Question VI: Concerning the Sick and the Dying

I. Concerning the Sacrament of Penance to be ministered to the dying. - Concerning ordinary dying persons nothing special occurs that must be said; only those are to be considered who cannot speak and at least apparently are deprived of their senses. These, in this way, are excused from the material integrity of confession; but they can be deficient in contrition or in its sensible manifestation, and in the essence of confession, which nevertheless are the proximate matter of the sacrament or the condition without which there is no absolution.

Concerning these the principle holds: they are to be absolved absolutely if they certainly are disposed, and have manifested that disposition in some way; conditionally, as often as it is somehow, even slightly, probable that absolution will profit them.

For the sacraments are for men, and in extremities extreme things are to be attempted; hence in a case of necessity it is licit to use doubtful matter and to expose the sacrament to the danger of nullity, provided some probability, even slight, is present of a valid absolution useful to the recipient. - Yet mere possibility does not suffice, since in practical matters probability, not mere possibility, is attended to; otherwise all would have to be rebaptized, and all priests reordained, because it is strictly possible that Baptism or Order was conferred invalidly.

In other words: the law of religion is that a sacrament cannot be exposed to the danger of nullity; the law of charity obliges one in a case of necessity to assist one's neighbor. But charity obliges more than religion. Hence in a case of extreme necessity, the law of religion ceases while the law of charity remains. For it is better to expose the sacrament to the danger of nullity, provided that it is in some way probable that it can be valid, than to leave a man exposed to the danger of eternal damnation.

Hence 1) a dying person is to be absolved absolutely: a) if he has in the present certain sufficient signs of contrition; or b) if, at the moment of absolution, wholly deprived of his senses, he now gives no signs, but previously gave certain signs to the priest himself; indeed c) if before witnesses he asked for the sacrament or for a priest and meanwhile lost speech and the use of reason. For in these cases there is contrition virtually remaining, and a sufficient confession made at least by means of an interpreter; and so great a necessity most certainly excuses from the material integrity of confession.

2. A dying person who gives no sign of penance and has not explicitly given one is to be absolved conditionally: a) if he lived as a Christian; or b) if he preserved the faith. For such persons can deservedly be presumed to wish to die as Christians, and besides to have elicited an act of contrition before they lost the use of reason, or even then to elicit it through some lucid interval and perhaps to exhibit a sensible sign through sighs or movements of the eyes or lips or other things of this sort, although the priest does not distinctly perceive it. Hence they can be absolved, yet under condition, because contrition is not certain, but only some probability of contrition. Such are reckoned those who have preserved signs of the Catholic faith, e.g., medals, a rosary, a scapular; and unknown persons are equated with these if they probably are Catholics, because they have lived in a Catholic region. Indeed c) a Catholic dying person who in the very act of sin, e.g., in drunkenness, adultery, or a duel, lost the use of reason, according to some can probably be absolved in this way, provided from his life there is some probability of contrition, insofar as at the moment when he perceived that he was losing the use of reason, he perhaps changed his mind and detested the sin.

3. In no way is he to be absolved who, after a life impiously spent, before he was deprived of the use of reason, positively refused out of contempt, unless such a manner of acting can be judged to have been revoked by some sign of contrition; for then every probability of conversion is lacking. For although, under the influence of an outstanding grace, he certainly could have been converted, this is altogether improbable, as being supported by no solid reason.

4. In the same manner as Catholics, schismatics deprived of their senses, who are in good faith, can be absolved under condition, scandal having been removed, S. Off. 20 July 1898 and 17 May 1916.

5. Likewise heretics who are in good faith, and at the same time admit the sacrament of Penance; not, however, if they reject it, because the intention of receiving it is lacking to them.¹ And although they have the will of saving themselves, nevertheless they do not have the will of receiving the sacrament and confessing, or of saving themselves through such a means. Perhaps they would wish to confess if they knew the sacrament of Penance to be a necessary means of salvation; but now they do not will it.

¹ Certain persons conclude by parity as for schismatics, and argue from the alleged decree of the Holy Office, 17 May 1916. But the decree speaks of schismatics, not of heretics; and the parity is not present, because schismatics admit the sacrament of Penance, but heretics generally do not.

When it is not licit to minister the sacrament to schismatics or heretics, the priest should take care that they elicit acts of faith, hope, charity, and perfect contrition.

It should be noted in the aforesaid cases that it is always expedient for the priest, before he imparts absolution, to address the dying person and excite him to contrition. For experience proves that there are dying persons who are able to hear, although they cannot speak or give certain signs; in which case they too are helped in this way toward contrition.

II. Practical corollaries. - 1) If concerning the value of the Baptism of non-Catholics there is a probable doubt, they must secretly be baptized under condition before they are absolved.

