Professional and ethical challenges during the COVID-19 pandemic

Professional and ethical challenges during the COVID-19 pandemic

Prof. Rok Čivljak, MD, PhD

University of Zagreb School of Medicine

Dr. Fran Mihaljević University Hospital for Infectious Diseases, Zagreb

The Croatian Catholic Medical Society, President

Mirogojska 8, 10000 Zagreb, Croatia

1. Introduction

The history of mankind is marked by numerous infectious diseases causing significant morbidity and mortality, including a great suffering. During the numerous epidemics, that sometimes escalated into pandemics, many people would fall ill at the same time, often with significant lethality, as has also been the case during the current COVID-19 pandemic. Owing to the specifics of caring for COVID-19 patients, the need for isolating the sick and dying, as well as limiting contact with them, healthcare workers found themselves confronting numerous medical, social and ethical challenges. Sometimes patients have been unjustifiably isolated from the society, without the possibility of contacting their loved ones, which has generated additional suffering and pain. Additionally, in order to prevent infection of a large number of people, possibly leading to the collapse of the healthcare system, very strict social isolation measures were introduced outside the healthcare institutions limiting freedom of social contacts. Besides professional medical care, millions of sick and dying patients also needed comfort, compassion and companionship that was an additional burden for healthcare workers.[1]

Western medicine, guided by the absolutized ideal of health and victory over death, predominantly oriented to a particular morphological, physiological and technological approach to diagnostics and treatment, has distanced itself from the human person missing to recognize the needs arising from the mental state of the sick and dying. We found ourselves facing the challenge of redefining the role of healthcare workers, even reviving the paradigm of holistic medicine that we have neglected over time. Therefore, the experience of the COVID-19 pandemic was an opportunity to restore medicine to its fundamental and original meaning by incorporating compassion into health care – caring for human being, not only his/her disease.[2]

2. COVID-19 pandemic timeline

In mid-December of 2019, a pneumonia outbreak erupted in China resulting in COVID-19 pandemic caused bySARS-CoV-2 with more than 777 million people fallen ill so far, of whom more than 7 million have died.[3] Just try to imagine how many families lost their grandfathers and grandmothers, children lost their parents, brothers their sisters, and how many among the dead were our friends, colleagues, neighbors…

The COVID-19 epidemic caught the entire society, healthcare systems and healthcare workers unprepared. When a newly discovered disease started spreading in China, few people thought it would soon appear in Europe, and nearly no one considered the possibility of a pandemic of the magnitude that occurred during the past five years. What few predicted happened: an infectious disease changed social and economic relations, in a certain way, humanity as a whole, by penetrating into every pore of society.[4]

At the beginning of the pandemic, when we thought that nothing worse could happen, a natural disaster occurred in Croatia: on March 22, 2020, the citizens of Zagreb were awakened by an earthquake. In addition to extensive property damage, several hospitals had to be evacuated, including the University Hospital for Infectious Diseases where patients with COVID-19 were being treated. Let us recall the scene around our hospital, where the old and young, personnel and patients, SARS-CoV-2-positive and negative, were scattered on the grass and the parking lot, shivering from the cold and fear, asking for help from each other, and remembering His words: Eli! Eli! Lama azavtani! (My God, my God, why hast Thou forsaken me?). Unfortunately, another earthquake in the vicinity of Zagreb occurred several months later, with even greater property damage and more human victims, including psychological consequences that are still being revealed. This additional misfortune jeopardized the safety of all, especially the most vulnerable members of our society: children, the elderly and the sick. What was the role of health professionals at that time? We were expected to stay level-headed, muster all our strength, knowledge and skills, and provide our patients with the best possible, and sometimes impossible, level of care.[5]

On March 11, 2020, after more than 118,000 cases in 114 countries and 4,291 deaths, the World Health Organization declared COVID-19 a pandemic. At the beginning of the pandemic, emphasis was placed on primary prevention including containment and management of the spread of SARS-CoV-2 outbreaks through the use of non-pharmaceutical interventions that addressed different modes of transmission. Secondary prevention focused on early detection, rapid response and containment measures to limit the spread of virus once iz has emerged and before it escalates into a full-blown pandemic. Tertiary prevention of pandemic aimed to mitigate long-term consequences, reduce morbidity and mortality, and promote recovery and resilience within affected communities.[6]

