Catholics should be instructed to call a priest
in the case of serious illness
well before, if possible, the moment of death.

Pastoral care
of the sick and dying

by Alfred E. Guthrie

n I have had the impression that there has been, over the last several years, in some places, a shift in pastoral practices concerning the priestly care of the sick. Since it seems to me that the basic attitudes that appear to be behind this shift are against the spirit of updated legislation and ritual directives regarding these practices, I have decided to offer the following observations based not only on current directives and consultation with two other chaplains of many years' experience, but also on my own experience as full-time chaplain with pastoral care accreditation for some years and part-time chaplain with hospital(s) in the parishes in which I have served for about 35 years.

The sacrament of the Anointing of the Sick has always been appreciated by priests as, in the words of one chaplain, "a powerful sacrament instituted by the Lord." In spite of this awareness, we found ourselves occasionally treating the Sacrament of the Sick as if it were nothing more than "last rites": like a magic post-mortem salvation slot-machine.

A renewal of our appreciation and administration of the Sacrament of the Sick was indeed needed.

But it appears that a justified response to past abuses in the name of sacramental renewal has turned into what can perhaps be described as an over-reaction resulting in questionable practices in the opposite direction. These over-reactions appear to result in the unjustified denial of the sacraments to those who, in extreme necessity, have a right to them, and in the negation of valid insights and practices of the past.

A fundamental principle of pre-Vatican II pastoral service of the sick was that the pastor's or chaplain's responsibility to anoint the seriously ill member of the faithful is grave.

As will be pointed out in this paper, this principle has never been, from the point of view of the Church, open to question.

Past practice allowed the use of conditional conferring of anointing. (It is my understanding that this practice has been suppressed although I can't remember where I saw the reference. Perhaps the reader knows.)

In the past the Oil of the Sick was not permitted if the same sickness grew worse. Nor was it permitted to a believing non-Catholic under any circumstances.

Past practice, as noted above, also tended to apply this sacrament only to the almost dead or very recently dead. Hence the exclusive meaning of the titles Extreme Unction and Last Rites.

On the other hand, what appear to be present trends in some areas bring on a whole set of new problems.

The fundamental rights of the Catholic to the sacraments, especially when in certain or probable imminent danger of death, and the resulting grave responsibility of the pastor involved as found in present Canon Law and Ritual instructions are the underlying principles determining current Church teaching.

As will be seen below, the principle of "doubt of law" is clearly intended by the wording of the Church documents to favor the needs of the sick or dying person above all other considerations.

But the newer approaches listed below have the common characteristic of appearing to interpret the principle of "doubt of law" in favor of the convenience of the priest or the protection of the institution ahead of the extreme spiritual needs of the sick or dying person. This is certainly not the intention of the priest or institution in all cases. But the sad results of failing, as listed below, to properly care for the needs of the seriously sick or dying are the same. Hence, not only do these emerging practices contradict the spirit of post-Vatican II legislation as found in Canon Law and the introduction to the new Ritual for the Pastoral Care of the Sick, but they also negate the very meaning of the responsibility of the priest to be a good shepherd who lays down his life for the sheep.

These newer approaches to pastoral practice are found in directives given by some priests, parishes and even, it seems, dioceses regarding hospital chaplains and those parishes that are responsible for service to local hospitals. They may be stated as follows:

Questionable guideline #1): If a Catholic is apparently dead, even for a very short time, he or she must not be anointed.

Questionable guideline #2): If a Catholic patient is unconscious and has not specifically asked for the priest the priest is not to be called.

Questionable guideline #3): If a Catholic patient is seriously sick and in imminent danger of death and is conscious and either has not asked for a priest or has said that he or she does not want the priest, the priest is not to be notified.

Questionable guideline #4): If a patient is in imminent danger of death and unconscious, and, while religion cannot be determined since no member of the family is available, it is nevertheless (because of name, neighborhood or religious symbols on the patient's person or clothing) very possible or quite probable that the patient is Catholic, the priest is not to be called; and if the priest happens to be present, he is not to give any sacraments to the dying patient, especially the Oil of the Sick, for fear of a possible lawsuit.

Regarding this last guideline, a well known and highly respected retired director of hospitals of a large archdiocese labeled it "baloney."

As opposed to these apparently developing approaches to pastoral practice in serving the sick and dying, we have the current official teachings and practice of the Church as found in official Church documents.

From the Constitution on the Sacred Liturgy (#73): "'Extreme Unction', which may also and more fittingly be called 'Anointing of the Sick', is not a sacrament for those only who are at the point of death. Hence, as soon as anyone of the faithful begins to be in danger of death from sickness or old age, the fitting time for him to receive the sacrament has certainly already arrived."

From the Constitution on the Church (#11): "By the sacred anointing of the sick and the prayer of the priests the whole Church commends those who are ill to the suffering and glorified Lord that he may raise them up and save them . . . And indeed she exhorts them to contribute to the good of the People of God by freely uniting themselves to the passion and death of Christ . . . ."

The above passages remind us of the need for the active participation of the faithful, to the fullest degree possible, in their benefiting from the sacraments, including the Anointing of the Sick. As a result the following passages regarding the obligation to instruct the faithful on the occasion of administering the sacrament, to the extent that they are able to understand the words of the priest, logically follow:

From the Constitution on the Sacred Liturgy (#14): "In the restoration and promotion of the sacred liturgy the full and active participation by all the people is the aim to be considered before all else, for it is the primary and indispensable source from which the faithful are to derive the true Christian spirit. Therefore, in all their apostolic activity, pastors of souls should energetically set about achieving it through the requisite pedagogy."

