(d) The recipient of the Sacrament is a Catholic who after attaining the use of reason has come into the danger of death through sickness or old age. No one is capable of receiving this Sacrament unless he is baptized, for Baptism is the gateway of the Sacraments (2671); unless he has reached the use of reason, for the Sacrament is a remedy against personal sin and supposes that the recipient can or formerly could distinguish between right and wrong; unless he is in danger of death through the infirmity of disease or of decrepitude, for St. James teaches that the anointing is for those who are enfeebled by illness dangerous unto death. Hence Extreme Unction cannot be administered validly to the unbaptized, to young children who have not come to the use of reason, to the perpetually insane, to those who are sick but not in danger of death, to those who are in danger of death but not sick (e.g., a strong man going to the gallows or to battle). But the Sacrament may be administered to children who have not yet made their first confession, if they are capable of sin, and to the insane who once had the use of reason. The danger of death need not be immediate, and hence Extreme Unction may be given when the disease is mortal but the patient will last for several months or even a year, as in tuberculosis. Illness includes not only chronic sickness, but also fatal disorders caused by wounds, accidents, poison. The rule about the old is that those who have reached sixty years and show some signs of approaching death, such as great feebleness or fainting spells, even though they have no special malady, may be anointed; for their old age itself is a disease.
(e) The minister of Extreme Unction is the priest, since St. James directs that the presbyters (i.e., the priests) of the Church be called to anoint the sick. Extreme Unction, unlike Penance, is not exercised in the form of a judicial process, and hence the power of Orders suffices for its valid administration, and any priest, even one who lacks jurisdiction, gives it validly. But for lawful administration church law prescribes that the minister regularly be the ecclesiastical superior or spiritual director (i.e., the pastor for his parish, the head of a clerical religious institute for his house, the parish-priest or chaplain for a lay religious body, the confessor for nuns), and that the minister extraordinarily (i.e., in necessity) be any other priest who has permission, or reasonably presumed permission.
(f) The effects of Extreme Unction are _per se_ an increase of sanctifying grace, since this is a Sacrament of the Living; _per accidens_ (i.e., when the recipient is not in the state of grace, but is in good faith and has attrition) the forgiveness of sins and first grace. Extreme Unction produces first grace more surely than does absolution, if the penitent is unconscious, since it does not call for any external manifestation of contrition; hence the importance of anointing those who are dying but unconscious. The special benefit of Extreme Unction is immediate preparation of the soul for entrance to heaven, though restoration of the health of the body is sometimes vouchsafed when this is for the spiritual good of the sick person. Venial sins and the remains of past sins (i.e., the debility left by them) are removed and the soul is strengthened with confidence as to things past and future and with peace and resignation as to present suffering. Since the Sacrament is given for the period of danger of death, it cannot be repeated during the same danger; but should the patient recover and relapse into a distinct danger through the same or another sickness, there arises a new need and the Sacrament may then be repeated.
2775. Special Duties.—In addition to the duties that are common in all the Sacraments, the following duties should be noted in reference to Extreme Unction.
(a) The Recipient.—_Per se_, Extreme Unction is not necessary as a means to salvation, for sanctifying grace may be had or recovered without it; but _per accidens_ it would be necessary as a means, if a dying person were in mortal sin and could not recover grace except through it. He who omits Extreme Unction unwillingly or for a good reason (e.g., because he is well prepared for death and cannot get a priest without very grave inconvenience) does not sin. He who omits the Sacrament voluntarily and without good reason, is guilty of grave sin if he acts from contempt, or gives scandal, or exposes himself to eternal damnation; but if there is no contempt, scandal or danger to salvation, sin is indeed committed by the neglect at such a crisis of so important a spiritual aid, but only venial sin, since there is no grave precept to receive this Sacrament. The recipient of Extreme Unction should be in the state of grace; and hence, if he has mortal sin on his conscience, he must beforehand make an act of contrition or receive absolution with attrition, or, if neither is possible, he must make an act of attrition. The custom of the Church calls for confession before Extreme Unction, and divine law commands confession if one is in mortal sin and in danger of death.
(b) The Minister.—The pastor is gravely bound in justice to give or have given the Sacrament of Extreme Unction to all his subjects who reasonably request it; other priests not charged with the spiritual care of the dying person are held in charity to anoint him, if he has not received the last rites and cannot otherwise be anointed. It is clear that sick calls should be attended to promptly, and it would be a serious matter to delay so long as to put the sick person in danger of dying without Extreme Unction or of receiving it when he had become unconscious and could not dispose himself properly. If the person has been pronounced dead before the priest’s arrival, he should nevertheless be absolved and anointed conditionally if the last breath was not long before; because physicians teach that death takes possession gradually, life lingering in the body for some time after its external signs have ceased, for about a half hour when the end has come after long illness, for one or two hours when death is sudden or accidental. The ceremonies are obligatory under pain of sin, and it is considered a serious matter to neglect the more notable parts, that is, without reason to omit all or nearly all the prayers, or to give the Sacrament without any sacred vestment.
(c) The Pastor.—The oil of the sick should be kept in a neat and properly decorated place, and should be contained in a vessel of silver or white metal. Only in exceptional cases is it lawful to keep it in the rectory (Canon 946). The Catechism of the Council of Trent (page 307) declares that Extreme Unction should form a subject of frequent instruction. It is important to exhort the people not to delay in sending for the priest till the sick person has become insensible, nor to omit to send for him in case of sudden death, since, as already said, life remains for some time in the body after apparent death.
(d) The People.—All those who are responsible for the good of the dying person, such as members of the family, physicians, nurses, relatives, friends, or neighbors, should beware of deceiving him about his condition and his need of preparation for death; on the contrary, they should see to it as far as they can, that he receives the last Sacraments in good time and while he has the full use of his senses, when the spiritual benefit and the comfort of mind will be of greater assistance and the bodily cure more likely.
Art. 4: HOLY ORDERS; MATRIMONY
(_Summa Theologica_, Supplement, qq. 34-68.)