What treatments, and when to act?


February 03, 2005|By Janice D'Arcy | Janice D'Arcy,SUN STAFF

As Catholics worldwide offered prayers for the recovery of Pope John Paul II yesterday, church scholars said the Vatican might eventually have to grapple publicly with legal and moral questions about the pontiff's potential incapacitation and efforts to keep him alive if his condition deteriorates.

"One of the great difficulties in dealing with life-sustaining treatment is that one cannot guess all the circumstances that can arise," said John Haas, president of the National Catholic Bioethics Center.

Discussion of a pope's death was once considered taboo in the Roman Catholic Church. But given the 84-year-old pontiff's long-declining health - he suffers from Parkinson's disease and debilitating arthritis - it's now unavoidable.

His current illness is a respiratory ailment that developed from the flu, according to the Vatican, where aides said his health was improving yesterday at the Gemelli Polyclinic in Rome. He was rushed to the hospital late Tuesday when he had difficulty breathing.

Little official precedent

The church has an elaborate protocol for funeral rituals and succession procedures that follow a pope's death. But there is little official precedent if incapacitating health problems emerge.

If the pope were to fall into a coma, for example, it is unclear how long the Vatican would have to function without an effective leader. Although the Vatican's secretary of state, Cardinal Angelo Sodano, could run day-to-day operations, he would not have the authority to appoint bishops, issue binding pronouncements on doctrine or perform other theologically critical assignments.

"How long can we have a church where nothing would happen?" said the Rev. Thomas Reese, a Jesuit priest who is the editor of America, a monthly magazine on religious affairs. "We may just have to wait."

Reese said speculation persists that the pope has written secret instructions that would trigger his resignation should he be incapacitated for a long period. Pope Paul VI kept such instructions in a letter in his desk, but they never came into play before his death in 1978. But the Vatican has not publicly acknowledged the existence of a similar document for Pope John Paul.

Less a mystery and more of a quandary may be the question of medical treatment. According to Haas, Catholic teaching offers a general framework that "if medical intervention holds out a reasonable hope of benefit, it is obligatory - provided it doesn't cause excessive burden."

In practical terms, that could mean dialysis is appropriate for one patient but too painful for another. As with most theoretical guidance, Haas said, there is wide latitude for personal interpretation.

Guiding principle

The guiding principle, he said, holds that a personal assessment must be made by either the patient or his designee. What is definitive in the eyes of the church is that medical decision on efforts to extend life should not be made by a third party based on assumptions about the resulting quality of that life.

"Every human life is valuable. We would say there should never be a judgment by someone else about whether a life is worth living," Haas said.

Some analysts believe the pope hinted at his own desire in a closely watched address last spring titled "Life-sustaining treatments and vegetative state: Scientific advances and ethical dilemmas."

In that address, Pope John Paul criticized the use of the word vegetative as demeaning. "A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a vegetable or an animal," the pope declared.

Moral obligation

The pontiff was adamant about the moral obligation to provide food and water to comatose patients in long-term, vegetative states. "It is necessary to promote the taking of positive actions as a stand against pressures to withdraw hydration and nutrition as a way to put an end to the lives of these patients," he said.

But Haas cautioned against reading too much into the March 20 address. He called it a restatement of the traditional Catholic attitude on the issue, prompted by recent public events rather than the pope's own health.

There is also ample evidence of the pope's concern in general about caring for the sick. In fact, before he fell ill, he designated February as a month for Catholics to pray for "the sick, especially the poorest of them, that they may receive the care and medical treatment worthy of human beings."

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