Who may receive Extreme Unction

IN order to be able to receive Extreme Unction validly a man must be baptized, must have attained the use of reason, and must be in probable danger of death from sickness. Extreme Unction, then, may be administered to those adults who are in danger of death from disease, from the pains of childbirth, from a wound, from poison, and from old age, even though they be no longer in their right senses. It cannot be validly given to soldiers before going into battle, to criminals who are going to be executed, to imbeciles who have never had the use of reason, to children who have not yet come to the use of reason, nor to unbaptized persons.¹

¹ Ritual.

I. In order that someone be capable of receiving Extreme Unction, it is required: 1. that he be baptized; 2. that he be or have been in possession of reason; 3. that his health be gravely afflicted, and indeed at least to that degree from which death not rarely follows within a time not very long; but such a degree also suffices, at least for validity. It is said:

1. That he be baptized (cf. n. 38).

2. That he be or have been in possession of reason; hence canon 940, § 1 indeed states that Extreme Unction cannot be given except after the use of reason has been attained, but does not add that actual or habitual use of reason is required.¹ The reason seems to be that the gravely sick person who neither has nor has had the use of reason is, and was, and will be, at least in himself, incapable of actual strengthening, to which the sacramental grace of Extreme Unction gives a right (St. Alphonsus, VI, 718). I said "and will be incapable," as a perpetually insane person. I said "and will be, at least in himself, incapable," as a gravely sick infant, who in himself will either recover or die before the use of reason, while accidentally it will happen that he is going to prolong the grave illness until he will attain the use of reason, and thus will be capable of spiritual strengthening. Therefore little children and the perpetually insane cannot be anointed. But adults who have lucid intervals, or who at least were not perpetually insane, are capable; likewise those who are delirious;² likewise children as soon as they have reached the use of reason (St. Alphonsus, VI, 720).

In doubt whether the sick person has attained the use of reason - understand: whether he either enjoys the use of reason or at some time enjoyed its use - the sacrament should be ministered conditionally (canon 941), for example: "if you are capable."

Question. Is one who has never sinned personally capable of Extreme Unction?

Response. It seems that it must be affirmed, because he is capable of the primary effect of the sacrament, that is, strengthening of soul. That it is not required that someone have sinned after Baptism follows from the fact that the Holy Office³ and the Sacred Congregation of Propaganda Fide⁴ responded that a pagan who becomes gravely sick immediately after receiving Baptism is to be anointed.

It is disputed whether the Blessed Virgin Mary was capable of Extreme Unction. It seems that it must be denied, because Extreme Unction strengthens by way of spiritual medication. Hence the Council of Florence, as we have already noted, teaches: "The effect of this Sacrament is the healing of the mind." But the Blessed Virgin Mary was incapable of strengthening of this kind.

3. That health be gravely afflicted, and indeed at least to that degree from which death not rarely follows within a time not very long; but such a degree also suffices, at least for validity. I said:

a) That health be gravely afflicted, whether from disease taken in the stricter sense, or from a similar cause, for example from a wound, from difficult childbirth, from poison swallowed, or from old age. That this is required is proved first by the words cited above of St. James, who advises the sick person to summon the priests, who will save him and comfort his depressed spirit; these things you would scarcely apply to one suffering from a slight illness. Then Benedict XIV in the Bull Ex quo primum, § 46, teaches that Extreme Unction is to be ministered "only to faithful persons gravely sick." Then the Council of Trent teaches that this sacrament was instituted by Christ so that He might "fortify the end of life as by a certain strongest protection" (p. 437). Finally, the whole rite of Extreme Unction does this one thing, that it commends to the divine mercy the sick person constituted in danger of death⁵ (St. Thomas, Supplement, q. 32, a. 2; St. Alphonsus, VI, 713, dub. 2).

b) That health be afflicted at least to that degree from which death not rarely follows within a time not very long, or at least to that degree that death not very remote must be feared. This is deduced from the fact that several ecclesiastical documents expressly state that Extreme Unction is not to be conferred except on those who are in danger of death or whose death is feared. Thus, for example, canon 940, § 1: "Extreme Unction cannot be given except to a faithful person who, after attaining the use of reason, is in danger of death by reason of infirmity or old age." Likewise the decree of Eugene IV in the Instruction to the Armenians: "This sacrament must not be given except to a sick person whose death is feared." But these things in their obvious sense signify the state described by us (St. Thomas, loc. cit.; St. Alphonsus, loc. cit.).

c) Such a degree also suffices, at least for validity. This is drawn from the fact that the Sacred Congregation of Propaganda Fide responded⁶ "Affirmatively" to the question: "Sometimes Missionaries encounter someone suffering from hectic fever, that is, a kind of consumption, or from another illness, who, experience being the guide, is going to live for several more months, but will die within the year: it is asked whether in such a case the Missionary can minister Viaticum and Extreme Unction to him, because when the time of receiving them is actually at hand, the Missionary will not be able to be present in the same place, either because of great distance or because of another impediment." I said at least for validity, because from the response cited it does not follow that, in itself or in ordinary circumstances, the sacrament is licitly conferred in a case in which death is judged to be fairly distant; therefore further observe: as soon as the state just described is present, the sacrament is indeed conferred validly; but with respect to liceity, take the following:

a) If death is judged to be fairly far away, as in the case just set forth and resolved by the Sacred Congregation of Propaganda Fide, one may doubt whether the sacrament is already in itself licitly conferred.

b) If death is indeed judged to be more at hand, but not yet imminent, the sacrament is licitly conferred, although its conferral can be deferred.

c) If death seems imminent, Extreme Unction must be conferred;⁷ nor is it permitted to wait until the sick person begins to lack the full use of reason. "The reason," says St. Alphonsus, "is that thus he is deprived of the richer fruit which he would have received if he had received the sacrament while he was in possession of reason, since then he would have disposed himself more for it. Likewise because he is deprived of spiritual strength for resisting the devil and for bearing the inconveniences of illness. Likewise because, if the sick person perhaps were in mortal sin and had received the sacrament while in possession of reason, by the help of attrition he perhaps would have obtained grace, of which otherwise he is deprived. Finally, because by virtue of this sacrament he perhaps would have obtained health of body, if it had been conferred at a suitable time; for although this sacrament by a certain supernatural power also works bodily health if it is expedient for the salvation of the soul, as Trent says, nevertheless it does not work by way of miracle, but in a certain ordinary way, namely by helping natural causes, as the Doctors commonly say. All these things at least when taken together seem to bring grave harm to the sick person" (VI, 714). Hence canon 944: "With every zeal and diligence care must be taken that the sick receive it while they are fully in possession of themselves." And the Roman Catechism says: "They sin most gravely who are accustomed to observe that time for anointing the sick person when, all hope of recovery now having been lost, he begins to lack life and senses."⁸

¹ Cf. Roman Ritual, title V, cap. 1, n. 8.

² Cf. Roman Ritual, loc. cit., n. 11.

³ May 10, 1703 (Collectio, n. 256, ad 8).

⁴ September 26, 1821 (Collectio, n. 768).

⁵ Kern, op. cit., p. 294.

⁶ February 20, 1801 (Collectio, n. 651).

⁷ Cf. Council of Trent, session 14, De extrema unctione, Prooemium and cap. 3; Roman Ritual, title V, cap. 1, n. 5.

⁸ Part 2, cap. 6, n. 9.

Corollary I. Extreme Unction cannot be conferred on those whose death is imminent from a merely external cause, for example "on those about to enter battle, or about to undertake navigation, or a journey, or other dangers, or on criminals soon to be punished with the final penalty."¹ Nor can it be ministered when the danger of death is not yet present but will arise shortly, for example from the dangerous surgical operation itself about to be undergone, or from the difficult childbirth itself about to follow; otherwise, if someone is already actually in danger.

