Who will care for us in an increasingly aging and lonely world? Using the film  Turno de guardia (Guard shift) as a starting point, Vicente Bellver Capella reflects on the global nursing crisis, the shortage of informal caregivers, and the ethical challenges posed by the future of care, emphasizing the centrality of the person, the community, and human dignity in healthcare.

The film “Turno de guardia” (Guard shift) is one of the contenders for the Oscar for Best International Feature Film. The protagonist, Floria Lindt, works as a ward nurse in a Swiss hospital. Her workday is exhausting because she has far more patients than time to care for them, and because her duties involve a level of risk and responsibility that demands she be constantly at the highest level of alertness and competence. Despite the pressure, her priority is always the well-being of each individual patient she attends to. Without resorting to sentimentality, the film is probably the greatest tribute that the big screen has paid to nursing to date. And it is only right that it has finally been made, because the most widespread cinematic image of the nurse has been quite superficial, and it was urgent to revise it. But it is also very timely that this tribute is being paid precisely now, when awareness is growing that care is a core aspect of healthcare. The technocratic paradigm that shaped healthcare after World War II is being replaced by a holistic paradigm, which proposes care centered on the person and not on the pathology. Of course, curing remains one of the goals of medicine. But when a cure is not possible, care can and should always be provided; and thanks to that care, people can live a dignified and high-quality life until the very end.

The film is set in a Swiss hospital, in one of the world’s wealthiest countries with a high standard of healthcare. And yet, it presents a hospital staff where there aren’t enough nurses to properly care for all the patients. If this is happening in Switzerland, what can we expect in most countries around the world? What the film shows us isn’t fiction. It’s a disturbing reality that will only worsen in the coming years: there’s a shortage of nurses worldwide. Without being exhaustive, we can identify four main causes of this crisis.

First, the increased demand is due to the rise in chronic illness and dependency, phenomena largely associated with the aging population. Second, the decline in the number of nurses due to retirements, burnout, or migration. When a nurse leaves to work in another country, it is obvious that they leave a gap in their home country that is not easily filled. Third, insufficient social and economic recognition, coupled with the grueling conditions of many nursing positions.

I want to draw more attention to what I consider the fourth cause of the nursing crisis: the gradual decline of informal caregivers. One of the effects of the unwanted loneliness increasingly affecting people worldwide is the lack of informal caregivers. The “companion” in a hospital room is not a mere extra who, at best, simply provides emotional support. They are an essential part of patient care, and their absence cannot be compensated for by nurses, whose workload is significantly increased. In the film, when one of the patients approaches Floria and says, “I’m alone,” the nurse replies, “No, you have me.” This response demonstrates Floria’s deep professional commitment to her patients. But she knows, and we all know, that this lack of a companion is irreplaceable, no matter how much she tries to alleviate it.

If we are facing a shortage of nurses and informal caregivers, and this problem is set to worsen in the coming years, what can we do? We must not despair and instead seek creative and realistic solutions, which is what human beings do when faced with life’s challenges. I propose three lines of action, presented in order of increasing importance. First, we must take advantage of all the possibilities that AI and robotics will offer. It is true that their development and implementation bring with them numerous ethical problems: dehumanization of care, invasion of privacy, a digital divide between those who can and cannot join the virtual world, and so on. This digital bioprecarity must be addressed with appropriate design of applications and robots and with policies that guarantee universal access to these technologies. Second, we must strengthen nursing. Although caring is not as apparent as curing, it is equally important and essential: there can be assistance without a cure, but never without care. If we convince ourselves that we cannot live without nursing and recognize its inherent value, technically competent nurses will emerge who place the person at the heart of their profession. And finally, but most importantly, we must promote caring communities. The epidemic of loneliness afflicting the world will only be reversed with the flourishing of communities, whose seed is always the family, the quintessential caring archetype. If we promote ‘family,’ communities will flourish again, and with them, care. In this conducive environment, nursing will be perceived as an attractive profession, one worth committing to. And, very importantly, we will feel empowered to guide the design of digital care technologies so that they care, not dehumanize.

Vicente Bellver Capella. Professor of Philosophy of Law and Politics. University of Valencia

*Opinion piece published in the newspaper “Las Provincias”