Roman Catholic Church (Latin Rite)

Introduction

It is presumed that the reader has a general familiarity with the history and theology of the Roman Catholic Church. In the limited space available here I will be focusing on common questions that I’ve been asked by chaplaincy students and by health care staff. The topics are listed in no particular order and reflect my understanding rather than the policy of the Archdiocese of Detroit.

I'd like to note that I've encountered a common misunderstanding in recent yearsóthe presumption that the stances taken by various "Right to Life" groups are also the positions of the Catholic Church. Often that’s true, but not always. There can be significant differences, with a much greater depth to the moral theology of the Catholic Church.

What would be the single best source for the position of the Church on health care issues?

For the United States, Directives for Catholic Health Care Organizations, prepared by the Conference of Catholic Bishops would be the single most important short presentation. That document is included in this text.

Is cremation acceptable?

Yes, so long as it is not being used as a way to deny belief in the Resurrection. At one time that was the case, and that was the reason for the now-outdated prohibition against cremation.

Can someone who commits suicide receive a Catholic burial?

Yes. However, care must be taken to avoid appearing to make any judgment about the person, as well as not condoning the act of suicide.

Can someone who is not Catholic or who committed suicide be buried in a Catholic cemetery?

Yes. Some cemeteries may require a written permission from a priest, which can be obtained at the local parish.

Are there special procedures that must be followed after death?

None, except that the body must always be treated with respect.

Is organ donation permitted?

Yes, there is no restriction on donating or receiving an organ. Great care must be taken, however, to ensure that there is justice and full protection for all those involved. Careful procedures to ensure that must be developed and followed. The concept of brain death is accepted, with the caution that the actual death of the whole brain must be established with medical certainty. There is no room for even potential error in the determination of death.

Is euthanasia, “mercy killing” or “assisted suicide” accepted?

No. However, no patient is required to make use of any medical intervention or treatment when there would be no reasonable or proportionate chance of benefit. If a medical intervention no longer offers that chance of benefit, it may be withdrawn, even if that would be expected to result in death. In effect, treatment delaying the process of dying is withdrawn, returning the person to an “unassisted” state.

Is it necessary to make use of tubes or IVs to provide fluid or nutrition?

In a situation where they are prolonging the process of dying, no. There is disagreement about situations in which the patient is chronically ill or disabled but not dying. We are always required to provide air, water, and food to someone as an act of simple charity. The issue arises when invasive procedures are needed in order to provide it. There is always concern that economic concerns, discrimination, or the unavailability of family support may unjustly influence decision-making in difficult situations. Advocacy and focusing on justice for the vulnerable patient must always receive the highest priority. The US Bishops have published a document entitled Nutrition and Hydration: Moral and Pastoral Reflections that discusses many of those issues. That document is included in this text.

Can high amounts of pain medication be used for a dying patient even if there is danger of immediate death?

Yes. It must be clear that the intent is to treat the pain or discomfort, rather than intending to kill the patient. Unusually high doses of medication may be necessary to treat the pain. There is a very simple way to tell whether someone is intending the death of a patient rather than treating pain/discomfort. It helps to ask, “Is the medication being used even though there is a safer drug that would still effectively treat the pain?” “Is the pain medication being adjusted in response to present or expected indications of pain?”

If an unusually high dose of an unnecessarily dangerous drug is being used without reference to the patient’s level of pain, it’s time to start asking questions.

May someone who’s not Catholic receive a Catholic burial?

Yes, but there should be a reason why that would be the most appropriate action. Care must be taken to avoid implying values or beliefs that the patient did not have, and the burial must not be contrary to the patient’s conscience during life. A Catholic burial may or may not mean a celebration of the funeral Mass of the Resurrection. Often, a scripture service and commendation of the body at the funeral home is the most appropriate route.

May Mass be celebrated at the funeral home?

The policy for the Archdiocese of Detroit is that it may not be, unless there is a compelling pastoral reason (weather, construction at the parish church, etc.).

Are there times when a funeral Mass may not be celebrated?

Because of the special importance of Holy Week, the Mass of the Resurrection may not be celebrated from Holy Thursday through Easter Sunday. Usually a scripture service at the funeral home with commendation and burial of the body is celebrated, with a later memorial Mass.

