Pope John Paul II's stunning pronouncement last month that hospitals and doctors are "morally obligated" to continue artificial feeding for patients in a "vegetative" state opened up new questions about advance directives and whether hospitals will honor them.

Hospitals and other health-care providers need to be out front in stating their policies at admission. And anyone declaring in advance how they want to be treated or not treated in worst-case conditions needs to understand that doctors, hospitals and nursing homes may refuse to comply with some instructions in living wills as a matter of conscience. Surgery or some sudden trauma could render any of us, at any age, unable to express our wishes about treatment.

The pope's address at a March 20 international congress on "life-sustaining treatments and the vegetative state" narrowed centuries of theological debate and took a stance directly counter to a 1990 Supreme Court decision. The court ruled feeding tubes are a medical treatment never intended to keep someone alive indefinitely in an unconscious state. But the pope says food and water, even if supplied artificially, are "always" a natural means of preserving life, not a medical act. His teaching could affect any of us.

Officials at this region's nine Catholic hospitals last week said they will continue to honor end-of-life directives until they are told otherwise. They don't expect most directives to be affected at all. The Catholic Hospital Association, made up of 565 U.S. hospitals, praised the pope for reaffirming the "inviolable dignity of human persons" no matter their condition and cautiously agreed that his "guidance" requires further "dialogue."

The law on advance directives varies from state to state. University of Dayton law professor Vernellia Randall says under Ohio law, doctors and hospitals are duty-bound to tell you at admission if they can't comply with some wish in a living will. A separate statute also says they may not try to keep a patient from being transferred. "They not only can't interfere, but they should do what they can to facilitate the transfer," she said. She also warned, "There is no legal right to health care." A patient's advance wishes could be moot in an area where there is only one hospital and it doesn't share the patient's belief system.

The Rev. Robert Hurd, a physician who teaches bioethics at Xavier University, agrees the pope turned a major corner in declaring feeding tubes ordinary care - and not an extraordinary medical act. Much of John Paul's speech was devoted to urging more sensitive support for such patients and their families, including setting up a network of "awakening centers" that would specialize in such care. Vatican experts have since added that the pope did not say feeding tubes are obligatory if the patient can no longer be nourished by food and drink. It's the difference between prolonging life and prolonging death.

Even if some disagree with the pope's teaching, he has brought more clarity to difficult, end-of-life issues.