Katholieke Stichting Medische Ethiek
27 november 2022

Waardigheid van de zieke gaat boven ziekte en winst

Address to members of the Biomedical University Foundation of the Campus Biomedico University of Rome

Pope Francis
18 October 2021

Dear brothers and sisters,

I welcome you and I thank you for your presence and your gift. I am grateful to Professor Paolo Arullani, President of the Foundation, for the words he addressed to me on your behalf. It is good to meet you in person precisely on the day on which we celebrate Saint Luke, whom the apostle Paul calls “the beloved physician” (Col 4: 14).

I gladly accepted the proposal to meet because of what I know of the Campus Bio-Medico in Rome. I know how difficult it is today to work in the field of healthcare, especially when, as in your hospital, the focus is not only on assistance, but also on research to provide patients with the most suitable therapies, and above all it is done with love for the person. Putting the sick person before the disease is essential in every field of medicine; it is fundamental for treatment that is truly comprehensive, truly human. The patient comes before the illness. Blessed Alvaro del Portillo encouraged you to do this: to place yourselves every day at the service of the human person in his or her entirety. I thank you for this, it is very pleasing to God.

The centrality of the person, which is at the foundation of your commitment to assistance, but also in teaching and research, helps you to strengthen a united and synergic outlook. An outlook that puts in first place not ideas, techniques and projects, but the real person, the patient, to be cared for by encountering his or her history and lived experience, establishing friendly relations, which heal the heart. Love for man, especially in his condition of fragility, in which the image of Jesus Crucified shines through, is specific to a Christian reality and must never be lost.

The Foundation and the Campus Bio-Medico, and Catholic healthcare in general, are called to bear witness to the facts that there are no lives that are unworthy or to be rejected because they do not respond to the criterion of usefulness or the demands of profit. We are living in a real throwaway culture: this is something in the air that we breath and we must react against this throwaway culture. Every healthcare structure, in particular those of Christian inspiration, should be the place where the care of the person is practiced, and where one may say: “Here we do not see only doctors and patients, but people whom we receive and help; here you encounter first-hand the therapy of human dignity. And this should never be negotiated, it should always be defended.

The focus should therefore be on caring for the individual, without forgetting the importance of science and research. Because treatment without science is vain, just as science without treatment is barren. The two things go together, and only together do they make medicine an art, an art that involves head and heart, that combines knowledge and compassion, professionalism and pity, competence and empathy.

Dear friends, thank you for promoting the humane development of research. Unfortunately, we often pursue the profitable paths of profit, forgetting that the needs of the sick come before the opportunities for profit. The needs of the sick are constantly evolving and we must therefore be prepared to deal with new diseases and problems. I have in mind, among others, those of many elderly people and those linked to the many rare diseases, which we know little about, since there has not yet been research to understand them well… In addition to promoting research, you help those who do not have the financial means to pay for university and you face significant costs that the ordinary budget cannot bear. I am thinking in particular of the efforts already made for the Covid Centre, the emergency room and the recent hospice project.

All this is very good, it is good to cope with greater urgencies with greater openings. And it is important to do this together. I stress this simple yet difficult word: together. The pandemic has shown us the importance of connecting, of collaborating, of tackling common problems together. Health care, particularly Catholic health care, has and will increasingly need this, to be in a network, which is a way of expressing togetherness. It is no longer time to follow one’s own charism in isolation. Charity demands giving: knowledge must be shared, expertise must be shared, science must be pooled.

Science, I say, not just the products of science which, if offered on their own, remain band-aids that can dress the wound but not cure it in depth. This applies to vaccines, for example: there is an urgent need to help countries that have fewer of them, but this must be done with far-sighted plans, not just motivated by the haste of wealthy nations to be safer. Remedies must be distributed with dignity, not as pitiful handouts. To truly do good, we need to promote science and its integral application: understanding the contexts, rooting out treatments, nurturing the healthcare culture. It is not easy, it is a real mission, and I hope that Catholic health care will be increasingly active in this sense, as an expression of an outgoing Church.

I encourage you to continue in this direction, welcoming your work as a service to the inspirations and surprises of the Spirit, who along the way makes you encounter so many situations in need of closeness and compassion. I pray for you, I reiterate my gratitude to you, and I give you the Blessing. And I ask you, please, to continue to pray for me. Thank you.