Are any of the sacraments celebrated after death?

No. Neither the Sacrament of the Anointing of the Sick, Communion, or any other sacrament may be administered after death. If there is any reasonable doubt as to whether death has actually occurred, the Sacrament of the Anointing of the Sick may be conditionally administered. The most common situation in which that may arise is when there is a determination of brain death. If there is certainty of brain death, the Prayers at the Time of Death should be used rather than the Sacrament of the Sick. Otherwise, confusion over whether death has occurred is merely increased for the family.

When should someone request that they be anointed?

It should always be stressed that there is no requirement to receive the Sacrament of the Anointing of the Sick (also called simply “The Anointing of the Sick” or “The Sacrament of the Sick” or simply “The Anointing”). The patient may always freely choose not to receive the Sacrament, and the family may object to that decision, but the patient’s choice must always be respected. The Sacrament may never be administered for “the benefit of the family” if that would be in opposition to the patient’s decision or conscience.

The Church does all that it can to make the Sacraments available to those who are sick. The Sacrament of the Anointing of the Sick may be administered to someone who is unconscious if the patient would have wanted to receive it if he were able to ask. If the patient is not known to the priest he should ask the family, as those who know the patient best, if the patient would, in fact, have wanted to receive the Sacrament.

As a pastoral issue, it’s advisable for the priest to explain who he is and what is being celebrated, even if the patient is unconscious, or at least appears to be. I’ve had too many “unconscious” patients respond in the middle of celebrating the Sacrament to take things for granted!

In general, the Anointing of the Sick should be celebrated early in the course of an illness, rather than waiting until a patient’s condition has deteriorated before requesting it.

Many parishes regularly schedule “Masses of the Sick” in which Anointing is offered to the sick in the midst of the parish community of faith. Liturgically, this is the preferred way to receive the Anointing.

Recognizing that people often don’t get sick on schedule, I’d also encourage the practice of administering the Anointing of the Sick at regular community Masses on Sunday or during the week. Patients who are physically able to attend Mass and know that they’re facing surgery, invasive procedures, or difficult treatment can plan to attend Mass along with family and friends, and receive the Anointing at the time of the closing Blessing. In my opinion, there are many advantages to this practice:

· It highlights the prayerful support of the community of faith.

· It places the Anointing in the context of the Eucharist.

· It discourages the outdated notion of the Anointing as being only for those “in immanent danger of death.”

· It encourages the sick to actively prepare spiritually for hospitalization, difficult treatment, etc.

· It lessons the practical difficulties in celebrating the Anointing of the Sick when the person is hospitalized:

¨ Lack of privacy, unfamiliar environment, difficulty in finding the patient available, distractions for the patient if in pain, sedated, nauseous, etc.

¨ Difficulty for the priest in setting aside a definite time for home, hospital, or nursing home visits, especially if asked to try to coordinate with family members who’d like to be present for the Anointing.

The Anointing is also regularly made available for the sick outside of the church setting, usually in the person’s home, a nursing home, or a hospital. A continuing effort needs to be made to encourage reception of the Sacrament in the most liturgically appropriate place and time. The practice of intentionally waiting until a patient is dying to request the Sacrament should be discouraged.

As fewer priests are directly assigned to hospital ministry and there are less priests available in the parishes, avoiding unnecessary obstacles to the administration of the Anointing of the Sick to parishioners becomes even more important.

I’d also like to stress that the Anointing of the Sick is only one facet of pastoral care for the sick, although it is a focal point. There are in fact many ways that the Church seeks to reach out with the compassion of Christ. In addition to the general support and prayer of the community of faith, there are ministers to the sick assigned to that ministry by the Catholic Church, to act in the name of the Church. There are:

· representatives from the parish appointed as visitors to the sick,

· Eucharistic Ministers who celebrate the Rite of Communion for the Sick with patients,

· chaplains and/or other pastoral care staff in parishes, hospitals, nursing homes, and other institutions,

· parish nurses who regularly visit the sick in their homes.

Part of the Church's ministry to the sick also includes those who minister outside of an official assignment, because of their faith in Christ:

· the family and friends of the patient,

· health care professionals,

· volunteers, such as those who help with transportation, programs of emotional support, etc.