Many countries enforced lockdowns of varying stringency in response to the pandemic. Some included total movement control while others enforced restrictions based on time. Schools, universities and colleges closed either on a nationwide or local basis in 63 countries, affecting approximately 47% of the world’s student population. The pandemic has led to the adoption of particular hygienic behaviors (e.g., wearing masks, washing hands) and discouraged certain daily practices (e.g., leaving home, shaking hands). Amid the worldwide lockdown and transition to online learning, students were most satisfied with the support provided by teaching staff and their universities’ public relations. However, they were mainly concerned about their future professional career and studies, experiencing significant anxiety and frustration. Students with certain socio-demographic characteristics (male, part-time, first-level, applied sciences, a lower living standard, from Africa or Asia) were significantly less satisfied with their academic life during the pandemic, while female, full-time, first-level students and students faced with financial problems were more affected in terms of their emotional life and personal circumstances.[7]

The COVID-19 pandemic has made a significant impact on various supply chains. Initially, extreme shortages emerged in the personal protective equipment for healthcare workers, diagnostic testing, equipment and staffing to provide care to seriously ill patients, and basic consumer goods disrupted by panic buying. These shortages left healthcare and frontline workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to all supplies, including gloves, medical masks, respirators, goggles, face shields, gowns, and aprons Although shortages of personal protective equipment were found in most countries, no significant impact on infection rate was found among healthcare workers.[8]

Due to the rapid increase in the number of patients and deaths, and the inability to find appropriate specific treatment, the process of licensing new drugs and vaccines against COVID-19 has been accelerated, although already existing advanced technology has been used. At the very beginning of the pandemic, three medications – chloroquine phosphate, hydroxychloroquine sulfate, and remdesivir – have been granted emergency use authorization for the treatment of COVID-19.[9] However, while subsequent research showed that the first two drugs were ineffective, remdesivir was the first one to receive approval for use in adult and pediatric patients for the treatment of patients with severe disease requiring hospitalization.[10]

Soon after, emergency use authorization was issued for the first COVID-19 vaccines that met the high standards for safety, effectiveness, and manufacturing quality required of an approved product.[11] As a messenger RNA (mRNA) vaccines, based on novel platforms with previously unregulated aspects of manufacturing, some serious concerns about the safety and effectiveness raised in the public, especially if such vaccine derived mRNA can be reverse transcribed into DNA with a risk of insertion into the human genome. New DNA insertion into the human genome would be a serious concern if it happens on the level of stem cells of the reproductive system. Although such suspicions have not been confirmed, actions like silencing dissenting voices, coupled with policy decisions often reliant on assumptions rather than robust experimental data, may have inadvertently undermined both science and public confidence. To rebuild trust, it is crucial to return to the fundamental principles of scientific inquiry.[12]

3. COVID-19 and maternity

Since the onset of the COVID-19 pandemic, the consequent lockdown and other social changes brought about by the pandemic, the question of the possible impact on women’s health and maternity immediately arose. In addition, particularly severe cases of COVID-19 were observed in young and previously healthy women during their pregnancy with numerous and various unfavorable outcomes for both the mother and child. Therefore, many questions has arisen, such as: if SARS-CoV-2 affects the pregnancy of an individual pregnant woman; if COVID-19 pandemic generally affects the fertility and birth rate of the population; are there indications for the increased protection of women against the SARS-CoV-2 with the aim of protecting motherhood and future generations; what about the possible impact of certain medicines and vaccines against SARS-CoV-2 on the outcome of pregnancy and the health of the offspring.[13]

