Article — Prümmer, Manuale Theologiae Moralis
Article III. On The Effects Of Extreme Unction
The Council of Trent44 enumerates the effects of Extreme Unction in this manner: "Moreover, the thing and effect of this sacrament are explained by those words: And the prayer of faith shall save the sick man, and the Lord shall raise him up; and if he be in sins, they shall be forgiven him. For this thing is the grace of the Holy Spirit, whose anointing wipes away offenses, if any still remain to be expiated, and the remnants of sin, and relieves and strengthens the soul of the sick person by arousing in him great confidence in the divine mercy, by which the sick person, sustained, bears the inconveniences and labors of sickness more lightly; and he more easily resists the temptations of the devil lying in wait for his heel; and he sometimes obtains health of body, when this is expedient for the salvation of the soul." From these words it is lawful to deduce the following conclusions:
576. Proposition 1. The primary effect of Extreme Unction is not the remission of sins (whether mortal or venial), but an increase of habitual grace, which of itself destroys the remnants of sin and, consequently, sins themselves.
Concerning this matter the Roman Catechism45 teaches: "For this sacrament was not instituted in the first place for the remission of graver crimes, but Baptism alone and Penance effect this by their own power." Therefore Extreme Unction is truly a sacrament of the living and not of the dead. Hence one receiving Extreme Unction must already be in the state of sanctifying grace, which is ordinarily to be obtained by a sinner through the sacrament of Penance; but in a case of necessity it suffices that, before receiving Extreme Unction, he elicit an act of contrition at least putatively perfect (although in reality it is imperfect). Although, according to the common opinion of theologians, the other sacraments of the living also produce first grace in a case of necessity after contrition (at least imperfect) has been elicited, nevertheless Extreme Unction produces this much more certainly, because: a) St. James says of it: "And if he be in sins, they shall be forgiven him"; b) in the form of this sacrament there is: "May the Lord forgive you whatever you have sinned"; c) the Council of Trent46 defines: "If anyone says that the sacred anointing of the sick does not confer grace or remit sins, ... let him be anathema." Therefore Extreme Unction produces first grace not only accidentally, as do Confirmation and the Eucharist, but was directly instituted by Christ that it might proximately dispose the soul for entrance into heaven and consequently remit all sins perhaps standing in the way. Therefore Extreme Unction is primarily indeed a sacrament of the living, but consequently (and indeed from its specific nature) a sacrament of the dead.
45 Loc. cit., q. 14.
577. Note. Although Extreme Unction remits mortal sins for a man who is in the impossibility of confessing, nevertheless, when this impossibility ceases, there arises the obligation of integrally confessing the sins thus remitted.
For dying persons deprived of their senses, Extreme Unction is a most precious sacrament. For although it is piously believed that sacramental absolution can also be validly given to them if they are at least attrite, nevertheless this is not altogether certain. For contrition and confession are the proximate matter of the sacrament of Penance, as was said above under n. 326. But the proximate matter, as an essential part of the sensible sign of the sacraments, must be manifested externally. It is difficult, however, to understand how a dying person deprived of his senses can externally manifest contrition and confession, and consequently the absolution granted to him is not altogether certainly efficacious. On the contrary, Extreme Unction, when conferred, is certainly efficacious provided that the sick person is at least inwardly truly attrite. Since these things are so, the pastor and the others standing by should strive altogether that the sacrament of Extreme Unction be conferred upon a dying person deprived of his senses.
578. Proposition 2. The sacramental grace of Extreme Unction produces: a) strength of soul; b) the wiping away of venial sin and of the remnants of sin; c) sometimes bodily health.
a) Strength of soul is an effect of Extreme Unction.
For St. James says: "And the Lord shall raise him up." The weakness of the soul, however, is produced especially from a threefold cause, that is, from past, present, and future evils: 1. from distrust concerning the sins of one's past life; for the sinner knows certainly that he has sinned often and gravely, but he does not know with equal certainty that God has forgiven all those sins; 2. from pusillanimity on account of present hardships, which indeed arise both from bodily illness, which weighs down the soul, and from diabolical assaults, which especially attack a man now about to die; 3. from trepidation because of one's uncertain lot in eternity. Against all these weaknesses Extreme Unction confers the most powerful strength.
b) The wiping away of venial sin and of the remnants of sin is the second effect.
Since Extreme Unction is the immediate preparation for heaven, it must remove all those things which obstruct entrance into heaven. These indeed are sins not yet destroyed and the punishments of sins not yet discharged. Therefore Extreme Unction ex opere operato destroys sins and the remnants of sins, if the man is rightly disposed, that is, if he sincerely grieves over all and each of his sins, even the least. But since such a disposition is not always present, Extreme Unction sometimes cannot wipe away all sins and all their remnants.
c) Bodily health is sometimes produced by this sacrament, if this is expedient for the salvation of the soul.47
This indeed follows from the words of St. James: "The prayer of faith shall save the sick man." Certainly this effect is not produced suddenly, nor even if the powers of the body are already altogether exhausted. Hence, also for the sake of recovering bodily health, it is to be counseled that Extreme Unction be conferred upon the sick person as soon as possible and not be deferred until the very end of life.
47 Thus the Council of Trent, loc. cit. The Scholastics instituted subtle indeed, but practically useless, disputations concerning the precise conditions under which the sick obtain bodily health through Extreme Unction. See Kern, De extr. unct., l. 3, c. 2.
579. Scholion. On the moment at which Extreme Unction produces its effects. Theologians go into diverse opinions in disputing about the moment at which Extreme Unction produces its effects. For there are several successive anointings. Concerning this question (which is purely speculative, since after the decision of the Holy Office cited above it is certain that in a case of necessity one anointing and one form suffice), St. Thomas48 writes: "When there are many actions ordered to the same effect, the last is formal with respect to all the preceding actions and acts in their power; and therefore in the last action grace is infused, which affords the effect to the sacrament."