2. In a positive doubt whether someone is a pagan, a heretic, or a Catholic, he can be absolved under condition.

3. Those who are certainly dead cannot be absolved, nor anointed, even under condition; but from recent experiments it is established that life can remain for some time in the body, even when someone seems to have given the last breath, because generally life recedes from the body only successively. Hence certain persons who were apparently dead, e.g., suffocated, or rescued from water or fire, have been restored to life after three hours by rhythmic traction of the tongue. Therefore, the other conditions being posited, those can be absolved and anointed who by such a process give certain signs of life, at least sensitive life; indeed, under condition, those who, although they seem dead according to ordinary signs, are prudently judged to survive. Yet the complete cessation of the motion of the heart, lasting for some time, and invading corruption of the body, or putrefaction already begun, are deservedly held as certain signs of death; cadaveric rigidity is less certain.

In practice, when a certain sign of death is lacking, if here and now the judgment of a physician cannot be had:

a) in a case of wholly sudden death, generally they can be absolved within two or three hours, because then it is probable that life remains for some time because of the resistant vital powers, which are not immediately destroyed; not longer, because it is no longer probable, even if it is possible in an extraordinary case that life remains hidden even for some days. An exception is made if death was violent, e.g., from compression or tearing away of principal members, because then death is evident.

b) In a case of ordinary death from a long-lasting and gradually wasting disease, they cannot be absolved, because it is not probable that life remains.

c) In an intermediate case of death, from a long-lasting disease but with a sudden new influence, which is called a "complication" and greatly accelerates the expected death, they seem able to be absolved for a space of about half an hour after apparent death.

4. The condition to be added is this: if you are capable, but not that one: if you are disposed. For since it is probable that one contrition, namely sincere but not appreciatively supreme, is required for the capacity and validity of receiving absolution, and another, namely appreciatively supreme, for the disposition required that it produce fruit, grace, and therefore that the sacrament can revive: the formula if you are disposed, in a case in which the disposition were absent, would render the sacrament altogether null and would forever impede its reviviscence. On the contrary, the form if you are capable would leave the sacrament valid in a case in which that lesser contrition was present which would suffice as a part of the sacrament, while that greater contrition was not present which is required as a disposition for justification; whence, when the dying person disposes himself by greater contrition, the sacrament would revive and the penitent would obtain the effect of grace. And in this sense Cajetan, in his little work on confession, St. Antoninus, and the old Thomists, such as Capreolus and Paludanus, interpret St. Thomas, Supplement, q. 9, a. 1.

With greater reason the same must be said of Extreme Unction, because it is certain that disposition, namely contrition, is required only for the fruit, not for the essence and validity, but for this latter the intention alone of receiving the sacrament suffices.²

² Concerning the sacraments not to be ministered under the condition if you are disposed, we wrote an article in the periodical Revue Eccl. de Liege, Nov. 1909, which quite generally received the approval of experts. Nevertheless Fr. Castillon moved certain difficulties in Nouv. Revue Theol., May 1910, which we subjected to examination and to which we gave satisfaction in Revue Eccl. de Liege, July 1910. No further response succeeded this.

5. In a case of extreme necessity, the shortest form is to be employed: I absolve you from all censures and sins in the name of the Father and of the Son and of the Holy Spirit. Amen.

6. But how many times can a dying person be absolved? If he is in possession of himself, as often as he makes a brief confession or manifests signs of sorrow anew and wishes to receive absolution. If he is deprived of the senses, as often as there is a probable reason of a more certain disposition or of a new necessity; to do this without a special reason twice or three times in a day, or with a space of three or four hours intervening, as certain persons say, does not seem to be admitted, because there is not a sufficient reason for so easily exposing the sacrament to the danger of nullity.

III. Concerning Extreme Unction. - Extreme Unction is not to be given to all Christians who are in danger of death, but to adults dangerously sick; for, besides Baptism, there is required for its validity that one be a) a sinner and therefore an adult, or have the use of reason; b) dangerously sick; c) intending to receive the sacrament. Therefore the following cannot receive the sacrament:

1. The insane, unless previously they had the use of reason and then formed the intention of receiving Extreme Unction.

2. The healthy, even if they are in extrinsic danger of death, as those condemned to death; those about to navigate or fight dangerously, unless after they have received a lethal wound; women who regularly give birth with some danger of death, unless death is to be feared on account of a special infirmity, or their strength has already been greatly weakened from childbirth; and those about to undergo a dangerous incision, unless from an illness already contracted they are in danger of death. - On the contrary, those can be anointed for whom, from illness, there is not only imminent but also probable intrinsic danger of death, as all who have contracted an infirmity that will probably bring death, those infected by poison, the gravely wounded, those who after surgical incision are greatly weakened, indeed also decrepit old persons even if they labor under no special disease, for old age itself is for them an incurable disease, can. 940, § 1.

