Italian nuns caring for a woman who has been in a comatose "vegetative state" for nearly 17 years have launched an appeal for her life to be saved after Italy's top appeals court ruled she could be allowed to die.

Last week the Court of Cassation court upheld a ruling in July by a lower court in Milan allowing for the removal of feeding tubes connected to Eluana Englaro, who has been in a coma since a 1992 car accident in the northern city of Lecco in Lombardy.

However no Italian doctor has yet agreed to remove the feeding tubes, including staff at the hospital in Lecco where she is cared for. Roberto Formigoni, President of the Lombardy region, warned that doctors performing such a procedure would face disciplinary action for "failing to honour commitments to the well-being of their patients."

Medical authorities and health officials in other northern regions such as Piedmont and Friuli - where the Englaro family comes from - have also refused. Vladimiro Kosic, head of health for Friuli-Venezia Giulia, said "Our hospitals are places of life, not death".

In a letter to the nuns of the Misericordine order who look after Ms Englaro at the Blessed Luigi Talamoni clinic at Lecco, Cardinal Dionigi Tettamanzi, the archbishop of Milan, said he was praying that the civil authorities would "change their minds" about allowing "a beloved creature of God" to be deprived of water and nutrition.

Cardinal Angelo Bagnasco, head of the Italian Bishops Conference, said "We fear that this is a first step towards the legalisation of euthanasia". La Repubblca said Beppino Englaro, Eluana's father, "might have to take her abroad, to Austria or Slovenia", to end her life.

In a letter to L'Avvenire, the newspaper of the Italian Bishops Conference, the nuns at Lecco said "Our hope, and that of many like us, is that the death by hunger and thirst of Eluana, and others in her condition, will not be carried out. If there are those who consider her dead, let Eluana remain with us, who feel she is alive".

Members of the centre Right government of Silvio Berlusconi attacked the Cassation ruling, accusing magistrates of usurping Parliament's authority. They questioned the competence of the court to rule that Eluana's condition was "irreversible."

But other deputies said there was a need to clear up confusion and introduce new "right to die" legislation in Italy, where terminating a life is forbidden but the Constitution gives patients the right to refuse medical treatment.

The Justice Minister, Angelino Alfano, also urged Parliament to "fill the legislative void" on right-to-die issues, adding: ''Anyone who believes in God is praying for Eluana''. Three pro-life associations said they would take the case to the European Court of Human Rights at Strasbourg.