Who Leads the Catholic Church When the Pope Is Hospitalized?

Pope Leo has been hospitalized after surgery and his audiences have been canceled until October 20, but he remains pope. Here's why.

Pope Leo XIV is expected to be hospitalized for about a week after having part of his right lung removed in surgery on Tuesday. The Vatican said tests have confirmed the diagnosis of lung adenocarcinoma, the most common type of lung cancer worldwide.

The pope's first night at Rome's Gemelli Hospital was "quiet," the Vatican shared in an update Wednesday morning, and doctors have since said Leo's tests show his "recovery is progressing normally." He has undergone respiratory physiotherapy, started walking around his room and "resumed eating normally". Leo will be watched as more tests are performed on the removed cancerous tissue as doctors decide what treatments may be needed in the future.

Leo, 71, publicly addressed his health during Sunday prayers in St. Peter's Square at the Vatican, during which he said doctors had discovered a "localized nodule" in his lung that required surgery. He thanked everyone for their "spiritual kinship" and said he put himself in their prayers.

After news of Leo's diagnosis broke, people all over the world sent their well wishes. U.S. Secretary of State Marco Rubio, a Catholic, prayed for the first American pope. US President Donald Trump, who has previously criticized Pope Leo, has yet to comment publicly. European Commission President Ursula von der Leyen wished Leo a "full and speedy recovery," while Canadian Prime Minister Mark Carney described the pope as "a source of hope and hope. An inspiration to billions around the world."

As head of the Catholic Church, Leo presides over an institution that has a huge global following. Figures released in March by the State Secretary's Central Bureau of Church Statistics show that the number of Catholics worldwide will be just over 1.422 billion in 2024.

All pop audiences have been canceled until October 20th while Leo focuses on his recovery. His distance from the Vatican has raised questions about who will oversee the church while the pope is in hospital.

Here's what you need to know about the pope's role and how the Vatican will run in his absence.

The Pope is the Bishop of Rome and, according to Catholic law, is described as "the head of the college of bishops, the vicar of Christ, and the priest of the universal Church on earth", giving him "ordinary supreme, absolute, immediate and universal power in the Church".

Miles Pattenden, a historian of the Catholic Church at the University of Oxford, says the pope is essentially "the man who makes executive decisions about how the church is run, from appointing bishops, cardinals, canonizing saints, [to] anything else that involves the pope's personal legal or doctrinal authority."

In addition to his role in the church, the pope is also a key international figure, frequently speaking on high-profile topics such as artificial intelligence and immigration and making apostolic trips abroad.

In June, Leo made his first major European trip to Spain in honor of Pope Francis, who in his final years had expressed a desire to visit the Canary Islands, a port of entry for migrants crossing the Atlantic from West Africa to Europe. In September, Leo also embarked on a four-day trip to France.

The pope is scheduled to make a 12-day trip to Latin America on Nov. 6, with a stop in Peru, where Leo is a citizen. This trip is going to go according to plan.

Ambassador Arjan has contacted the press office of Serir Moghaddis to comment.

What happens if the Pope becomes ill, incapacitated or hospitalized?

The Vatican has detailed rules and procedures for the transfer of papal power in the event of the pope's death or resignation. But none of them apply when he is sick or even unconscious.

Unlike other positions in the Church, Catholic canon law does not provide a clear mechanism for transferring power to the Pope if he is unable to fulfill his responsibilities. Canon 335 declares that when the Holy See is "vacant or completely obstructed, nothing changes in the administration of the Universal Church." The papacy is only vacated if the pope dies or resigns, and that resignation is "freely and properly made known."

"There is no alternative law," Pattenden says. "The pope is responsible, and there is no mechanism that says the pope can't be responsible. There is no law about that." "When the pope is incapacitated, it is a serious problem for church government."

In February 2013, Pope Benedict XVI, then 85, gathered cardinals and announced his resignation from the leadership of the Catholic Church, citing his "advanced age." Pope Francis confirmed in 2022 that shortly after being elected pope in 2013, he had prepared his letter of resignation "in case of impediment for health reasons". The letter, the contents of which are unknown, was not used as Francis remained in office until his death at the age of 88 in April 2025. His final weeks included an extended hospital stay as he struggled with a number of health issues.

Pointing to the lack of a vice president as something that could be seen as a "weakness in the church," Pattenden says, "The church has no process or procedure like the U.S. Constitution, there is no equivalent to the 25th Amendment, and there is no 'vice pope' like the vice president."

As such, "anything requiring [the pope's] personal or doctrinal authority" during the hospital stay must wait until the pope can address such matters.

Pope Leo, who is fully conscious and currently walking around, is still contactable and will likely be able to communicate with church officials should any issues arise during his hospital stay. On Wednesday, Cardinal Luis Antonio Tagle presided in Leo's place and read a homily prepared by the pope.

Interestingly, other positions in the church have made clearer provisions for periods of incapacity.

For example, canon law provides for situations in which an diocesan bishop is unable to govern his own diocese and allows an auxiliary bishop, vicar general, or other designated official to delegate its day-to-day administration.

The Pope has now delegated the day-to-day running of the Vatican and the Church to a group of officials, whether they are in the Apostolic Palace or not, and whether they are vigilantes.

The Roman Curia is the central administrative body of the Holy See that supports the Pope in running the Catholic Church and carrying out its wider responsibilities.

"It has many departments, called dicasteries, which continue to function according to their current structure and guidelines," Pettenden says. "For example, there is an education department that is involved in running Catholic universities, creating links for them, seminaries, and schools, etc., and there are a lot of authorities with delegated powers."

Among the most senior officials is the Vatican's secretary of state, Cardinal Pietro Parolin, whom Pettenden describes as "the second most important person in the Vatican."

Parolin attended Leo's surgery early Tuesday while expressing concern about Pope Leo's calm demeanor.

Other senior figures in the Church include the President of the College of Cardinals, who presides over the College and has responsibilities during the transition of the Pope.

Another important position is the Camerlengo of the Holy Roman Catholic Church, currently held by Cardinal Kevin Farrell, who assumes certain administrative responsibilities in the event of a papal vacancy following the death or resignation of a pope. The Camerlengo helps oversee the administrative and financial affairs of the Holy See during this period, but does not take over the authority of the Pope or take over from the interim Pope, especially during hospitalization.

Currently, the Vatican has not shown that Leo is in any way incapable of performing or delegating his duties.

"It's very clear that Pope Leo wants to be as transparent as possible," Pattenden says.