On September 7, 2025, Pope Leo XIV canonized Carlo Acutis. Saint Carlo’s enthusiastic love of God and his selfless service are inspirational, especially to young Catholics. So it was with great enthusiasm that the Church celebrated his first feast day on Sunday, October 12.
As is typically the case for saints, the feast day of Saint Carlo corresponded to his death day. It is noteworthy that Saint Carlo’s feast day is not October 11, the date when he was declared “brain dead,” but rather October 12, the date when his heart stopped beating.
The Church, it seems, recognized that true death occurs only after the cessation of all vital functions.
This footnote in the story of Saint Carlo raises an important and controversial question: are “brain-dead” patients alive or dead?
This short essay will specifically address one aspect of that question: should “brain-dead” patients receive the sacrament of anointing of the sick (Extreme Unction)?
The Catholic Church has not provided an explicit answer to this question. Fr. Tad Pacholczyk of the National Catholic Bioethics Center has come out firmly against “brain-dead” patients receiving the sacrament. At the 2021 Catholic Medical Association Annual Education Conference, he stated that “to the extent that moral certitude has been achieved, that this is now a ventilated corpse that we are dealing with, the sacraments are given for the living. They are not for the dead or the deceased. And one must not provide them to a corpse…”
It is certainly true that the sacraments can only be administered to the living. However, Catholic priests can and do administer anointing of the sick to “brain-dead” patients, conditionally or not, precisely because there is a lack of moral certainty that they are dead.
A 2005 article from the Associated Press titled “Brain-dead Virginia woman dies after giving birth; was kept on life support as fetus developed” began with this: “A brain-dead woman who was kept alive for three months so she could deliver the child she was carrying was removed from life support Wednesday and died, a day after giving birth.”
How can a dead woman be “kept alive,” gestate a child for three months, and then give birth? The priest caring for the woman must have asked himself those questions and concluded she was alive, for the article goes on to state, “Doctors removed Torres [the “brain-dead” woman] from life support early Wednesday with the consent of her husband, Jason Torres, after she received the final sacrament of the Roman Catholic Church.”
In response to the question “Last Rites for the Clinically Dead?”, well-respected Dominican priest Fr. Brian Mullady, OP, affirmed that the sacraments can–and should–be administered conditionally to those for whom there is any possibility of still being alive.
“Morally the presumption should be very broad,” he wrote, “since there is no harm given to the spiritual order in interpreting the possibility of giving a sacrament conditionally.”
Fr. Mullady makes clear that there is a distinction between clinical death and metaphysical death. D. Alan Shewmon, MD, has elegantly made that same distinction: clinical/civil death (which he calls “passing away”) corresponds to the onset of the permanent cessation of all vital signs, a moment that is observable and can be diagnosed by a physician.
In contrast, ontological/metaphysical death (which he calls “deanimation”) corresponds to the onset of the irreversible cessation of all vital signs, a moment which is unobservable and corresponds to when the soul ceases to inform the body. In traditional cardiopulmonary death, a period elapses between these two time points, which may be a few minutes or maybe a few hours, and it is during this time that Extreme Unction can and should be conditionally administered.
In the words of Fr. Mullady: “If life could still be present, justice and charity would not only permit the priest to anoint conditionally but would seem to oblige him to do so.” Fr. Mullady then favorably quotes his predecessor in the “Questions Answered” column, Fr. Farraher: “If there is any chance that the Sacraments can help a dying person, we should give that person the benefit of the doubt.”
If Extreme Unction should be given conditionally to “circulatory death” patients within a few minutes to a few hours after cessation of all vital functions, all the more reason why the sacrament should be given to “brain-dead” patients who retain many vital functions.
This brief article can only brush the surface of the topic of “brain death.” However, these concise observations demonstrate that clinical and pastoral practice conflict with respect to whether “brain-dead” patients are alive or dead.
On one hand, organs are harvested from “brain-dead” patients at Catholic hospitals, presupposing moral certainty exists that the “brain-dead” donors are truly dead. On the other hand, the Vatican did not consider a diagnosis of “brain death” the true death of Saint Carlo, and Catholic priests can and do administer Extreme Unction to “brain-dead” patients precisely because such moral certainty does not exist.
This divergence in practice affirms the fact that, as I have argued extensively elsewhere, moral certainty does not exist that “brain-dead” patients are truly dead. Therefore, justice and charity obligate priests who act as chaplains in hospitals to administer anointing of the sick to “brain-dead” patients, at least conditionally. While chaplains are not in a position to change hospital policy on organ harvesting from “brain-dead” patients, they can provide sacramental grace at the end of life to speed souls heavenward.
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I certainly hope that if I am ever in such a situation and any doubt exists, a priest would resolve the doubt in my favor and administer the sacrament. If we can baptize conditionally (such as when doubt exists if a valid baptism took place for whatever reason), we can certainly admminister Anointing of the Sick conditionally to one who may still be alive.
“Brain death” is a materialist take on life, denying, really, the existence of the soul. Pope Benedict,in an interview in 2011, answered a question regarding a man in the so-called “vegetative” state. The soul is still present:
Q. The second question presents us with a Calvary because we have a mother under her son’s cross. This mother is an Italian named Maria Teresa and she asks you: “Your Holiness, has the soul of my son Francesco,who has been in a vegetative coma since Easter Sunday 2009, left his body,seeing that he is no longer conscious, or is it still near him?”
