As his body declined in the last few months, Pope John Paul II placed more faith in medical technology than any pontiff ever had. He relied on a ventilator when his breathing failed, a feeding tube when he could not eat, and drugs to treat a spiral of infections.
But the defender of tradition would not let machinery rule his final hours. He stayed in his rooms at the Vatican’s 400-year-old Apostolic Palace, not the hospital where he had spent 28 days this year. And at the end, when his breathing grew shallow and labored, he let death take him.
Throughout his long papacy the pope had struggled over how much to embrace the changing technologies that threatened traditional Catholic teachings. While praising the power of science to extend life, he worried about its potential to subvert human dignity. The way he died–depending on technology but not a prisoner of it–offered his last lesson on the mixed blessing of scientific advances.
What might have surprised many of his followers was the pope’s open-mindedness about the advances that swept the world during his lifetime, some scholars said. Even on abortion, which he rejected utterly, John Paul II urged biologists to shed light on the moral issue by studying the mystery of when human life begins.
“He was the least dogmatic of men about these things,” said David Solomon, director of the Center for Ethics and Culture at the University of Notre Dame.
The question of whether to prolong lives that seem beyond hope may have presented the toughest test of the pope’s beliefs. Last year, as the Terri Schiavo controversy gained national prominence, he made statements suggesting that for patients with such profound brain damage it could be acceptable to withdraw a ventilator–but not to remove a feeding tube. Some ethicists saw his words as an awkward attempt to draw a sharp ethical line where new technology left no easy solutions.
“That was an unfortunate move,” said James Walter, director of the bioethics institute at Loyola Marymount University and a former consultant to the late Cardinal Joseph Bernardin. Walter said the pope’s intentions were good, but “there are limits to our obligation to preserve life.”
The pope was tireless in fighting other changes in medicine, especially when they challenged his vision of sexual morality. His tenure saw the advent of in-vitro fertilization, the expansion of birth control and abortion, and the new science of embryonic stem cells–all changes the pope opposed.
Yet his caution on reproductive technology did not stem from simple prudishness or hidebound devotion to tradition. In fact, the pope viewed the excesses of reproductive medicine partly as the worst expression of capitalism, a materialistic consumer culture that can remove people from God and the true meaning of life.
In a 1995 encyclical affirming his opposition to abortion and any tampering with embryonic life, John Paul traced such problems to a modern obsession with material comforts.
“Life itself becomes a mere `thing,’ which man claims as his exclusive property, completely subject to his control and manipulation,” the pontiff wrote. “The only goal which counts is the pursuit of one’s own material well-being.”
Fostering harmony between faith and science was a constant theme of the pope’s work. In the 1980s he cautiously embraced gene therapy, the modifying of a person’s genetic code to treat disease or even to enhance natural abilities such as intelligence.
“He didn’t discount the idea of changing genes solely for enhancement purposes,” Walter said. “He just said this has to be placed in a broader moral context.”
What John Paul fiercely opposed was the use of genetic testing as a tool for eugenics and the selective abortion of diseased embryos and fetuses.
“Such an attitude is shameful and utterly reprehensible,” the pope said in 1983, “since it presumes to measure the value of a human life only within the parameters of `normality’ and physical well-being.”
A major initiative of his papacy was the rehabilitation of the astronomer Galileo, imprisoned by the Inquisition in 1633 for insisting, counter to church tradition, that the Earth revolves around the sun. The pope said in 1992 that the church had erred in convicting Galileo. Yet even that well-intended gesture was so late in coming that it reinforced criticisms of the church as woefully behind the times.
Decades after most Catholics in Europe and America chose to ignore the church’s teachings against artificial birth control, the pope refused to reconsider that prohibition. A recent Gallup poll found that 78 percent of U.S. Catholics believe the next pope should permit birth control.
Some Catholic theologians believe that disconnect between the church and its followers on a basic issue of medical ethics undermines the church’s credibility on other vital issues, such as abortion.
“Nobody understands what they’re talking about,” said Thomas Shannon, a professor of religion and social ethics at Worcester Polytechnic Institute in Massachusetts. “People basically say, `Gee, they can’t get this right, what’s the problem?'”
Catholics also were divided over the pope’s teachings on end-of-life care. The church has always taught that Catholics are not obligated to use extraordinary means to preserve life, or to prolong life when treatment would offer no benefit. Many Catholic ethicists believe those principles mean it is acceptable to remove feeding tubes from some brain-damaged patients, like Schiavo, who have no chance of recovery.
“Death is not the ultimate evil. It’s not a failure. It’s the transition from this life to eternal life,” said Rev. John Paris, a professor of bioethics at Boston College and an ordained Jesuit priest.
Paris cited a 2001 statement by the U.S. bishops encouraging the use of feeding tubes, “as long as this is of sufficient benefit to the patient.” In a more arcane case, a 16th Century moralist argued that Catholics would not be obliged to maintain a special diet of chickens and partridges if it was too arduous or expensive. Paris said he believes the removal of Schiavo’s feeding tube was consistent with such teachings on the acceptable boundaries of medical care.
John Paul rebuffed that idea in a speech to an international physicians group in March 2004. In the speech he described removing nutrition and hydration from brain-damaged patients as “euthanasia by omission.” Keeping such patients on feeding tubes, he said, is “a natural means of preserving life, not a medical act.”
Still, the pope’s own decision to limit medical interventions at the end of his life showed that he understood that there is a time to give up the material world, many ethicists said.
In fact, in some of his writings John Paul voiced reservations about the use of medicine to relieve physical suffering. The pope and many other Catholics believe that in some situations pain and suffering can have redemptive value–an experience that modern treatments can mute. In his writings the pontiff quoted the early church figure Paul: “I rejoice in my sufferings for your sake.” The pope believed that pain offers a chance to participate in Jesus’ ordeal on the cross and strive for a spiritual solace, said Daniel P. Sulmasy, a Franciscan friar and director of the bioethics institute of New York Medical College.
“He argued that one should never seek suffering for its own sake, but that avoiding it at all costs amounted to a denial of one’s nature as a creature,” Sulmasy wrote in an e-mail for this article. “Here, he taught by example.”
The pope’s painful ordeal from Parkinson’s disease came years after a 1984 letter he wrote on suffering. But the ideas he laid out there gave a glimpse of the courage he later showed to the world.
Suffering, John Paul wrote, is “deeply human, because in it the person discovers himself, his own humanity, his own dignity, his own mission.”