Corollary II. A woman in childbirth who "labors in childbirth with only common pains will indeed not be able to be anointed, even if she gives birth for the first time, or at another time had been in danger of death; because then she is not yet laboring under a dangerous infirmity" ... "But otherwise, if the woman has already begun to be distressed by very grave torments, so that she is already actually in proximate danger of death; because then she is truly already dangerously sick" (St. Alphonsus, VI, 713, dub. 3). The old cannot be anointed because of advanced age alone; otherwise if there is added such weakness of the vegetative functions that health must be called gravely afflicted. Hence canon 940, § 1 speaks of old age by reason of which someone is in danger of death. And the Roman Ritual states: "Extreme Unction is to be ministered to those who fail because of old age and seem day by day about to die, even without another infirmity."²

Those about to undergo a dangerous operation, but not yet constituted in danger of death, cannot be anointed before the operation; nor can the same be anointed as soon as they have been deprived of the senses by chloroform, unless the state of the sick person induced by the chloroform is regarded as gravely dangerous. If the disease is lethal, and physicians can avert the danger of death by the operation to follow, the sick person can be anointed if he does not wish to undergo the operation; if he wishes to suffer it, the matter seems doubtful.

But if it is rightly feared that someone, for example a person condemned to death, is going to die from fear, he is certainly validly anointed if fear has so afflicted his health that, even if the fear vanished, nevertheless grave danger would persist. Otherwise he seems able to be anointed only doubtfully validly, because it is doubted whether fear can really be called a disease.

Corollary III. A merely estimated danger of death does not suffice; for the things by which we proved that danger of death is required, in their obvious sense, signify a truly existing danger and not merely an estimated one. I add these things: suppose that someone lying on the ground, according to bystanders, is in danger of death and is anointed by a priest. A physician arrives and declares that he is well, but completely drunk. Who would say that he had been validly anointed?

Corollary IV. When it is doubted whether the sick person is really in danger of death, or whether he is dead, this sacrament should be ministered conditionally (canon 941). As to the extent to which one apparently dead can be conditionally absolved and anointed, this has been set forth in the treatise on Penance, n. 477.

¹ Roman Ritual, title V, c. 1, n. 9.

² Title V, cap. 1, n. 5.

II. Once the requisites for the capacity of receiving Extreme Unction have been posited, it must be given, and indeed absolutely, not only to those who here and now ask for it, but also "to sick persons who, when they were in possession of their mind, asked for it at least implicitly or would probably have asked for it, even if afterwards they lost the senses or the use of reason" (canon 943).¹ But "this sacrament is not to be conferred on those who, impenitent, contumaciously persevere in manifest mortal sin; but if this is doubtful, it is to be conferred conditionally" (canon 942). It is said:

1. They asked for it at least implicitly; these words certainly comprehend those who had, and did not retract, an implicit will or intention in the stricter sense, for example the will of dying as a Christian (p. 33). With respect to implicit intention in the most general sense - for example the will of employing the means of salvation - the matter seems doubtful and not settled by the Code (p. 33).

2. Or would probably have asked for it; for one who, in possession of himself, would probably ask for Extreme Unction is presumed to have had, and not retracted, an explicit will or intention of receiving Extreme Unction, or at least an implicit intention in the stricter sense.

3. This sacrament is not to be conferred on those who contumaciously persevere in manifest mortal sin.

What if someone rejected the priest up to the deprivation of the senses?

Response 1. If he did not certainly reject him from an evil will, but perhaps because he was not sufficiently conscious of the danger, with also an indifferent spirit being added, Extreme Unction can be conferred.

Response 2. If he certainly rejected the priest from an evil will, considering the reverence due to the sacrament, it is better, as it seems, not to anoint him, unless the deprivation of the senses endures longer, or the dying person gives a sign which with some probability can be regarded as a declaration of a changed will.

4. But if this, that is, contumacy, is doubtful, it is to be conferred conditionally, namely, considering the more obvious sense, under the condition: "If you are now not contumaciously persevering in mortal sin." Nevertheless, it can seem to someone that this is the sense of the canon: "If you are doubtful about the contumacy, the sacrament is to be conferred conditionally," the determination of the condition being left undecided; this being posited, the canon does not prevent the condition "if you are capable," etc., from being added. Besides, it is certainly lawful to minister the sacrament "according to the mind of the Church."

¹ Roman Ritual, title V, cap. 1, n. 11.

With respect to both the valid and licit reception of Extreme Unction, we refer to those things which we noted in the treatise on the Sacraments in general. It is useful, however, to complete in a few words those things which regard licit reception. Now:

I. For licit reception the state of grace is required. For the reverence due to the sacrament requires a state which corresponds to the end to which it is primarily ordered. But Extreme Unction is primarily ordered to increasing grace. Therefore the state of grace must already be present. If, however, someone attrite and in good faith receives the sacrament, he recovers grace (n. 6).

II. The state of grace can be recovered, by one who is in mortal sin, by reason of Extreme Unction either through confession or through perfect contrition; but by reason of Communion, if this is placed before Extreme Unction, it must be recovered through confession (n. 43). But Communion - although at most only under light obligation - is to be placed before Extreme Unction, according to these words of the Roman Ritual: "From the general custom of the Church it is to be observed that, if time and the condition of the sick person permit, the Sacraments of Penance and Eucharist be given to the sick before Extreme Unction"¹ (St. Alphonsus, VI, 716).

Note 1. If the one to be anointed is excommunicated, he should be freed from excommunication before he is absolved from sins and given holy Communion and Extreme Unction.

Note 2. If the sick person suffers from frenzy or insanity, care must be taken that he do nothing against the reverence of the sacrament, for example, if necessary, by binding or firmly holding the sick person (St. Alphonsus, VI, 732).

¹ Title V, cap. 1, n. 2.

"When some adult Pagan sufficiently instructed and duly disposed is baptized, because he has fallen into grave illness, ought, indeed can, the sacrament of Extreme Unction be conferred upon him immediately after Baptism? Resp. Affirmatively, with the form of the Decree of the Holy Office of the year 1803 observed." S. C. de P. F. 26 Sept. 1821.

"Whether Extreme Unction is to be conferred on dying adults whom we sometimes believe capable of Baptism, but not of the other Sacraments? Resp. The sacrament of Extreme Unction is not to be conferred on a dying neophyte whom the Missionary believed capable of Baptism, unless at least the same person has some intention of receiving Sacred Unction ordered for the benefit of the soul for the time of death." Holy Office, 1803; 10 Apr. 1861. Cf. On Confirmation, N. 271.

Who is the subject of extreme unction? - The subject of Extreme Unction is a baptized man who has reached the use of reason and is sick in probable danger of death, from disease, difficult childbirth, a received wound, poison, or old age, although he has not yet communicated, although he is mute, deaf, or blind from birth; although he is insane, if he has lucid intervals; although he is delirious or deprived of the senses, if beforehand he asked for the sacrament or would have asked for it if he had thought of this, and all irreverence toward the sacrament is absent. - Therefore it is invalidly given to healthy persons about to enter battle, to those condemned to capital punishment, to children not yet having attained the use of reason, or to those like children, namely idiots and the insane from birth, and to the sick outside the aforesaid danger. - But it is to be given only once in the same infirmity and danger; if the infirmity is long-lasting and the danger has at least probably passed, when a new danger is imminent it can be given again; and it must be given if the new danger is certain. - Trent, sess. 14, Doctrine on the Sacrament of Extreme Unction, C. 3; Decree for the Armenians; Roman Ritual, de Sacr. E. U.; Benedict XIV, Constitution Ex quo primum, de Syn., l. 8, c. 5-8; Suarez, d. 4, s. 2; L. 713-721, 732; St. Thomas, 4, d. 23, q. 2, a. 4, q. 2; Suppl., q. 32, q. 33; Roman Catechism, n. 9, 11; E. M.

Is there a grave obligation of receiving extreme unction? - No precept is present concerning this matter. Therefore, with contempt, scandal, and danger of combat with the devil removed, one who does not receive it does not sin gravely. L. 733; St. Thomas, III, q. 65, a. 4. But the proper pastor is nevertheless bound from office to minister it, and consequently sins gravely, unless some grave cause excuses him, by not conferring it on those asking, or by deferring it until the sick person, with health despaired of, is deprived of the senses. For thus the sick person lacks the richer fruit which he would have perceived, is deprived of spiritual strength for resisting the devil and for enduring the inconveniences of sickness; if he were in mortal sin, by conceiving attrition he would have obtained grace; and if it had been given at a suitable time, he could also have obtained bodily health. - It is given by custom after Viaticum, but it can be given before it. S. R. C., March 8, 1879, n. 3486. - Roman Ritual, de Sacr. E. U.; Roman Catechism 9; La-Croix 2120; L. 714, 716, 728, 729.

