Debunking the Papal "Euthanasia" Doctor Assails Claims Surrounding John Paul II's Death
ROME, OCT. 11, 2007 (Zenit.org).- Here is a translation of a response written by Doctor Renzo Puccetti, specialist in internal medicine and secretary of the Association Science and Life of Pisa and Livorno, Italy, to claims that Pope John Paul II was euthanized.
He responds to the article of Doctor Lina Pavanelli, medical anesthesiologist and professor at the University of Ferrara, titled "La Dolce Morte di Karol Wojtyla" (The Sweet Death of Karol Wojtyla), which appeared in the May edition of the bimonthly Italian magazine Micromega.
Time Magazine reported on Pavanelli's statements in the Sept. 21 story titled "Was John Paul II Euthanized?"
An article that recently appeared in the Italian political magazine Micromega has attracted some attention in the medical community, mostly because of the relevance of the person whom it discusses.
According to this article, Pope John Paul II is supposed to have died as the result of an omission in medical care that the Pontiff himself had desired as a patient. The author of the article, Lina Pavanelli, an anesthesiologist and political activist, says that her findings are not the result of firsthand knowledge of the clinical situation of the events and the patient -- she had never paid a direct visit to Karol Wojtyla -- but stem from an Internet news search and the reading of a recent book by the Pope's personal physician, Renato Buzzonetti.
We can divide the article into two parts. In the first part the author furnishes a personal evaluation of the last weeks of John Paul II's life based on the above-mentioned sources. This is a reconstruction that, at least in intention, should be technical and scientific. In the second part of the article this reconstruction becomes a point of departure for a kind of bioethical evaluation dealing with the issues surrounding end-of-life care and euthanasia.
We will attempt to show how, using the same research methods, it is possible to arrive at conclusions that are diametrically opposed to those of article under discussion. The thesis advanced by the libel can be summarized in the following way: Because the Pope's Parkinson's had caused him to have difficulty swallowing it would have been necessary to insert a nasal-gastric feeding tube and start artificial nutrition much earlier than had actually been done.
According to the author, who holds that any omissions on the part of the medical personnel who cared for the Pontiff were "improbable," the delay in starting the artificial nutrition is to be imputed -- as the only "plausible" hypothesis -- to Pope Wojtyla himself, who, despite being "informed" and having "understood" "the gravity of the situation and the consequences of his decision," is supposed to have "refused"; such a procedure was allegedly understood by the patient himself as "aggressive medical care."
And yet this decision of the Pontiff to not be fed supposedly brought on the fatal crisis prematurely by weakening the defenses of the Pope's immune system. The author has no doubts: "Karol Wojtyla would have been able to live for a long time, but he rejected this option."
It is claimed that the naturalness of the Pope's death was only an appearance, "sweetly false." John Paul II was supposedly "sweetly accompanied along an easier route, toward a less dramatic end than he would have met."
From this assertion and from various Church documents that indicate that hydration and artificial nutrition are normal and obligatory, the author goes on to accuse Catholics and the same Pope of inconsistency -- it is probably not by chance that Matthew 7:3 is cited at the beginning.
According to Catholic moral teaching, in fact "when a patient consciously refuses life-saving treatment, his action, along with the compliance or omission of the physicians, must be considered as constituting euthanasia, or, more precisely, assisted suicide." This is why, according to the author, there is no difference between the case of Piergiorgio Welby and the death of Karol Wojtyla: "The only difference is that [Welby] had breathing support removed at his request, whereas [Wojtyla] chose not to have support in the first place. Both patients died on account of their not having the necessary apparatus to keep them alive."
We have multiplied the citations so as not to incur misunderstandings. From here we would offer an alternative analysis of the facts. In regard to the presumed delay in starting artificial nutrition through nasal-gastric feeding tubes, the author speaks of the necessity of this measure in "the last two months of [the Pope's] life" -- therefore, from the beginning of February, postulating a two-month delay in medical treatment, pointing to March 30 as the day in which the feeding apparatus was installed. The Holy Father was allegedly malnourished for almost two months, from the beginning of February to the end of March. And yet there are a number of elements that contradict such an assumption, some are related by the author herself.
On the evening of Feb. 1 the Pope was at dinner, thus, he was able to eat, but having difficulty breathing, he was hospitalized at Gemelli, where he remained until Feb. 10. On Feb. 3 the Vatican spokesman, Joaquín Navarro Valls, referring to the general condition of the Holy Father, adds that "he eats normally and alternative forms of nourishment have been excluded."
This claim does not convince Pavanelli, who suspects that already at this time, contrary to the official statements, malnourishment had manifested itself, making the nasal-gastric feeding tube necessary. Pavanelli's hypothesis is difficult to reconcile with the fact that the difficulty in swallowing in question often regards not only solid food but liquids and is accompanied by the danger of aspiration pneumonia. This would be a situation in which the positioning of a nasal-gastric feeding tube, even for preventative purposes, would have been necessarily urgent; the supposed refusal by the patient is incongruous with his later agreement to the more invasive tracheotomy procedure.
That the Pope's nutritional problems need not have been grave can also be adduced from the fact that on Feb. 23, the eve of his last hospitalization, the Holy Father was at dinner, and from the Feb. 24 statement by the director of the Parkinson's Center at the Milan Istituti Clinici di Perfezionamento, Gianni Pezzoli: The Pope "recovered very well after his first stay in the hospital." Immediately following the tracheotomy, sources report him eating again -- a caffe latte, 10 small cookies, a yogurt -- it is hard to imagine a sudden recovery of the capacity to swallow after having lacked it for nearly a month.