In most women during and following pregnancy, the clinical feature of COVID-19 is similar to those in non-pregnant women, with some minor exceptions. Approximately 70-80% women who become infected with SARS-CoV-2 during pregnancy will develop asymptomatic infection, and the majority of those who do become symptomatic will only ever experience mild to moderate symptoms. However, natural physiological adaptation to pregnancy results in changes to the immune and respiratory systems, cardiovascular function, and coagulation, which may in turn affect the progression of COVID-19. It have been shown that pregnant women have a higher incidence of severe COVID-19, as well as the need for admission to the intensive care unit (ICU) and mechanical ventilation, and death, than infected non-pregnant women of the same age.[14]^,[15]

SARS-CoV-2 infection among pregnant women and women in labor is associated with a higher risk of maternal mortality or morbidity caused by obstetric complications.[16]^,[17] In a US retrospective study among 14,000 women, pregnant women infected with SARS-CoV-2 had a significantly higher incidence of a composite outcome of maternal death or serious morbidity related to hypertensive disorders of pregnancy, postpartum hemorrhage, or non-COVID infections compared to uninfected pregnant women. The risk of complications was higher in pregnant women with severe COVID-19.[18]

Unfortunately, the incidence rates of SARS-CoV-2 infection in pregnant women, as well as health outcomes for mothers and children, have been shown to vary significantly across the world, depending on economic and underlying social differences. A study conducted in Italy showed that pregnant women with COVID-19 were more likely to be <35 years of age, foreign women, unemployed, or living with an unemployed partner.[19] The highest infection rates were observed in Latin America and the Caribbean and in lower-middle-income countries. Lower-middle-income countries had significantly higher rates of maternal mortality, ICU admissions, and stillbirths compared to high-income countries.[20]

When all the psychological and social effects of the COVID-19 pandemic are added to the usual vulnerability of women during and following pregnancy, an increase in the negative psychosocial effects of the pandemic was to be expected. During the pandemic, an increase in depression and anxiety was observed in women following pregnancy, highlighting the need for increased screening and interventions for the prevention of peripartum mood disorders and anxiety. In women who gave birth during the pandemic, the average incidence of depression and anxiety was significantly higher compared to women who gave birth before the pandemic.[21] A higher proportion of women with psychosocial problems arising in connection with pregnancy and childbirth during the pandemic was associated with the introduction of social distancing measures. In a study conducted in the United Kingdom in mid-2020, as many as 11.4% of women developed depression in the first three months after giving birth, and 18.4% developed anxiety. However, using the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory, even 43% of women had clinically significant postpartum depression, and even 61% had clinically significant anxiety.[22]

The COVID-19 pandemic has also negatively impacted female fertility and birth rates. Nine months after the pandemic began, birth rates have begun to decline in many developed countries. In Italy, birth rates fell by more than 21% in December 2020 compared to the previous year.[23] In the United States, the largest decline in birth rates was among those living in higher socioeconomic status.[24] Study investigating the impact of the first wave of the pandemic on birth rates in 24 European countries showed that 10 months after the onset of the pandemic (and the first lockdown), an average decrease in the number of live births of 14% was observed compared to 2018 and 2019. The only variable associated with this phenomenon was the duration of the lockdown, while the factor that influenced the reduction of this unwanted effect was a higher national income per capita. Although the number of births rebounded in the following months in many countries, it seems that in most countries it failed to compensate the previous decline in birth rates. The negative demographic impact of the pandemic was all the greater as the mortality rate increased at the same time which resulted in a further decline in the natural increase rate.[25]

Although vertical transmission of SARS-CoV-2 itself, as well as a direct prenatal effect of SARS-CoV-2 on the child during pregnancy, has rarely been confirmed,[26] SARS-CoV-2 is not regularly found in the placenta[27] nor it may be transmitted to infants by breastfeeding[28]. However, maternal immune activation during pregnancy could negatively affect the development of the child, including altered offspring neurodevelopment, as has been confirmed in the case of other prenatal infections. Namely, recent research shows that infection with the SARS-CoV-2 during pregnancy also causes immune activation of the mother, placenta and fetus, which could ultimately result not only in undesirable effects on the pregnant woman but also in neurodevelopmental consequences for the offspring. Children born to mothers who experienced such immune activation during pregnancy are at increased risk of various diseases and conditions, such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, anxiety, depression, cognitive disorders, learning disabilities, and even schizophrenia.[29] Therefore, it is necessary to monitor other possible long-term effects of COVID-19 on children conceived, born, and raised during the pandemic, as there is a possibility that such long-term effects may also occur in the case of SARS-CoV-2 infection.

