Dr. Robert White understood how Pope John Paul II would face death, more than two decades ago. The Cleveland neurosurgeon stood by the pontiff in the intensive care unit after the assassination attempt on the pope's life in 1981.
Tubes were coming out of John Paul's abdomen, and the pain was intense. Even the head of a billion-member church, regularly surrounded by a sizable retinue, felt lonely. They were some of the longest and most difficult nights of the pope's life, said White, a member of the Pontifical Academy of Sciences.
Still, the pope's final prayer each night, he told White, was for the care and comfort of those suffering in hospitals throughout the world.
"The bottom line," White said, "was he felt part of all the people in the world who were undergoing operations in intensive care units."
In his final days, John Paul showed the same commitment to endure suffering. He considered it the will of God as long as it was done to protect the dignity of the sick and dying. He used his own pain, following the example of Christ on the cross, to share with compassion the pain of others.
After the church fought aggressively to keep Terri Schiavo alive and John Paul allowed himself to be attached to feeding tubes, there was speculation Vatican officials might attempt to keep the dying pope alive by any technological means available.
In the end, however, the pope followed the strand of Catholic tradition that says death, when it is inevitable, should also be embraced as the will of God.
John Paul had been near death since Thursday, after suffering blood poisoning from a urinary tract infection. But the pontiff, described as fully conscious and extraordinarily serene, declined to be hospitalized.
As the pope clung to life, Bishop Anthony Pilla and hundreds of worshippers at the noon Mass at St. John Cathedral in Cleveland did not ask for a miraculous recovery for John Paul. Instead, they prayed repeatedly for his comfort in his hour of need.
"The pope, and each of us, cannot promise ourselves a tomorrow," Pilla said in his homily. "We learn from his life. We pray that God will be with him and grant him peace."
The Catholic Church has always fought to protect the dignity of life from the moment of conception to the moment of natural death. The traditional way to make those ethical decisions was to ask whether ordinary or extraordinary methods were being used to prolong life.
"Human life is of enormous importance, of tremendous value, but biological existence is not of absolute value," said Paul Lauritzen, director of the Program in Applied Ethics at John Carroll University.
The ultimate goal of the Catholic Church "is to have eternal life," said Betsy Knestrick of the department of marriage and family of the Diocese of Cleveland. "This is physical life."
Still, she said, it is difficult for many people to talk about any limits on care for themselves or their loved ones. "We're a very death-defying society. We just don't want to talk about end-of-life issues."
Some church observers had sensed a shift in recent years toward more restrictive standards in limiting end-of-life care in response to the growth of what John Paul often condemned as the "culture of death." Attempts to legalize assisted suicide and even changes in the language of ethics so human beings were sometimes referred to as vegetables alarmed the pope and Vatican officials.
In March 2004, the pontiff said that it was immoral to remove feeding tubes from people who are awake but not aware of their environments and that providing food and water to patients is a natural and morally obligatory means of preserving life.
The Rev. Richard John Neuhaus, director of the Institute on Religion and Public Life in New York City, said there are serious concerns about going down a slippery slope of medical ethics by withholding care based on utilitarian models of who is worthy or not worthy of life.
At the same time, he said, there is no moral obligation to prolong someone's dying.
"The most elementary and in many ways the most difficult thing for all of us is to know we're not God," Neuhaus said. "We're mortal."
Taking disproportionate, last-minute measures to prolong life can be "resurrection-denying in some ways," said the Rev. Donald Dunson, a moral theologian at St. Mary Seminary in Wickliffe, Ohio.
"My death does not belong to me," Dunson said. "I belong to God. I belong to another."
After the pope died on Saturday, Pilla spoke with wonder about "what a witness he has given, not only how to live, but how to die."
Pilla said John Paul showed the world in his final days that every human life has value, not only when people are healthy, vibrant and strong.
The bishop said it was significant that when it came time for the pope to accept death, he chose not to do it in a hospital, but in his residence where thousands of pilgrims could be with him in his final hours. "He remained to the end with his people," Pilla said.
David Briggs writes for The Cleveland Plain Dealer.
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