Pope John Paul II’s deteriorating health has left us all wondering what might happen if he can no longer carry out his papal duties.

There could be a major crisis should his condition worsen, because some powers, such as appointing bishops and issuing major documents, are strictly his prerogative. Popes can resign, but John Paul has shown no such indication he would do so. The last Pope to step down was Celestine V in 1294.

The frail pontiff, who suffers from Parkinson’s disease, has been cutting back on his activities for quite some time. Most of his speeches are now read in his name. Trusted aides have stood in for him on a number of occasions, which has enabled him to concentrate on major documents and more important appearances such as at Christmas.

Still, before he was taken to hospital last week, he had not missed a scheduled audience in 16 months and was planning a trip to Germany in August.

The pope was taken to hospital because of a voice box spasm, according to the Vatican – which has insisted that there is no cause for alarm.

Doctors are saying that the small amount of information given about the Pope’s health could mean a lot of things: the 84-year-old pope could return to the state of health he had before his latest illness, or face a sudden or gradual decline that leaves him bedridden and unable to communicate.

The length of John Paul’s hospital stay may be indicative of what the future beholds A long stay could mean a serious illness and a bigger chance that he might not return to his previous condition.

It is difficult to say if the pontiff had a simple viral infection that caused his windpipe to swell and the voice box to tighten or whether the problem involved a chest infection, which is more serious.

Chest infections are common in people suffering from Parkinson’s disease because they often have difficulty swallowing. Food or saliva may go down the wrong way, to the lungs instead of the stomach – a process called aspiration. That can set off inflammation in the airway and infection. Aspiration pneumonia is a common cause of death among Parkinson’s disease patients.

Church experts have argued that the Church could face a crisis, should a pope lapse into a coma or become mentally disabled. They point out that there are no procedures such as the 25th Amendment to the US Constitution that sets out a succession formula.

Only a pope can appoint bishops – an action taken weeks before they are announced – or create dioceses. He cannot delegate some aspects of his authority, such as infallibility.

Even some cardinals have broached the problem publicly. Belgian Cardinal Godfried Danneels, himself mentioned as a possible successor to John Paul, has said that future popes will face the need to abdicate.

“You cannot continue to bear the responsibility if you turn 90 or 100, no matter how well you’re cared for. But the choice of the right moment must be the prerogative of the pope and that’s how it will work,” he said in a 2003 magazine interview.

It is also 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 on whether John Paul has left written instructions.

While wishing Pope John Paul a swift recovery, we must also question what is going to happen if his health deteriorates further. Can the Church permit that its head is not in a position to keep up with his duties? Will he be forced to abdicate?