Pope's health raises ethical questions

By Peter Gould
BBC News, Rome

To what extent should medical science be used to prolong the life of John Paul II?

The delicate question has been raised by the fragile condition of the 84-year-old pontiff.

He is now thought to be close to death, despite efforts by doctors in recent days to halt his decline.

A tracheotomy was performed to help him breathe, but it left him almost without the power of speech.

Then, after concern over his loss of weight, doctors inserted a nasal feeding tube to allow him to receive nutrition.

But over the past 48 hours, there has been a dramatic worsening of his condition.

It is necessary to approach the ill with that healthy realism which avoids generating in those who suffer the illusion of medicine's omnipotence Pope John Paul II 2002

The Pope has apparently refused the option of being taken back to hospital, and appears to be serenely waiting for death.

The measures used to treat the Pope have given a new focus to discussions within the Catholic Church about the care of the dying.

Euthanasia by omission

It was the Pope himself who re-opened the debate a year ago with remarks to a medical conference in Rome.

Speaking about the treatment of patients in a persistent vegetative state, he said that artificial feeding was "morally obligatory".

Providing food and water by tube was a natural means of preserving life, he argued, and not a medical act.

Furthermore, he warned doctors, the removal of feeding tubes would be "euthanasia by omission".

It is widely believed that John Paul II has written a letter authorising the Church to hold an election if he becomes incapacitated. Peter Gould

The Pope's words caused a stir in the medical world, particularly in the 600 Catholic-run hospitals in the United States.

Many doctors had assumed that it was permissible to withdraw such treatment where there was no hope of recovery.

The Pope's words also created doubts about the ability of Catholic doctors to comply with the terms of a "living will" in which the patient asks not to be resuscitated in the event of them slipping into a coma.

But while John Paul II defends the sanctity of human life, he has made it clear he is opposed to extreme measures being used to keep patients alive "at all costs".

"It is necessary to approach the ill with that healthy realism which avoids generating in those who suffer the illusion of medicine's omnipotence," he said in 2002.

No extremes

In the United States, Catholic doctors who care for the terminally ill have been given guidelines by the US Conference of Catholic Bishops.

They have been told that the duty to preserve life is not absolute, and the patient may reject any procedure that is "insufficiently beneficial or excessively burdensome".

But the bishops go on to warn that suicide and euthanasia are never morally acceptable options.

"Physicians and their patients must evaluate the use of the technology at their disposal," they say.

"The use of life-sustaining technology is judged in light of the Christian meaning of life, suffering, and death.

"Only in this way are two extremes avoided: on the one hand, an insistence on useless or burdensome technology even when a patient may legitimately wish to forgo it and, on the other hand, the withdrawal of technology with the intention of causing death."

Incapacity conundrum

One unresolved issue is what would happen if the Pope becomes incapacitated but remains alive. Who will then decide what to do?

"The same moral rules apply to the Pope as to anyone else," says Father Thomas Reese, editor of the religious journal America.

The same moral rules apply to the Pope as to anyone else Father Thomas Reese Editor, religious journal America

"His situation is problematic because he does not have a living relative and Church law does not say who would make medical decisions for him if he is unconscious.

"Whether he has a living will or not is unknown, but his statement of a year ago on these issues would have to be respected as an indication of his will.

"In the past, most moralists would have considered feeding tubes a medical intervention like a respirator.

"If a person is going to get better, obviously you do not disconnect them. If they are dying, you do not have to keep them connected. The disputed issue is a person in a persistent vegetative state.

"The Pope now says they should continue to receive liquids and nourishment."

It is widely believed that John Paul II has written a letter authorising the Church to hold an election if he becomes incapacitated.

But has he left instructions over the medical options open to his doctors?

We simply do not know, and the Church remains in a state of uncertainty over the health of its ailing Pope.