“When an adult pagan, sufficiently instructed and rightly disposed, is baptized because he has fallen into a grave illness, must—indeed, can—the Sacrament of Extreme Unction be conferred upon him immediately after Baptism?—Response. Affirmative, with the form of the decree of the Holy Office of the year 1703 being observed.” Sacred Congregation for the Propagation of the Faith, 26 September 1821.

“Is Extreme Unction to be conferred upon dying adults whom we sometimes believe capable of Baptism, but not of the other sacraments?—Response. The Sacrament of Extreme Unction is not to be conferred upon a dying neophyte whom the missionary has judged capable of Baptism, unless he at least has some intention of receiving the sacred anointing ordained for the benefit of the soul at the time of death.” Holy Office, 1703 and 10 April 1861. Cf. no. 271; Canon 1158.

689. • The subjects of this Sacrament are all and only sinners who are sick and in danger of death. This is established: first, from the words of St. James: Is any man sick among you? Let him bring in the Priests of the Church, etc.; but the Greek word is sick signifies a dangerous illness. Second, from the definition of the Church. For thus in the Decree of Union: This Sacrament ought not to be given except to a sick person concerning whose death there is fear. The Council of Trent, session 14, chapter 3, agrees.

Hence children before the use of reason and the perpetually insane are not capable of this Sacrament, because they have committed no actual sins.

690. Questions. - QUESTION 1. Must Extreme Unction be conferred upon delirious sick persons?

Reply. Yes, if they previously asked for the Sacrament, or would have asked for it if they had thought of this, or showed a sign of sorrow for sins. Indeed, also upon sick persons deprived of the senses, as is established from the Roman Ritual. - Recall what was said concerning the Sacraments in general, no. 230.

QUESTION 2. Can this Sacrament licitly be conferred upon a sick person in doubtful, or probable, danger of death?

Reply. Yes, with the common and true opinion, because for administering this Sacrament validly and licitly, it suffices that the sick person labor under a disease so grave that he is prudently judged to be in danger of death. This is confirmed from the Roman Ritual, where it is thus established: This Sacrament must be furnished to the sick who labor so gravely that the danger of death appears imminent. - St. Ligorius, no. 714, etc.

QUESTION 3. Can Extreme Unction be conferred upon children?

Reply. Yes, provided they are possessed of reason and are judged capable of malice and fault. Thus Benedict XIV (On the Synod, book 8, chapter 6), who sharply condemns certain synodal Constitutions by which a determinate age was fixed before which children could not be anointed.

691. • QUESTION 4. Can this Sacrament be repeated, or when can it be repeated?

Reply 1. It can certainly be repeated whenever a sick person anointed in a dangerous illness recovers and again falls into a dangerous disease. This is established from the Council of Trent, session 14, On Extreme Unction, chapter 3, where it is said: But if the sick, after receiving this anointing, recover, they can again be assisted by the aid of this Sacrament when they fall into another similar danger of life.

Reply 2. It can also be repeated in the same illness if it has been prolonged and the sick person has notably recovered, so that he appeared to have been rescued from the danger of death, and falls into the same danger again. The reason is that then there is truly a new danger of death. This is established from the Roman Ritual, where it is said: In the same illness this Sacrament ought not to be repeated unless it is prolonged, as when the sick person, after having recovered, falls again into danger of death.

QUESTION 5. Can it be repeated in the same prolonged disease if it is doubted whether the state of the disease has truly changed?

Reply. More probably, yes, if the doubt is truly positive, namely, when it is truly probable that the sick person has passed out of the danger of death; for this repetition in these cases is more conformable to the ancient custom of the Church. - St. Ligorius, no. 715.

692. • QUESTION 6. Is there a grave obligation to receive this Sacrament?

Reply. There is a twofold probable opinion.

The first OPINION affirms it. First, it is evident (they say) from the words of the Apostle James himself: Is any man sick among you? Let him bring in the Priests of the Church, etc. But the word let him bring in contains a precept. Therefore, etc. Second, there is added the practice of the Church, which has always taken the greatest care that it be received by all the sick. It also appears to be established from the custom and sense of the faithful. Third, in addition, it is grave and contrary to the charity which each owes to himself to omit a means so efficacious and a most firm protection, as the Council of Trent says, against the attempts of the demon in the final agony. - Thus Roncaglia with others.

The second OPINION denies it. The reason is that neither from Tradition nor from the Decrees of Councils is a precept of receiving this Sacrament established. But what St. James says, let him bring in the Priests..., is understood and explained as counsel. Therefore, a grave obligation of receiving Extreme Unction cannot be imposed. - Thus Billuart, article 7, after St. Thomas, part 5, question 65, article 4; Sporer, no. 106, etc.; and St. Ligorius, no. 733, where he calls this opinion common, although he thinks the first altogether to be recommended, chiefly by reason of the charity which each owes to himself: For in so great a danger, he says, he appears to expose himself to succumbing to temptations who neglects to fortify himself with this Sacrament instituted by Christ the Lord as a most firm protection in so great a conflict.

693. • QUESTION 7. What disposition is required for the reception of this Sacrament?

Reply 1. Confession of sins, if the sick person is in mortal sin; for this Sacrament is the complement of Penance, and therefore Penance must precede it. - Billuart, article 7, at the end.

Reply 2. But if the sick person cannot confess his sins, it is necessary that at least contrition precede; for this Sacrament of Extreme Unction is primarily a Sacrament of the living and was instituted chiefly for removing the remnants of sins. - Billuart, ibid. But in such a case attrition itself seems able to suffice; for it is at the same time a Sacrament of the dead and can remit mortal sins with attrition. - The Salmanticenses, no. 13, and others.

— "Extreme Unction cannot be given except to a faithful person who, after having obtained the use of reason, by reason of infirmity or old age is in danger of death" (c. 940, §1).

Therefore there is required a baptized subject, possessed of the use of reason, in danger of death not because of an extrinsic cause of battle or capital sentence, but because of a cause intrinsic to the body from illness or old age. Moreover a wound and childbirth are assimilated to illness.

The Greek word of the epistle of St. James, asthenei, designates a serious illness, by which someone is broken in strength. From the decree of Eugene IV for the Armenians, it can be given "to him concerning whose death there is fear." The Council of Trent, sess. XIV, c. 3, says only that it is especially to be conferred on those who are placed at the end of life. From the Ritual, it is to be given to those who "labor so gravely that danger of death seems imminent, and to those who fail by reason of old age and seem about to die day by day." Therefore they admit that a probable indication, or positive doubt concerning death to follow from this infirmity, suffices. And nothing compels us, as it were, to obtain the license of a physician.

If the danger itself is doubtful, as if it is doubted whether the sick person has attained the use of reason or whether he is dead, this sacrament is to be administered under condition.

— Corollaries. Therefore, from Fr. Kern, a) it is not even validly conferred in an illness which neither greatly afflicts a man nor is actually dangerous;

b) it is validly and licitly conferred in an illness which, although it lightly afflicts the sick person, is nevertheless joined with danger of imminent death; in a grave illness and one dangerous by its nature, although objectively there is no risk of life; in an illness which by its nature is dangerous and which at the same time gravely afflicts the sick person, although subjectively it does not yet seem to bring with it risk of life.

If the sick person is gravely afflicted by an illness whose nature is not yet established, he will be able to be anointed at least conditionally.

In an illness which brings a certain danger of death, but only remote danger, so that death is not indicated as to follow before several months, Extreme Unction is validly conferred. Liceity will depend on the adjuncts: on the opportunity which the sick person will have, or will not have, of receiving the sacrament, on the state of the illness, hope of fruit, etc.

On account of opinions not so long ago put forth concerning apparent death, the sacrament can be conferred conditionally, at least when an expert man is absent who can render us more certain concerning perfect death, within a half-hour from the moment at which, according to common judgment, death has followed; indeed within an hour, if someone has been affected by sudden death. Indeed R. P. Ferreres thinks that absolution and Extreme Unction can be conferred at least for a half-hour after an expert physician, after every inspection has been made, has declared the person dead.

At least illicit would be an administration made to a sick person consenting to a safe use of the knife, or operation, by which every danger from the illness which he now has will be removed.