Who may baptize?

To administer the Catholic Sacrament of Baptism when there is danger of death and the parents request it, anyone may baptize an infant. There should never be an “automatic procedure” of baptizing without the parents’ request, even of infants in danger of death.

To administer Catholic Baptism the most appropriate person immediately available (whether or not the person is Catholic) may administer the Sacrament of Baptism, pouring water over the infant’s head and saying, “I baptize you in the name of the Father, and of the Son, and of the Holy Spirit.”

There are times when someone who is Catholic may be asked to baptize an infant because a minister of the parents’ faith is not available. Using the same formula, a Catholic may baptize on behalf of another Christian group when such Baptism would not involve denying the Catholic understanding of Baptism. It would be very unusual for there to be such a problem.

There can be times when the parents request Baptism even though they are members of a religious group that does not practice infant Baptism. In that case, I would encourage them to make contact with their own minister. Often there will be a special prayer, blessing, or “naming” rite that would be used in that situation.

When there is danger of death and the person is an adult, the request for Catholic Baptism should be referred to a priest or deacon. There are additional precautions to be taken to assure that Baptism is appropriate, that there is sufficient knowledge on the part of the person, and that the decision is being made with full free choice. In the situation of a patient who is unconscious, the concern increases. It may also be appropriate for a priest to administer the Sacrament of Confirmation at the time of Baptism.

If the patient has earlier approached a parish about being baptized and/or received into the Catholic Church, that parish should be contacted.

May someone who is not Catholic receive Communion?

Yes, if the patient freely requests to receive, knowing that it is Catholic Communion, and at least implicitly believes that Christ is present in the way that the Catholic Church understands that presence. Giving the person Communion in those circumstances is seen as an act of charity to a patient whose own minister is not available. If the situation repeats itself, it would be appropriate to help in making arrangements for the person to be seen by someone from their own church. Communion is never to be “offered” to a non-Catholic patient because of the risk of unintentional pressure or coercion.

What about those who are members of one of the Eastern Rites of the Catholic Church?

There are a number of Churches fully in union with Rome, but following a different liturgical tradition than the Latin Rite. A member of an Eastern Rite Church may freely receive sacramental ministry through the Latin Rite, and vice versa. However, the most appropriate route is for ministry to be provided by someone from the person’s own Rite whenever possible. The liturgical tradition to be followed is always that of the minister. Thus, someone of the Latin Rite should never attempt to follow the prayers or tradition of the Eastern Rite. For example, when I saw an Eastern Rite bishop as a patient, the Sacrament of the Sick was followed according to the Latin Rite.

What about cultural or devotional differences between Catholics?

Catholics come from virtually every country on the face of the earth. Often, the practice of the faith has become entwined with the culture of the area, pre-Christian beliefs and customs, the unique history of the Church in that area, etc. At times it is extremely difficult to tell what is cultural and what is religious. As a simple procedural practice, customs and religious practices that reflect a specific geographical area or ethnic group can be viewed as “devotions” that may be helpful and very important to the individual, but which are always secondary to the celebration of the Sacraments. Participation by others in those devotions can never be demanded or expected. This would also hold true for novenas, private devotions centered around Catholic shrines such as Lourdes or Fatima, practices such as “praying in tongues” or anointing with non-sacramental oil, etc. It should be mentioned that the Oil of the Sick or Communion is never to be taken and used privately outside of the Rites appropriate to them. Anointing with non-sacramental oil is never to be confused with the Sacrament of the Anointing of the Sick.

Also, no Catholic should be put in a position where conscience would be violated. For example, even in an ecumenical ministry setting a Catholic would be expected to not participate in any prayer or religious practice that would deny the Trinity or the divinity of Christ, or that would imply belief in pagan gods, or that would imply repudiation of Baptism.

Similarly, in ecumenical ministry to someone who is not a Catholic, reasonable care should be taken not to suggest a belief that is not affirmed by the person receiving that ministry. To be insensitive to the faith of someone receiving ministry can inadvertently constitute a form of religious assault and battery.

Are there special issues for Catholics seeking to enter the Sacrament of Marriage while hospitalized?

