Doctor Assails Claims Surrounding John Paul II's Death
ROME, 11 OCT. 2007 (ZENIT)
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
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
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
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
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
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
* * *
 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:
 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,
 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.