Those who are about to suffer the hands of a surgeon generally are already actually subject to an internal danger of death, so that even before the use of the knife they can be anointed. Yet if someone bodily healthy is about to undergo a dangerous use of the knife, for example for correcting a deformity, he cannot be anointed before the very use of the knife has induced a danger from an internal reason.

— To those who, impenitent in manifest mortal sin, contumaciously persevere, Extreme Unction is not to be conferred; but if this is doubtful, let it be conferred under condition (c. 942).

Observe that the contumacy of one who is destitute of the senses is no longer established. In what way there is introduced here a condition which is not necessary for validity was explained above, n. 184. What if he who with doubtful disposition was anointed under condition afterward arrives at a better disposition? Let the sacrament be given again under the condition "if you have not yet been anointed," rather than under the condition "if you are capable." For, as will be said immediately, repeated administration is rather to be judged valid; and since repeated administration is forbidden, the condition "if you are capable," which does not exclude repetition, would not impede illicit administration.

— The sacrament is to be conferred absolutely on sick persons who, when they were in possession of their mind, asked for it at least implicitly, or likely would have asked for it, even if afterward they have lost sense or the use of reason (c. 943).

— "It is lawful for no one to neglect this sacrament; and with every care and diligence it must be seen to that the sick receive it while they are fully in possession of themselves" (c. 944).

Yet a grave obligation of receiving this sacrament is not judged to be present of itself. Thus the probable opinion. Yet it would be grave to contemn this sacrament, or to neglect it with scandal of contempt of this kind.

Moreover the abuse of delaying the sacrament until instant death, or until health is certainly despaired of, meanwhile deprives the sick person a) of the spiritual helps of this sacrament; b) of the effect of recovering health.

Counsel. - One who has weighed the marvelous effects of this sacrament, how would he not desire for himself, even several times in life, that spiritual renewal which the holy oil works? Therefore we judge it most to be commended that it not be reserved for desperate sick persons alone, nor be for many a dreaded omen of certain death, but that it become the common sacrament of all who are afflicted by an illness dangerous by its nature. Our Most Holy Lord Pius XI calls it "a deadly error," by which it happens that, with detriment to the soul, the sick are not anointed with holy oil before, death being imminent, they have almost or altogether lost the senses. One who, when a probable indication of danger is present, "takes care that it be administered, not only follows the doctrine of Mother Church, but piously and salutarily fulfills her desires." Brief Explorata res, February 2, 1923, concerning the sodality of Our Lady of a good death (Tinchebray).

— So that he may receive this sacrament with fruit, the sick person who is conscious of mortal sin must either confess before he is anointed, or be contrite if he can. Therefore judged contrition suffices; indeed a later attempt of contrition suffices, if opportunity for confession is not had, provided attrition is had.

— "In the same infirmity this sacrament cannot be repeated, unless the sick person, after receiving the anointing, has recovered, and has fallen into another risk of life" (c. 940).

Therefore the sacrament is licitly repeated in a twofold case: a) in a different illness; b) in the same illness but in a new danger of death, as if the sick person has imperfectly recovered and then again is brought into risk.

Formerly it was conferred on several successive days, so that the forbidden repetition is to be referred to more recent discipline, unless nevertheless those successive anointings can be held as one integral administration. Therefore repetition of this sacrament in the same danger, although gravely prohibited, nevertheless does not seem invalid.

— I. The subject of Extreme Unction is a baptized man, possessed of the use of reason, who, because of a cause intrinsic to the body, from illness, to which a wound or childbirth is assimilated, or from old age, is in danger of death.

In doubt concerning the danger, concerning life, concerning the use of reason, let it be administered conditionally. To him who perseveres in manifest impenitence, which a man destitute of the senses is not, Extreme Unction is not to be conferred. If this is doubtful, let it be conferred under condition. The sacrament is conferred absolutely on sick persons who, while possessed of sense, would have asked for it.

It must be seen to that the sick receive it while they are fully in possession of themselves.

A grave obligation of receiving it is not proved.

It cannot be repeated in the same infirmity. Yet if the sick person has sufficiently recovered and has fallen into a new risk of life, it can be administered anew.

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.

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.

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

1881. Principles. I. The SUBJECT of Extreme Unction is only a baptized man, who has attained the use of reason and is in danger of life from disease. - It is clear: 1. from the words of St. James: Is any one of you sick?, etc.; 2. from Trent (sess. 14, cap. 3), where it is declared: "This anointing is to be applied to the sick, but especially to those who lie so dangerously ill that they seem to be placed at the exit of life."

Hence, for the VALID reception of this Sacrament the following things are required:

It is required, 1. that the one to be anointed BE BAPTIZED; for Baptism is the gate of the Sacraments. But this Sacrament can be conferred on an adult immediately after Baptism. "The reason is both because, more truly, through Baptism the remnants of mortal faults committed before Baptism are not wiped away, such as torpor toward good and proneness toward evil; and because the primary effect of this Sacrament is not so much the remission of faults as the strengthening of the sick person against the temptations of the devil, as Suarez and others commonly say."¹³

It is required, 2. that the one to be anointed HAS ATTAINED THE USE OF REASON. For otherwise the form would become vain: May the Lord forgive thee, etc. Hence it follows: 1) Children who have not yet attained the use of reason cannot be anointed. On the contrary, whatever Soto with others may say, children endowed with reason are to be anointed, although they cannot receive the Sacrament of the Eucharist and have not yet reached the age of seven, as Benedict XIV teaches.¹⁴ In doubt concerning the use of reason, let them not be deprived of so salutary a remedy, but let them be anointed under condition: If thou art capable.¹⁵ - 2) The perpetually insane cannot be anointed; otherwise, if they have had lucid intervals; or even if it is probable that they had them, in which case they ought to be anointed under condition. But the RITUAL admonishes: "If the sick person, while he labors under frenzy or insanity, likely could do anything against the reverence of the Sacrament, let him not be anointed, unless the danger is removed altogether," for instance, if he is held or even bound. - 3) The sick who are destitute of the senses ought to be anointed, and indeed without condition, if they have given a sign of a pious soul, or have lived as Christians, so that it can be presumed that they would have asked for the Sacrament if they had been masters of reason: or, as the Ritual speaks, if they likely would have asked. And the reason is that, in one receiving this Sacrament, an interpretative intention suffices (cf. n. 1434, 3).

It is required, 3. that the sick person BE SICK UNTO DEATH, "so that there is fear concerning his death," as the Council of Florence says in the Decree to the Armenians. - Hence, neither validly nor licitly can the healthy be anointed, even if they are in open danger of death, such as those in danger at sea, in battle, etc.; those to be punished by public death; women laboring only with common pains in childbirth, even if they give birth for the first time, or at other times have been in danger of life; otherwise, if most grave torments supervene, through which illness with danger of death is verified. But those can be anointed who are infected with lethal poison; likewise those laboring under some evil on account of which they are about to undergo a difficult operation of surgery; likewise decrepit old persons "who fail from old age (as the Ritual speaks) and seem to die day by day, even without another infirmity": for old age itself is a disease.¹⁶

To the following question: "Sometimes, when Missionaries are visiting Christians committed to themselves, there occurs a sick person laboring with hectic fever or a similar disease, who according to experience will live still several months, but within a year will die. - It is asked whether, in such a case, the Missionary can administer Viaticum and Extreme Unction to him, because when the truer case for receiving them will be present, a Missionary will not be able to be had present, on account of the great distance and other circumstances impeding this?" The S. C. DE PROPAG. FIDE responded on February 20, 1801: Affirmatively.¹⁷

1882. II. For the LICIT and FRUITFUL reception of Extreme Unction, certain dispositions of the subject are required besides. For it is primarily, and of itself, a Sacrament of the living (cf. n. 1395).

Hence, besides the intention, at least presumed, of receiving the Sacrament, which is also necessary for validity, there IS REQUIRED: 1. Confession of sins, if the sick person is in the state of mortal sin. - 2. Contrition, at least estimated, in the case in which he cannot confess; for he must be at least putatively in grace; but if he has only attrition, the Sacrament will not lack its effect (cf. n. 1395 and 1397, qu. 2). - 3. The Most Holy Eucharist, from the general custom of the Church (but at most under venial sin), must be premised, unless vomiting or another reasonable cause excuses.¹⁸ - The other dispositions, such as lively faith, firm hope, perfect conformity with the divine will, etc., effect that a richer fruit is perceived from the Sacrament (cf. n. 1437).

