Special Update
Posted Monday, Feb. 28, 2005 at 11:18 a.m. CST

The pope's hospitalization:
Five questions to ask at this time

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By John L. Allen Jr.
NCR Rome Correspondent

Catholicism's master communicator was at it again on Sunday, Feb. 27, as Pope John Paul II made the Sign of the Cross from the window of his 10th floor room at Rome's Gemelli Hospital, defying reports that this would be the first time in his 26-year pontificate the pope was neither seen nor heard during the Sunday Angelus prayer.

A senior Vatican official confirmed to NCR that the appearance was a last-minute decision by the pope himself.

Though it was the most fleeting of moments, the pope's firm arm movements and composed face suggested a man on the mend rather than someone on death's door, and was enough to reassure many observers that this crisis too, like so many health scares before, may well pass.

Since John Paul II was rushed back to the Gemelli with a relapse of his breathing problems, the world's media have once again turned their eyes to Rome. What follows are the five most commonly asked questions in this period, and the best answers that can be given.

What do we really know about the pope's condition?
The truth is, relatively little. Information from the Vatican has been infrequent and limited.

To some extent, this parsimoniousness has to be seen in historical context. In earlier eras, it used to be said that, "The pope is not sick until he's dead." The Vatican has historically been loathe to admit that the pope is ill, in part because it can seem ghoulish, in part because it can be a way of politically undermining the pope, suggesting that one doesn't have to take his wishes seriously because he may not be around much longer. Sometimes this reserve has been taken to absurd lengths. On Aug. 19, 1914, for example, L'Osservatore Romano, the official Vatican newspaper, published a stinging editorial denouncing unnamed commentators who had suggested the previous day that Pope Pius X had a cold. "How dare they?" was the editorial's wounded tone. Less than twenty-four hours later, Pius was dead.

By that standard, the Vatican has actually been rather forthcoming this time around. Statements from spokesperson Joaquin Navarro-Valls have given details about the nature of the pope's illness (an acute respiratory problem caused by a constriction of the larynx), the types of care delivered, the names of the physicians involved, even details about meals he's eaten and notes he's written.

Yet there's still a great deal we don't know. For example, how long is John Paul II likely to remain in the hospital? What is it about his condition that requires ongoing care at the Gemelli rather than in the Vatican, where there already is medical equipment to treat routine illnesses? When might John Paul be able to speak again? How lucid is he, and for how long each day? Will he need respiratory assistance from now on? How solid are his basic indicators -- diet, circulation, sleep patterns, and so on? To what extent will age and Parkinson's disease impede the full recovery that might be expected from a healthier patient? On virtually all of these questions, we're left with more or less informed speculation. To date, none of the physicians treating the pope has been made available to the press.

The bottom line is that while the bulletins from the Vatican are reassuring, and the pope's brief appearance Sunday lent those bulletins a measure of credibility, there are still grounds for concern. We probably won't see or hear a great deal of the pope between now and Holy Week (Palm Sunday is March 20), which means that we may be living with uncertainty for some time to come.

While the pope is sick, who's running the church?
There's a bit of mythology behind this question, which is that a healthy pope makes all the decisions in the Catholic church. In fact, Catholicism is one of the most decentralized organizations on earth -- 2,650 employees in the Roman Curia for a population of 1.1 billion Catholics worldwide. If the same ratio of bureaucrats to citizens were applied to the United States, exactly 500 people would work for the federal government, instead of the hundreds of thousands currently on the federal payroll. Most decisions that matter are made by bishops' conferences, local bishops and parishes.

None of this means that Rome doesn't make its presence felt, but that its capacity to do so on anything other than an exceptional basis is limited by personnel and infrastructure.

Even in the Vatican, a pope in the prime of health is only tangentially involved in day-to-day business. Moreover, John Paul II has always delegated much of the internal administration of the church to aides, a decision he made in 1978 in order to allow him to pursue his trips, his encyclicals, and his outreach to other religions and cultures. In addition, the Vatican in recent years has adjusted to the reality of a sick pope, with only the most important big-picture decisions that cannot be deferred reaching the pope's desk. All this means that a few days in the hospital for the pope will not slow the church down one bit. (Even in the three days John Paul's been in his hospital bed undergoing a tracheotomy, two messages have been released in his name, one to bishops involved in the Synod for Africa and another to the Focolare movement, along with a telegram of sympathy for the death of Fr. Luigi Giussani, the founder of Communion and Liberation. Vatican press bulletins also announced that John Paul has appointed a new nuncio in Ecuador, and new members to the Congregation for Divine Worship and the Council for Pastoral Assistance to Health Care Workers).

After 26 years, Vatican personnel are well aware of the pope's wishes on most questions. It's clear that John Paul wants greater unity with the churches of the East, for example, especially the Russian Orthodox; it's clear that he wants youth ministry to be a priority within Catholicism; it's clear that he's opposed to the use of military force except as a very last resort. He doesn't have to be behind the desk to ensure that the Vatican operates according to these principles.

Yet the pope cannot anticipate every question, and somebody has to give answers when the pope can't or won't. In the Catholic system, there is no vice-pope, so that when the pope is not exercising the fullness of his authority, no one can step in and do it for him. Instead, pieces of that authority are divided among a variety of officials depending on their area of competence. Among them, the most prominent are: Cardinal Angelo Sodano, the Secretary of State, responsible for diplomatic questions; Cardinal Joseph Ratzinger, head of the Congregation for the Doctrine of the Faith, responsible for theological questions; and Cardinal Giovanni Battista Re, prefect of the Congregation for Bishops, responsible for the appointment and oversight of bishops. In addition, the pope's private secretary, Archbishop Stanislaw Dziwisz, plays a key role as the most trusted interpreter of the pope's mind. But no member of this "gang of four" can function in place of the pope; according to Catholic theology, papal powers are non-transferable. Officials of the Roman Curia are therefore relatively free in this period to act on their instincts and judgment, without much coordination among them.