So knowing the skill of the medical personnel at Gemelli and the long-established relationship of confidence between them and John Paul II, along with his absolute and total abandonment to the Mother of God, it is hard to imagine a negligence in vigilance in regard to symptoms of solid-food swallowing problems over the whole period of the Pope's last hospital stay until March 13. Doctor Buzzonetti subsequently clarified that the Pope was outfitted with the nasal-gastric feeding tube from Monday of Holy Week, that is, March 21, and that during the Via Crucis [on Good Friday] the Pontiff was lying on his back precisely for this reason.
The presumed omission, then, would not regard a whole two months but, in the worst case, only eight days, an interval of time in which it is possible and likely that the doctors were waiting and watching in hopes of a possible improvement in the ability to swallow, an improvement which, when it did not present itself, it is possible that the medical personnel decided on the feeding tube. It is, moreover, difficult to understand how Pavanelli can infer the reduced efficaciousness of the tube from brief interruptions of a few minutes that occurred when the Pope appeared at the window of his Vatican apartments. I cannot but admire Pavanelli's ability in two different articles to define the same removal and re-application of the tube first as "not at all risky," "simple and not traumatic,", and then as a torment.
But Pavanelli's consideration of the concept of natural death in this context is even more stupefying, if this is possible. It is stupefying that she interprets Pope Benedict's XVI's expression "natural passing away" as a death without any modification to the natural course of the illness and not rather as a death that takes account of man, of his ontologically rational nature, respecting him, a death that takes place in the presence of reasonable care, or, more exactly, care that is proportionate to the situation.
On many points Pavanelli seems to want to advance the idea that trying from time to time to patch up the malfunctioning organs of a gravely sick organism, one can put off death almost indefinitely[5; 17], almost as if, with the nutritional problem being resolved, Pope Wojtyla would have certainly lived for a long time.
Unfortunately, the scientific literature teaches that after 10 years of sickness, despite all the modern medical helps available, patients suffering from Parkinson's continue to have a mortality rate 350% greater than that of others the same age who do not have the disease.
In the end, the author's position seems to be strongly influenced by a retrospective reading of the events, forgetting -- at least this appears to be the case -- that often in medicine the nature of the actions and omissions is revealed only by the time decreed by the consequences. It is a consideration that renders the difference between the Welby case and Pope Wojtyla's evident. In the Welby case the consequences of disconnecting the patient from the ventilator were well-known -- it was a consequence that was desired, wanted by the patient, and accepted by the physician.
In the Pope's case honesty forces us to recognize that the theoretically possible, although improbable and undemonstrated, delay of some days in the start of artificial nutrition was dictated by contingent situations unknown to us, perhaps with a view to the opportune moment for the placement of a PEG tube (percutaneous endoscopic gastrostomy), or in the hope of the patient's functional recovery.
This leads us to the, so to speak, bioethical interpretation that the author gives of the events, an interpretation that uses in an inappropriate way official texts of the Church and the magisterium together with the resolutions of authoritative bioethical consensuses and Catholic authors to argue that any omission of life-saving treatment must be considered as euthanasia and as such implicates the patient who voluntarily refuses such treatment along with the medical personnel who consent to his refusal. Such a perspective completely distorts the content itself of the documents of the Church, which always, along with the clear indications of general norms, take care to underscore the necessity of specifying the subject and the circumstances in the moral judgment of the actions to which conscience is called.
Furthermore, Doctor Pavanelli completely fails to consider the content of the agent's intention. In a 1980 document titled "Iura et Bona," the Congregation for the Doctrine of the Faith defines euthanasia as death procured "with the purpose of eliminating all suffering."
As Pessina observes, there is a difference between a request for death and putting one's life in the service of others through the category of "sacrifice." If one is not able to see the difference between euthanasia and the conduct of John Paul II, then one is unable to see the difference between taking and giving. What we have here is a choice that unites those who, while they consider life a primary good, do not consider it the absolute good, who remember that "No one has greater love than this: to lay down his life for his friends" (John 15:13), who have not refused Jesus' example, but have followed it to the very end: "Totus tuus."
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 Lina Pavanelli, "La dolce morte di Karol Wojtyla," Micromega. May 2007: pp. 128-140.  Ibid., p. 129.  Ibid., p. 137.  Ibid., p. 132.
 Ibid., p. 135.  Ibid., p. 136.  Ibid., p. 138.  Ibid., p. 133.
 Archbishop Stanislaw Dziwisz, "Una vita con Karol," Rizzoli. 2007: p. 219.  Lina Pavanelli, op. cit., p. 131.  E. Alfonsi, et al., "La disfagia oro-faringea nelle sindromi parkinsoniane. Aspetti clinico-elettrofisiologici e terapeutici," Oral presentation at the XXXIII National LIMPE Congress, Stresa. Nov. 15-27, 2006.  Ibid. 9, p. 220.
 "Pope Breathing Well After Tracheotomy," ZENIT. Feb. 23, 2005.  Luigi Accattoli, "Quel sondino che nutriva Wojtyla," in Corriere della Sera. Sept. 15, 2007.  Lina Pavanelli, op. cit.  Ibid. 1, p. 132.
 Ibid. 1, p. 134.  Chen H, et al., "Survival of Parkinson's Disease Patients in a Large Prospective Cohort of Male Health Professionals," Mov Disord. July 21, 2006: Vol. 7:1002-7.  "Papa, niente udienza del mercoledì e si parla di un nuovo intervento," La Repubblica. March 29, 2005.
 Congregation for the Doctrine of the Faith, "Iura et Bona," (Declaration on Euthanasia). May 5, 1980.  Adriano Pessina, "Eutanasia. Della morte e di altre cose," Cantagalli. 2007: pp. 49-51.  Ibid. 9, p. 221.