The RITUAL admonishes: "But to the impenitent, and those who die in manifest mortal sin, and the excommunicated... (the Sacrament) is to be denied." - Nevertheless, it is given both to the drunken now about to die, and to those wounded in a brawl now destitute of senses, and to any others whatever concerning whom it is doubted whether they are in the state of mortal sin or are sufficiently disposed. - Benedict XIV also says:¹⁹ "Concerning any faithful person, concerning whom the contrary is not established, it must be presumed that he would have asked for this Sacrament, if he could have."²⁰

1883. Questions. Q. 1. In what degree of infirmity CAN or OUGHT Extreme Unction be conferred?

Resp. 1. It CAN be conferred validly and licitly as soon as the sick person is prudently or probably judged to be in danger of death, although not yet proximate. It is proved from Trent (sess. 14, cap. 3, on Extreme Unction), where it is had: "This anointing is to be applied to the sick, but especially to those who lie so dangerously ill that they seem to be placed at the exit of life." That particle especially sufficiently indicates that Extreme Unction can be ministered also to the sick who do not yet seem to be at the exit of life. The matter is proved more strongly from the Bull Ex quo of Benedict XIV,²¹ in which it is read: "Let the Sacrament of Extreme Unction not be administered to those well in health, but only to those who labor under a grave disease." Wherefore, whenever Viaticum can be furnished to a sick person who is not fasting, Extreme Unction can also be given to him; indeed, it is expedient that it then be given. - But if it were given in a GRAVE disease, though danger of death at least remote were not judged to be present, it would indeed be given validly, but illicitly; if in a LIGHT disease, it would be administered neither licitly nor validly.²²

2. It OUGHT to be given when danger of death urges; for thus the RITUAL speaks: "This Sacrament ought to be furnished to the sick who labor so gravely that danger of death seems to be imminent." - Nor is the last time of life to be awaited, as the Roman Catechism says:²³ "They sin most gravely (priests) who are accustomed to observe that time for anointing the sick person when already, all hope of health having been lost, he begins to lack life and senses." The reason is, says St. Alphonsus, because the sick person is deprived of the richer fruit which he would have received if, master of himself, he had received the Sacrament; likewise because he is deprived of spiritual strength for resisting the devil and for bearing the inconveniences of disease; he is perhaps deprived also of health of body, if he had been anointed at the suitable time, according to what was said at n. 1872; indeed also of the eternal salvation itself of the soul, in the case in which, existing in mortal sin, he would have attained grace with the help of attrition. - All these things, at least heaped together, seem to bring grave damage to the sick person.²⁴

Q. 2. Whether and when can this Sacrament be REPEATED?

Resp. It must be repeated: - 1. In a different and dangerous infirmity; for it is ordered to healing; "but healing medicine ought to be repeated as often as infirmity is repeated," as D. Thomas says.²⁵ - 2. In a different danger of a long infirmity; for the RITUAL says: "In the same infirmity it ought not to be repeated, unless it is long-lasting, as when the sick person has grown better and again falls into danger of death."

Hence, IN A LONG-LASTING DISEASE, such as phthisis and dropsy, if the sick person after anointing certainly has remained in the same state of infirmity, or only for a brief time, for instance for 4 or 5 days, has had himself better, it ought not to be repeated. - But if such a change has intervened in his state that with probability it must be judged that he had exited from the danger of death, because for a notable time, for instance for a month, he had had himself better than before, in such a case, with Benedict XIV as witness,²⁶ one must stand for repetition of the Sacrament, "because," he says, "this repetition is more conformed to the ancient custom of the Church, and through it a new spiritual help comes to the sick person."

Q. 3. Whether the reception of this Sacrament is NECESSARY for salvation?

Resp. 1. It is not necessary by necessity of means, since salvation can be obtained without this Sacrament. Thus all. - But whether it is necessary by necessity of precept is controverted. St. Alphonsus judges the affirmative opinion as very probable, and altogether to be advised in practice: but this, not now by reason of a precept, concerning whose grave obligation it is not established; but by reason of charity which the sick person owes to himself, and which urges especially in the extreme article of life. For although other protections, with which he can fortify himself, are not lacking to him, nevertheless he would act mercilessly toward himself if willingly he deprived himself of this most powerful protection. For he who is in danger of death, on the one hand, is able to excite himself to good acts only with great difficulty, and on the other hand is subject to strong attacks of enemies, since "in this point of time (as Trent speaks), the snares of the devil are more vehement." Hence (thus the Blessed Doctor concludes) he seems to expose himself to great danger of succumbing to temptations, who neglects to fortify himself with this Sacrament instituted by Christ the Lord as a most firm protection in so great a conflict.

2. Although of itself it is not established that there is a grave obligation of receiving Extreme Unction, nevertheless all agree that the sick person PER ACCIDENS is held, and indeed UNDER GRAVE SIN, to the reception of the Sacrament, whether by reason of special necessity, namely if, existing in mortal sin, he could not receive another Sacrament, or by reason of scandal to be avoided, or finally by reason of contempt. - For it is certain that formal contempt induces grave fault. Moreover, contempt is censured formal when the sick person refuses this Sacrament because he values it little; but not when he refuses from some repugnance or ignorance. It is confirmed from the Bull of Martin V: This Sacrament can neither be neglected without fault, nor contemned without mortal sin. "Hence, the Pontiff seems sufficiently to have expressed that contempt of this Sacrament indeed carries grave fault, but negligence no more than light fault."²⁷

Note. Concerning ASSISTANCE TOWARD THE DYING, see the Opuscule of St. Alphonsus at the end of the Praxis Confessarii, or in Hom. Apost., last Treatise, Appendix II. - Concerning the Indulgence to be imparted to the dying²⁸ (cf. n. 1854, 9).

1507. - The subject of this Sacrament is all, and only, sinners, i.e. those who are capable of sin or at some time were capable, and these sick persons whose life is in danger. It is established 1° from the words of St. James: Is anyone sick among you? Let him bring in the priests of the Church, etc.; but the Greek word is sick signifies a dangerous disease; 2° from the definition of the Church. For thus in the Decree of Union: This Sacrament ought not to be given except to a sick person, concerning whose death there is fear. Trent agrees. - But that they ought to be sinners is clear from the Form itself.

Hence children before the use of reason are not capable of this Sacrament, nor those perpetually insane, because they have committed no actual sins, nor could they commit them. In doubt concerning capacity, let it be conferred under condition.

1508. Questions. - Quaer. 1° Whether Extreme Unction ought to be conferred on the delirious sick?

Resp. Affirmatively, if previously they asked for the Sacrament, or probably would have asked for it if they had thought about this, or showed a sign of sorrow for sins. Indeed also to the sick destitute of the senses, as is established from the Roman Ritual. Cf. n. 1240. R. 4°. - But to one laboring under frenzy or insanity, who probably could do something against the reverence of the Sacrament, it is not to be ministered unless the danger is altogether removed, for example by binding him.

Quaer. 2° Whether this Sacrament can licitly be conferred on a sick person in doubtful or probable danger of death?

Resp. Affirmatively, with the common and true opinion, because for ministering this Sacrament validly and licitly it suffices that the sick person labor under a disease so grave that he is prudently judged to be in danger of death. It is confirmed from the Roman Ritual, where it is thus established: this Sacrament ought to be given to the sick who labor so gravely that the danger of death seems to threaten. I said: 1° that he is prudently judged to be in danger of death. For in mere doubt, i.e. unless there is truly probability of danger present, it will not be administered, since then it cannot be said that danger of life is present. - I said: 2° for ministering this Sacrament validly AND licitly. For St. Alphonsus judges that this Sacrament is always validly conferred if the infirmity is grave. This opinion, especially among us, can be brought into practice in this sense: that the priest ought to be much less anxious in judgment concerning the danger, if he is far distant from the sick person and cannot easily return. (29) p. 421.

Quaer. 3° Whether Extreme Unction can be conferred: a) on a woman laboring in childbirth; b) on those about to undergo a difficult surgical operation; those failing from old age; those infected by poison; c) on those to be punished capitally; those about to join battle; those placed in danger of shipwreck?