3. Those who do not intend to receive the sacrament; but an actual or virtual intention is not required, but a habitual intention, not retracted, even implicit, suffices, such as the intention of Catholics not to die without the sacraments, or of dying as a Catholic; not, however, the simple intention of saving oneself. Hence:

a) Of itself and regularly Extreme Unction is to be given to all the sick to whom absolution is granted, even if they are deprived of the senses. The reason is that it is a more secure means of salvation than absolution itself, for it is certain that Extreme Unction remits mortal sins, Jas. V, 15, and it is also certain that it is valid if absolution certainly valid cannot be had. For when sufficient external signs of contrition are lacking and therefore absolution is very doubtful, Extreme Unction is received validly, because contrition, which is a part of the sacrament of Penance, is not a part of Extreme Unction required for its validity, but only a disposition for its fruitfulness.

b) Accidentally, however, it can happen that Extreme Unction must be denied, when it cannot be given without the scandal of those standing by to some impious man already deprived of the senses, to whom absolution was granted secretly; likewise to him who now appears dead. Scandal can often be prevented by secretly administering one anointing, or even by admonishing those standing by; but if this cannot be done, the sacrament is to be denied, because the spiritual evil of many prevails over the conjectural good of one.

c) In doubt whether the sick person has attained the use of reason, whether he is actually placed in danger of death, or whether he is dead, the sacrament is to be ministered under condition, can. 941.

d) Extreme Unction is to be ministered absolutely to all, even sinners, who in life had an intention, not retracted, of dying as Catholics, can. 943; under condition, if you are capable, if it concerns unknown persons, or those who do not certainly live, as was already said, or sinners so impious that it can be doubted whether they have the intention of dying as Catholics; but not to those who, impenitent, contumaciously persevere in manifest mortal sin, can. 942.

e) In a case of necessity, Extreme Unction is to be ministered by one anointing only on the forehead, with the form: Through this holy anointing may the Lord pardon you whatever you have sinned. Amen. But if death has not followed, the other anointings are to be added as indicated in the ritual, and indeed absolutely, not under condition. The anointing on the loins is now to be omitted; the anointing of the feet can be omitted for any reasonable cause, can. 947.

IV. Concerning Viaticum. - To those deprived of the senses Viaticum A) is to be denied: 1. to sinners, even ordinary and hidden sinners, unless they have given certain signs of penance; 2. likewise to those whose disposition is unknown; 3. to the insane and the half-witted, unless previously they had at least the implicit intention of communicating. The general reason is that on the one hand the Sacrament is not necessary, and on the other hand reverence toward so great a Sacrament must be set before the conjectural utility of the faithful.

B) On the contrary it is to be granted to those who certainly are in the state of grace, provided nevertheless that every danger of irreverence toward the Sacrament is absent, which can arise from those who are furious, or who are going to vomit the Sacrament, or who are not able to swallow it. In a case of vomiting, Holy Communion is not to be given unless vomiting has ceased for several hours; a physician should be consulted, otherwise an experiment can be tried by giving a very little bread, and, if the sick person retains it for a sufficiently long time, a consecrated particle can also be given. But if a grave doubt remains, that great Sacrament, since it is not necessary, is rather to be denied than exposed to such irreverence.

It should be noted, however, that coughing is not to be confused with vomiting, because sputum does not come from the stomach; hence from coughing there is no danger for the sacrament, unless it is assiduous.

But if there is doubt concerning the capacity of swallowing, by way of experiment something liquid is administered to the sick person, and if this can be swallowed, the sacred Host or at least a particle can be conferred on him in a small quantity of water or wine by means of a spoon.

Moreover, even outside the danger of death, so that sick persons can swallow the host or particles adhering to the mouth, after the host there can be given an ablution of water or wine, although this is swallowed before the host; for the violation of the fast at least morally does not precede communion, indeed the law of fasting prescribes only that nothing be taken before the reception of the Sacrament, and this is fulfilled.

V. Cases. - In the article of death certain cases can occur which present a special difficulty, and which, unless they have been examined beforehand, could not be solved rightly.

1. It often happens that a priest is called to a dying public sinner. In this case the sacraments are not to be ministered to him publicly, especially Viaticum, unless the scandal is publicly repaired; but if this is impossible, it can be brought secretly. And indeed:

a) regularly for ordinary sinners the public bringing of the Eucharist itself is a sufficient retraction or sign that they repent;

b) for great sinners a declaration is to be made by retraction before witnesses;

c) but for those who live in a proximate occasion, e.g., in publicly known concubinage, the occasion must first be removed; but if this is impossible, or if extreme necessity is urgent, absolution and Extreme Unction can be given secretly after a promise of removing the scandal; and communion is to be brought secretly, after a promise before witnesses of removing the scandal as soon as possible.

