Summa Theologica Suppl, q. 32: On Whom Should this Sacrament be Conferred and on What Part of the Body?
Article 2. Whether this sacrament ought to be given in any kind of sickness?
Objection 1It would seem that this sacrament should be given in any kind of sickness. For no kind of sickness is determined in the fifth chapter of James where this sacrament is delivered to us. Therefore this sacrament should be given in all kinds of sickness.
Objection 2Further, the more excellent a remedy is, the more generally should it be available. Now this sacrament is more excellent than bodily medicine. Since then bodily medicine is given to all manner of sick persons, it seems that this sacrament should be given in like manner to all.
On the contraryThis sacrament is called by all Extreme Unction. Now it is not every sickness that brings man to the extremity of his life, since some ailments prolong life, according to the Philosopher (De Long. et Brev. Vitae i). Therefore this sacrament should not be given in every case of sickness.
I answer thatThis sacrament is the last remedy that the Church can give, since it is an immediate preparation for glory. Therefore it ought to be given to those only, who are so sick as to be in a state of departure from this life, through their sickness being of such a nature as to cause death, the danger of which is to be feared.
Reply to Objection 1Any sickness can cause death, if it be aggravated. Hence if we consider the different kinds of disease, there is none in which this sacrament cannot be given; and for this reason the apostle does not determine any particular one. But if we consider the degree and the stage of the complaint, this sacrament should not be given to every sick person.
Reply to Objection 2The principal effect of bodily medicine is bodily health, which all sick people lack, whatever be the stage of their sickness. But the principal effect of this sacrament is that immunity from disorder which is needed by those who are taking their departure from this life and setting out for the life of glory. Hence the comparison fails.
Article 3. Whether this sacrament ought to be given to madmen and imbeciles?
Objection 1It would seem that this sacrament should be given to madmen and imbeciles. For these diseases are full of danger and cause death quickly. Now when there is danger it is the time to apply the remedy. Therefore this sacrament, which was intended as a remedy to human weakness, should be given to such people.
Objection 2Further, Baptism is a greater sacrament than this. Now Baptism is conferred on mad people as stated above (TP, Q[68], A[12]). Therefore this sacrament also should be given to them.
On the contraryThis sacrament should be given to none but such as acknowledge it. Now this does not apply to madmen and imbeciles. Therefore it should not be given to them.
I answer thatThe devotion of the recipient, the personal merit of the minister, and the general merits of the whole Church, are of great account towards the reception of the effect of this sacrament. This is evident from the fact that the form of this sacrament is pronounced by way of a prayer. Hence it should not be given those who cannot acknowledge it, and especially to madmen and imbeciles, who might dishonor the sacrament by their offensive conduct, unless they have lucid intervals, when they would be capable of acknowledging the sacrament, for then the sacrament should be given to children the same in that state.
Reply to Objection 1Although such people are sometimes in danger of death; yet the remedy cannot be applied to them, on account of their lack of devotion. Hence it should not be given to them.
Reply to Objection 2Baptism does not require a movement of the free-will, because it is given chiefly as a remedy for original sin, which, in us, is not taken away by a movement of the free-will. On the other hand this sacrament requires a movement of the free-will; wherefore the comparison fails. Moreover Baptism is a necessary sacrament, while Extreme Unction is not.