under the sign of fraternity. Barriers do not exist; we ourselves put them in place and they are destined to be sadly ineffective and even senseless in the face of global emergencies.

This evangelical heritage can be translated into the so-called principle of subsidiarity, which in turn is based on the principle of social solidarity and on the personalistic vision of the economy and society. This principle becomes the moral criterion in the face of the problem of patient rights – and the corresponding duty of society – the protection of health, even when the need results from risky lifestyles chosen voluntarily. It is precisely the principle of subsidiarity that must find a place in any theoretical elaboration and practical application that is truly fair and in accordance with human rights. Pope Francis, in his Letter Humana Communitas of February 11, 2019, addressed to the President of the Pontifical Academy for Life, wrote: “The many extraordinary resources made available to human beings by scientific and technological research could overshadow the joy of fraternal sharing and the beauty of common undertakings, unless they find their meaning in advancing that joy and beauty. We should keep in mind that fraternity remains the unkept promise of modernity. The universal spirit of fraternity that grows by mutual trust – within modern civil society and between peoples and nations – appears much weakened. The strengthening of fraternity, generated in the human family by the worship of God in spirit and truth, is the new frontier of Christianity.” In this era of globalization, this is a very precious instruction to rediscover that we are all part of a universal and supportive fraternity. Solidarity is a constant of the Gospel message, overshadowed by the exaggerated and unbridled individualism of our time.

Conclusion

We must all take seriously the human and social challenge that the fragility of old age and serious or terminal illness poses to all of us today. Against this backdrop, it falls to medicine to apply its efforts, and – with all the intelligence of the mind and compassion of the heart – to find worthy answers for a humanity deeply in need.

I firmly believe that family doctors can transfigure modern health systems and society as a whole. This is a perspective, moreover, in line with what Pope Francis indicates in his Apostolic Exhortation Evangelii Gaudium on the proclamation of the Gospel in today’s world: “I especially ask Christians in communities throughout the world to offer a radiant and attractive testimony of fraternal communion. Let everyone admire how you care for one another, and how you encourage and accompany one another” (EG, 99).