First, a priest or deacon who is not assigned as Chaplain to the institution must receive delegation to witness the Marriage. He must be delegated by the priest appointed as Chaplain for the institution, or, if there is none, by the parish in which the institution is located.

Second, care must always be taken to ensure that the patient’s medical condition or medication the person is receiving does not significantly interfere with the patient’s ability to give consent.

Third, the actual celebration must take into account the condition of the patient as well as the needs of other patients and staff.

No one should ever be involved in any way in any marriage where there is an attempt at fraud or where the patient’s ability to give consent is in realistic doubt. Granted that it’s very unusual, but as an example I have seen situations where, because of concern over the guardianship of children, inheritance, or health insurance benefits, someone wanted to “marry” someone totally unconscious. In one case it involved someone already dead.

Not only should someone refuse to perform or witness such a marriage, but, depending on the role in health care of the person involved, there may be a positive duty to act to prevent fraud or in defense of the patient.

There may be situations where a Catholic couple was already planning on Marriage, have completed their pre-marriage preparation, met with the parish priest, etc. when one of them became sick or experienced a worsening of their condition. Then, it may be a situation of celebrating Marriage in the hospital rather than at the parish, or of advancing the planned date of the Marriage. The sickness of a close family member may also lead to a request to be married in a hospital setting.

The requirements for celebrating the Sacrament of Marriage remain the same—both parties must be free to marry, prepare to celebrate Marriage as a sacrament, and be able to give true consent. However, especially in the situation of serious sickness, those involved in the Marriage plans as representatives of the Church will do all in their power to be of help and to make the process as smooth as possible. The earlier contact is made about Marriage, or about a possible problem with an already-planned Marriage, the better.

Are there special issues concerning the Sacrament of Penance?

First, often when a patient requests the Sacrament of Penance they are seeking a sense that God is present with them through their sickness. Often it is far more appropriate to celebrate the Sacrament of the Anointing of the Sick, even if followed by the Sacrament of Penance.

Second, the absolute confidentiality of the Sacrament of Penance can be difficult to maintain in many hospital situations. Others can often easily overhear what is said, and the problem is made worse if the patient has hearing problems requiring the priest to speak more loudly. It should be noted that anyone overhearing what is said should carefully honor the confidentiality of the Sacrament.

Third, it is not unusual for a family member or staff person to directly ask if the patient received the Sacrament of Penance. In my opinion, no information at all should be given, including the simple fact of whether or not the person received the Sacrament. There are usually underlying issues prompting the question, and conclusions will be drawn regardless of what the priest says. My personal policy is to simply assure that the patient was seen (as opposed to being out of the room or asleep). I refuse to make any statement or answer any question beyond that.

Fourth, there are special issues that arise when someone has been admitted to a psychiatric unit, or where psychiatric problems are a significant issue in the patient’s care.

In those situations the patient’s ability to realistically assess their life may not be present, or their emotions may be unusually intense or inappropriate. The patient may be disoriented or confused, or even delusional. In these situations, the priest may be faced with the option of appearing to confirm whatever the patient’s present understanding may be, or arguing about what is reality. Neither is fitting in the context of the Sacrament.

However, it may be critically important to proclaim God’s forgiveness and love. One way to handle the situation is to simply ask for a expression of sorrow for sin that may have been committed, with no details, followed by Absolution. The patient is expected to celebrate the full Sacrament of Penance at some point in the future when they are able to again realistically assess their life. Often that will be weeks or longer after they’ve left the hospital.

This procedure is unusual, but it has been discussed several times with bishops of the Archdiocese and supported as a reasonable pastoral approach.

Can someone who is unconscious, confused, or disoriented received Communion?

To receive Communion someone must at least be able to know that it is Communion, understanding that it is the presence of Christ, and must choose to receive it. If those conditions are not clearly present, Communion is not to be administered.

There must also be an ability to receive Communion appropriately, taking into account both physical and mental factors. Respect for the Eucharist means that there must be appropriate precautions against intended or accidental abuse. Care should be taken with some psychiatric patients to ensure that they in fact swallow the host rather than removing it. Surprisingly, patients with eating disorders do not seem to have a problem in receiving Communion, even when all other food leads to nausea and vomiting.

