VATICAN CITY — Pope John Paul II died the way he wanted.
He spent his final hours in his Vatican apartment, surrounded by nine members of his mainly Polish inner circle. Three doctors were present, but no elaborate hospital technology to help prolong his life.
Just before the end, the pope's longtime secretary celebrated Mass and began to anoint the pope's hands with oil, according to one account. John Paul gripped his secretary's hand, an apparent farewell gesture to a faithful aide who helped the pontiff fulfill his wish to die unencumbered by tubes and machines. It was 9:37 p.m. Saturday.
The cause of death was septic shock and irreversible heart failure, according to the death certificate made public Sunday by the Vatican. John Paul's decision last week not to return to the Gemelli Polyclinic hospital where he had spent so much time in recent years mirrored decisions made every day by severely ill patients and their families.
His very public choice also highlighted profound moral questions within Catholicism about the balance of preserving life and accepting death.
The debate has intensified with advances in medical technology. Church teachings simultaneously emphasize the sanctity of life as well as the acceptance of the final embrace of God. The pope's ordeal has raised comparisons with the recent ethical and theological battles over the Terri Schiavo case, though churchmen and theologians said Sunday that his struggle was different because he was in a position to help dictate the terms of his final medical care and she was not.
John Paul's final hours, as described by doctors, churchmen and sources close to his inner circle, did not include aggressive efforts to revive him as his organs failed. No kidney dialysis machine was used in his apartment, and the insertion of a sophisticated feeding device in his stomach would have required a return to the hospital, sources said. Instead, doctors said, they relied mainly on antibiotics and a respirator.
"There were no therapeutic extremes," said Rodolfo Proietti, a longtime anesthesiologist on the pope's medical team, quoted Sunday in the Corriere della Sera newspaper.
Proietti and the pope's personal physician, Renato Buzzonetti, supervised John Paul's care in the final days, according to a doctor who recently treated the pope and asked not to be named.