Resp. to a) Distinguish. Negatively, if there is question of a woman laboring under ordinary pains in childbirth, even if she gives birth for the first time, or at other times was in danger of life; affirmatively, if she labors under extraordinary and lethal pains. For in the latter case, not in the former, danger exists from disease.

Resp. to b) Affirmatively, because danger exists from disease. (51) p. 430.

Resp. to c) Negatively, for the contrary reason.

Quaer. 4° Whether Extreme Unction can be conferred on children?

Resp. Affirmatively, provided they "are in possession of reason, and are judged capable of deceit and fault." Thus Benedict XIV. Indeed in doubt concerning the use of reason, according to the opinion more probable to St. Alphonsus, they are to be anointed under condition. Cf. n. 1507.

Quaer. 5° Whether, or when, this Sacrament can be repeated?

Resp. 1° Certainly it can be repeated as often as a sick person anointed in a dangerous disease has recovered, and again falls into a dangerous disease. It is established from Trent.

Resp. 2° It can also be repeated in the same infirmity, if it has been long-lasting and the sick person notably recovered, so that he seemed to have been rescued from the danger of death, and again has fallen into the same danger. The reason is that then there is truly a new danger of death. It is established from the Roman Ritual, where it is said: "in the same infirmity this Sacrament ought not be repeated, unless it is long-lasting, as if, when the sick person has recovered, he again falls into danger of death."

Quaer. 6° Whether it can be repeated in the same long-lasting disease, if it is doubted whether the state of the disease has really been changed?

Resp. Affirmatively, more probably, if the doubt is truly positive, namely when it is truly probable that the sick person has come out of the danger of death; for this repetition in these cases is more conformable to the ancient custom of the Church. But a doubt of this kind will be present if the sick person seems to have escaped danger of death for a notable time, say for a month.

Quaer. 7° Whether there is a grave obligation of receiving this Sacrament?

Resp. There is a twofold probable opinion.

The first affirms. 1° It is clear, they say, from the words of the Apostle James himself: Is anyone sick among you? Let him bring in the priests of the Church, etc. But the word let him bring in contains a precept. Therefore, etc. 2° There is added the practice of the Church, which with the greatest solicitude has always taken care that it be received by all the sick. It seems to be established also from the custom and sense of the faithful. 3° Moreover it is grave, and against the charity which each one owes to himself, to omit a means so efficacious, and a most firm protection, as Trent says, against the efforts of the demon in the last struggle. - Thus Roncaglia with others.

The second denies. The reason is that neither from Tradition nor from the Decrees of Councils is there evidence of a precept of receiving this Sacrament. But what St. James says, let him bring in the priests, etc., is received and explained as counsel. Therefore a grave obligation of receiving Extreme Unction cannot be imposed. - Thus Billuart, after St. Thomas, Sporer, and St. Alphonsus, who calls this opinion common. Yet the first pleases St. Alphonsus more, and he calls it very probable in the case in which the sick person, exhortations having been employed, should continue to be unwilling to be anointed.

But he certainly would sin gravely: 1° who from contempt refused this Sacrament; or 2° could not overcome grave temptations without it; or 3° would give grave scandal by not receiving it.

Moreover Extreme Unction would be necessary for salvation to one placed in mortal sin, lacking contrition, and unable to give a sign of Confession. "But Suarez and Palaus say well that this case can scarcely occur," i.e. then indeed the necessity of Extreme Unction for salvation would be present, but not the obligation of asking for it, as being impossible to fulfill.

Quaer. 8° What disposition is required for the reception of this Sacrament?

Resp. 1° Confession of sins, if the sick person is in mortal sin, practically.

Resp. 2° But if the sick person cannot confess his sins, let contrition, at least estimated, precede: for this Sacrament of Extreme Unction is primarily a Sacrament of the living, and was instituted chiefly for taking away the remnants of sins. - But in such a case attrition itself suffices and is required; for it is at the same time a Sacrament of the dead, and can remit mortal sins with attrition. - The Salmanticenses, Benedict XIV, and others.

Hence it is clear that this Sacrament, as the Roman Ritual says, is to be denied to "the impenitent, ... and those who die in manifest mortal sin."

It is said: to the impenitent and those who die in MANIFEST mortal sin. But under these words there ought not to be comprehended the dying who, in the act of mortal sin, are destitute of the senses; for it is not altogether certain that they die in manifest sin. Therefore, absolution being given under condition, this Sacrament can be conferred on these conditionally. (30) p. 421.

Note. - He also can be anointed who is baptized in grave infirmity. (31) p. 422.

S. Th., Suppl., q. 32 and 33.

704. The capable subject of Extreme Unction is a baptized wayfarer, having attained the use of reason and capable of malice, who by reason of infirmity is placed in grave danger of death. - This is clear from the testimony of James, from the tradition and practice of the Church, from the Council of Florence, decree for the Armenians, and Trent, sess. 14, c. 3, from the Ritual, tit. 5, c. 1, n. 8, and from can. 940.

It is said: 1) wayfarer, both generally because the sacraments are destined for wayfarers, and specifically because this sacrament prepares for death;

2. baptized or faithful, as is indicated by the words of James: Is anyone sick among you? for by Baptism man becomes capable of receiving the other sacraments;

3. having attained the use of reason and capable of malice, as is implied by the word: let him bring in the presbyters, which says a human act, and is clear from the primary end of the sacrament, which was instituted against the remnants of actual sin, as the form has it: May he forgive whatever you have sinned. Hence an adult who is baptized while dying can receive this sacrament immediately after Baptism, so that he may be freed from the infirmity left from actual sins (S. C. P. F., Sept. 26, 1821);

4. who by reason of infirmity is placed in grave danger of death, as is indicated by the word: is sick (n. 689), and is taught explicitly by the Council of Florence; but since old age is a true infirmity, the aged also can receive the sacrament if, by reason of weakness from old age, they are in grave danger of death. The danger of death is not required to be wholly imminent, but grave danger suffices; hence the sacrament can be conferred not only at the exit of life or article of death, but upon every sick person whose death is feared.

For the primary effect of Extreme Unction is the relief and strengthening of the soul of the sick person, the secondary effect is the restoration of bodily health; each supposes mortal infirmity; otherwise the sick person would not need a special sacrament by which he might be strengthened or healed. St. Thomas says, q. 32: "This sacrament a) is a certain spiritual healing, which indeed is signified by a certain manner of bodily healing. And therefore this sacrament must not be conferred upon those to whom bodily healing does not belong, namely, the healthy... b) it is the last remedy which the Church can confer, as immediately disposing for glory. And therefore it must be exhibited only to those sick persons who are in the state of departing, because their sickness is by nature apt to bring on death, and danger is feared" (a. 1 and 2).

Hence: 1. The following are not capable of this sacrament: the dead, - infidels or catechumens, - children and the perpetually insane, as incapable of sin, because "it is not given against the remnants of original sin except according as they are in some way strengthened through actual sins; hence it is given principally against actual sins, which are not in children" (a. 4, ad 2), - likewise, as it seems, the Blessed Virgin Mary, who neither had sin nor needed relief, - finally, the healthy or those lightly sick, although exposed to proximate extrinsic danger of death, such as those condemned to death, those about to sail or fight dangerously unless after they have received a lethal wound, those about to undergo a dangerous operation unless from an infirmity contracted they are already in danger of death or danger arises after the operation has been done, women who regularly give birth with some danger, unless because of a special infirmity death is to be feared, or from childbirth their strength has already been very much weakened.

2. On the contrary, those can receive the sacrament for whom from infirmity there is not only imminent but also probable intrinsic danger of death, such as all who have contracted an infirmity which will probably bring death, those infected with poison, those gravely wounded, those who after a surgical incision are greatly weakened, and decrepit old people even if they labor under no special disease, since old age itself is for them an incurable disease.

3. If there is doubt whether the sick person has attained the use of reason, whether he is truly placed in danger of death, or whether he is dead, the sacrament is to be ministered under condition (can. 941).

4. In a case in which, true grave danger being lacking, the sacrament was ministered in a merely supposed danger of death, if then a true danger arises, it is to be repeated at least under condition, for example: if you have not yet been validly anointed.

