Will pope's condition lead to tough choices?

Addition of a feeding tube means church guidelines on treatment may be tested.
WASHINGTON POST
ROME -- A decision by Pope John Paul II's doctors to feed him through a nose 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.
Already mute because a tube to aid breathing has been inserted into his throat, John Paul II is also having difficulty eating. He has noticeably lost 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.
Conflicting reports
Optimistic official descriptions of the pope's health over the past two months have clashed repeatedly with clear 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 they excessively burden a patient's family.
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.
The pope will be fed the equivalent of baby food -- semi-liquid meat, milk and vegetables -- through the tube, doctors said. 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.
In recent weeks, illness has reduced John Paul II's public papacy to a few short televised appearances in which he fought silently to deliver blessings to his flock.
Recent appearance
The pope made a brief appearance at the fourth-floor window of his Apostolic Palace residence Wednesday, and at that time there was no evidence of the feeding tube. He struggled to bless a large crowd of well-wishers in St. Peter's Square and was unable to pronounce a coherent syllable.