If the pope is unable to speak, can he still be pope?
As a matter of canon law, which is the body of law that governs the Catholic church, the pope does not have to speak in order to exercise his authority. As long as he can indicate his wishes in some fashion, whether in writing or through gestures, he can still fulfill his administrative responsibilities. Without the capacity to speak, the pope would probably not be able to perform the sacraments, but in recent months we have become accustomed to the pope "presiding" rather than "celebrating" the Mass in any event.

Yet the legal capacity to give assent to decisions is only one element of the "job description" for a pope. The Holy Father is also supposed to be a voice of conscience for humanity, and it's an open question how well John Paul could perform that role without the power to speak. One recalls the pope in Warsaw in 1979, for example, thundering that Christ could not be removed from the history of Poland, or in March 2003, exclaiming "No more war!" as U.S.-led forces prepared to invade Iraq. To what extent such messages will retain their moral force in written form remains to be seen.

Moreover, while the pope may still be able to assent to policies, the extent to which he is in a position to initiate them is also an open question. Some observers would argue that given the multiple crises besetting the Catholic church today, from the sexual abuse scandals in America to the growth of evangelical movements in Latin America to the relationship with Islam in Africa and Asia, the church needs energetic leadership that a weakened pope can't provide. Only time will tell if the John Paul II who emerges from this episode will be able to address the business awaiting him.

Why not resign?
For people who think of the Catholic church by analogy to a Fortune 500 corporation or a secular government, it seems obvious that John Paul is no longer capable of running the show and that he ought to step aside. For others, stirred by compassion for the pope's struggles, resignation seems like the merciful option.

Yet John Paul II has made it clear on multiple occasions that he has no intention of resigning, saying "Christ did not come down from the Cross." Some will see this is simply stubbornness or ego, but in fact there are four powerful reasons why resignation is viewed as a last-ditch, undesirable option among those closest to the pope.

Division: If the pope resigned and the cardinals elected another one, the church would in effect have two popes, with the risk that some Catholics would be loyal to the old one and some to the new.

Witness: Many observers believe John Paul II is offering a precious witness to the world about bearing suffering with dignity, and about the inherent value of every human life. That witness would not have the same impact from a retired pope.

Ecclesiology: The pope is not a corporate CEO or a prime minister, but fundamentally a father of the spiritual family Catholicism understands itself to be. Some think it would send the wrong signal about the nature of the church for the pope to step down for reasons of efficiency.

Mysticism: John Paul II believes his pontificate is in the hands of God; this is a pope, after all, who believes that on May 13, 1981, the Virgin Mary altered the flight path of a bullet to keep him alive. He is unlikely to ever feel that it's up to him to decide when to quit.

There is, of course, a more mundane reason why some Catholics, including some in the Vatican, don't want the pope to resign. Those who favor his policies want them to continue, and those whose jobs depend upon his tenure don't want to be out of work.

What would happen if the pope became incapacitated?
At one level, this question can be phrased in terms of John Paul's health care: How far would physicians go to keep the pope alive, should he slip into a coma or persistence vegetative state? Catholic moral teaching holds that ordinary treatment is obligatory, "extraordinary means" are not, but leaves open precisely what constitutes "extraordinary means."

While it seems the pope has not left behind any specific directives on the question, he did send a message a year ago to a Rome conference on the care of patients in these circumstances: "The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery. … I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering."

Since this is the closest thing to an expression of the pope's wishes, it seems likely physicians would feel obliged to honor it.

In an Feb. 25 interview with CNN, Cardinal Jorge Medina Estévez, a Chilean and former head of the Congregation for Divine Worship, and currently the cardinal in line to make the announcement of a new pope in St. Peter's Square, said that the use of "extraordinary means" to some extent depends on the specific person -- "on the role of this person in his family, in society." Medina added that the use of an artificial respirator today would not constitute "extraordinary means."

All this seems to suggest that if the pope ever arrived in such a condition, the Vatican consensus would be to prolong his life as much as possible through use of standard medical technology and the administration of food and water.

The other level on which the incapacitation question occurs is church governance, and there the waters are considerably murkier. Canon law makes no provision for the removal of a pope except through his own free choice to resign, exercised in the moment. Without a pope able to give assent to decisions for an extended period of time, bishops could not be appointed and teaching documents on faith and morals could not be issued. The long-term risk would be paralysis.

Commentators from a wide variety of points of view, such as the liberal Fr. Richard McBrien and the conservative Michael Novak, concur that this represents a "hole" in church law. There's general agreement that this legal gap is unlikely to be filled now, since it would seem like a maneuver to depose John Paul. This may well be one of the first tasks awaiting the next pope - appointing a blue-ribbon panel of canon lawyers and experts on the papacy to work out a system for declaring the See of Peter vacant.

What might happen in the meantime if we get to this point? The initial impulse would be to continue routine church business along the lines already indicated by the pope, deferring new challenges. How long that strategy would work against the force of changing circumstances, especially the need for bishops in dioceses, is impossible to predict.

Watch the NCR Web site, NCRonline.org, for breaking news and updates on the health of Pope John Paul II.

John L. Allen Jr. is NCR Vatican correspondent. His e-mail address is jallen@natcath.org


National Catholic Reporter, February 25, 2005

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