In a case of concubinage or civil marriage let it be examined whether marriage is not to be contracted for legitimating offspring or for fulfilling a promise; in which case the confessor should know that the Ordinary can dispense from all impediments of ecclesiastical law, excepting presbyterate and affinity in the direct line, can. 1043, and, if time is lacking to have recourse to the Ordinary, the parish priest or the priest himself can also do this, can. 1044.

2. It can also happen that a woman or girl illegitimately pregnant, with no one knowing this, is in imminent danger of death. Now after the fourth month of pregnancy has begun, there is a founded hope of extracting the living fetus from the uterus of the dead mother. Hence the woman has a grave obligation to disclose the matter directly to some person, so that after her death a Caesarean operation can be performed and the infant baptized. She can accomplish this:

a) by writing letters in which she declares that she wishes the womb to be opened after death and the offspring to be baptized, which letters, signed and closed, she should hand over to a trustworthy person to be opened only after death. For thus, as far as can be done, provision is made both for her own good name and for the salvation of the offspring.

b) If she is unable or unwilling to write, let her manifest the matter by word of mouth to an entirely discreet person who will reveal the fact only after her death.

c) Other things being equal, for a duty of this sort the physician is to be chosen before others, who perhaps already knows the matter under professional secrecy, who can more suitably provide for the good name of the mother and family, and who, when necessity is urgent, can proceed at once to the section and Baptism; parents are less suitable, for perhaps through excessive fear of infamy they will abstain from revelation.

d) The confessor himself should take upon himself the burden of revealing only with difficulty and in the last place, especially if he fears that from this the sacrament may be rendered odious to the girl's relatives.³

³ De Smet notes, de Sacr. in gen. Bapt. et Confir., p. 257, note 3: "It will perhaps be better if the girl permits that, already before death, the physician or midwife be admonished most cautiously and under gravest secrecy, so that, when death supervenes, they may be ready at hand for the operation. It also seems good that, if it can be done, besides a suitable external person, also the father or mother be admonished by the girl herself, lest afterward they contradict the operation to be performed." We doubt, however, that these things will always be opportune.

But the confessor should induce the penitent to this by persuading and commending, not impose it as obligatory if he experiences that the penitent certainly refuses it; for then he would uselessly disturb good faith, which in fact would not profit the infant and would harm the salvation of the mother. If, however, she doubts and asks concerning the obligation, the confessor must confess the obligation.

To a girl who is sick from the pregnancy itself the sacraments can be brought secretly, in order to preserve her good name.

3. The dying person can also be an impious man who by work or writing has attacked the faith. Concerning this case, if there is time, the Ordinary should first be consulted. But such a sick person is to be admonished concerning the obligation of removing scandal and retracting errors; for this end let him declare, by himself or through the confessor, before witnesses, that he retracts all errors condemned by the Church and professes Catholic doctrine whole and entire; or let him sign a formula of retraction; or at least let him consent before witnesses that the confessor publish his retraction. But if the scandal perseveres, it is to be removed insofar as possible, e.g., writings are to be removed from circulation, or a written retraction is to be published for reading.

But he who has given his name to a Masonic sect must besides abjure the sect, and, if possible and if time permits, give up Masonic insignia and writings, and manifest to the Ordinary the names of leaders, if he knows any.

It should be noted, however, that one excommunicated can be absolved from all censures in danger of death by anyone.

4. Sometimes a dying person is bound to restitution or to reparation of damage; in this case:

a) if he is found in good faith, and no time remains for prudently admonishing him concerning his obligation, or it is foreseen that the admonition will not profit, this being omitted, he is to be absolved;

b) if fruit is hoped for, or if the penitent is not in good faith, e.g., if he doubts, then he is to be admonished and helped at once toward restitution, for if this can then be fulfilled, it does not suffice to transfer this burden to the heirs, to whom trust is not easily to be given;

c) if restitution cannot be made at once and the obligation is hidden, let him commit the money to the confessor, or rather to another faithful man, so that it may be secretly sent back to the creditor. But if he does not have the money, let him leave that sum to the creditor himself in the testament, omitting mention of restitution; or he can also add a codicil by which he orders the heirs to give a sum to a trustworthy person to be expended according to the will of the sick person; or if a notary could not conveniently be had, in regions or circumstances where his office is required, let him declare by word or writing that he has left a note with a third person for notifying what he wishes to be done after death, and that he wishes this to have the force of a testament;

d) if the obligation is not hidden, nor can it be fulfilled at once, let the confessor procure that restitution certainly be made through the heirs, whether by a note to be handed to the creditor, etc.

