The reality of distress among healthcare workers is not always adequately addressed. It is suggested that we delve deeper into the individual and open a space for reflection on this issue. This brief article can facilitate new guidelines to reduce the anxiety that professionals currently experience due to both patient care and the accumulation of tasks.

Introduction. Placing this work

I wish to begin this work briefly by pointing out what we all consider ourselves to know and understand; I wish to do so with respect, because the constant spread of distress among healthcare professionals ^[1]  does not diminish its importance, and because clarity of judgment is an inseparable companion for ensuring that every action is as accurate as possible in any situation, particularly in painful ones.  I affirm, without fear of being wrong, that every healthcare professional, from the least qualified to the most advanced, possesses in their heart a dimension—I would say an added and profound one—of selfless compassion ^[2] ,  a primary and fundamental desire to heal, care for, and comfort every patient. This compassion may be obscured or blurred in these times, but, as I maintain, it is always deeply rooted. And it is time to dust it off so that we may be freer, happier, and overcome, or almost overcome, distress.

This dimension, which we might call beneficial, of high existential and moral dignity, is what breaks down when a person is invaded, to a greater or lesser degree, by a tension that fractures them at the very core of their being—not so much their professional status, which it certainly is, but their personal one. And unfortunately, they become partially or completely incapacitated, unable to make decisions, to share doubts, and to discuss what is best for the patient. These obstacles, which their colleagues might see as a more or less high mound, are for them the tip of an iceberg, not only large or grand, but heavy and immovable: distress exists. In reality, there is a negative and dangerous overflow of what one is—not so much of what one has, although it may not be considered as such—and this affects, or can affect, one or more of the dimensions we know in each person: physical, psychological, spiritual, social, etc. It is then complex and difficult to discern, at least, the degree of intensity of the discomfort; uninvited elements become intertwined: insecurity, confusion, anxiety, worry.

“We have wanted to understand life as synonymous with physical and mental well-being, forgetting that illness is an inherent part of life and that death is intrinsic to existence itself (…). Understanding existence as a dynamic process of expectations and projects, successes and failures, deficiencies and qualities, can make coping with illness, etc., more acceptable. (…) There is a need to train healthcare professionals, and society itself, to face the inherent limitations of human nature (…) ^[3] . Therefore, recognizing limitations is essential, primarily to learn how to cope with them.

Naturally, people are looking for remedies to avoid or at least lessen it. These remedies, for now, cover a very broad range and are perhaps not as effective as they should be, at least in their depth. I have read in various sources different ways of dealing with distress; from advising people to drink green tea, to personal psychological efforts, help from the relevant specialist, insisting on finding the causes of the situation, distancing oneself from the matter that worries one, and relying more on family and loved ones ^[4] . All of this may be acceptable and appropriate, but perhaps quite incomplete, since  what one is remains unchanged , even after losing so much of what one has. It is this being that I suggest focusing on ^[5] .

 I’m not sure to what extent my work can be considered original, since I support the project I’m working on with professionals in Anthropology and Bioethics who advocate this approach. I believe some works are original because of their novelty; others are original because they emphasize, in different ways, enduring realities, where nuances should enrich that reality, not obscure it. That’s why I include accurate and well-supported opinions that facilitate the understanding and application of this work. Certainly, there are quotes from years ago, but they are invaluable because they are virtually unalterable; as are quotes from recent research.

I wish to point in the person something higher, deeper, and above all, more real. As Socrates already pointed out, “an unexplored life is not worth living” ^[6] . And that is the aim of my contribution. The great scientific, empirical, and technological development of our time does not keep pace with the study of  who we are  , and we have the paradox of knowing a great deal about something and knowing very little about what is important: who we are and what we are called to be.

From the very beginning, if one can speak in this way, I have maintained that bioethics cannot and should not be based solely on data; its line of reasoning is either the person or it is nothing. This is somewhat curious, given the splendid possibilities of advances of all kinds that surround us. I learned from the eminent Professor López Quintás that “our era shows a special proclivity towards ambiguity, disregarding the analysis of the decisive potentialities for human existence. Therefore, it is a matter of condensing, from different perspectives, the core meaning of those aspects of human life that are disrupted and are causing too many ruptures and imbalances in behavior” ^[7] . This loss of meaning and purpose is not something new; Saint-Exupéry already recognized it in  The Little Prince  , when he commented that a great mystery of man is losing what is essential and not ignoring that he has lost it ^[8] .