Considering all the previously mentioned possible effects of SARS-CoV-2 infection, COVID-19, and the entire pandemic on women during and following pregnancy, as well as the possible short-term and long-term negative impacts on children born to mothers who have contracted COVID-19, it is essential to implement all necessary preventive measures to prevent severe forms of COVID-19 during pregnancy and after childbirth, as this also prevents possible adverse effects on children. In the first waves of the pandemic, when a larger proportion of the population was uninfected and immunologically naive to SARS-CoV-2 infection, mandatory mask-wearing and limiting access to health facilities for pregnant women and women in labor were necessary to reduce the risk of acquiring the infection. However, with the advent of the first vaccines against SARS-CoV-2, we have obtained a safe and effective measure to prevent the occurrence of infection, and more importantly, to prevent the progression to severe COVID-19 requiring hospitalization and ICU treatment. Vaccination reduces the risk of developing COVID-19 and reduces the severity of the disease if the infection does occur, and all available data indicate the safety of the use of currently available vaccines against SARS-CoV-2 before, during and after pregnancy.[30]

Prevention and treatment of COVID-19 in pregnant and postpartum women do not differ significantly from that in non-pregnant individuals. However, it is recommended that pregnant women be treated in institutions that are competent in providing specialized multidisciplinary care that includes appropriate monitoring of both mother and child. It is important to emphasize that pregnant and breastfeeding women should not be denied some forms of prevention (including vaccination) or treatment due to hypothetical suspicion of possible adverse effects.[31][32][33][34] Compared to placebo, most of the SARS-CoV-2 vaccines approved by the FDA and EMA have reduced the risk of symptomatic infection in clinical studies, such as BNT162b2 (BioNtech/Fosun Pharma/Pfizer) by 97.8%, mRNA-1273 (ModernaTx) by 93.2%, ChAdOx1 (Oxford/AstraZeneca) by 70.2%, Ad26.COV2.S (Janssen) by 66.9%, while for some there is high-certainty evidence that they reduce the risk of severe or critically ill disease. There is little or no difference in the occurrence of serious adverse events between most vaccines and placebo.[35]

However, post-marketing safety monitoring of vaccines has shown that they cause some side effects that were not detected in clinical studies, such as myocarditis, pericarditis, vaccine-induced thrombotic thrombocytopenia or Guillain-Barré syndrome.[36] However, the use of vaccines against COVID-19 has also raised some controversies resulting in vaccine hesitancy, partly due to unfounded claims that vaccines can adversely affect the reproductive health of women and future generations, and partly due to their moral unacceptability because some of them are produced using human cell cultures obtained from aborted fetuses.[37] A review on the ethical aspects of vaccination and their relationship to the doctrine of the Catholic Church has been published in which all examples of vaccines and the moral justification of their use are clearly argumented.[38] Namely, back in 2005, the Pontifical Academy for Life declared itself in favor of the use of the aforementioned vaccines, explaining that the use of these vaccines is morally permissible if there is no formal participation in evil, that is personal consent, if there are no alternative vaccines, and if their non-use could cause a serious risk to the health of children and the entire population.[39] The Congregation for the Doctrine of the Faith also took the same position on COVID-19 vaccines, emphasizing that vaccination must be voluntary, and to those who do not vaccinate, it conveyed the importance of responsible behavior and implementing all other forms of prevention.[40]

Research has shown that maternity restrictions during pregnancy and childbirth at the beginning of the pandemic have also negatively affected the experiences of fathers in several ways. The exclusion of fathers (e.g. during prenatal care and childbirth) produced feelings of isolation and a sense of loss, the inability to create an initial bond between father and child, and the absence and lack of closeness of the husband/father also had a detrimental effect on the mental health of pregnant women and mothers. However, the new living conditions during the pandemic, especially working from home, increased the presence of fathers in the first months of a child’s life and subsequently provided an opportunity to build a more intensive parental relationship for fathers and a closer long-term connection between father and child, compared to pre-pandemic conditions.[41]

