We are living through the change of an era, as Pope Francis has said. \u00a0The globality of every human experience, the hard-to-fathom, irresistible and invasive development of innovative technologies, with their harmful ecological consequences, are radically and rapidly changing the human condition, with outcomes that are, at the same time, both encouraging and troublesome.\u00a0 Today, humanity is being put to the test.<\/p>\n
In this contest, the Covid-19 pandemic has made our times drastically more difficult, forcing on us a situation that is unprecedented, dramatic, and world-wide.\u00a0 Lost in our technological euphoria, we found ourselves unprepared for the spread of the disease: \u00a0we struggled to understand its impact and how to deal with it. \u00a0And even now, even as we see the first fruits of exceptional and unimaginable scientific breakthroughs, we are still struggling to halt its spread.<\/p>\n
The medical profession that every day you represent with pride and courage is radically challenged by these new situations and by our understanding of them.\u00a0 Today, I thank you sincerely for giving me the opportunity to share with you my reflections on these challenges.\u00a0 There are four aspects of the situations that I consider crucial.<\/p>\n
The pandemic has definitively shown how the global interconnectedness that is part of every human experience is particularly visible in the healthcare sector. \u00a0It is clear to everyone that alone we cannot stay healthy, and that the health of the wealthy and hyper-technological West is subject to planet-wide influences.\u00a0 The current debate on the appropriateness (or necessity) of anti-Covid vaccination in Africa shows how an understanding of globalized health phenomena calls for acceptance of different points of view and different priorities. \u00a0We all know that the most pressing health emergency in Africa today is not Covid.\u00a0 It is the great number of other diseases that affect the continent.<\/p>\n
Understanding global health issues requires each of us to know how to integrate our treatment of an individual patient within a broader and more complex framework.\u00a0 If that is initially frightening, in reality it offers broader and more useful solutions. \u00a0We must understand that from the moment we learn of a phenomenon and decide how to address it and relate it to a larger context, we take on a responsibility that is not limited to our particular and individual circumstances.<\/p>\n
Talking about phenomena in terms of public health and in a global framework means placing oneself at the intersection of the search for causes and clinical definitions on the one hand, and, on the other, the economic and political dynamics that have influenced their onset, spread and management. \u00a0We are at the convergence between two practices that take place in society:\u00a0 one concerns how we present phenomena conceptually and scientifically, and the other results from operational choices, power relationships, balance of forces, and value systems.<\/p>\n
In this sense, the challenge of global healthcare is the challenge of inequality. \u00a0Two years ago, Pope Francis wrote: \u201cProgressively more sophisticated and expensive treatments are accessible to increasingly restricted and privileged groups of people and populations.\u00a0 This raises serious questions about the sustainability of healthcare services, and about a systemic tendency to increased therapeutic inequality. \u00a0It is clearly visible at the global level, especially when different continents are compared. \u00a0But it is also present inside the richest countries, where access to care risks depending more on peoples\u2019 economic resources than on their actual healthcare needs.\u201d (Francis, Message to the President of the Pontifical Academy for Life, November 16, 2017).<\/p>\n
Health, in a global context, offers privileged visibility to the thesis (repeated several times in the United Nations 2030 Agenda) concerning the interconnection and indivisibility of the 17 Goals related to the three dimensions of sustainable development\u2014economic, social, and environmental. \u00a0Protecting people’s health means working for a more just and therefore sustainable society.<\/p>\n
The second challenge flows logically from what is said above.\u00a0 I would describe it as the need for planetary governance<\/em> of healthcare.<\/p>\n The global epidemic requires, as an exercise of responsibility, the creation of global coordination of healthcare systems. \u00a0We must be aware that the level of disease containment is dependent on the weakest link in the containment chain. \u00a0It is also necessary that an authoritative agency be able to take a global view of emergencies, make necessary decisions and communicate effectively; that it be recognized as a central point of reference in order to avoid the disorientation produced by communication overload (infodemics) that results from the uncertainty of data and the fragmentation of news.<\/p>\n I won\u2019t go into detail on this point, but I do want to say that Pope Francis has spoken about it as well.