Pope Francis has been hospitalized for nearly two weeks for a complex lung infection that has brought on the initial phases of kidney failure — and thoughts about what will happen should the 88-year-old pontiff resign, become incapacitated or die amid his papacy.
Francis remained in critical condition at Gemelli hospital in Rome, where the Vatican said Monday that he had spent a quiet night and was resting. He is being treated for pneumonia in both lungs and is receiving high flows of oxygen via a mask. Blood tests have shown “early, slight kidney insufficiency,” doctors said.
“As our Holy Father Pope Francis is in very, very fragile health, and probably close to death,” Cardinal Timothy Dolan, archbishop of New York, said Sunday in his homily from the pulpit of St. Patrick’s Cathedral. He later told reporters that he hoped and prayed that Francis would “bounce back.”
Vatican watchers say that the conclave that would convene to vote on Francis’ successor will likely be one of the most ideologically charged and diverse gatherings of cardinals in modern history, thanks in part to Francis’ own appointments.
The conclave would be conducted in Vatican City’s Sistine Chapel, where 138 cardinals under the age of 80 would vote in successive rounds of secret ballots until one candidate secures a two-thirds majority.
“And the cardinals, particularly those based outside Rome, are deeply sensitive to the concerns of their local constituencies,” said Mathew Schmalz, professor of religious studies at the College of the Holy Cross in Worcester, Massachusetts. “There are strong cultural currents within Catholicism that shape the way they understand their mission and purpose.”
“I think it unlikely that you will get the pope-as-policeman that some on the American right seem to want,” David Gibson, director of the Center on Religion and Culture at Fordham University, told Newsweek. “The church is becoming more global, and less centered on Rome as ’running’ everything.”
According to Catholic news outlet The Pillar, Francis has significantly reshaped the College of Cardinals during his 11-year papacy — 79% of voting-age cardinals are now his appointees. Many come from parts of the world historically underrepresented in Vatican leadership, including first-time cardinals from Africa, Asia and Latin America.
The geographical shift means that, for the first time, a significant number of cardinals will enter the conclave with little prior familiarity with one another —making pre-conclave meetings critical, The Pillar reported.
Mr. Schmalz said this dynamic could lead to two scenarios: “Either the conclave moves quickly if they rally behind a known figure, or it drags out as factions emerge and candidates rise and fall.”
Several frontrunners have emerged from progressive and conservative factions within the Catholic church, according to multiple reports:
• Cardinal Pietro Parolin (Italy). At 70, Cardinal Parolin is the Vatican’s secretary of state and the highest-ranking prelate in the Roman Curia. He is seen as a moderate who could provide continuity with Francis’ foreign policy while taking a more centrist approach on doctrinal matters.
• Cardinal Luis Antonio Tagle (the Philippines). Cardinal Tagle, 67, is widely regarded as the leading progressive candidate. Often described as the “Asian Pope Francis,” Cardinal Tagle has emphasized social justice and inclusivity, calling for a more welcoming church for divorced Catholics and LGBTQ individuals. His election would mark the first papacy from Asia.
• Cardinal Fridolin Ambongo Besungu (Democratic Republic of the Congo). At 65, the conservative Cardinal Besungu leads the church in one of the fastest-growing regions of the faith. He serves as president of the Symposium of Episcopal Conferences of Africa and Madagascar, and has been a vocal critic of the Vatican’s recent decision to allow blessings for same-sex couples.
• Cardinal Robert Sarah (Guinea). One of the church’s most prominent conservative voices, Cardinal Sarah, at 78, is a staunch advocate of traditional Catholic teachings. He has called for a return to Latin Mass and criticized what he sees as theological drift under Francis.
• Cardinal Péter Erdő (Hungary). A theological heavyweight, Cardinal Erdő, 72, has served as the archbishop of Esztergom-Budapest since 2003. The conservative prelate has opposed allowing divorced Catholics to receive Communion and has taken a firm stance against secular influences in the church.
• Cardinal Malcolm Ranjith (Sri Lanka). Cardinal Ranjith, 76, was a close ally of Pope Benedict XVI and a defender of the Latin Mass. However, after the 2019 Sri Lanka bombings, he became more outspoken on issues of mercy and reconciliation. In 2024, he made headlines for opposing same-sex marriage legislation in Sri Lanka and banning female altar servers.
• Cardinal Matteo Zuppi (Italy). Cardinal Zuppi, 69, is president of the Italian Episcopal Conference and a key figure in Vatican diplomacy. A favorite of Francis, he was tapped to lead peace talks in Ukraine and meet with U.S. leaders, including former President Joseph R. Biden.
• Cardinal Odilo Scherer (Brazil). Cardinal Scherer, 75, has served as archbishop of São Paulo since 2007, and is widely viewed as a pragmatic administrator. Theologically moderate, he has experience in Vatican financial oversight and governance, making him a possible compromise candidate if conservatives or progressives cannot secure enough support.
An unpredictable conclave
The geographical, ideological and doctrinal diversity among the front-runners indicates broader changes within the College of Cardinals. Under Francis, the Vatican has appointed prelates from dioceses that had never previously held such positions, bringing in leaders from historically underrepresented regions.
According to The Pillar, the demographic shift has significantly reduced the dominance of European cardinals, who now comprise just 45% of the college electorate — down from 57% in 2013.
Meanwhile, the share of cardinals from Latin America, Africa and Asia has steadily risen.
Though some Catholics see this as a step toward making the College of Cardinals more reflective of the global Church, others warn that the lack of familiarity among many cardinals could lead to a fractured conclave.
“It’s possible that when the next papal conclave comes, many of the men gathering to elect the next pope will be strangers to one another,” The Pillar reported last year.
But Mr. Schmalz said the conclave’s outcome will hinge on how cardinals balance continuity with change.
“Usually what happens, either the cardinals, you know, really in the end, don’t know what to do, and so they fall back on a really obvious candidate, of which I don’t think there is one right now,” he said.
Some Catholics are eager for a new pope who causes less of a stir than Francis has.
“Our God may be a God of surprises, but just now my sense is that we need much less that’s novel, interesting, and ’surprising,’ much more that is plain, solid, and sane,” Catholic commentator Robert Royal wrote in a recent opinion piece for The Catholic Thing. “Between JPII [John Paul II] and Benedict XVI, we were given an enormous spiritual, moral, and social legacy that still desperately needs to be absorbed at every level of the Church — from the tiniest parish to the most powerful dicasteries in Rome — and even beyond.”
Mr. Schmalz said it’s unlikely the conclave chooses someone with less pastoral capacity than Francis displayed in his tenure.
“I don’t think, in terms of public relations, it would be good to have a very distant and regal pontiff. So someone who’s a man of the people … but someone who engages with others a little bit differently than Pope Francis, is what I would expect. If they don’t, the conclave could be a very long time,” Mr. Schmalz added.
• Emma Ayers can be reached at eayers@washingtontimes.com.