705. Conditions required for the reception of Extreme Unction. - There is required:

1. for valid reception of the sacrament, intention, because the sacrament must be received by an adult in a human manner; but a habitual intention not retracted suffices, even an implicit one, such as exists in all who wish to live or die as Catholics: for thus they have already implicitly sought the sacrament, or would probably have sought it explicitly if the occasion had been given;

2. for fruitful or licit reception, the state of grace, at least legitimately presumed, because it is a sacrament of the living, and the complement of Penance. Hence one who has sinned mortally must first receive the sacrament of Penance; or if this here and now is impossible, he must at least elicit perfect contrition; nevertheless one who in good faith thinks that he is disposed obtains the effects of the sacrament even with attrition alone.

Hence: 1) It is to be provided absolutely to sick persons who, when they were in possession of a sound mind, at least implicitly sought it or probably would have sought it, even if afterward they lost the senses or the use of reason. Thus can. 943.

2. To unknown persons and others about whom it can be doubted whether they have the aforesaid intention of seeking the sacrament, it is to be ministered under condition.

3. To the insane who have had the use of reason, it can be conferred, provided they then had at least an implicit intention of receiving it and did not revoke it.

4. Likewise to the furious and delirious: nevertheless the sacrament is not to be conferred upon them except in lucid intervals; but, when necessity is altogether urgent, it can be ministered even in the crisis, provided there is no danger of irreverence toward the sacrament.

5. To schismatics or heretics, while they enjoy the use of reason, the sacrament is not to be ministered unless they first have cast away heresy or schism; if they are destitute of the senses and are in good faith, it can be ministered under condition and with scandal removed, but regularly only to those who admit that Extreme Unction is a sacrament, as was said above, n. 653.

6. The sacrament is not to be conferred upon those who, impenitent, contumaciously persevere in manifest mortal sin; but if this is doubtful, let it be conferred under condition (can. 942), with scandal however removed.

The condition to be added is that which regards the validity of the sacrament, not however that which regards the disposition for the fruit of the sacrament, because the reviviscence of the sacrament is not to be impeded. This is the general principle which has force for all the sacraments; hence Extreme Unction should be conferred under the condition: if you are capable, or another similar one, not under the condition: if you are disposed. Nor should it be thought that in can. 942 an exception is placed to this rule, because in those who contumaciously persevere in manifest sin, an intention of receiving the sacrament can no longer be supposed with any probability; hence if there is doubt concerning this contumacy, there will likewise be doubt concerning the intention, not concerning the disposition alone. Therefore the general rule has force.

706. A special precept of receiving Extreme Unction is not proved to be given in itself, because the sacrament is not necessary for salvation, nor was it commanded by James but commended, as the Council of Trent says, sess. 14, c. 1.

Hence: 1) Those who do not receive it do not sin gravely in itself.

2. Accidentally grave sin can be present, by reason of special danger of temptations, or contempt, or scandal.

3. Indeed, to omit so great a means of salvation and firm protection, when the occasion is offered and a sufficiently great inconvenience is excluded, in proximate danger of death, regularly is not done from a reasonable motive, and therefore is accustomed to include light fault. Hence can. 944: "Although this sacrament is not of the necessity of means for salvation, nevertheless it is lawful for no one to neglect it; and it must be cared for with every zeal and diligence that the sick, while they are fully in possession of themselves, receive it."

The care belongs to the pastor, and indeed under grave obligation; also to blood relatives and relatives by marriage, who by a special title have care of the sick person, or even to friends: these are bound under grave obligation at least if the sacrament is necessary for salvation; indeed then, if they are lacking, every man is bound. But care must be taken that the sick person, fully in possession of himself, receive the sacrament, so that he may perceive the fruits more fully and more certainly.

707. Extreme Unction can be repeated, because it does not confer a character (q. 30, a. 3) nor a perpetual effect, since health of mind and body can be lost (q. 33, a. 1). Nevertheless it cannot be repeated in the same infirmity and in the same danger of death, because the commending or placing back of the sick person into the hands of divine mercy, which is reality and sacrament, is made for the whole danger and confers helps during the whole time of the danger and in the very article of death.

But when the danger has ceased through convalescence, if a new danger arises even in the same infirmity, as is accustomed to happen in long-lasting illnesses, the sacrament can be repeated (a. 2), as the Council of Trent says, sess. 14, c. 3. Hence can. 940, § 2: "In the same infirmity this sacrament cannot be repeated, unless the sick person after receiving the anointing has recovered and has fallen into another danger of life."

Question 1. Whether Extreme Unction can be given to adult neoconverts immediately after Baptism absolutely and rightly received, if nevertheless true danger of death is present?

Resp. Affirmatively, and the reason is because the chief end of this sacrament is to strengthen the sick against the temptations of the devil, and to wipe away the remains of sins. But an adult recently baptized, otherwise than an infant, can suffer temptations and perhaps is subject to many remains of sins. - Cf. St. Alphonsus, n. 721. - Lehmkuhl, n. 576.

For thus the S. C. de Propaganda Fide says: The sacrament of Extreme Unction can be conferred upon adult pagans already baptized, sufficiently instructed and fully disposed, who are oppressed by grave infirmity (26 September 1821). To this should be added the response of the Holy Office: The Sacrament of Extreme Unction is not to be conferred upon a dying neophyte whom the missionary believed capable of Baptism, unless at least the same has some intention of receiving Sacred Unction ordered for the benefit of the soul for the time of death. 10 May 1703.

Question 2. Whether this sacrament can be conferred validly and licitly upon a sick person in doubtful or probable danger of death?

Resp. Affirmatively, with the common and true opinion; thus in the Roman Ritual, edition of the year 1913: "This sacrament must be furnished to the sick who labor so gravely that danger of death seems to be imminent." Note besides that the word imminent does not signify that death is now-now going to follow, but only that the sick person labors under a lethal disease. Therefore a sick person can be validly and licitly anointed who lies seized by hectic fever (consumption), although he is foreseen to live still for several months or even for an entire year. - Cf. St. Alphonsus, n. 714. - Konings, n. 1508, question 2, with note (29). Canon 941 is to be noted:

When it is doubted whether the sick person has attained the use of reason, whether he is actually situated in danger of death, or whether he is dead, this sacrament is to be ministered under condition (Can. 941). Let the illustrious Kern, De Extrema Unctione, pp. 296 and following, be compared.

Question 3. Whether this sacrament can be conferred upon those who are about to enter battle or a dangerous navigation, or upon the guilty who are immediately to be affected with the ultimate punishment?

Resp. Negatively, because these are not properly sick. Yet the case of a soldier already gravely wounded and still wishing to fight would have to be excepted, or of a guilty person who, after the sentence of death has been heard, would be seized by fever. - Women also who suffer extraordinary and dangerous labors in childbirth can be anointed. Likewise those who are altogether failing from old age, even if they were held by no other disease. - Cf. O'Kane, nn. 868 and 859.

Question 4. Whether, or when, this sacrament can be repeated?

Resp. § 2. In the same infirmity this sacrament cannot be repeated unless the sick person, after receiving unction, has recovered and fallen into another danger of life (Can. 940).

It can also be repeated in the same infirmity if it has been long-lasting, and the sick person has notably recovered, so that he seemed to have been rescued from the danger of death, and again has fallen into the same. The reason is because then there is truly a new danger of death. Let the Roman Ritual, edition of the year 1913, be consulted. "In the same infirmity this sacrament ought not to be repeated, unless it is long-lasting, as if, when the sick person has recovered, he again falls into danger of death." Indeed in the same long-lasting disease, if it is doubted whether the state of the disease has truly been changed, if namely a probable reason is present for judging that the sick person has gone out of the danger of death, this sacrament can more probably be repeated. - Cf. St. Alphonsus, n. 715. - O'Kane, nn. 878 and following.

Question 5. Whether there is a grave obligation of receiving this sacrament?