\u00a0 Addressing the Members of the Pontifical Academy for Life a few days ago he said, \u201cWe affirm that life and health are both fundamental values for all and are based on the inalienable dignity of the human person. \u00a0If, however, this affirmation is not followed by a proper commitment to overcome inequalities, we must accept the painful reality that not all lives are the same and health is not protected for everyone in the same way. \u00a0Therefore, we need to support international initiatives\u2013I am thinking, for example, of those recently promoted by the G20 \u2013 aimed at creating a global governance<\/em> for the health of all the inhabitants of the planet, which is to say a set of clear and coordinated international rules that are respectful of human dignity.\u201d<\/p>\n The third challenge, which I believe will affect your daily practice the most, concerns the unbelievable progress of modern technologies which, in the medical field, have experienced particularly significant growth<\/p>\n These almost miraculous results must be understood within a broad framework that can also present the costs, limits, and risks of such developments, certainly not to disavow them, but to use the best resources we have available\u2014the result of human genius\u2014in the best and most conscious way possible.\u00a0 In this context as well, I would like to make four points that I believe to be very important.<\/p>\n I will illustrate the first with my own personal experience.\u00a0 Two years ago, I visited Microsoft’s headquarters in Redmond, Washington. \u00a0It was in their auditorium that I performed my first gastroscopy, as a pretend doctor.\u00a0 They gave me hyper-technological glasses, and two small joysticks, and connected me to a 3D simulator.\u00a0 Suddenly I was navigating the esophagus of a real person, whose biometric data and earlier analyses had been uploaded to the system. \u00a0The ease with which they reassured me about the total safety of what I was doing (I saw a real body but did not touch any real body), made me think. \u00a0The hyper-technologization of medical practice always runs the risk of marginalizing the body, avoiding physical contact, reducing the person, the patient, to a series of data and medical practices. \u00a0This was confirmed for me at the MD Anderson Cancer Center in Houston where Professor Bruera, one of the world’s leading palliative care specialists, proudly showed me his most important scientific discovery\u2014a wooden stool. \u00a0It was built to put the face of the doctor at the same level as the patient\u2019s face during the examination. \u00a0Bruera says that, when we think about life and death, what really matters is seeing a face up close.\u00a0 It is a human, warm, physical contact.<\/p>\n The second I will simply mention because I imagine that what really fills your days is not so much the hours spent with patients, but rather endless bureaucratic budget meetings.\u00a0 Thanks to the development of a more interventionist idea of medicine that speaks of conservation and enhancement of efficiency, the theme of health will in fact be one of the cornerstones of future economic systems. \u00a0We will have very expensive medicine, intended for only the few, functional in a society of performance and economic competitiveness, marginalizing populations that cannot access basic health services. \u00a0It is unthinkable, in fact, as Hans Jonas reminds us, that in a world of limited resources, in which scenarios of ecosystem collapse are already current, such a system could really include everyone living on earth.<\/p>\n More deeply, we must reflect carefully on the fact that we will be able to manage the variables related to human generation that until now were left to nature, considered to be \u201cchance\u201d or, from a religious perspective, as \u201cthe will of God.\u201d\u00a0 So now the question is obvious:\u00a0 if such conditions (economic and technological) exist, why leave reproduction to the randomness of events and why not leave it instead to individuals? \u00a0Or else\u2014don\u2019t the development of robotics and the integration of man with machine (just think of issues such as artificial intelligence, new neuroscience projects, and all those initiatives on which billions are being invested on the assumption that a more evolved human being can result from a human who is simply technically more advanced) raise a question about the terms on which today we can talk about the nature of humankind? \u00a0And to follow on that: \u00a0does it make sense to continuing to speak of \u201cnature\u201d in a public square dominated by faith in the power of technology, or to even mention it in a way that is not simply defensive?<\/p>\n Finally, let me just mention the many questions posed by the introduction of artificial intelligence systems into medicine. \u00a0These systems, increasingly complex and effective, offer brilliant solutions, but they also present numerous questions\u2014based on the criteria for judgment and diagnosis\u2014related to medical choices and to the use and custody of sensitive personal data. \u00a0I must say that I was very impressed when I was able to see the operations of the Babylon Health online healthcare portal available in Great Britain and tested in some African countries.<\/p>\n In this same area, I point out that last year the Pontifical Academy for Life launched an appeal, the \u201cRome Call for AI Ethics,\u201d for human-centric artificial intelligence systems. \u00a0The first signatories of the Call were Microsoft President Brad Smith, IBM Senior Vice President John Kelly III (one of the inventors of Watson which I imagine many of you know about) and Director-General QU Dongyu of the United Nations Food and Agricultural Organization.