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St. Thomas Aquinas drew an intriguing comparison between the life of the body and the life of the soul, suggesting that each of the sacraments corresponds to an event or element of our natural existence. Just as baptism corresponds to birth, and confirmation to the passage to adulthood, he called the Eucharist
spiritual food and spiritual medicine,
corresponding spiritually to the nourishment and healing brought about by food in our bodily lives.
Catholics believe that not all sins carry the same weight or have the same effect on our souls, and traditionally make a clear distinction between “mortal sins,” which separate a Christian from the life of grace, and “venial sins,” which do not. In the text of his First Letter, St. John already speaks of a sin that leads to death (pros thanaton), as opposed to a sin that does not lead to death (me pros thanaton) - referring here to a spiritual death.
Moreover, in speaking of the Eucharist, St. Paul writes that whoever “eats the bread or drinks the cup of the Lord unworthily will have to answer for the body and blood of the Lord” and then adds that a person “should examine himself, and so eat the bread and drink the cup.” (1 Cor 11:27-28)
Clearly, then, for St. Paul, though no one is truly worthy to receive the Eucharist, there is a sort of unworthiness that needs to be addressed before approaching the table of the Lord. The Catholic Church has traditionally understood this sort of unworthiness to be a state of having committed a mortal sin. The way that this is expressed in the Catholic Catechism is that anyone “who is aware of having committed a mortal sin must not receive Holy Communion … without having first received sacramental absolution.” (No. 1457)
Aquinas, carrying on his analogy between the spiritual life of the soul and the natural life of the body, explains this by saying that the Eucharist is food, but food only helps the living. The one who commits a mortal sin
is not alive spiritually, and so he ought not to eat the spiritual nourishment, since nourishment is confined to the living.
While Holy Communion, like bodily food, strengthens the weak and helps heal the infirm (which Aquinas equates with venial sin), it does not raise the dead. This, he said, is what the sacrament of penance or reconciliation is for. The Church sees the state of grace - the life of the soul - to be a minimum condition or a low bar, so to speak, to be able to fruitfully receive the Eucharist. But that should be the only reason. As Aquinas says further:
Mortal sin alone necessarily prevents anyone from partaking of this sacrament.
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Therefore whoever eats the bread or drinks the cup of the Lord unworthily will have to answer for the body and blood of the Lord. A person should examine himself, and so eat the bread and drink the cup. For anyone who eats and drinks without discerning the body, eats and drinks judgment on himself.
2 Corinthians 11:27–29
In the Catechism of the Catholic Church, Part 2, Section 2, Chapter 1, Article 3, Part 6 discusses "The Paschal Banquet". Reflecting on the greatness and holiness of the act of Christ coming down to be with us, the Catechism states:
To respond to this invitation we must prepare ourselves for so great and so holy a moment. St. Paul urges us to examine our conscience: "Whoever, therefore, eats the bread or drinks the cup of the Lord in an unworthy manner will be guilty of profaning the body and blood of the Lord. Let a man examine himself, and so eat of the bread and drink of the cup. For any one who eats and drinks without discerning the body eats and drinks judgment upon himself." Anyone conscious of a grave sin must receive the sacrament of Reconciliation before coming to communion.
It is a matter, then, of making sure that you are in a fit condition to approach God Himself. To do so while conscious that your relationship with God is gravely impaired is at best to misunderstand Who and what the Eucharist is. At worst, it's a refusal to acknowledge the need to maintain your relationship with God, and thus it's a rejection of who you are and Who God is. This is itself a grave sin.
There is one caveat. Imagine for example a soldier deploying to a war zone who is going into danger of death and may not have another opportunity to receive the Eucharist for some time. The Church might call this a grave reason (that is, an extremely important reason) to receive the Eucharist. If for some reason confession is not available to the soldier, they can still receive Communion. But they must make a sincere Act of Contrition, and they must resolve to go to confession as soon as possible:
A person who is conscious of grave sin is not to ... receive the body of the Lord without previous sacramental confession unless there is a grave reason and there is no opportunity to confess; in this case the person is to remember the obligation to make an act of perfect contrition which includes the resolution of confessing as soon as possible.
Code of Canon Law, Canon 916
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whosoever shall eat this bread, or drink the chalice of the Lord unworthily, shall be guilty of the body and of the blood of the Lord.
The Catholic Haydock Commentary says on this verse:
Ver. 27. Or drink. Here erroneous translators corrupted the text, by putting and drink (contrary to the original, e pine ) instead of or drink. --- Guilty of the body, &c. not discerning the body, &c. This demonstrates the real presence of the body and blood of Christ, even to the unworthy communicant; who otherwise could not be guilty of the body and blood of Christ, or justly condemned for not discerning the Lord's body. (Challoner) --- The real presence in the sacrament is also proved by the enormity of the crime, in its profanation. See St. Chrysostom, hom. de non contem. ec. and hom. lx. and lxi. ad pop. Antioch. where he shews that the unworthy receiver imitates the Jews in crucifying Jesus, and trampling under foot his sacred blood. Hence the dreadful punishments we read of in verses 27 and 30.