The impact of the COVID-19 pandemic on the health of the population will last for a very long time, and according to some predictions, it could be felt well into the 22^nd century.[42] Both the infection caused by the SARS-CoV-2, as well as some epidemic-prevention measures, have had a negative impact on the health of the population, especially mothers and children. It is expected that some of these impacts will also affect child development, including early childhood, puberty and adolescence. Therefore, a comprehensive review of the effects of COVID-19 and the pandemic, as well as the long-term effects on children conceived, born and raised during the pandemic, is important for understanding and possibly mitigating the adverse effects.

4. COVID-19 and compassion

Compassion is not just an understanding of a person’s needs and suffering but also something more. Compassion motivates people to do their best to alleviate the physical, mental, or emotional pain of others and themselves. However, compassion does not just involve “feeling for the other” but also the desire to alleviate the suffering of others. And among healthcare professionals, this includes not only medical treatment, but also offering oneself to others as brothers, like the Good Samaritan, and ultimately, like Jesus Christ himself (Christus Medicus).[43]

Can compassion help in the treatment of patients, but also help healthcare professionals themselves? Research in this area is growing rapidly in recent years, thanks to magnetic resonance imaging and other high-tech methods in order to “understand the brain to understand the mind”.[44] Medical care that includes compassion is associated with greater patient compliance and better treatment outcomes. Compassion has a positive effect on healthcare workers, as it affects the lower incidence of burnout and greater satisfaction among them. Therefore, some medical schools have implemented programs for studying compassion in their curricula, either as core or elective courses. Compassion should be a virtue that we learn in medical school, just as we learn how to perform a thorough physical examination.[45]

In the midst of the COVID-19 pandemic, the European Federation of Catholic Medical Associations (FEAMC) organized a conference “The challenges of competence and compassion in contemporary medicine” in Assisi, Italy. At the conclusion of the Conference, Prof. Msgr. Jacque Suaudeau, ecclesiastical assistant of the FEAMC, emphasized the importance of holding the conference and its title precisely at the time of the pandemic. “The very title given to the Assisi symposium is significant. If compassion is the virtue and the way forward for the Christian doctor today, in order to move away from technical and impersonal medicine “for the disease” and find the way back to medicine “for the patient”, professional competence is an integral part of compassion. There is no true compassion if there is no professional competence.” Pope Francis says it very well: “In today’s hurry, amidst a thousand errands and constant worries, we are losing the ability to be moved and to feel compassion, because we exhaust this return to the heart”. Between these two opposing tendencies – the illusory dream of transhumanism and the reality of the scarcity of means – the Christian doctor must make his way in the service of patients in imitation of Jesus himself. A key virtue for him is compassion, compassion for the sick person, compassion for the patient’s family, despite all obstacles. For the Church, this goal of compassion in the medical field should become a pastoral priority.[46]

5. COVID-19 and healthcare workers

Only human is aware that he shares the same ultimate fate with all living things – All of life has a beginning and end! This human orientation towards death has dramatically come to the fore during this pandemic. In this pandemic, death does not happen by chance since many people die, including people close to us. Therefore, COVID-19 has confronted us with the realization that we are disposable, mortal. People have become aware that they are an “endangered species”, although the technological and scientific progress of medicine has instilled in them a belief in indestructibility, almost immortality.[47] At the beginning of the pandemic, the dignity of dying was also called into question. A person often died alone, sometimes without a dignified farewell to what had been his body until recently, which was sometimes not even dressed but “packed” in a bag. There was no dignified funeral either, but everything took place only in the circle of a few closest people who themselves lived in fear of the virus catching them too. Both the farewell and the mourning process in the pandemic were deprived of their natural course and noble psychological medicine. Despite the progress of science and technology, providing adequate health care to life-threatening patients suffering from infectious diseases requires an additional dimension: an ethical approach that goes beyond mere science, professional competence and technical skills.[48]

