Pope Francis recently delivered a powerful message to participants at the Conference on the Declaration of Helsinki held at the Vatican, an event organized with the Pontifical Academy for Life. He recalled how the central role of the sick person in the context of modern medicine has not yet been fully realized and underlined the need for his continuous protection and promotion. The Pope also urged us not to reduce healthcare to mere market and technological logic, recalling that since 1964 the Declaration of Helsinki has aimed to orient the thinking of the international community towards the service of humanity, based on values of social friendship and fraternity.
His message pushed us to re-examine our work in practicing, studying and teaching spiritual aspects of care. The recent Covid-19 pandemic, although it seems now distant in memory, has offered the opportunity to reevaluate the value of healthcare work and to stimulate reflections on the economic costs and values involved in the care process. This experience has highlighted the need for more careful consideration and a humanistic and sustainable approach to the right to health, a fundamental value of our society.
The Italian healthcare system, for years, has suffered from significant cuts in terms of resources and personnel, which has gradually limited its ability to respond effectively to an ever-increasing and more complex healthcare burden. The pandemic has openly revealed the shortcomings of the system, in which healthcare personnel have often filled the structural gaps with their heroism. This has highlighted the need for a change in the healthcare paradigm, where health is not just an asset to be managed economically but a fundamental right to be protected.
Precisely during the pandemic, the fundamental value of human relationships in the treatment process emerged. The lack of direct contact between patients, family members and healthcare personnel has highlighted the importance of the human and relational dimension in care. This questions us directly on the current model of healthcare, which is too often concentrated on a technological approach, with the consequence of leaving the importance of emotional support, the consideration of the psychosocial aspects of the disease, the role of human relationships and the desire to seek a sense of respect for what is happening in one’s life.
The pandemic has also raised questions about the current economic model of healthcare management. For example, the DRG system has favored a profit logic based on the volume rather than the quality of care, revealing the risks of an industrialized medicine that overshadows the individual needs of patients, in favor of operational efficiency and economic productivity. Furthermore, it showed how health is influenced by factors beyond the availability of advanced medical care. Living conditions, economic and social well-being and equity in access to care are aspects that significantly contribute to the general well-being of the population. This requires an approach to health that considers the aspects of the human not supported by the mere provision of healthcare services.
Precisely the tiring season of the pandemic has reminded us that adequate attention to the health issues of our society cannot neglect the elderly part of society itself, which will progressively flood and which currently numbers around 14 million people. During the pandemic, those who suffered most during this period were the elderly people relegated to their homes or in RSAs, however confined and unable to have contacts and relationships with people who are significant to them. These obligations, valid for all people, have had a much more negative outcome for older people in cognitive, social and relational terms. They are the ones who have not been able to recover the damage caused by months spent mainly alone, thus confirming once again the centrality of relationships. The recent law to protect elderly people indicates a new attention to this issue which increasingly interests and will interest the entire nation. Among the other rights listed is that of being able to have relationships with older people.
Here the further topic immediately arises: how to calculate the value of relationships. Perhaps we can think retrospectively, as happened with the pandemic, and verify that canceling relationships penalizes the sick person; this requires that these dynamics be sufficiently guaranteed. Immersed in an economic logic where only what can be verified and objectified has value, we ask ourselves: how much is a good relationship worth? How trained and prepared are we to live relationships capable of supporting the person we meet? This tension becomes increasingly problematic when living within a world that considers egolatry capable of giving meaning and directing one’s steps, where the other is perceived only as an instrument capable of satisfying one’s own benefit and not, positively, opportunity for mutual enrichment. Experience and objective data say that it is not possible to live “self-centered” if one does not want to lose an authentically human dimension. To live fully human, each of us needs to let ourselves be shaped by good and positive relationships; otherwise there will be a crushing of one’s human dimension, which inevitably also has repercussions on a social level.
