Case XLIII: Sudden Sick Calls

Titus is hurriedly called to the bedside of a dying man, who desires very earnestly to see him. Taking the Blessed Sacrament and the holy oils, he hastens to the house of the sick man, only to learn that just as he crossed the threshold of the house the dying man had passed away. Having the Blessed Sacrament with him, Titus did not tarry longer, but returned immediately to the church.

On another occasion, being summoned to a sick person, Titus, on entering the sick chamber, finds the patient just breathing his last. He quickly pronounces the words of absolution over him. But before he can administer Extreme Unction the pulse and heart have ceased to beat, and Titus, concluding that the man was dead, returned home without administering Extreme Unction.

Reflecting on these cases, Titus makes up his mind that in the future, whenever he receives a sudden sick call, he will pronounce the words of absolution over the sick person when within twenty paces of the house, in order to be able to proceed to the administration of Extreme Unction immediately on entering the sick chamber.

Answer.—It is hardly necessary to say that a person who is certainly dead can not receive any Sacrament, neither sacramental absolution, nor Extreme Unction. To absolve or anoint a person who, beyond doubt, is dead would be a sacrilege. It would be a grievous desecration of the Sacramental rite and a mortal sin. But if there be any reasonable grounds for doubting whether the person be really dead or not, then the priest not only may, but must administer, conditionally, of course, Sacramental Absolution and Extreme Unction. That a person is, in every case, really dead when he ceases to breathe is by no means certain according to expert medical testimony.^* In the case of normal death, where the person has been sick for sometime and gradually sinking, only a few moments, at most, will intervene between the cessation of respiration and actual death. But in cases of sudden and violent death, as, for instance, drowning, asphyxiation, etc., the last visible sign of life may have disappeared long before death occurs.

^* Cf. the chapter "The Moment of Death," in Sanford's Pastoral Medicine.

Dr. Gourand, a well-known Parisian physician, with large hospital experience, writing in the "Bulletin de la société médicale de S. Luc, S. Come, S. Damian," 1895, says, àpropos of the question of administering the last Sacraments, that it is physiologically wrong to conclude that actual death has occurred because respiration has ceased. It used to be thought, he says, that when the breathing had ceased the heart action also had ceased, and, therefore, that death had occurred. It is comparatively easy to verify the cessation of breathing, but difficult to determine just when the heart has finally ceased to act. "It is incontestable," he continues, "that a person who, after a long agony, ceases to breathe is, in most cases, dead. But, physiologically, he is not dead because respiration has ceased, but because the cessation of breathing follows, as a consequence, upon the cessation of the action of the heart." In regard to cases where respiration has ceased before the action of the heart has been stilled, he says: "Between the last breath and the final cessation of the heart's action there is often an interval, whose length is determined by the greater or lesser vitality of the cardiac ganglion."

Dr. Capellmann (Pastoral Medicine, Agony) says: "After the last respiration the person is considered dead, although perhaps sometimes minutes elapse before the vital spark becomes completely extinct, the muscles of the heart and of the arteries make, often after the last respiration, some, though feeble, movements. If the agony and the gradual fading away have been observed, we may be convinced of death some minutes after the last respiration. However, there are some forms of death wherein doubts may be entertained whether death has really taken place." In other cases, as for example, cases of drowning, asphyxiation, great loss of blood, etc., hours may elapse between apparent and real death, or between apparent death and resuscitation.

Father Tanquerey, de Poenit, p. 247, says: “It is established by recent experiments that life remains in the body for some time even when a person seems to have breathed his last, because life withdraws from the body only successively. Hence some who were apparently dead have at times been restored to life after three hours by the rhythmic drawing of the tongue. Therefore, with the requisite conditions observed, those who by such a procedure exhibit some signs of life, at least sensory life, may be absolved and anointed; indeed, under the condition ‘if you are alive,’ so may those who, although they appear to be dead according to the ordinary signs, are prudently judged by experts to survive.”

In the light of all this, therefore, we can not endorse unconditionally Titus' method of administering the last Sacraments.

As regards the first case, although the sick person was dying for some time and gradually faded away, and although the attendants had noticed the cessation of respiration, nevertheless Titus could not affirm with certainty that life did not linger still in the heart and nerve centers, for at least the few moments that were required to reach the sick-chamber from the main entrance of the house. On entering the sick-room, therefore, Titus should have immediately pronounced the words of absolution, with the condition "si tu es capax." As regards the administration of Extreme Unction in this case, so much time would be required before the Sacrament could be given that there would scarcely be any reasonable grounds for not concluding that death had occurred before the Sacrament could be administered.

Were this a case of sudden or violent death, like drowning or asphyxiation, etc., Titus should have administered Extreme Unction also, because there was a reasonable probability that life might not be altogether extinct.

In case a physician were present and would not affirm with certainty that death had already occurred, Titus would be justified and even bound to administer Extreme Unction. And if considerable time were required to discover probable signs of life or death, Titus should proceed immediately to administer Extreme Unction, using the shortest valid form, without waiting for any further examination of the patient, because every moment of delay may prove fatal.

In the second case, Titus did well to give conditional absolution. Had he had the holy oils ready, he could have given Extreme Unction immediately after pronouncing the words of absolution, because there was sufficient reason for doubting whether life really became extinct with the last respiration. At least there was a probability that a spark of life might still remain in the body, and therefore sufficient warrant for giving conditional Extreme Unction, although there would be no sufficient warrant under the circumstances for administering the Holy Viaticum.

The resolution that Titus took in consequence of these cases, of always imparting conditional absolution when within twenty paces of the house of the sick person, can not be approved of; rather, it must be condemned. In order to be absolved, the penitent must be morally present to the confessor; and although St. Alphonsus says that if the penitent be no farther than twenty paces distant from the confessor he is morally present and may be absolved, the holy doctor means that both the confessor and the penitent must be in the same room or hall, and must perceive one another by sight or hearing. Even a greater distance than twenty paces would not render the absolution certainly invalid, although it would jeopardize it. But if the priest be separated from the penitent by a house or a street, or if the penitent occupy a room in the house altogether unknown to the priest, there can be no question of moral presence. In fact, even under circumstances where the absolution "in distantiam" would be most likely valid, the confessor would not be justified in administering it always and on all occasions in that way, but only in cases where, unless he administered it in that way, he would not be able perhaps to administer it at all. It is not to be taken for granted that every time the priest receives a sudden urgent sick call it will be necessary to give conditional absolution before reaching the bedside of the dying person. On the contrary, it is to be taken for granted, as a rule, that the priest will be summoned in ample time to administer the last Sacraments to the dying with dignity and decorum. The faithful are to be reminded repeatedly, when necessary, that they should summon the priest in good time. And the priest, on being called to the sick, should not delay in hastening to them. Exceptional accidental cases must be left to the providence of God.