A. Certainly his soul is still present in his body. The situation, perhaps, is like that of a guitar whose strings have been broken and therefore can no longer play. The instrument of the body is fragile like that,it is vulnerable, and the soul cannot play, so to speak, but remains present. I am also sure that this hidden soul feels your love deep down, even if unable to understand the details, your words, etc. He feels the presence of love. Your presence, therefore, dear parents, dear mother, next to him for hours and hours every day, is the true act of a love of great value because this presence enters into the depth of that hidden soul. Your act is thus also a witness of faith in God, of faith in man, of faith, let us say, of commitment, to life, of respect for human life, even in the saddest of situations. I encourage you,therefore to carry on, to know that you are giving a great service to humanity with this sign of faith, with this sign of respect for life, with this love fora wounded body and a suffering soul.
https://www.catholicnewsagency.com/news/22384/pope-benedict-speaks-on-suffering-persecution-in-historic-q-a
It’s true as articulated by Dr Eble that the distinction between death and life is not easily determined with insults to the Nervous system in particular what is called brain dead.
From experience in hospital chaplaincy the sacrament of anointing has been overly practiced, according to some bishops, and needlessly withheld. First, anyone admitted to a hospital care is eligible and should receive the Anointing of the Sick – in accord with the Rite as promulgated by Pope Paul VI Decree Pastoral Care of the Sick, and Paul’s Apostolic Constitution Sacrament of Anointing the Sick.
As an observation the difference between a sick patient and a dying patient is not always clearly defined in accord with a medical condition. For a general rule any person admitted for hospital care is eligible for the Anointing of the Sick.
When a person’s condition is medically diagnosed as terminal imminent or otherwise we may offer the sacrament in the context of extreme unction, or last rites. If there is any question regarding a patient’s diagnosis such as brain death as well described by Dr Eble a priest should not, best said, must not refrain from offering the sacrament of anointing. Whether the patient is simply sick in process of recovery, diagnosed as terminal, or questionable as in so called brain dead diagnosis, the actual words for conferring the ancient Gospel sacrament are the same:
Through this Holy Anointing, may the Lord in his love and mercy help you with the grace of the Holy Spirit. May the Lord who free you from sin save you and raise you up.
Can one receive the sacrament of the Sick when no priest is available? In July my cousin Marino who, because of functionally weak kidneys, was receiving dyalisis treatment in an isolated part of Mexico, but had been told by the clinician that dyalisis was now going to stop, giving him a life expectancy of about a week, suddenly asked for the sacrament! Marino’s nephew, recently ordained in France, kindly phoned him and recited the prayers of the sacrament, thus allowing Marino to die in presence of his wife and close relatives who had flown from France, in an evident state of grace.
Technically no. Although God’s gracious love knows no distance.
JFK was probably gone already when the two priests arrived?
Of course, the Karen Ann Quinlan case but that was one of the first “pull the plug” cases which her Catholic parents finally were granted, but then she breathed on her own. The parents cited Pope Pius XII, 1957, that extraordinary means are not a requirement to maintain life.
Certainly if there’s any doubt chalk it up to a prayer for the repose of the soul.
The priest who undertakes the [man-devised] ritual associated with the enactment of any of the sacraments is purely an instrument of the risen Christ. The sacrament is the embodiment of the union of Christ with the sacramental recipient and God alone bestows the gifts of sacrament to the recipient, in his own time and only if he chooses. It is a curious waste of time trying to second guess His intentions and I suspect He pays no attention nor responds to the rituals unless it is His intended will. I doubt that He pays any attention to the demands of the administering priest if it is not his intention, something to which no mere mortal is privy. The brain not the heart dictates the presence of life, the ability to know and serve God the creator, something very different from muscular tissues such as the heart which can continue to function when removed from the body provided the correct physiological environment is provided – something that modern Medicine can provide and does provide every day in its Intensive Care Units. Best for man to leave God’s work to God rather than to try to emulate godliness.
John Frawley the sacraments were instituted by Christ. Not man. You haughtily assume yourself as God’s mouthpiece. Christ, who instituted all the sacraments is present in all the sacraments.
One day you will face death. I urge you to seek humility and faith in Christ’s means for our salvation. The sacraments. At the time of death we all require acknowledgement of our sins and seek remission for them. Then, and only then is the sacrament useless, when someone remains arrogant and unrepentant.
Fr Morello,
I am sorry if I didn’t make myself clear. Of course Christ instituted the sacraments which I firmly believe. What I am saying is that the ritual used in the present day and age may not necessarily be accompanied by the coming of the risen Christ to the potential recipient unless it is God’s will, something that Man cannot dictate. A bit like the ritual of placing the hand on the heart and demanding that “God love America”. I suspect He stopped responding to that oft repeated and demanding instruction a long time ago!!
Your response is appreciated, John. It does offer greater clarity. Although as to whether Our Lord responds in every instance as God’s prerogative does depend on the willingness and proper disposition of the recipient as you suggest, we must accept the validity of the sacramental institution. That is, its potency to effect good.
The minister of the sacrament need not make his determination entirely on the medical prognosis insofar as whether the patient’s condition warrants the sacrament. He may confer the sacrament simply on the basis that he requires hospitalization. As such the patient’s diagnosis/prognosis becomes a mute issue.
I think it goes:” God bless America. ”
It’s a petition, not a demand.
The Sacraments are an entirely different thing.
Mr. Frawley, you describe the sacraments as “man-devised,” but Catholic teaching is clear that they are instituted by Christ. God has chosen to share His life with us through the sacraments. He is faithful to His promises, so we can trust that He will do so. Paragraphs 1076-1134 of the Catechism of the Catholic Church give a beautiful exposition of the sacramental economy, which does in fact enable us to not only emulate, but actually participate in godliness.