If the obligation of restoring is doubtful, as can happen in the administration of goods, let the sick person take care that, the matter having been examined, his own be given to each.

But if reputation is to be restored, let him do it in the better manner in which he can, by word, or by writing to be published if necessary, or by a retraction before witnesses who can attest publicly. But the best restitution of reputation is made through a third person of great authority.

5. How should the priest act if, arriving with Viaticum to a hidden sinner and hearing his confession, he finds him indisposed?

Haine, Th. M. III, de Euch. q. 43, responds:

The priest a) "should strive altogether to dispose him;

b) If he certainly remains indisposed, because, for example, he does not wish to leave the proximate occasion, or does not wish to promise grave and certainly owed restitution, it is not licit to absolve him.

c) As regards communion, he is earnestly to be induced, after confession has been completed, to declare publicly that he no longer wishes to receive the Eucharist.

d) If he refuses to declare this and wishes to communicate, the Eucharist is to be ministered to him, although indisposed, lest the seal of confession be violated."

To avoid this danger, it will be better that in hospitals or clinical houses the priest, or the sister appointed for caring for the sick, not prepare all things for ministering Holy Communion on his or her own motion, but only after the sick person, having confessed, asks for it; but when the priest is asked, let him uniformly say: ask the penitent whether he wishes to communicate.

VI. Observations. - 1) To the dying to whom the sacraments are ministered, the general absolution according to can. 468 is also to be granted by any priest: "To any priest who assists the sick there belongs the faculty of granting to them the Apostolic Blessing with plenary indulgence in the article of death, according to the form handed down by approved liturgical books, which blessing he should not omit to impart."

Therefore under the name of general absolution comes the plenary indulgence which the Roman Pontiff imparts to the dying, by himself or by delegates, under the form of a blessing; and under this aspect it is altogether distinguished from the plenary indulgence which, without any blessing, those can gain in the article of death who possess a blessed or pious object, e.g., a cross or plaque, to which an apostolic indulgence is attached, or members of a confraternity to which such a privilege has been granted.

General absolution can be granted to all placed in grave danger, even from a cause other than illness, but the indulgence remains suspended and does not attain its effect except in the true and physical article of death. And therefore it neither ought nor can be repeated, nor given under several titles, in the same illness however long-lasting, since this would be altogether useless, even if afterward the dying person fell into a new mortal sin; - but it is to be repeated only if the sick person recovers and afterward falls into a new danger, S. C. Indulgences, 24 Sept. 1838; 12 March 1855; 12 Feb. 1842.

The conditions required in the sick person for gaining it, from the bull of Benedict XIV Pia mater, 5 Apr. 1747, are: a) that he not be excommunicated or manifestly impenitent; but if he is doubtfully disposed, let the apostolic blessing be granted as often as absolution or Extreme Unction is given, even only under condition;

b) that he has received the sacraments of Penance and Eucharist, if he can; but if he cannot, the state of grace suffices while he gives forth his supreme breath;

c) that he offer himself prepared to accept whatever shall please God, and to undergo death itself patiently in satisfaction for the punishments which he has merited by sinning;

d) that he devoutly invoke the most holy Name of Jesus by mouth if he can, otherwise in heart; and elicit an act of sorrow and charity.

2. Commonly it is not expedient to hear the confession of a public sinner unless he has promised amendment and due satisfaction, for if he is unwilling to obey the commands of the confessor, the latter, blocked by the seal, will be held to minister Viaticum to an unworthy person. He will avoid this inconvenience if he does not admit to confession except one who is prepared.

3. Viaticum, Extreme Unction, and the apostolic blessing are to be administered to children, provided they have sufficient discretion.

4. Although a dying person, Noldin notes, Th. M. III, n. 459, is to be absolved before the administration of Extreme Unction, because Extreme Unction is a sacrament of the living and the complement of the sacrament of Penance, and because the Church so prescribes, nevertheless this is not required by so great a necessity that it would not be licit to anoint a dying person before absolution, where it is deservedly feared that time for both sacraments may fail.

5. Sacraments ministered to sinners deprived of the senses, who gave no signs of contrition, are not a title to ecclesiastical burial.

VII. Concerning the manner of helping the dying.⁴ - Certainly no work of charity is more acceptable to God than to help the sick and the dying toward a holy death; wherefore one of the principal priestly duties is to have care of the sick. This principally regards the parish priest, who, says the Ritual, tit. 5, c. 4, n. 1, "as soon as he knows that any one of the faithful committed to his care is sick, will not wait until he is called to him; but of his own accord he should go to him, and this not only once, but often, insofar as there is need; and let him exhort his parishioners to inform him when anyone in his parish happens to be sick, especially if the illness should be graver." But, St. Alphonsus adds, care of the sick is not the duty of parish priests only, but the work of all confessors.

