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When and how any particular Christian participates in the Christian sacrament of Eucharist, regardless of intellectual disability or cognitive capacity, depends on the way the administering Christian community understands the sacrament. Because there is a plurality of Christian accounts of Eucharist, there is a plurality of practices and traditions concerning the norms for participation in that case of a Christian who has an intellectual disability. Some Christian traditions maintain that a theological understanding of the sacrament is necessary to receive Eucharist and, therefore, do not administer the sacrament to intellectually disabled persons. Other Christian traditions maintain that spiritual devotion to the real presence of Jesus Christ is necessary to receive the Eucharist and, therefore, administer the sacrament to intellectually disabled persons under particular conditions—presuming the benefit of the sacrament can be received even if the Eucharist is not consumed. Still other Christian traditions understand the practice of Eucharist principally as a communal expression of community solidarity or unity and, therefore, administer the sacrament indiscriminately during the liturgy.
Both the theological and material history of how intellectually disabled persons have participated in the sacrament of Eucharist is available to researchers. Unfortunately, due to the limitations of printed text and challenges of translation, that theological and material history is generally unfamiliar to non-specialists. Nevertheless, advances in the digitization of rare texts has allowed for an unprecedented rediscovery of Ancient, Medieval, and Early Modern Christian practices and teaching on how persons who "lack the full use of reason" participate in the Christian sacraments. There is a well documented contemporary prejudice against premodern accounts of intellectual disability / mental illness, which supposes that premodern philosophers and theologians took those forms of impairment to be instances of demon possession. Although that contemporary prejudice has been wholly discredited by historians, the association has lingered in the popular imagination of western Christians—such that many contemporary Christian traditions and communities do not administer the sacrament of Eucharist to intellectually disabled and/or mentally ill persons.
Thomas Aquinas maintained that all cognitively impaired Christians have a right to the Eucharist and that the sacrament should not be withheld from such persons, except in the most extreme of circumstances (STh III.80.9). According to Aquinas, the extreme circumstance that warrants withholding the Eucharist from a cognitively impaired Christian is if the Christian is entirely incapable of expressing their desire to receive the Eucharist. The worry of Aquinas is that the Eucharist would be forced upon someone who does not want to participate in the sacrament.
The Code of Canon Law of the Roman Catholic Church (and those bodies in full communion with it) has official policy about how the sacraments should be administered in the case of adult Christians who lack the use of reason. The rationale is developed on the understanding that persons who lack the use of reason, like infants, need the assistance of others to participate in the sacraments of the Church. See Canons 96-99. Thus, ecclesial care for infants provides the principles for the ecclesial care of intellectually disabled persons. Regarding the administration of Eucharist to children and other persons who lack the use of reason, Canon 913 states
This policy is reflected in the positions published by many Roman Catholic dioceses in the United States. For example, in the section regarding preparation for First Communion:
Additionally, the United States Conference of Catholic Bishops stated in its Guidelines for the Celebration of the Sacraments with Persons with Disabilities (approved 1995):
In an effort to better reach marginalized populations, such as those struggling with autism and other developmental disabilities, while at the same time providing for their religious education, organizations have emerged offering online alternatives to traditional Faith Formation in keeping with the USCCB's Guidelines.
Similar to the Roman Catholic view, Eastern Catholic Churches which practice infant communion, favor the right of intellectually disabled Christians to receive the Eucharist.
Orthodox Christianity makes Communion available to all baptized and chrismated church members who wish to receive it, regardless of developmental or other disabilities. The theory is that the soul of the recipient understands what is being received even if the conscious mind is incapable of doing so, and that the grace imparted by Communion "for the healing of soul and body" is a benefit that most especially should not be denied in such cases. This is consistent with the practice of Infant Communion in Eastern Orthodoxy.
Orthodox Christians typically receive the Sacrament of Confession before receiving the Eucharist (see Eucharistic discipline). However, for those who are either mentally incapable of recognizing or recalling their sins, or who are mentally or physically incapable of communicating their sins to a priest, this requirement is dispensed with, just as it is for very young children.
In the Lutheran Churches, the sacrament of Holy Communion is administered to people with intellectual disability, as with people with dementia.
The Church of Scotland says this regarding those with learning difficulties:
In most evangelical Christian churches, the only requirement for any individual to participate in Communion is that the person professes to have a personal relationship with God and to have accepted Jesus Christ as their Savior. Before Communion in these churches, the policy is usually verbally outlined and the decision is left up to the individual.