Don’t let the ‘culture of waste’ affect you

Address to the participants in the congress promoted by the Italian Society of Hospital Pharmacy and Pharmaceutical Services of Health Authorities

Pope Francis
14 October 2021

Dear brothers and sisters, good morning and welcome!

I would like to thank the President of the Italian Society of Hospital Pharmacy and the Pharmaceutical Services of Health Authorities for his words on behalf of you all. Thank you! You have come from all over Italy for your Conference, representing different realities. The Conference is first and foremost an opportunity for you to exchange views, but it is also an opportunity to reaffirm the importance of the national public health system, an essential element in guaranteeing the common good and the social growth of a country. And all this in the context of the pandemic, which has changed and will change the way we plan, organise and manage health and healthcare. In this regard, I would like to point out three paths on which to continue your efforts.

The first is taken from the figure of the innkeeper in the parable of the Good Samaritan: he is asked to take in the wounded man and care for him until the Samaritan returns (cf. Lk 10:35). In this character we can see two significant aspects of the work of the hospital pharmacist: daily routine and hidden service. These are aspects common to many other jobs, which require patience, constancy and precision, and which do not have the gratification of appearances, which have little visibility. Daily routine and hidden service have little visibility, shall we say: little visibility. Precisely for this reason, if they are accompanied by prayer and love, they generate “everyday holiness”. Because without prayer and without love – as you well know – this routine becomes arid. But with love, done with love and prayer, it leads to the holiness “next door”: anonymous saints who are everywhere because they do what they have to do well.

The second way concerns the specific dimension of the hospital pharmacist, namely his or he professional role, or post-graduate specialisation. Together with the clinician, it is the hospital pharmacist who researches, experiments, proposes new routes; always in immediate contact with the patient. This involves the ability to understand the disease and the patient, to personalise medicines and dosages, sometimes dealing with the most complex clinical situations. In fact, the pharmacist is able to take into account the overall effects, which are more than just the sum of the individual drugs for different diseases. Sometimes – depending on the structure – there is an encounter with the sick person, other times the hospital pharmacy is one of the invisible departments that makes it all work, but the person is always the recipient of your care.

The third way concerns the ethical dimension of the profession, in two respects: personal and social.

On an individual level, the pharmacist, each one of you, uses medicinal substances which can become poisons. Here it is a question of exercising constant vigilance, so that the goal is always the patient’s life in its entirety. You are always at the service of human life. In some cases this can lead to conscientious objection, which is not disloyalty, but on the contrary fidelity to your profession, if validly motivated. Today there is something of a tendency to think that perhaps it would be a good way to approach conscientious objection. But this is the ethical intimacy of every health professional and this should never be negotiated, it is the ultimate responsibility of health professionals. It is also a denunciation of the injustices done to the detriment of innocent and defenceless life. It is a very delicate issue, which requires both great competence and great rectitude. In particular, I have had occasion to return to the subject of abortion recently. You know that I am very clear about this: it is a homicide and it is not licit to become an accomplice. Having said that, our duty is to be close to people, our positive duty: to be close to situations, especially women, so that they do not come to think of the abortion solution, because in reality it is not the solution. Then after ten, twenty, thirty years, life sends you the bill. And you have to be in a confessional to understand the price of this, which is so hard.

This was the personal ethical level. Then there is the level of social justice, which is so important: “Health strategies, aimed at the pursuit of justice and the common good, must be economically and ethically sustainable”. Certainly, in the Italian National Health Service, great space is occupied by the universality of access to care, but the pharmacist – even in the hierarchies of management and administration – is not a mere executor. Therefore, management and financial criteria are not the only element to be taken into consideration. The throwaway culture must not affect your profession. And this is another area in which we must always be vigilant. “God our Father gave us the task of protecting the earth – not for money, but for ourselves: for men and women. We have this task! Nevertheless, men and women are sacrificed to the idols of profit and consumption: it is the ‘culture of waste’”. Even in the elderly: give half the medicines and your life is shortened… It is rejection, yes. This observation, which originally referred to the environment, applies even more so to human health.