⁴ Cf. St. Alphonsus, Pr. conf., nn. 105-107 and 227-280; Reuter, o. c., nn. 209-227; Billuart, de Poen., diss. 6, art. 10, § 7; Aertnijs, Th. P., nn. 187-203; Theol. Mechl., de Poen. (4), n. 74, pp. 218-219; Berardi, Pr. conf., nn. 772-791; Marc, Th. M., II, nn. 1854-1855; Lehmkuhl, Th. M., II, nn. 645-658; Noldin, Th. M., III, nn. 292-295; Tanquerey, de Poenit., nn. 557-559.

For rightly exercising this duty authors are accustomed to hand down various admonitions, to be applied not invariably but according to opportunity; the principal of these we set down here. First:

A. General counsels: 1) "Let the priest approach the sick person," says the Ritual, ib. n. 7, "so prepared that he may have at hand arguments fitted for persuading; and especially examples of the Saints, which have very great force, by which he may console him in the Lord, excite and refresh him." - Therefore a) let him trust in divine help and pray to Christ, the Blessed Virgin, and the guardian angel for the sick person whom he visits, and whom he will not convince unless the grace of God so counsels as to persuade; b) and that he may help better, let him, as far as he can, explore the sick person's disposition, manners, and condition, on the way or in the house of the sick person, e.g., whether he is an educated and prudent man, uses his senses, has asked for a confessor, is believed to be near death, whether he has already confessed, whether he has made a testament, what kind of life he has led, whether there is something of some moment concerning which it is necessary to admonish him, whether he desires another confessor, etc.; c) then let him premeditate the manner of acting with the sick person, turning over in his mind what things are to be said and done.

2. If relatives are foreseen as not easily going to admit the priest, a) let him take care, at least by indirect means and the intervention of friends, that he be called as a friend; b) but if he has attempted this in vain, with all prudence let him ask that at least for the sake of courtesy he may be able to visit the sick person; c) and if he knows that his ministry is desired by the sick person, let him press more urgently and personally plead the cause of the sick person in the better way; d) if he cannot approach the sick person without witnesses who are unwilling to withdraw, let him not urge an entire confession, being content with a general accusation only or with that of a lighter fault; this being posited, having first excited the sick person to contrition, let him absolve him; - but if he cannot approach him at all, what would prevent him, in an extreme case, from addressing him with a loud voice through the door or window and inducing him to contrition and absolving him under condition?

But once admitted and having entered the room, let him kindly greet the sick person, with a great affection of charity and compassion inquire concerning the disease, pains, inconveniences, rest, etc., bring consolation and exhort him to patience, especially by the example of Christ suffering.

B. Specially as regards the sacrament of Penance. 1. Before confession: If he was not called by the sick person for confession and the danger of death is not imminent, let him not at once speak of it, especially if the sick person fears to undertake it, but a) first let him strive to conciliate his mind to himself, by setting forth the mercy of God and His benefits and paternal care, and Christ's love toward sinners; b) on the second or third visitation, let him propose the utility of confession for quiet of mind, and at the same time show that it is not difficult and does not require much time, that the sacrament can contribute to bearing the illness fruitfully, indeed to obtaining health; and then let him exhort the sick person to wish to confess at once; c) if he asks for some delay to prepare himself, this can be granted, e.g., one or another hour, unless danger stands in the way; but care must be taken that it not be deferred longer; d) but if he cannot be brought to confessing, let the confessor carefully explore the cause: if it is difficulty of the work, let him explain that the difficulty is exaggerated and promise every help and ease; - if it is lack of confidence or even despair, with every effort let him raise him to hope and confidence, recalling to mind the Passion of Christ, the parables of the prodigal son or the lost sheep, the examples of David, Peter, Magdalene, the good thief, etc.; - if finally it is hardness of heart, to these let him add the unhappiness of the impenitent sinner, the rigor of divine judgment, the eternity of punishments, and the happiness and peace of conscience of him who returns to God. Nor should he ever despair, but let him solicit the exhortations of other priests or upright persons, especially the physician, together with private and public prayers for obtaining grace for the salvation of the bedridden person; e) but if the sick person is now prepared for confession, let him inquire from what time he has confessed, exhort him to perfect sincerity, and kindly ask whether he has doubts or anxieties concerning past confessions, since now there is the best opportunity of correcting all defects.

