After the consideration of the four last things, and with his household affairs set in order, it is necessary that a man — whether old, or laboring under a dangerous illness — should free himself from other cares and set about receiving the Sacrament of Penance in due manner. For it often happens that the Sacrament of Penance is received with less care at the very time when it is most necessary. For those who labor under a grave illness — whether hindered by pains or by weakness, or by failing judgment, or by the horror of approaching death, or by love of the dear ones they are loath to leave — make a rather imperfect confession of their sins, and amid those straits can arouse true and perfect contrition within themselves only with great difficulty. I myself can bear witness to this difficulty, which the sick for the most part endure. For once, when I was visiting a friend — a wealthy and noble man who, on account of a certain grave sin he had committed, had fallen into a mortal illness — and was telling him that nothing could be more salutary for him at that critical moment than true repentance and contrition for his sins, since God never despises a contrite and humbled heart, he answered: "And what is contrition? I do not understand what you are asking of me." I replied: "This is what I ask: that from a true heart you be displeased that you have sinned against God, and that you firmly resolve, should you live longer, never again to offend God — and that all this proceed from a true love of God, who has bestowed innumerable benefits upon you, and to whom you, most ungrateful, have returned injuries for His favors."
He answered: "I do not understand; I am not capable of such things." And so he died, leaving us clear enough signs of his damnation. This and similar examples warn us, while we are in good health, so to unburden our conscience and do true penance as though that confession were to be our last.
Nevertheless, even in the midst of a grave illness, sacramental confession ought to be made with all the diligence that is possible, and contrition especially must be stirred up — from true sorrow for past sins and a most firm purpose of sinning no more, should life have to continue. Nor must penance be done only for sins committed, but also for good works omitted which we were bound to perform by duty or by charity; for many examine with fair care the sins they have committed against God or neighbor, yet readily forget their omissions, or make little of them. I can add here an example that is quite instructive.
A bishop, very learned and devout, lay sick unto death. A priest who was a friend to us both came to him, and from him I heard what I am relating. Our mutual friend asked the bishop whether his conscience was clear of sins; he answered that, by the grace of God, nothing grave came to mind which he remembered having committed against God since his last confession. His priestly friend added whether his conscience did not reproach him for omissions, since the Apostle had so earnestly admonished Bishop Timothy, saying: "I charge thee, before God and Jesus Christ, who shall judge the living and the dead, by His coming and His kingdom: preach the word, be urgent in season, out of season; reprove, entreat, rebuke, in all patience and doctrine" (2 Tim. 4). Hearing this, the good bishop groaned and said: "Truly, my omissions alarm me not a little." And with these words, his eyes began to pour forth rivers of tears.
Furthermore, for those who are preparing themselves to die well, contrition is especially necessary; for confession without true contrition or attrition does not suffice for salvation, and satisfaction likewise either is of no avail without contrition, or can hardly be rendered by a sick man; but contrition, which includes charity, leads to salvation even without confession and satisfaction when these cannot be performed. For, as we said a little before, "A contrite and humbled heart, O God, thou wilt not despise" (Ps. 50). Contrition, therefore, is what we must earnestly seek when sick; and for this we have a splendid example in the holy Father Augustine who — as Possidius, who wrote his life, attests — in his last illness, of which he died, ordered the few psalms of David that concern penance to be written out for him; and as he lay in bed, he gazed at them, posted on the wall opposite, during the days of his sickness, and read them, weeping constantly and copiously. And lest his attention be hindered by anyone, he took care: about ten days before he departed from the body, he asked his household that no one should enter his room except at those hours when the physicians came in to examine him, or when food was brought to him; for all the rest of the time he devoted himself to prayer. O most blessed and most wise man! After receiving baptism and the forgiveness of the sins of his earlier life, he lived forty-three years, during which, right up to his last illness, he constantly preached the word of God; he wrote innumerable books most useful to the whole Church; he led a life without complaint, innocent and most holy; and yet in his last old age and illness he so devoted himself for many days to contrition and penance that in reading the penitential psalms he wept constantly and copiously. And those two words — "constantly" and "copiously" — are certainly to be noted. For he did not give himself to contrition on a single day or for a single hour, but over many days he bewailed his sins most frequently and most copiously; and what kind of sins did that most holy man bewail? In my opinion, only venial sins — so that, free not only from the flames of hell but also from the fire of purgatory, he might ascend straight to heaven. And if a holy and prudent man wept over venial faults for so many days, constantly and copiously, what must those do who have to satisfy God not only for venial faults but for mortal sins as well?
Therefore let all the sick who have death near at hand so prepare themselves before they fall ill, that in old age or sickness it will not be necessary for them to expiate grave sins, but only to do penance for lighter faults; and let them strive so to fortify themselves with holy confession, and communion, and Unction against the snares of the Devil, that, with God as their guide and the holy Angel as their companion, they may happily reach the heavenly fatherland.