However, not only during the COVID-19 pandemic, but also during previous pandemics, many healthcare workers have been shown to suffer from various forms of stress related to working with more demanding patients, occupational exposure to infection in the workplace, infection-related stigma, or the many challenges associated with the physical, mental, and social condition of patients. It is therefore necessary to increase institutional support for healthcare workers and develop training programs to improve their skills in addressing these challenges, leading a healthy lifestyle, and developing self-compassion. The same could apply to healthcare workers during the COVID-19 pandemic.[49]

During previous epidemics, such as the recent one in Africa caused by the Ebola virus, healthcare workers did not hesitate to provide health care to the sick even at the cost of their own lives. Then, and during the COVID-19 pandemic, providing high-level healthcare, such as intensive care, meant exposing healthcare workers to efforts and self-denials that could have resulted in endangering their own lives. This opened up new questions about determining the boundaries of the professional and the moral. Healthcare workers in these situations had a double obligation: to provide patients with maximum healthcare for the purpose of recovery and survival, while at the same time preventing the transmission of infection to themselves and others (other healthcare workers, members of their families, the wider environment in which they moved).[50]

During the COVID-19 pandemic, entire families fell ill: grandparents, fathers and mothers, brothers and sisters, husbands and wives, and even children. Sometimes, several members of the same family died in just a few days, which must have left a mark on the healthcare workers who cared for them. In the solitude of hospital isolation, patients were often infused with spiritual strength by physicians and nurses – sometimes the only ones with whom the patients had the opportunity to communicate – which gave an unexpected new dimension to the profession of healthcare worker.

Even religiosity itself has been put to the test during the COVID-19 pandemic. Namely, spiritual activities that believers carry out with priests in the auspices of sacred spaces (liturgical celebrations, baptisms, confessions, communions, confirmations, pilgrimages, weddings and funerals) came into question with the declaration of a lockdown due to which joint worship, gatherings, mass celebrations were interrupted. Even more drastic was the deprivation of access to the sacraments of those who were in greatest need: the sick and the dying, especially those who were separated from their loved ones in isolation units in hospitals and faced COVID-19 and death straight in the eye. The sick rightly asked themselves: where are those clergymen, hospital chaplains?[51]

During the pandemic, the Church used modern media channels to broadcast sermons and liturgical celebrations. These broadcasts kept the spiritual community of believers together. However, problems remained with the sacraments of confession, the Eucharist and the anointing of the sick, and the understanding of priestly life during the pandemic. Prof. Ivan Bodrožić, clergyman of the Croatian Catholic Medical Society, published a practical monograph on the pandemic and its consequences, a theological-spiritual analysis of the situation in the Church and its activities during the pandemic in Croatia. In three chapters – Confession as a victim of the COVID-19 pandemic, The Eucharist as a victim of the COVID-19 pandemic and The Priest as a victim of the COVID-19 disease – he presented the problems related to the activities of the Church during the pandemic. His thoughts on the crucial meaning of the Eucharist will certainly bear fruit in the future.[52]

At a time when healthcare workers were expected to make up for all the shortcomings of epidemiological measures, etiological treatment, and poorly planned dynamics of vaccination coverage, and when they were the only hope for patients from whom help (and even compassion) was expected – from whom should healthcare workers expect even the slightest dose of compassion: from employers, bosses, colleagues, family members, society and the public, or from the patients themselves? Therefore, under the influence of overexertion from excessive work, an extraordinary lifestyle and selfless giving, healthcare workers themselves have become in need of compassion. These extraordinary demands on healthcare workers have become particularly evident during the COVID-19 pandemic. Healthcare workers sometimes require emergency assistance when confronting such challenges. Therefore, Code Lavender, so-named for lavender’s calming effects, has been launched to support healthcare workers in crisis situations. The support protocol can be activated at any time for healthcare workers, patients and members of their families by a single phone call. Support is achieved through physical presence, thereby demonstrating an interest in helping, warm beverages and snacks, all the way to individual or team conversations, supplemental psychological and/or pharmaceutical therapy, or even prayers and spiritual assistance. Intervention can be performed by a trained individual or often by an entire multidisciplinary team, which includes a social worker, psychologist, member of the clergy and other trained personnel. The specific manner of implementing such intervention can vary from institution to institution but the fundamental principle is the same: providing immediate and holistic care at moments of increased stress or emotional need while fostering a culture of care and support focused on the well-being of healthcare workers. In some institutions, permanent interdisciplinary Code Lavender Teams have already become integral components of a coordinated form of spiritual, emotional and psychological support for healthcare workers, often involving priests and hospital chaplains as essential team members who provide holistic care not only to patients but also to medical personnel. Perhaps the introduction of Code Lavender Teams could raise awareness of the psychological and spiritual needs of the healthcare workers in the healthcare system, enhance the role of the clergy and promote an interdisciplinary holistic approach to caring for the needs of healthcare workers.[53]