Communion must be received as food. It must be taken into the mouth and swallowed, and then digested. Water may be taken before or after to make reception easier. It may not be administered via IV, feeding tube, etc.

The minister of Communion should always be aware that, if there is any tube in the GI tract, it may interfere with swallowing and lead to choking. Any tube which may take the swallowed host and aspirate it must be clamped by the staff before Communion and for a period of time sufficient to ensure digestion.

In some situations it may be advisable to offer Communion in the form of consecrated wine, using a spoon to place a small amount of wine in the person’s mouth. Again, the wine must be swallowed.

Usually situations preventing the reception of Communion are temporary and brief. In the event of a long-lasting or permanent inability to receive because of a physical condition, consultation should be sought.

Who may receive the Sacrament of the Sick?

Any Catholic who requests the Sacrament, understanding what it is, or, if confused or unconscious, any Catholic who would have requested it if they were able to ask. If there is true doubt as to whether the person would want to receive, the Sacrament may be administered. If it is probable that the person would in fact not want to receive, it may not be administered. Instead, a general blessing should be offered. It must never be administered on the basis that it would be “good for the family.”

Someone who is not a Catholic may request the Sacrament, accepting the Catholic understanding. In such a situation it may be administered.

A child may receive the Sacrament if the child is “old enough to be comforted by it.” There should be a positive reason to believe that the child would, in fact, be comforted. Otherwise, a general blessing or Confirmation may be more appropriate.

In all cases, the Sacrament is not to be administered unless there is a serious condition that interferes with the person’s life and faith in a significant way. Thus, having a cold, a sprained ankle, or being elderly would not qualify. Going to the hospital for surgery or a major testing procedure, suffering from chronic arthritis or having some other chronic condition would qualify along with more serious conditions.

At times, after careful assessment, it may be appropriate to administer the Sacrament to someone with a serious emotional problem, substance abuse problem, etc. I would hesitate before administering the Sacrament solely on the basis of developmental disability.

May an inactive priest administer the Sacrament of the Sick?

If the patient is in danger of death and there is not an active priest available, an inactive priest has a positive moral responsibility to administer the Sacrament, as well as to celebrate the Sacrament of Penance if requested.

What is the Church’s position on reproductive issues?

As a very general short description, it could be said that sexual activity and reproduction is only viewed as appropriate within marriage, between a man and woman, and that every marital sexual act of intercourse must be open to the possibility of pregnancy.

Thus, there are objections to sterilization, artificial birth control, in vitro fertilization, fertilization not involving the egg of the wife and the sperm of the husband, surrogate pregnancy, human cloning, etc.

Fertility testing or assisted fertilization are approved only via collecting sperm in a punctured condom during an act of intercourse between the couple.

What is the Church’s position on abortion?

Again, in short, abortion is not allowed. Usually the term “abortion” is used for situations involving an intentional ending of the pregnancy. An ectopic pregnancy is considered a “pathological condition” and a section of the Fallopian Tube may be removed to correct that condition.

Any drugs, procedures, intrauterine devices, etc., that have a primary intention or purpose of aborting the fetus are not allowed.

To avoid possible confusion, it is helpful to use the term “miscarriage” for a spontaneous abortion.

What approach should be used for those who have had an abortion?

While not condoning abortion, pastoral concern should be expressed and made available. There are often many issues that contributed to the situation, including a lack of practical and emotional help at the time of the pregnancy. Secrecy, a sense of shame, and grief can haunt a person for years after the abortion. It is not unusual for someone in a hospital situation to express concern and unresolved pain over an abortion that occurred many years before. The situation may have been compounded by a harsh, judgmental, and condemning attitude encountered in the past.

If help is needed in dealing with this very difficult situation, you may contact Project Rachel through the Christian Service Department, at (313) 237-5910.

Are there special dietary concerns?

No fasting or dietary rules are required for those who are sick, but individuals may still choose to honor them. There are two days of fasting observed, Ash Wednesday and Good Friday. On those days two meals should not be greater than the main meal and there should not be eating between meals. There are also days of abstinence from meat: Ash Wednesday, and the Fridays of Lent. There is also a custom that is voluntary of abstaining from meat on all Fridays of the year.

