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Pope's Feeding Tube Brings End-of-Life Questions Closer

By Daniel Williams
Washington Post Foreign Service
Thursday, March 31, 2005; Page A01

ROME, March 30 -- A decision by Pope John Paul II's doctors to feed him through a nasal tube takes the treatment of the chronically ill pontiff closer to the ethically and religiously wrenching decisions of what medical measures should be taken to prolong life and for how long.

Doctors have threaded a tube through the pope's nose to his stomach to "better the supply of calories and favor a sound recovery of strength," the Vatican spokesman, Joaquin Navarro-Valls, said Wednesday in a statement. The pope continues a "slow and progressive convalescence," he said.

Mexican faithful watch the pope as he tries to deliver a blessing from the window of his apartment. In addition to a breathing tube, the pope has received a nasal feeding tube. (Tony Gentile -- Reuters)

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Video: Pope John Paul II blesses the faithful in St. Peter's Basilica on Wednesday.
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Already mute because a tube to aid breathing has been inserted into his throat, John Paul II is also having difficulty eating. He has lost a noticeable amount of weight in the past month. He suffers from Parkinson's disease, an incurable neurological illness that causes trembling, stiffens muscles and, in advanced cases, inhibits swallowing and breathing and diminishes intellectual capacity.

"The pope spends many hours of the day in his armchair, celebrates the Holy Mass in his private chapel and is in working contact with his collaborators, directly following the activities of the Holy See and the life of the Church," the statement read.

Optimistic official descriptions of the pope's health over the past two months have clashed repeatedly with evident signs of his decline. The use of a feeding tube, initiated at the time of the Terri Schiavo life-support controversy in the United States, suggested that the church's teaching on medical treatment might come to be tested on its highest leader.

Long-standing Catholic doctrine links continuation of extreme measures of life-support to the possibility of recovery. Under that approach, it can sometimes be morally permissible to cut off such measures if there is no hope of improved health and a patient's family would be excessively burdened.

The pope has never publicly discussed details of his own care, but he has made numerous statements regarding measures that ought to be taken to preserve life in the most desperate situations. He does not view the provision of food, regardless of how it is done, as an extreme measure.

A year ago, the pope criticized the withdrawal of food from patients in a vegetative state. "The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, even to patients in a vegetative state with no hope of recovery," he said during a conference of physicians and ethicists.

Someone in a vegetative state "has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.) and to the prevention of complications related to his confinement to bed," the pope said. The pontiff added that provision of food and water "should be considered . . . morally obligatory" if the goal "consists of providing nourishment to the patient and alleviation of his suffering."

The Vatican applied these guidelines to the Schiavo case directly when its newspaper, L'Osservatore Romano, said recently that the decision to remove Schiavo's feeding tube, which was inserted into her stomach, is indicative of a "society incapable of appreciating and defending the gift of life."

In 1985, the pontiff told another group of physicians that "even when the sick are incurable, they are never untreatable. Whatever their condition, appropriate care should be provided for them." These sentiments provide insight into choices John Paul might make if his own condition becomes desperate.

The possibility that the pope might indefinitely need assistance to eat and breathe has raised the question of whether he could become so incapacitated as to be unfit to continue his mission. Provisions exist in church law for removing a bishop "impeded" by illness. Although the pontiff is technically the Bishop of Rome, few people here believe the rule can be applied to the pope except by the pope himself.

Reports have long circulated that John Paul has written a directive about whether and when to remove life-support systems. No one has indicated who might possess such a letter and under what conditions the bearer would be authorized to execute it.

The pope will be fed the equivalent of baby food, semi-liquid meat, milk and vegetables, through the tube, doctors say. Surgical insertion of a tube through his abdomen into his stomach is an alternative for the longer term, but that surgery would require hospitalization. "The Holy Father cannot eat or drink on his own. If they didn't do something, he'd die," Corrado Manni, a former Vatican physician, said in an interview.

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