Nor is it pointless to repeat here the opinion of one of my colleagues in defending the person both as a vulnerable being and when, in the perhaps excessive development of work and the tensions it entails, the core of their existence is negatively impacted. For Dr. Ferrer, the protection of dignity is the guiding principle of Bioethics: “Without the founding principle of human dignity, it would be difficult to find a basis for the rights of the person and impossible to arrive at an ethical judgment on the conquests of science that directly intervene in human life. It is necessary to firmly reiterate that there is no understanding of human dignity linked only to external elements such as the progress of science, the gradual nature of the formation of human life, or facile piety in the face of extreme situations. When respect for the dignity of the person is invoked—a dignity that intrinsically possesses its natural end from the first instant of life—it is fundamental that this respect be full, total, and unconditional, except for the recognition—if one wishes to seek a condition—that one is always dealing with a human life” ^[9] .

It is insidious, not once but many times, that society must recover a respectful and delicate way of caring for life, and we lack more established, broader solutions that are in accordance with dignity and that do not generate significant new conflicts, as is currently the case, at least in Europe, with distress and other problems. “It is common for the teaching of Bioethics to be based on learning the basic principles of autonomy, beneficence, non-maleficence, and justice, which are widely used. Regarding the topic at hand, some authors point out that the biomedical professional may lack humanistic training, and therefore resorts even to simple handbooks that provide guiding principles for their professional practice. These do not always reflect the reality that emerges; in fact, reality is often obscured by a certain formalism ^[10] .

An invitation to live in freedom

To briefly develop this, we might say, evidence, which is an unknown evidence, I feel indebted to a young theologian, Martín Luque, and to a powerful philosopher, Leonardo Polo.

Martín Luque is Argentinian, with degrees in Medicine and Theology. One of his areas of study is the potential challenge of psychological and spiritual maturity. To this end, he employs a symbolic method which I briefly explain below ^[11] .

It goes like this: a mature person is someone who is more or less grounded and understands themselves. We can identify these characteristics as an inward-facing vector. In turn, the person possesses another outward-facing vector that holds a magical personal richness. It is personal, unique, and creative because it encompasses everything around them: work, family, friends (personally, I would add two more areas: customs and beliefs).  Maturity, Luque would say, is functioning with both vectors: the vector of self-knowledge and the vector of giving . Although, it’s good to know, they are never fully resolved. Knowing oneself means not being a surprise to oneself: virtues, traumas, flaws… which are, and should be, a potential solution to rediscover sufficient and peaceful inner silence, and thus connect with the other vector. This dynamic balance allows the person to respond by managing tensions and prioritizing life; The outward-facing vector has much to say to others, because it clarifies that I am, that we are, beings of relationships, and therefore with the need and the good fortune to be able to connect with people to love, with people who need me. The knowledge and connection of both vectors not only enhance personal creativity, but more importantly, a person’s transcendence. Rediscovering ourselves as open beings, free within and deeply committed and grateful on the outside.