The management of resources and care not to waste what is entrusted to the hands of each individual pharmacist take on not only an economic meaning, but also an ethical, I would say human, one: very human. Think of attention to details, to the purchase and conservation of products, to the correct use and application in those who are in urgent need. Think about the relationship with the various workers – the ward managers, nurses, doctors and anaesthetists – and with all the structures involved. I thank you for this visit, and I hope that you will be able to continue in your work, which is so human, so worthy, so great and so often so silent that no one notices. Thank you very much! May God bless you all. And pray for me. Thank you!

Wereldwijde gezondheidszorg: géén wegwerpcultuur

Address to the participants in the plenary assembly of the Pontifical Academy for Life.

Pope Francis
27 September 2021

Dear sisters and brothers,

I am happy to be able to meet you on the occasion of your General Assembly and I thank Msgr Paglia for his words. I extend a greeting also to the many Academics who are connected.

The theme you have chosen for these three days of workshops is particularly timely: that of public health in the horizon of globalization. Indeed, the crisis of the pandemic has made “both the cry of the earth and the cry of the poor” reverberate even more strongly (Enc. Laudato Si’, 49). We cannot remain deaf before this dual cry. We have to listen to it well! And it is what you are setting out to do.

Examination of the numerous and grave issues that have emerged in the last two years is not an easy task. On the one hand we are worn out by the Covid-19 pandemic and by the inflation of issues that have been raised: we almost do not want to hear about it any more and we hurry on to other topics. However, on the other hand, it is essential to reflect calmly in order to examine in depth what has happened and to glimpse the path towards a better future for all. Truly, “even worse than this crisis is the tragedy of squandering it” (Pentecost homily, 31 May 2020). And we know that we do not emerge from a crisis the same: we will either emerge better or we will emerge worse. But not the same. The choice is in our hands. And I repeat, even worse than this crisis is the tragedy of squandering it. I encourage you in this effort. And I think the dynamic of discernment in which your meeting is taking place is wise and timely: first and foremost, listening attentively to the situation in order to foster a true and proper conversion and identify concrete decisions to emerge from the crisis, better.

The reflection that you have undertaken in recent years on global bioethics is revealing itself to be precious. I had encouraged you in this perspective with the letter Humana communitas on the occasion of the 25th anniversary of your Academy. The horizon of public health in fact offers the possibility to focus on important aspects for the coexistence of the human family and to strengthen the fabric of social friendship. These are central themes in the Encyclical Fratelli Tutti (cf. Chapter 6).

The crisis of the pandemic has highlighted the depth of the interdependence both among ourselves and between the human family and our common home (cf. Laudato Si’, 86; 164). Our societies, especially in the West, have had the tendency to forget this interconnection. And the bitter consequences are before our eyes. In this epochal change it is thus urgent to invert this noxious tendency and it is possible to do so through the synergy among different disciplines. Knowledge of biology and hygiene is needed, as well as of medicine and epidemiology, but also of economy and sociology, anthropology and ecology. In addition to understanding the phenomena, it is a matter of identifying technological, political and ethical criteria of action with regards to health systems, the family, employment and the environment.

This outlook is particularly important in the health field because health and sickness are determined not only by processes of nature but also by social life. Moreover, it is not enough for a problem to be serious for it to come to people’s attention and thus be addressed. Many very serious problems are ignored due to lack of an adequate commitment. Let us think of the devastating impact of certain diseases such as malaria and tuberculosis: the precariousness of health and hygiene conditions cause millions of avoidable deaths in the world every year. If we compare this reality with the concern caused by the Covid-19 pandemic, we can see how the perception of the seriousness of the problem and the corresponding mobilization of energies and resources are very different.

Of course, taking all measures to stem and defeat Covid-19 on a global level is the right thing to do, but this moment in history in which our health is being threatened directly should make us aware of what it means to be vulnerable and to live daily in insecurity. We could thus assume the responsibility also for the grave conditions in which others live and of which we have so far been little or not interested at all. We could thus learn not to project our priorities onto populations who live on other continents, where other needs are more urgent; where, for example, not only vaccines but also drinking water and daily bread are in short supply. I don’t know if one should laugh or cry, cry sometimes, when we hear government leaders or community leaders advise slum dwellers to sanitize themselves several times a day with soap and water. But, my dear, you have never been to a slum: there is no water there, they know nothing about soap. “No, do not leave your home!”: but there the whole neighbourhood is home, because they live… Please, let us take care of this reality, even when we reflect on health. Let us welcome then, any commitment to a fair and universal distribution of vaccines — this is important —, but taking into account the broader field which demands the same criteria of justice for health needs and for the promotion of life.