For the future, it is essential to start a process of renewal of the healthcare system that takes these lessons into account. This implies not only the need to invest to a greater extent in resources and personnel but also to reconsider the values that guide healthcare, promoting a person-centred care model and evaluating the effectiveness of interventions not only in direct economic terms but also for their impact on the quality of life of patients. Putting the sick, elderly or disabled person at the center is not just a strictly individual matter. Beyond the patient’s personal involvement, and beyond the family, a social and relational dimension is necessarily involved. The person who becomes ill, who experiences the condition of disability, and the elderly person question and call into question the entire community, as we are reminded and recalled, moreover, by our Constitution. The purely economic dimension instead risks putting these aspects aside, with the result that only those with greater economic possibilities and organizational skills are favored in the possibility of obtaining adequate care.
There is an urgent need for a renewed commitment and interest in the implementation of the right to health, perceiving it as one of the highest expressions of civilization. A new challenge that is opening up is the dialogue between public structures and private affiliated profit structures and private affiliated non-profit structures. The underlying belief is that good dynamics capable of building valid and lasting prospects must be based on mutual trust and the ability to overcome ideological positions, remaining open to new possibilities and opportunities for the good of the entire community, in particular for most disadvantaged people. What should be clear to everyone is that at the center there is the person with all their needs and not other interests, which are often overlooked.
Another equally significant fact is the progressive detachment on the part of the young generations from the now outdated ways of offering and presenting purely religious discourses, while the search for meaning along one’s life path continues to arouse interest. Many recent observations highlight the transition from a way of living prayer understood as a relationship with God to the desire to cultivate and learn to achieve inner peace and serenity, with particular techniques. We seem to be witnessing a decline of religions understood in their purely communal forms towards more purely solitary forms that involve less collective exposure. The risk – it seems quite evident – is to move towards a superficial and self-therapeutic #spirituality in search of temporary well-being. This logic finds continuous confirmation as we are constantly reminded and reminded at a socio-cultural level, i.e. the immediate satisfaction of the need. However, we must be aware that doing so promotes the growth of people incapable of maintaining long waits, continually prey to individual needs that demand to be satisfied immediately. Reality helps us understand that credible results often appear only after a long time and that what we desire does not always happen. This means becoming increasingly aware of one’s human dimension.
In this context, attention to the practice and teaching of pastoral care in healthcare, as well as the recognition of the spiritual needs of patients, takes on a non-secondary role. Today, spiritual practice is sometimes reduced to a means of maintaining daily balance rather than a path to pursuing enlightenment or higher wisdom. It is therefore necessary to reconsider the role of religiosity in a constant tension between personal well-being and broader connection with the transcendent. This vital connection between the individual and the transcendent is accompanied by an attention open to the entire community and therefore not closed only to individuality. Such a perspective can lead to renewed attention towards the need to support and reevaluate the right to health.
To guarantee a more complete and humanized future in healthcare it is necessary to introduce university training dedicated to those who will carry out spiritual assistance in healthcare contexts, following the example of many Western countries. In addition, it is essential to include training on spiritual topics as a fundamental part of the preparation of healthcare professionals.
The training curriculum should focus on teaching healthcare professionals how to listen and respond to patients’ spiritual needs, viewing health holistically, a reality that encompasses body, mind and spirit. This more attentive approach can contribute to personalized and human-centered care, recognizing the singularity of individuals affected by diseases, who are fragile and vulnerable human beings, seeking hope in a more welcoming world.
As already mentioned, it is crucial to promote close collaboration between different actors in the healthcare sector, which include both public and private, for-profit and non-profit entities. This ongoing commitment must aim to ensure care that is equitable, accessible and centered on human needs. This requires a constant commitment to promoting research and innovation in the healthcare field, not only for the development of new technologies, but also for the creation of more effective and humane models of care.
* Chaplain of the Irccs National Cancer Institute Foundation – Milan
** Associate Professor of Clinical Psychology – Department of Oncology and Hemato-Oncology – University of Milan
The authors are editors of the website www.curaspirituale.it dedicated to research, dialogue and training on #spirituality in medical care. They are also authors of «Spirituality in care. Dialogues between clinics, psychology and pastoral care” (San Paolo, 2022)
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