6. Lesson for the future

The experience of the COVID-19 pandemic was an emergency during which healthcare professionals found themselves facing numerous professional and ethical challenges. Although it was difficult to respond to all these challenges, and many questions still remain unanswered, perhaps the pandemic was supposed to consolidate Catholic doctors in promoting a holistic, integrative approach to medicine, while incorporating compassion into health care, in order to return medicine to its true original meaning – caring for the person, not just for their illness. This could restore the lost trust of patients in Western medicine, and by scientifically-based integration of compassion into technologically advanced methods of practicing modern medicine, improve today’s medical practice – improve patient care and treatment outcomes, while at the same time increasing patient satisfaction and trust.

On the occasion of the 30^th World Day of the Sick, on February 11, 2022, Pope Francis published a message entitled “Be merciful, even as your Father is merciful” (Lk 6:36), which encourages us, above all, to turn our gaze towards God, who is “rich in mercy” (Eph 2:4), who always watches over his children with a father’s love, even when they turn away from him. “When individuals experience frailty and suffering in their own flesh as a result of illness, their hearts become heavy, fear spreads, uncertainties multiply, and questions about the meaning of what is happening in their lives become all the more urgent. How can we forget, in this regard, all those patients who, during this time of pandemic spent the last part of their earthly life in solitude, in an intensive care unit, assisted by generous healthcare workers, yet far from their loved ones and the most important people in their lives? This helps us to see how important is the presence at our side of witnesses to God’s charity, who, following the example of Jesus, the very mercy of the Father, pour the balm of consolation and the wine of hope on the wounds of the sick.”[54]

On 8^th December, 2020, on the 150^th anniversary of the proclamation of St. Joseph as Patron of the Universal Church, the Holy See published an Apostolic Letter of Pope Francis entitled Patris Corde (With a Father’s Heart).[55] The background to the Apostolic Letter was the COVID-19 pandemic, which, as Pope Francis writes, has helped us to understand the importance of ordinary people, people often overlooked, daily demonstrate the virtue of patience, offer hope in others and encourage responsibility. Pope Francis’s letter Patris corde seems to speak of healthcare workers: a multitude of humble and self-denying people who first chose the arduous and demanding path of becoming a physician, nurse, pharmacist or dentist, because the studies for these professions are the most demanding and time-consuming, and then to study for the rest of their lives, because pursuing these professions inevitably requires lifelong learning, and ultimately serving humanity in its most difficult moments: illness, hardship, suffering and death. Moreover, healthcare workers often have to be in contact with the entire family of their patient, listen to their stories, offer them advice, a warm word, and paternal care. The healthcare workers become like a father, like Saint Joseph, the one on whom the survival of the entire family depends.

Patients need physician who are both professional and compassionate. These qualities are important for providing appropriate care to patients with infectious diseases, but also in general. Moreover, a physician cannot act alone. A physician needs other to provide satisfactory care, but also to remain healthy, satisfied, and professional. Therefore, interdisciplinary teams are what medicine should strive for in the future. And along with the physician, the nurse, and other healthcare personnel, a clergyman – spiritual assistant, should definitely be part of that team because he understands the spiritual needs of the patient, but also of the healthcare professionals.

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