I was just wondering how everyone feels about the state of the Pope, and the state of Roman Catholicism.

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MSNBC News Services

Updated: 9:12 p.m. ET March 31, 2005

<?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />VATICAN CITY - Pope John Paul II developed a high fever Thursday because of a urinary tract infection and was being treated with antibiotics at the Vatican, his spokesman said. The latest health setback for the 84-year-old pontiff came one day after he began receiving nutrition through a feeding tube. There were reports that the pope received the sacrament of the anointing of the sick — what used to be called the last rites.

The Italian news agency Apcom, without citing any sources, reported that John Paul’s condition was “stable” early Friday, several hours after he started receiving antibiotics.

Another Italian news agency, ANSA, said the pope “seems to showing a first positive reaction” to antibiotic therapy.

At the Gemelli Polyclinic, the hospital where the pope has been treated before, an emergency room chief said there were no plans to admit John Paul “at the moment,” ANSA reported.

His assessment could mean that the Vatican medical staff feels confident it can handle the latest medical crisis with the sophisticated medical equipment installed at the Vatican. But it could also mean that the pope’s condition was considered so precarious it would be better not to move him immediately.

At the edge of St. Peter’s Square, hundreds of people gathered early Friday in a sign of concern over the pope’s fragile condition. A few kneeled down on the cobblestones to pray, others wrapped blankets around themselves as they prepared to keep vigil throughout the night.

“There’s nothing we can do but pray. We’re all upset,” said Agriculture Minister Giovanni Alemanno, who was in the crowd.

“I was in the car and I heard on the radio about the grave condition of the pope. I immediately thought I would come to St. Peter’s,” said Antonio Ceresa, a Roman.
Police barriers kept the faithful and curious out of the square itself.

Report: ‘Last rites’ administered
Italian media reported that the pope John Paul has received the Roman Catholic sacrament reserved for the sick and dying. The sacrament, which involves anointing the sick person with special oils, was once called last rites. It is now known as the Sacrament of the Infirm.

A Vatican spokesman said he could not confirm the reports but Church sources said it was likely the Pontiff had received the sacrament, given the precarious state of his health.

The sacrament is often misunderstood as signaling imminent death. But it is performed not only for patients at the point of death, but also for those who are very sick — and it may be repeated.

The last time the Pope was known to have received the sacrament was on May 13, 1981, the day he was shot and nearly killed in an assassination attempt in St Peter’s Square.

Age elevates infection risk
A urinary infection can produce fever and a drop in blood pressure as reported in the pope, said Dr. Marc Siegel, a specialist in internal medicine at the New York University Medical Center.

The pope’s risk of such an infection is heightened because he is elderly — which suggests his prostate is probably enlarged — debilitated and run down from the illness that recently sent him to the hospital, Siegel said.

Urinary infections tend to respond well to antibiotics, given either as pills or intravenously, and “I would suspect there’s a very good chance he’s going to recover well,” Siegel said.

Other physicians offered far more guarded assessments.

Physical ‘cascade effect’ feared
“His body has come to a standstill,” said Dr. Zab Mosenifar, who treats elderly patients at the intensive care unit at Cedars-Sinai Medical Center in Los Angeles. “Usually, these people go in a downhill course.”

 Mosenifar noted that the body’s organs are interdependent on one another and if one system fails, it could cause a “cascade effect” of other systems shutting down.

“It becomes a vicious cycle,” Mosenifar said.

Dr. Benjamin Ansell, an internist at UCLA School of Medicine, said a healthy person may recover from a high fever with no problem, but it could be devastating for those with neurological disorders such as Parkinson’s disease, which the pope has suffered for at least a decade. Some Parkinson’s patients who develop a fever may turn catatonic, Ansell said.

“It’s not a very promising situation,” Ansell said.

Hospitalized twice last month after two breathing crises and with a tube placed in his throat to help him breathe, John Paul has become a picture of suffering. When he appeared at his apartment window Wednesday to bless pilgrims in St. Peter’s Square, he managed to utter only a rasp.

Later that day, the Vatican announced he had been fitted with a feeding tube in his nose to help boost his nutritional intake.

Pontiff's moral imperative
The use of the feeding tube illustrates a key point of Roman Catholic policy John Paul has proclaimed: It is morally necessary to give patients food and water, no matter their condition.

As Parkinson’s disease and other ailments have left him increasingly frail, the pope has been emphasizing that the chronically ill, “prisoners of their condition ... retain their human dignity in all its fullness.”

The Vatican’s attitude to the chronically ill has been apparent in its bitter condemnation of a judge’s order two weeks ago to remove a feeding tube from Terri Schiavo, the severely brain-damaged American woman who died Thursday.

Vatican Cardinal Jose Saraiva Martins, reacting to Schiavo’s death, denounced the removal of her feeding tube as “an attack against God.”

While John Paul is fully alert, some see parallels in the two cases.

Euthanasia rejected
Under John Paul, Vatican teaching on the final stages of life includes a firm rejection of euthanasia, insistence on treatments that help people bear ailments with dignity and encouragement of research to enhance and prolong life.

 A 1980 Vatican document makes the distinction between “proportionate” and “disproportionate” means of prolonging life.

While it gives room for refusal of some forms of aggressive medical intervention for terminally ill patients, it insists that “normal care” must not be interrupted.

John Paul set down exactly what that meant in a speech last year to an international conference on treatments for patients in a so-called persistent vegetative state.

“I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory.”

A papacy on behalf of aged, sick
John Paul’s 26-year papacy has been marked by its call to value the aged and to respect the sick, subjects the pope has turned to as he battles Parkinson’s disease and crippling knee and hip ailments.

The Rev. Thomas Williams, a Rome-based theologian, said there are parallels between Schiavo and John Paul, based on the church teaching that such feeding is required. “In that sense, there is a great similarity,” he said.

But he pointed out that the pope is fully conscious and running the church. Court-appointed doctors had determined that Schiavo was in a persistent vegetative state with no hope of recovery before her death. Schiavo’s parents had argued that she could get better and that she would never have wanted to be cut off from food and water.

It is not clear who would be empowered to make medical decisions for an unconscious pope. The pope has no close relatives, but the Vatican has officially declined to comment whether John Paul has left written instructions.

Reuters and The Associated Press contributed to this report.