On “brain death” and the conflict between clinical and pastoral practice

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.