I now turn to my second mentor, Leonardo Polo (1926-2013), who has been called the Aristotle of the 21st century ^[12] . The depth and originality of his thought reveals, among other fields, who man is, surpassing with his description and simultaneously building upon the contributions of the great philosophers of all time, from Aristotle to Saint Thomas Aquinas, Kant, Hegel, and others. He created what he calls Transcendental Anthropology ^[13] ; his work, on which his disciples continue to collaborate, exceeds 40 volumes, covering profound topics. One of his more accessible books is entitled  “Who is Man?” ^[14] , in which he describes man as “a spirit in time .” This is where I pause, as understanding this description sheds a powerful light on the present situation of the individual in the world. His method consists of abandoning mental limitations—which I will not delve into now—; It presupposes a philosophical architecture not built on isolated, brilliant intuitions, but on curiously hidden truths that clarify and illuminate our temporal condition, which is fully realized only when approached from what we truly are: intimacy, freedom, and heart. It is revolutionary; such is the truth he so loved. Polo warns us that it is neither sufficient nor real to believe that we are body and soul. No;  the person is strictly spirit,  a spirit that coexists freely, that seeks reflection, with the capacity to give of itself and to know; and all of this, he teaches us, is expressed in its  possessions : a body and an essence in which its will, its intelligence, and its self reside. Allow me a pedagogical explanation, which may seem to lack rigor, but this is not the case; on the contrary, it is appropriate for these reflections. We can affirm that Polo maintains that we are a personal life upon which rests an additional life—the one we cultivate with our intelligence and our will—and a received life, the body. It is the spirit, personal life, authentic life, that governs everything else and enables us to be prepared to face the unforeseen. Man, Don Leonardo will explain, not only solves problems, but also creates them. But no animal invents a resource; and man does; and not just one, but many. All healthcare workers know and experience that the sick, or any staff member distressed for whatever reason, need our set of resources and our spirit. And if I am the one in need, I too must cultivate those resources and protect my privacy.

I know these are just brief observations. My concern is that, sometimes, we approach problems poorly because we use insufficient or even invalid methods. And also because our stubbornness toward a specific outcome prevents us from considering that some problems have more than one solution; that different approaches broaden our perspective; that natural healing always works. Ultimately, framing each issue accurately means identifying what is relevant, and the analytical method, which is the one primarily applied in my understanding of distress, can sometimes create more problems than it solves.

It is suggested

I end by leaving these windows open, let’s say creative and also healing; I respect and accept the use of known means to avoid distress, but let’s not forget that we must cultivate what heals the most; counting on the fact that  each person, with their presence, contributes new capacities for acceptance and hope .

Man is not a machine and cannot define his life or his profession solely in terms of efficiency, effectiveness, or failures. The defining characteristic of a person’s truth is their dynamic integrity. This interplay of self-knowledge and self-giving—the nurturing and development of one’s freedom, heart, and inner self—must be given before all other possessions.  We are who we are from within . In this way, to the extent possible, we enrich and heal ourselves.

Gloria Mª Tomás y Garrido. Honorary Professor of Bioethics. Catholic University of Murcia. Full Member of the Santa María Academy of Pharmacy of Spain

***

[1]  https://www.wordreference.com/  (Accessed 2/11/2024)

[2]  García González, J. Man as a person, AEDOS, 2019, pp. 150-165. Human will, the acting self

[3 ] Cerdá-Olmedo, G. “Man facing suffering and death: palliative care vs. euthanasia”, in Tomás G. and Ferrer M. “Responses to contemporary bioethics” Texts on Bioethics. UCAM, 2012, pp. 182-183

[4]  https//:www.reverso.net (Consulted 11/30/24)

[5]  Sellés, JF Theology for Nonconformists. Ed. Rialp, 2019, pg308-319

[6]  Socrates (470 BC-399 BC) described in the work Apology of Socrates written in the year 399 by Plato

[7]  L.Quintás, A. in . “Responses to contemporary Bioethics” Texts on Bioethics. UCAM, 2012, pg.7.

[8]  Saint-Exúpery, Citadelle, pg.59

[9]  Ferrer, M. “Responses to Contemporary Bioethics” Texts on Bioethics. UCAM, 2012, pg. 10

[10]  Pardo, A. The principles of Bioethics in teaching: difficulties and proposal. In Cuadernos de Bioética, no. 112. Vol. XXXIV, 3rd, 2023, pg. 297

[11]  Oral lecture, August 13, 2024. Material can be found at the Joan Baptista Torelló Research Group on Psychology and Spiritual Life. Pontifical University of the Holy Cross, Rome.

[12]  Cardona, L. in Philosopher, Teacher and Friend, 278 testimonies about Leonardo Polo. Vol. II, EUNSA, pp. 322-336

[13]  A brief, synthetic summary from the different philosophers is the one made by Armando Segura in Almudí. Org. articles, 27/June/2022 (accessed 9/January/2025)

[14]  Polo, L. Who is man, a spirit in time, 5th ed. Edic. Rialp, Madrid, pp. 102-124, 243, 244