Letter 34
To my beloved colleague,
You describe a situation that I think every priest and bishop faces: the dying person who has not received the sacraments, who may or may not have lived a Christian life, who is now beyond speech or coherent response, and whose family is asking desperately whether anything can be done.
The tradition here is clearer than in many areas of pastoral practice. Extreme unction [the anointing of the sick, now called anointing of the sick] can be administered to one who is unconscious, provided there is reasonable grounds for believing the person would wish to receive it and has not explicitly refused it while competent. The sacrament does not require the active cooperation of the recipient in the way that confession and communion do.
What I would say about the broader question you are raising — whether the church's ministry to the dying is adequate — is that the problem is usually not one of sacramental theology but of timing. The person who is near death and has not called for a priest is usually in that situation because they were not in the habit of turning to the church in life. The pastoral work that matters is the pastoral work done long before the deathbed.
Build a congregation in which it is normal, expected, and easy for people to request the sacraments when they are seriously ill. Make clear from the pulpit that calling for the priest is not "giving up" — a superstition I have encountered surprisingly often — but a sign of faith. If that culture is present, most of the deathbed crises take care of themselves.
Braulio
Modern English rendering for readability. See the 19th-century translation or original Latin/Greek for scholarly use.