Looking at health in its multiple dimensions at a global level helps to understand and take on with responsibility the interconnection between the phenomena. In this way, we can better observe how even the conditions of life that are the result of political, social and environmental choices have an impact on the health of human beings. If we examine in different countries and in different social groups the hope of life — and of a healthy life — we discover great inequalities. They depend on variables such as the amount of wages, the educational level, the neighbourhood in which one resides even though it is in the same city. We state that life and health are values that are equally fundamental for all, based on the inalienable dignity of the human person. But, if this statement is not followed by an adequate commitment to overcome inequality, we are de facto accepting the painful reality that not all lives are equal and health is not protected for everyone in the same way. And here, I would like to repeat my concern: that there always be a free healthcare system. May the countries which have them, not lose them, for example Italy and others, which have a good free healthcare system: do not lose it because otherwise we would end up with only members of the population who can afford it, having the right to healthcare and the others not. And this is a very big challenge. This helps overcome inequality.

Therefore, international initiatives are to be supported — I am thinking for example of those recently promoted by the G20 aimed at creating a global governance for the health of all the inhabitants of the planet, that is, a set of clear rules agreed at the international level that respect human dignity. In fact, the risk of new pandemics will continue to be a threat also for the future.

The Pontifical Academy for Life can also offer a precious contribution in this sense, seeing itself as a travelling companion of other international organizations committed to this same aim. With regards to this, it is important to participate in shared initiatives and in the appropriate manner, to the public debate. Naturally, this requires that, without “watering down” contents, attempts be made to communicate them in a language that is suitable and topics that can be understood in the current social context, so that the Christian anthropological proposition, inspired by Revelation, can also help today’s men and women to rediscover “the primacy of the right to life from conception to its natural end” (Discourse to participants in the Meeting sponsored by the Science and Life Association, 30 May 2015).

Here too, I would like to mention that we are victims of the throwaway culture. In his presentation, Msgr Paglia referred to something: but there is the throwing away of children that we do not want to welcome, with that abortion law that sends them back to their sender and kills them. Today this has become a “normal” thing, a habit that is very bad; it is truly murder. In order to truly grasp this, perhaps asking ourselves two questions may help: is it right to eliminate, to end a human life to solve a problem? Is it right to hire a hitman to solve a problem? Abortion is this. And then on the other side, are the elderly: the elderly who are also a bit of “throwaway material” because they are not needed…. But they are the wisdom, they are the roots of the wisdom of our civilization, and this civilization discards them! Yes, in many places there is a “hidden” law on euthanasia, as I call it. It is the one that makes us say: “medicines are expensive, only half should be given”. This means shortening the lives of the elderly. In so doing, we deny hope, the hope of the children who bring us the life that makes us go forward, and the hope that is in the roots that the elderly give us. Instead, we discard both. And then the everyday throwing away, that life is thrown away. Let us be careful about this throwaway culture. It is not a problem of one law or another. It is a problem of throwing away. And on this point, you academics, the Catholic universities and also Catholic hospitals cannot allow themselves to go this way. This is a path which we cannot take: the throw away path.

Therefore, the work that your Academy has undertaken in recent years on the impact of new technologies on human life and more specifically on “algorethics” should be looked upon favourably in such a way “that science may truly be at the service of mankind, and not mankind at the service of science” (ibid ). I encourage in this regard, the work of the fledgling foundation, renAIssance, for the spreading and deepening of the Rome Call for AI Ethics which I strongly hope many will join.

Lastly, I wish to thank you for the commitment and contribution that the Academy has provided by actively participating in the Vatican Covid Commission. Thank you for this. It is beautiful to see cooperation within the Roman Curia in the fulfilment of a shared project. We have to increasingly develop these processes brought forth together, in which I know many of you have participated, urging greater attention to vulnerable people such as the elderly, the disabled and the younger ones.

With these feelings of gratitude, I entrust the work of this Assembly and also your activity as an Academy on the whole in favour of the defence and promotion of life, to the Virgin Mary. I offer my heartfelt blessing to each of you and your loved ones. And I ask you please to pray for me because I need it. Thank you.