Q: I work in the dementia unit of an assisted living facility. On Sundays, a Eucharistic minister gives communion to the residents who are Catholic. Some of them have advanced dementia and don't understand that the consecrated host is the body of Christ.
Some take the host in and out of their mouths repeatedly, even when the Eucharistic minister tells them to eat it. I've heard him saying, "Eat it; it is the body of Christ." He persists in administering the sacrament despite their resistance until the resident finally takes the host. I find the situation troubling and disturbing.
I feel that the minister should not be giving communion to people who don't understand that they're receiving a consecrated host, the body of Christ. I think it's important that communicants both understand and believe that they're receiving the body of Christ.
I've discussed this matter with friends and their opinions are split on the subject. Some agree with me that it's disrespectful to be treating the host as if it were a plain wafer. Others feel no one should be deprived of receiving communion, regardless of their lack of understanding due to diminished mental capacities.
To the best of my knowledge, the families of these residents are not insisting that their loved ones receive communion each week. What do you think about all this? - Anonymous, via email@example.com
A: Yours is a heart-wrenching and theologically important question. The first issue is whether or not there is any reason to deny the sacrament of Holy Communion to any baptized Catholic. There are, in fact, reasons to deny communion, but they must be clear and overwhelming. The main issue is whether the person receiving the Eucharist understands that he or she is receiving the Body of Christ. This understanding is canonically necessary. The mystery of the Eucharist must be understood and internalized, and if the person, because of mental disability, cannot do this, there is a good argument to be made that, under Catholic canon law, they cannot receive communion.
This is why only children of a certain age of discernment can receive communion (see Canon 913). However, adult patients with dementia are not children, and so this analogy may not be apt. The U.S. States Conference of Catholic Bishops directly addressed this issue in its Guidelines for the Celebration of the Sacraments with Persons with Disabilities (approved 1995), as follows:
"The criterion for reception of holy communion is the same for persons with developmental and mental disabilities as for all persons, namely, that the person be able to distinguish the Body of Christ from ordinary food, even if this recognition is evidenced through manner, gesture, or reverential silence rather than verbally. Pastors are encouraged to consult with parents, those who take the place of parents, diocesan personnel involved with disability issues, psychologists, religious educators, and other experts in making their judgment. If it is determined that a parishioner who is disabled is not ready to receive the sacrament, great care is to be taken in explaining the reasons for this decision. Cases of doubt should be resolved in favor of the right of the baptized person to receive the sacrament. The existence of a disability is not considered in and of itself as disqualifying a person from receiving the Eucharist."
Therefore, while what you see happening at the assisting living center may seem like a violation of canon law, it is not. The patients you mention do deserve and should receive the spiritual benefit of the doubt, even though this troubles you. They may understand more than you realize simply by observing them.
In the depths of my father's battle with Alzheimer's disease, he said to me, "All I know is that I belong to you and you belong to me." It was one of the most profound things he ever said to me.
You don't always know what mentally-disabled people know. My experience is that most religious traditions try hard to moderate their strict rules with a healthy dose of mercy and compassion for the mentally disabled. This lack of understanding of the way dementia is actually experienced by the mentally disabled person opens the door for compassion, not judgment.
I personally admire those in the Catholic Church, as well as those in the Eastern Catholic Churches, Eastern Orthodox Churches, and Protestant churches who also allow persons with dementia to receive communion.
Sometimes, bending a rule for the sake of hope shows compassion and wisdom. The hope that some healing element of this great Christian sacrament might reach even those who struggle to find their way through the fog of dementia is a healing hope and I encourage you to hope with them and pray for them.
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