2. In confession a) of itself: he ought to question, but sparingly, so that, avoiding excessive and indiscreet questions, he takes care that the sick person not have to speak much, being more solicitous concerning contrition than concerning procuring material integrity; nevertheless it will often be opportune to ask concerning four things: concerning a sin never accused, concerning hatred, concerning a depraved custom formerly had and never expiated by general confession, and concerning restitution or reparation to be made. The accusation having been heard, let him excite confidence by recalling Christ's mercy toward sinners in words and examples; immediately before absolution let him ask whether the sick person has anything that disturbs his mind; let him briefly propose to him motives of contrition and help him in eliciting acts of faith, hope, charity, and contrition, and impose a lighter satisfaction;

b) accidentally, if restitution, satisfaction, or reconciliation is to be made, or scandal repaired, let the confessor smooth the way and at once indicate or apply efficacious means according to the manner in which we spoke above, n. V.

3. After confession: a) if there is certain danger of death, for knowing which he will be able, by himself or through another, secretly to ask the physician, let him exhort the sick person to dispose of his affairs opportunely, for the peace of the family and the relief of conscience; b) likewise to prepare himself for receiving Viaticum with great desire and Extreme Unction; c) secretly let him tell the household to ask the sick person whether he does not desire another confessor, and add that this will not be displeasing to him.

C. When agony is imminent. 1. "When the disease grows heavier," says the Ritual, "a) the parish priest, likewise the confessor, will visit the sick person more frequently, and will not cease diligently to help him toward salvation; and, when danger is imminent, he will admonish him that he be called immediately, so that he may be present in time for the dying person." By these words the obligation of helping those in agony more diligently is proclaimed; the gravity of this obligation depends on the different condition of the dying person. For if he has lived as a Christian and is surrounded by pious persons, the presence of the priest will be most useful, but by no means necessary; but if he has led a vicious life and remains subject to grave temptations, much more if up to this point he has not received the last sacraments, the parish priest, or even the confessor, is held under grave obligation to attempt all things for procuring his salvation, or procuring it more certainly. He will accomplish this last by helping with prayers, exhortations, and especially by repeated absolution, after confession has been at least very briefly renewed, or even by Holy Communion.

b) But if he is legitimately impeded, let him commit the office to another priest, and exhort pious persons from the neighborhood to visit the dying person and bring help for dying well.

c) Let him take care, as far as he can, that in the room of the sick person all things be ordered and clean, even among the poorer; and especially that profound silence be preserved there and that they speak only in a subdued voice, and only concerning those things which edify and refresh the sick person; nor should just anyone be admitted to conversation, but only those by whose company the sick person is relieved. Let this person be ordered to be wholly occupied in the business of the soul, and not to admit profane conversations; let too frequent visits of parents, children, wife, and especially the sight of those persons from whom temptation could arise, be kept away. Near the sick person let holy water be placed, and in his sight a Crucifix and image of the Blessed Virgin Mary.

2. When death approaches: a) let him timely admonish the sick person concerning the imminent danger of death, not importunately but cautiously, so that he announces it more obscurely at first, then openly, gently nevertheless, and at the same time suggesting pious affections;

b) by name let him inspire in the sick person, but with few words, and only at intervals, acts of faith, hope, charity, especially perfect contrition, conformity to the divine will and acceptance of death, and other brief ejaculatory prayers, according to the circumstances, e.g., "O my Jesus, mercy! Thy will be done!"

c) let him often offer the Crucifix and image of the Blessed Virgin Mary to be kissed;

d) let him take care that the sick person gain all the indulgences he can, especially the plenary indulgence in the article of death which the apostolic blessing has attached to itself;

e) hence let him admonish him to invoke the names of Jesus and Mary once or more often, by mouth if he can, otherwise in heart;

f) let him frequently sprinkle him with holy water, especially if he is vexed by diabolical temptations; frequently also let him fortify him with the sign of the cross and bless him.

3. When the time of expiration is now imminent, let the priest, or in his absence a pious person, with knees bent recite the prayers of the dying and the commendation of the soul, "Go forth...," admonishing those assisting to pray at the same time for the dying person; let him hand the dying person a blessed candle that he may hold it, to signify that he dies in the holy faith. He himself or another will suggest to the one in agony, and often repeat aloud to his ears, brief aspirations: "Into Thy hands, O Lord, I commend my spirit" - "Holy Mary, my mother, help me in the hour of death" - "Jesus, Mary, Joseph..." - etc.