It is appropriate and expressive of concern for Catholic religious traditions to make at least one non-meat choice available for each meal on Ash Wednesday and Good Friday, and the Fridays during Lent.

There is also a period of fasting before receiving Communion of one hour. That can be observed by the sick when they know at what time Communion will be available. When it is not known, the fast can be set aside. This fast does not extend to medication or non-alcoholic liquids.

What is Viaticum?

Viaticum is the “food for the journey” or the last reception of Communion before death. In modern times, it is unlikely that the last opportunity for reception of Communion can be clearly identified, that the person is clearly dying, and that the person is still conscious enough and physically able to receive Communion.

Also, Communion is regularly made available in most institutions and in my opinion special concern does not ordinarily need to be paid to making Viaticum available.

At one time in the Church there was a custom of placing the consecrated host in the mouth of someone who was dying even if unconscious or otherwise unable to swallow, or even who was newly dead. That practice is never to be followed.

Are there funeral or burial rites for stillborn infants or children who die soon after birth?

A funeral, although often simplified, will often be arranged for a very young child. However, in my understanding stillborn infants are usually simply cremated without special prayers or funeral rites. The body must always still be treated with respect, regardless of the age of development.

Can someone’s body be donated for medical research or medical school training?

Yes, but again, there must be respect of the person who died. When the research or training is completed, the body is buried or cremated by the medical school.

Are autopsies permitted?

Yes, but unless required by law the choice is always left to the family. No invasive procedure or test may be done after death without the permission of the family or in accord with the appropriate laws.

Is the Sacrament of the Sick “required” for a Catholic?

No, but reasonable efforts should be made for it to be available, especially in emergencies when the person hasn’t had earlier opportunities to receive the Sacrament. At times one or more family members will be concerned about a patient’s ability to enter Heaven without being anointed. It should be strongly explained that the Sacrament is to be a positive help to someone who is sick, but that it is never required.

How is Communion for the Sick administered?

Much depends on the condition of the patient and the liturgical style of the minister. The minister should always avoid imposing private devotions on the patient and remember that they are representing the Church in celebrating the Rite of Communion for the Sick.

The following could be suggested: Beginning with an opening Sign of the Cross, followed by the Our Father, the proclamations “This is the Lamb of God” and “The Body of Christ,” followed by reception of Communion. The Rite could end with either a brief thanksgiving or, if appropriate, the Sign of the Cross.

Depending on the condition of the patient and other practical concerns there can be one or more readings from Scripture with reflections on them, an Opening Prayer, etc.

In actually administering Communion water may be offered before and/or after Communion. Visitors present may also receive Communion along with the person who is sick, but care should be taken not to create an awkward situation if someone does not want to receive, is not Catholic, etc.

What is the Catholic understanding of faith healing?

There is general acceptance of the idea that God and faith play a part in the process of healing, with or without medical care. There is no support for the idea of healing “by faith alone” when that means rejecting usual medical care. There is for some a strong charismatic influence, with adoption of aspects of theology from Pentecostalism, including speaking in tongues and the expectation of sudden, miraculous healing based on intense and emotional expressions of faith.

What is the Catholic understanding of sin?

In English the word “sin” can be understood in several different ways. First, it can refer to the general human condition of not being in full relationship with God, and to the effects of that alienation. Second, it can refer to an action that is objectively considered as not in keeping with the demands of faith. Third, it can refer to a person’s free choice to do what they know is wrong, as a way of rejecting God and that which is good. It is often presumed when the word “sin” is used that this third sense is meant.

We can say that something is wrong, or even that someone has objectively done something wrong. The only person who can say “I have sinned” in the moral sense of personal sin is the person involved. No one, regardless of their position in the Church or in society, can say that another has sinned.

I believe that pastorally we must be very careful in the way we speak of sin, and we must be very careful about presuming that another person has sinned. In classic Catholic moral theology, in order for there to be personal sin there must be: 1) an act that is objectively wrong and capable of being sin; 2) knowledge by the person that the act is wrong; 3) a free choice to perform that act, at least implicitly rejecting or acting against God in the process. Anything that lessens the presence of one of those three aspects lessens the possibility of there being serious sin for a particular person.

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Page was last updated on 08/14/00