Will you kindly answer the following difficulty that has confronted me in my own professional career. A patient who had been suffering from diabetes for some time and whom I was attending was suddenly taken with pneumonia, which developed coma. He had been to his confession about two months before this. The priest was called and found the patient in a semiconscious condition, making some attempt, as I thought, to bless himself. Extreme Unction was administered by the priest, who expressed also the desire to give him Holy Communion. This, in view of the profuse expectoration from which the patient suffered, seemed to me somewhat dangerous, as he might not be able to retain the sacred particle. A relative who attended him concurred with me in this fear, and accordingly the priest desisted.
Was this patient absolved from his sins sacramentally, as though he had actually confessed them with full mental capacity ?
And did the privation of the Blessed Sacrament affect the condition of the patient's salvation ?
I ask this for my own guidance in cases similar to this where the responsibility of such privation largely rests upon the decision of the physician by which the ministering priest is disposed to abide.
When a priest gives Extreme Unction without previous confession, because the patient is morally or physically unable to confess either by words or intelligent signs, the Ritual obliges him to elicit from the patient some sign of sorrow for sin. Such a sign would be the attempt to make the cross with the right-hand, as Catholics are accustomed to do. Indeed any movement that would even remotely indicate either that the patient is a Catholic or that he feels sorrow for sin, would induce the requisite condition for giving him sacramental absolution such as he receives in confession; for it may be safely assumed that a professed Catholic desires to do what God through His Church requires of him at the hour or when in danger of death. If there be a doubt about the patient's realizing his condition, as when he is in a mere stupor, the priest, after attempting to elicit sorrow for sin, will give him conditional absolution, so that if the patient is disposed he will get the benefit of the sacrament. However, as we never fully know whether a patient who happens to fall into apparent complete coma may nevertheless be conscious of approaching death and of his sins and grieve over them, the duty of the priest is to let him have the benefit of the doubt, and hence always to give sacramental (conditional) absolution before administering Extreme Unction. The sins of the patient, if he be penitent, are thus absolutely forgiven in virtue of the power of Christ committed to the Apostles and their successors, although he has not actually confessed them.
But if the patient is thus absolved from his sins by reason of his inward sorrow for the same, what further need is there of Extreme Unction or of Holy Communion, assuming that the latter can be given without risk of irreverence or inconvenience? Is it not true that a soul freed from sin is in a right condition to enter Paradise? Not necessarily. A father may forgive the theft committed by his son, because the latter is sorry for the act. But if there is in the youth a tendency to peculate and to deceive, his sorrow will not be a sufficient reason for the father to admit him to his business confidence or to a share in his financial responsibilities until he has tried him by a method of sustained correction calculated to eliminate the vicious inclination. Similarly, the forgiveness of sins as an explicit result of a penitent disposition, through sacramental absolution, does not take away the habit of evil inclination to sin for which man may be directly responsible on account of his former acts or neglects. Whilst this inclination to evil, which life and religion were given him that he might root out by penance and prayer, still clings to his soul, it unfits him' for heaven.
Now the Sacrament of Extreme Unction supplies a special grace of strength to the soul by which this tendency is weakened or eliminated. It acts in virtue of the merits of Christ, or, as theologians say, ex opere operato. But it is rendered additionally efficacious according to the disposition of the one who receives it with devout consciousness or with a longing to be entirely free from all that can separate the soul from God's love.
In this way we see that Extreme Unction blots out the remnant of sin which remains after sacramental absolution ; that is to say, those sins which have not been sufficiently and explicitly recognized or confessed, and also those habits and inclinations to sin which, whilst not actualized, are yet virtually committed by the acquiescence of the soul's inclination. The patient, then, who is unconscious and who therefore may or may not be able to profit by the conditional absolution which the priest gives him before administering Extreme Unction, receives in the latter sacrament a secret grace which, through the merits of Christ and by His institution, supplies the soul with a secret strength, enabling it either inwardly or outwardly to elicit both sorrow for actual sin and a sustained aversion to sin as the primary obstacle to the true happiness in God for which the soul was created. The frequently noticed revival of vital strength and consciousness on the part of the patient which accompanies the administration of this sacrament, is more easily understood if we remember this principal object of the institution of Extreme Unction. The patient gets a new respite during which he may render more efficacious the hidden grace conveyed to him in the sacred Unction, and make use of the virtue instilled so that he may deliberately renounce all tendency to. sin and attest his preference for things eternal to those that satisfied his sinful in clinations before.
It is easily understood how the reception of Holy Communion must add to this revival in the soul of the life-giving principle at a time when the physical and moral faculties are weakened by disease, and claim for their better exercise all the sustenance that can be obtained from the spiritual support and physical contact with the Bread of Life, the Real Presence, Christ Jesus in the Blessed Sacrament.