What happens if the Pope can't do his job?

Speculation is mounting in Rome that John Paul's health is posing a dilemma for the Vatican

It Was a few minutes before 8am last Tuesday, and Pope John Paul II had just been put to sleep in the operating theatre of the Gemelli hospital in Rome. It was an anxious moment, the pressure on the 12 doctors present made all the greater by mounting speculation that the 76-year- old pontiff might be nearing the end of his life, and that the official diagnosis of appendicitis was merely window-dressing for something far worse.

"Our first reaction as we made the incision and opened him up," Professor Luigi Ortona, a specialist in infectious diseases, later recounted, "was to glance at each other for a fraction of a second. I was in the second row, behind the surgeons and anaesthetists. But that quick glance was enough to realise that each of us was heaving a sigh of relief."

The news, as it turned out, was all good for the Pope, undergoing his sixth operation in 15 years. His appendix came out without problem, as did the scar tissue left over from previous surgery which may or may not - the medical bulletins were not clear - have been causing a minor intestinal obstruction. He came round immediately after the operation, and within 24 hours he was back on his feet.

However good the immediate medical news, though, a deeper problem remains for the papacy as an institution. John Paul remains a severely weakened, elderly man whose physical ailments are painfully visible to all who set eyes on him. The robust Polish prelate who once dashed up mountains in the summer and skied down them in the winter is a shadow of his former self, uncertain in both speech and step and beset by increasingly violent tremors in his left hand.

Whatever the precise nature of his troubles - speculation has focused on both Parkinson's disease and cancer - last week's spell in hospital has brought forth a question that is not only uncomfortable but likely to become more insistent as time goes on: what happens if the Pope becomes too sick to carry out his duties?

Curiously, the question is virtually unprecedented in the history of the Roman Catholic Church. Popes have always been mortal, of course, but until relatively recently medical science was not advanced enough to allow them to survive a serious illness for long. Before the advent of sophisticated communications technology, it was also usually possible to keep any bad news firmly within the Vatican until the very end.

John Paul II, perhaps unwittingly, has completely altered the Church's perspective on the mortality of its leader. His whirlwind schedule of engagements has made him a uniquely visible Pope, a factor which has the unfortunate side-effect of revealing his physical weaknesses all too glaringly. The very fact that he has gone to hospital for his various operations is in itself a novelty - Pope Paul VI, for example, never once left the Vatican during his final illness in 1978, even though a heart operation in a specialist clinic would almost certainly have prolonged his life significantly.

The fact that the present Pope is prepared to suffer his ailments in public does not mean that he is about to give in to them, however. Everyone who knows him is adamant that he means to go on with the same punishing schedule, whatever it takes, and that he is determined to see in the new millennium.

But inevitably there are those within the Vatican who are beginning to doubt this ambition. The few indications to have leaked out of the tight-lipped Papal state all point in the same direction: that resignation is now being discussed as a serious possibility, and that speculation has markedly increased on the identity of the next Pope.

A resignation would be a spectacular event, since it has not happened since 1284, when the elderly Celestine V was tricked into standing down by the man who succeeded him, Boniface VIII. It is an option that John Paul has flatly rejected; the only chance of him giving way is if he became completely debilitated and looked like staying that way for a protracted period.

As for the succession, a number of sources within the Vatican say John Paul has recently indicated the man he would like to follow him on to St Peter's throne: the Brazilian primate, Cardinal Lucas Moreiva Neves.

Predicting the next Pope is a notoriously inexact science, but Cardinal Neves is at least a plausible candidate to carry on John Paul's doctrinal conservatism and pastoral internationalism.

The main candidate on the liberal wing of the Church is likely to be Carlo Maria Martini, Cardinal Archbishop of Milan. Cardinal Martini was once considered the all-out favourite, but he has over time been put into the shade by an increasingly conservative, and un-Italian, College of Cardinals, the body that elects Popes. Another name that pops up regularly is that of Cardinal Francis Arinze of Nigeria, who would be the first black Pope.

The city of Rome has a cynical saying that it doesn't matter if the Pope dies, because all you have to do is elect another. Modern medicine and the media may well conspire, however, to complicate the matter this time around. It is not the prospect of death that is worrying the Vatican so much as the process of dying.

The successor?

Cardinal Lucas Moreira Neves, the 71-year-old Roman Catholic Primate of Brazil, is the man believed to be the Pope's choice as his successor, writes Andrew Gumbel.

A conservative in much the same mould as John Paul II, Cardinal Neves is an opponent of liberation theology and a hardliner on both artificial birth control and the celibacy of the priesthood. He is familiar with the inner workings of the Vatican, having worked in the Curia in various posts from 1974 until 1987, when he was elevated to be head of the Church in Brazil. He is also Archbishop of San Salvador de Bahia.