Pope’s ‘living will’ wants life support to the end

The ailing pontiff sharply narrowed Catholic guidelines for treating patients nearing death in March 2004 when he described tube-feeding as a normal treatment rather than an extraordinary measure that can be stopped if all hope of recovery fades.

This indicates he would want to be kept alive by artificial means even if he fell into a coma or a persistent vegetative state, such as the brain-damaged Ms Terri Schiavo in the United States whose feeding tubes have been removed after 15 years.

“The pope’s statement would have to be considered the equivalent of his living will,” said Fr Thomas Reese S.J., editor of the Jesuit weekly America in New York. “It would be very difficult to unplug him if it came to that.”

Increasingly popular in the United States, a living will is a written statement adults make to indicate whether they want doctors to use all means possible to keep them alive at life’s end or to let them die if all hope of recovery seems lost.

As the Ms Schiavo case shows, modern medicine can extend basic body functioning for years — a worrying prospect for the world’s largest church if that means its elected-for-life leader is incapacitated indefinitely.

The Catholic church has traditionally taught that doctors and families could end artificial life-extending measures in good conscience if a dying patient’s prospects seemed hopeless. John Paul, who has long railed against a ‘culture of death’ he saw in abortion and artificial birth control, surprised moral theologians in a speech in March 2004 by insisting Catholics can no longer make such decisions even in extreme cases.

“The intrinsic value and the personal dignity of every human being does not change no matter what the concrete situation of his life,” he told doctors and ethics experts attending a Rome conference about 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, not a medical act,” he said. Denying them this treatment would amount to “euthanasia by omission.”

“Considerations about the ‘quality of life,’ often actually dictated by psychological, social and economic pressures, cannot take precedence over general principles,” he said. John Grabowski, associate professor of ethics at Catholic University of America in Washington, said the Pope had made his views clear but “left many theologians scratching their heads.”

The problem was that he expressed this in a speech, not in a doctrinal document that made it official church policy. “The pope can say any number of things but he has to tell the bishops’ conferences when they have to change something,” added Fr James Keenan S.J., ethics professor at Boston College. “He hasn’t done this.”

As a result, he said, the US Bishops’ Conference and the Catholic Health Association have not renounced the more flexible-earlier position even though many Catholic leaders support Ms Schiavo’s parents’ demand to continue feeding her.

“We’ve spent centuries letting people figure out how they want to go to meet god, and now we have these fairly intrusive claims on a patient,” Fr Keenan said in his critical assessment of how the pope was changing church teaching on the end of life.

“It doesn’t seem good for the church to rethink how to die when the pope himself is ailing,” he said. “The dying of a pope should not set our agenda.”

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