Resp. Negatively, probably; for neither from tradition nor from the Decrees of Councils is there established a precept of receiving this sacrament. But what St. James says, let him bring in the presbyters ..., can be received and explained as counsel. Nevertheless, as is asserted in the Code: although this sacrament of itself is not of necessity of means for salvation, nevertheless it is lawful for no one to neglect it (Can. 944). Truly by accident it can be the sole means, if someone in extremis is situated in the state of mortal sin, and cannot confess nor receive communion, and meanwhile is deprived of the senses. Besides, it is not lawful to neglect it; hence the negligent person sins. Certainly of itself he would not sin gravely "who therefore did not seek this sacrament because it was not a precept, or, as the Wurzburgers say, v. 10, p. 286: because from elsewhere he feels difficulty and repugnance. Therefore for grave contempt it is required that one esteem the sacrament and its fruit as little ... But if someone rejects this sacrament which he can easily receive, such contempt is deservedly presumed in him." - Cf. St. Alphonsus, n. 733. - Lehmkuhl, n. 578.

Question 6. What must the priest do if he approaches the sick person and finds him just now dead, as is commonly said?

Resp. The priest can and, as it seems to us, must absolve him and endow him with Extreme Unction, under condition. For as long as probable hope is present that life still remains and it is not certain that death has truly entered, so long the sacraments which such a person perhaps needs can and must at least conditionally be conferred; but these are Penance and Extreme Unction. Now then, from the opinion of very many most learned physicians, it is probable that men in almost all cases, after the instant of death, as is commonly said, or after the last respiration, live internally for some time, for a shorter or longer time, according to the nature of the cause which induced death. In cases of death from diseases of slow progress it is probable that internal life endures for some moments, about six, or, according to some experts, one half hour; but in cases of sudden death internal life endures longer, perhaps not improbably, up to putrefaction. And therefore if the priest arrives morally at the same time at which death, whether from ordinary disease or from some sudden accident, is commonly thought to have entered, the priest can and, as it seems to us, must confer the aforesaid two sacraments conditionally. And we judge that the same must be held if in cases of sickness the priest has arrived before half an hour, and in cases of sudden accident before an hour, from the entrance of apparent death. But if nevertheless, in a case of sudden death, he has arrived one or another hour after the last respiration, but before corruption, he can administer the sacraments; but whether he must, I leave to wiser men to decide. It is to be noted: 1°. that those who are deprived of the senses and have not previously sought the sacraments are more securely assisted by Extreme Unction than by Penance; 2°. that the reverence owed to the sacraments is saved by the condition being added; 3°. that scandal of the faithful is forestalled by opportune instruction. - Cf. Gury-Ferreres, nn. 693bis-693ter; Casus, nn. 1192 and following. Alberti, Theol. Pastoralis, part 1, n. 18, VI. - Antonelli, Medicina Pastoralis, vol. 2, p. 260 and following. - Villada, Casus, vol. 3, p. 244. - Capellmann, Medicina Pastoralis, p. 178. - Lehmkuhl, Linzer Quartalschrift, vol. 57, p. 600. - Amer. Eccl. Review, vol. 33, p. 168 and following; 273 and following.

Question 7. Whether this sacrament can be given to those who are deprived of the senses in the act of sin?

Resp. A twofold opinion is given: the negative rests upon the words of the Ritual itself: This sacrament is not to be conferred upon those who, impenitent, contumaciously persevere in manifest mortal sin, tit. V, ch. 1, n. 10. The other opinion affirms that it can be given to them under condition according to the principle: "Concerning any faithful person about whom the contrary is not established, it must be presumed that he would have sought this sacrament if he had been able." - Benedict XIV, de Syn. Dioec., l. 8, ch. 6, n. 5. - Lehmkuhl, v. 2, n. 274. - Piat, Nouv. Rev. Theol. v. 31, p. 481. Indeed such dying persons in the very state of destitution of the senses can often be changed, by the help of grace, and elicit an act of sorrow; and truly more securely provision will be made for them through unction than through conditional absolution. - Cf. Dict. de Theol. Cath. v. 5, col. 2019.

Question 8. Whether this sacrament can be given to those who refused to receive it and then have been deprived of the senses?

Resp. The matter is involved: in some cases refusal does not come from an evil will of rejecting the sacrament, but rather from some fear or judgment that they are not so sick. In these circumstances it does not seem to be denied to them. Indeed is there not hope in almost every case, at least of those who remained Catholics, of some changed will by force of grace in unconsciousness, by which, if they had been able, they would have sought it? Therefore I certainly would not condemn a priest who, under condition and with precautions employed lest scandal arise, would anoint these. - Piat, Nouv. Rev. Theol. v. 31, p. 482. - Genicot, n. 423. - Ball.-Palm. n. 32.

Question 9. To which adults is this sacrament to be denied?

Resp. This sacrament is not to be conferred upon those who, impenitent, contumaciously persevere in manifest mortal sin; but if this has been doubtful, let it be conferred under condition (Can. 942).

Question 10. How is the sacrament to be furnished to the sick who, when they were masters of their mind, sought it at least implicitly, or probably would have sought it, even if afterward they have lost the senses or the use of reason?

Resp. Let it be furnished absolutely: thus can. 943.

Question 11. How must the oil of the sick be kept?

Resp. Let the pastor diligently keep the oil of the sick in a neat and decently adorned place, in a silver or tin vessel; nor let him retain it at home except according to the norm of can. 735 (Can. 946).

Note 1°. - Concerning visitation of the sick, the following statute of the Baltimore Fathers must be kept before one's eyes: "According to the prescriptions and mind of the Roman Ritual, let the Pastor of souls be diligent in visiting the sick and agonizing even after they have received the last sacraments; and let him exhort, console, and help them; and, after a new act of confession and contrition has been elicited from them, if they can, let him again and again give new absolution." - Cf. Second Plenary Council of Baltimore, n. 116.

Note 2°. - Priests indeed are always held to carry prudence before them, but never so gravely as in visiting the sick, both with relation to the sick themselves and with relation to their blood relatives or friends and neighbors who perhaps have gathered at the home of the sick person. Cf. Konings, nn. 1509 and following.¹

¹ Cf. Addenda, p. 1142, n. 111, n. 112.

Caius, a missionary, during Eastertide visits a certain village five or six miles distant from the church where some Catholics live. There he comes upon a previously unknown Catholic family whose members never come to church, either because of the distance or because of negligence. The mother of the family, perhaps forty years of age, evidently suffers from consumption, although she is not confined to bed; indeed, she attends to her ordinary occupations. When she says that she cannot come to church because of her domestic duties, Caius warns her to be ready at home on the following morning to receive the Easter sacraments. When she agrees, early on the following day he successively administers Penance, Communion, and Extreme Unction. After eight months he is called to the same woman, now dying, and when he finds her deprived of her senses and at the very point of death, without delay he anoints her again on the forehead under a general form; a little afterwards the woman expires. Hence it is asked:

1. Who is the subject of Extreme Unction?

2. Can Extreme Unction be repeated in the same illness?

3. What is to be said of Caius’s manner of acting in all these things?

1. Who is the subject of Extreme Unction?

To receive Extreme Unction validly one must be baptized, have attained the use of reason, and must be in probable danger of death from sickness.¹

1 Manual of Moral Theology, vol. ii, 238.

2. May Extreme Unction be repeated during the same sickness?

The Ritual lays down that this sacrament ought not to be repeated in the same sickness, unless it is prolonged, as when the sick man has got better and he is again brought into the danger of death. Many approved authors hold that in practice it may be repeated after a month’s interval.²

2 Ibid., 238.

3. What about the actions of Caius?

Caius found a mother of a family who never came to church, partly on account of distance, partly on account of negligence. She was now far advanced in consumption, but still attending to her household duties. He told her to prepare herself to make her Easter next morning, and then came again to the house and administered Penance, the Eucharist, and Extreme Unction. There is little difficulty about the administration of Penance. It is forbidden to take Holy Communion out of the Church except to the sick. The woman in question was apparently sufficiently ill for Easter Communion to be brought to her. Extreme Unction should not be given except to the sick who are in danger of death. If Caius judged that the woman was probably in danger, he did right to administer Extreme Unction, otherwise he did wrong.

Eight months afterward Caius was called to the same woman and found her dying in a state of unconsciousness. He anointed her on the forehead with the general form, and then she died. Caius should first of all have given her conditional absolution, for Penance should always precede Extreme Unction, as this sacrament is the complement of Penance. He did right after such an interval to repeat Extreme Unction, for although the sickness was the same, still without doubt there had been a change in the sick person’s state.¹

1 Génicot, vol. ii, n. 423.