\u00a0 I invite you to get to know about this document that we presented to the Pope, and I invite you to sign it as well\u2014why not?<\/p>\n We still have to ask ourselves whether we can really understand the challenges that are facing us while remaining within the linguistic and cultural horizon of techno-sciences, or whether instead we need the \u201cconversion\u201d of our minds and our language that will come from opening ourselves to broader horizons, capable of putting in their proper place all the factors that form humankind.\u00a0 In this situation \u201cwe have all set sail,\u201d as Blaise Pascal said, and we are called to a new sense of responsibility for building ever wider alliances among peoples, cultures, religions, and ethical perspectives.<\/p>\n This means directing technology towards development, and not simply seeking progress for its own sake\u2014which in any case is not workable.\u00a0 Although it is not possible to think about technology or to implement it without thinking in specific ways (i.e., technical and scientific thought), technical-scientific thought is not in itself able to put integral human development at the center of our concerns.\u00a0 We need approaches that are different but complementary.\u00a0 We need different disciplines. \u00a0We must strive together toward an integral human development.\u00a0 The hyper specialization that characterizes all scientific research today is clearly showing its limits. \u00a0It must be counterbalanced by a wise, comprehensive, and holistic vision. \u00a0Only in this way will we protect people and not just heal bodies. \u00a0And not only our patients, but ourselves as well.<\/p>\n The question we are facing is not only the development of so-called humanities for sciences<\/em>. \u00a0It is something deeper. \u00a0The anthropological challenge symbolically involved in every disease is beyond the reach of healthcare science and technology.\u00a0 It would be unfair\u2014and wrong\u2014to burden scientists and technicians with this responsibility. \u00a0At the same time, it is certainly indisputable that, in addition to the search for therapies and vaccines, it is equally urgent to gain greater depth of vision, as well as greater concern for a thoughtful contribution to the meaning and values of humanism.<\/p>\n Yes, we need a spiritual vision to deal with every aspect of everyday reality.\u00a0 I suggest you a magnificent novel of the French writer Maylis de Kerangal, The Heart<\/em>, a story of a hearth and its trasplant.<\/p>\n Conclusion<\/em><\/p>\n Dear friends, this is the challenge \u2013 very difficult and very human \u2013 that must unite us. \u00a0The goal of that \u201cresponsible closeness\u201d to which we are called by being human is accompanying others, and ourselves, in the acceptance of the necessity of living a truly human life, even in illness and death, without losing the love that fights against life\u2019s loss of dignity. \u00a0The whole community must be involved. \u00a0Love for that life during which we have loved and been loved is no longer ours alone.\u00a0 It belongs to all those with whom it has been shared. \u00a0And so it must be, to the end. \u00a0No one should feel guilty about the burden that his mortal condition imposes on our community.\u00a0 We are human, and the human idea of healthcare is totally opposite to the idea of illness as exclusion from the community and unforgivable guilt. \u00a0It is true, however, that we believers have at times forgotten that Jesus presented himself as a doctor and that he gave us his own power to heal \u201call sorts of sicknesses and infirmities in the people.\u201d (Mt 4:25). \u00a0Pope Francis, since the beginning of his pontificate, has presented the Church as a field hospital. \u00a0I would like to read in this image the singular covenant that sees believing doctors \u2013 together with the whole Church \u2013 becoming close to all men and women wounded by life and often put at the margins of attention and care, if not excluded entirely. \u00a0Today, the healthcare profession has expanded to the whole world and thus the urgency for us to widen our listening to hear the cries of the Spirit and to retrace today the ancient story of the Samaritan who bends over a half-dead stranger, takes care of him and provides him shelter \u2013 which we can imagine to be the field hospital that Pope Francis speaks of \u2013 where many of us support each other in order to hasten that kingdom of love that Jesus came to create, with our help, here on earth.<\/p>\n Thank you very much.<\/p>\n SOMOS Symposium.\u00a0<\/em><\/strong>Punta Cana, October 15, 2021<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":" We are living through the change of an era, as Pope Francis has said. \u00a0The globality of every human experience, the hard-to-fathom, irresistible and invasive development of innovative technologies, with their harmful ecological consequences, are radically and rapidly changing the human condition, with outcomes that are, at the same time, both encouraging and troublesome.\u00a0 Today, 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