4. After death. - Let the priest beware lest he say prematurely that the sick person is dead. Yet, as soon as there is now moral certainty concerning death, let him exhort those standing around to pray with him for the departed, e.g., "Come to his assistance...," or a decade of the rosary, or the Litany of the Blessed Virgin Mary. Then let him sprinkle the dead person with holy water; afterward let him console the relatives, speaking confidently and from the heart concerning the great mercy of God and eternal happiness; and to those standing around, according to opportunity and circumstances, let him inculcate that prayers will profit the departed more than tears; let him call back to their memory the brevity of life, the vanity of the world, the happiness of those who die well, and on this occasion excite them to a truly Christian life. All these things in very few words, but from the heart.

VIII. As regards the temptations of the dying, since they are accustomed to be attacked by various temptations, the confessor must fortify them against these. And indeed:

1. He must remove impediments to salvation; hence a) let bad companions and proximate occasions of sinning be removed, such as dangerous images or persons complicit in sin; on the contrary, let pious images of the Crucified and the Blessed Virgin Mary be hung before the sick, by which they may be helped in pious thoughts concerning God and eternal life;

b) if love of life presents an impediment, let there be proposed the great merit of death accepted for God's sake, the great misery and calamity of the present life together with the joy of the future life, and the counsel of divine goodness which cuts off life for us when this conduces most to our salvation;

c) if the obstacle comes from love of relatives, let it be said that God will receive into the guardianship of His paternal providence the spouse, children, family, and all affairs of him who subjects his own will to the divine will and from it freely accepts death;

d) if care of temporal things renders him anxious, the sick person is to be exhorted not only to dispose of all things in good time, but also, if he is endowed with goods of fortune, to provide for his own soul and take care that Masses be celebrated and alms be given, yet without the priest exciting any suspicion of cupidity or stirring up the hatred of the family against himself.

2. The confessor must guard against temptations: if the sick person experiences temptations

a) against faith, let him not discuss these, but turn the mind elsewhere and frequently profess the faith with simple affection, repeating: I believe whatever God has revealed, whatever the Church teaches. I believe, O Lord, but help my unbelief;

b) if against hope, let him recall to mind words or examples of Scripture which show that God is ready to pardon; that He does not will the death of the sinner but that he be converted and live; that He sent His Son Christ, who said: "I came not to call the just but sinners"; that He at once pardoned the publican saying, Be merciful to me a sinner; that He promised paradise to the thief hanging on the cross, etc.;

c) if against charity toward the neighbor, so that he has hatred for a determined person, let him think again upon the words of the Lord's prayer, by which he may know that he who does not forgive cannot hope for pardon from God; - that he himself has inflicted greater injuries on God; - and that Christ hanging on the cross prayed for those crucifying Him, and for us, while we were enemies, gave His life;

d) if against patience, let these three things be inculcated: it is necessary to suffer, both because we are men, whose common lot is that pains cannot be avoided, and because we are Christians, to whom it is fitting to bear the cross just as Christ, who was innocent, suffered most bitter pains in soul and in body for us sinners; - it is just to suffer, because as sinners we have risen up against God, whom it is fitting to compel to be subjected again by adversities, and because by sinning we have merited to suffer more than the pains of this life; - it is most useful to suffer; for if pains are borne impatiently, they are increased and remain fruitless; but if patiently, for God's sake: they purge the affection while they draw it away from earthly and illicit things and lift it up to heavenly things; - they blot out sins by offering an obvious and opportune reparation, kinder than the punishment of Purgatory; - they merit glory by a new merit, for "the momentary and light tribulation of ours works in us an eternal weight of glory," II Cor. IV, 17. Therefore it is glorious to God to have sons who gladly accept from His hand whatever things He sends, and to us it will be glorious in eternity; but to bear impatiently adversities sent by God Himself is harmful to the soul, dangerous, and most unbecoming.

3. The confessor must minister every assistance; first

a) the sacraments; wherefore it will be opportune that, after a renewed petition for pardon and contrition, he impart absolution anew several times and invite him again to Holy Communion; but if it should happen that the sick person falls into mortal sin, let him instill confidence in him, suggest contrition, and absolve him at once;

b) let him propose brief ejaculatory prayers and pious affections toward God to be repeated rather often, and remove earthly matters, having no conversation about children, wife, goods;

c) let him suggest acts of the virtues in few words: of faith, hope, charity, contrition, desire of eternal life, conformity to the will of God, forgiveness, acceptance of death: "this is necessary; we are not greater than Christ and the Blessed Virgin; it procures happiness and frees us from the valley of tears!" etc., without bringing annoyance by longer exhortations;

d) let him offer images of the Crucified or of the Blessed Virgin to be kissed, and suggest that the most holy names of Jesus and Mary be invoked by mouth or at least by heart;

e) let him impose the scapular and procure a blessed rosary, and take care that the sick person gain indulgences according to his strength, especially the plenary indulgence in the article of death.