From the Constitution on the Sacred Liturgy (#35 [2]): "The most suitable place for a sermon ought to be indicated in the rubrics, for a sermon is part of the liturgical action whenever a rite involves one. The ministry of preaching is to be fulfilled most faithfully and carefully."

While the thrust of the liturgy focuses on the conscious and educated participation of the faithful in their reception of the sacraments, the Anointing of the Sick has the added benefit of restoring the recipient to the Grace of God-even while the patient is unconscious but properly disposed. Hence, the "Introduction to the Ritual of Anointing" (Bishop's Committee on the Liturgy, NCCB, 27 November 1983; from the Editio Typica, 7 December, 1972) reads: "If necessary, the sacrament (of Anointing of the Sick) also provides the sick person with the forgiveness of sins and the completion of Christian penance"(# 6).

In the light of the above principles and teachings found in Church documents that came from the Second Vatican Council or resulting published reforms, the succeeding paragraphs from the above-quoted "Introduction to the Ritual of Anointing" logically follow:

par. 8: "The letter of Saint James states that the sick are to be anointed in order to raise them up and save them. Great care and concern should be taken to see that those of the faithful whose health is seriously impaired by sickness or old age receive this sacrament.

"A prudent or reasonably sure judgment, without scruple, is sufficient for deciding on the seriousness of an illness. If necessary a doctor may be consulted."

par. 9: "The sacrament may be repeated if the sick person recovers after being anointed and then again falls ill or if during the same illness the person's condition becomes more serious."

par. 10: "A sick person may be anointed before surgery whenever a serious illness is the reason for the surgery."

par. 11: "Elderly people may be anointed if they have become notably weakened even though no serious illness is present."

par. 12: "Sick children are to be anointed if they have sufficient use of reason to be strengthened by this sacrament. In a case of doubt whether a child has reached the use of reason, the sacrament is to be conferred."

par 13: [paraphrased] The faithful should be taught in public and in private to ask for anointing and, when the time for anointing comes, to accept it with full faith and devotion, not misusing the sacrament by postponing its reception. "All who care for the sick should be taught the meaning and purpose of the sacrament."

par. 14: "The sacrament of anointing is to be conferred on sick people who, although they have lost consciousness or the use of reason, have, as Christian believers, at least implicitly asked for it when they were in control of their faculties."

par. 15: "When a priest is called to minister to those who are already dead, he should not administer the sacrament of anointing. Instead, he should pray for them, asking that God forgive their sins and graciously receive them into the kingdom. But if the priest is doubtful whether the sick person is dead, he should confer the sacrament, using the rite given in no. 269."

Also using the general principles given above and touching further on those to whom this sacrament may be given, are the following directives found in the revised edition of the Canon Law of the Church [as found in the Paulist Press edition, edited by Coriden, Green, Heintschel, 1985]:

Canon 844, 4: "If the danger of death is present or other grave necessity, in the judgment of the diocesan bishop or the conference of bishops, Catholic ministers may likewise licitly administer these sacraments [penance, Eucharist, and anointing of the sick] to other Christians who do not have full communion with the Catholic Church, who cannot approach a minister of their own community and spontaneously ask for it, provided they manifest Catholic faith in these sacraments and are properly disposed."

Canon 1004 1: "The anointing of the sick can be administered to a member of the faithful who, after having reached the use of reason, begins to be in danger due to sickness or old age."

Canon 1005: "This sacrament is to be administered when there is a doubt whether the sick person has attained the use of reason, whether the person is dangerously ill, or whether the person is dead."

While reflecting on the above guidelines and directives, we are tempted to adopt the view that the sacrament of the Anointing of the Sick is also the primary sacrament for the dying. This understanding is incorrect even from point of view of past sacramental practice. The Roman Ritual on the Pastoral Care of the Sick, cited above, states (#174): ". . . it should be remembered that viaticum rather than anointing is the sacrament for the dying."

As we now turn from the present guidelines and principles of the Church to the formulation of practical principles that would embody the duties of the priest towards the sick and dying, we should take special note of the interesting and significant difference in language of Canon 1004 and 1005.

Canon 1004 is dealing with the rights of the faithful, that is with those who are entitled to this sacrament. Hence, the word "can" is used. (Latin: ministrare potest). On the other hand, Canon 1005 is dealing with the obligations of the pastor or chaplain. Hence the Canon uses words of obligation. (Latin: ministratur).

Using the above texts and taking into account the canonical understanding of the application in favor of the sick of the principle of "doubt of law" (Canon 14), and taking into account practical problems that are almost certain to arise, the following guidelines are offered for pastoral practice especially in difficult cases:

1) Catholics should be instructed in the importance of calling the priest in the case of serious illness well before, if possible, the moment of death.

2) Catholics should be instructed on the meaning of the sacrament and its benefits for the sick and their families.

3) Seriously sick people should be encouraged to request the Sacrament of the Sick.

4) The administration of the Sacrament of the Oil of the Sick should be accompanied, whenever possible, by some catechesis on the value of suffering in union with Jesus on the cross, the vocation of suffering in terms of the needs of the Body of Christ, the meaning of the sacrament, the consoling presence of Jesus to the sick, and the fact that Jesus is coming quickly for all of us to take us into eternity with him if we are faithful to the end.

5) If a dying Catholic, whether conscious or unconscious, has not yet been anointed or attended by a priest, there is a most serious responsibility on the part of all Catholics and non-Catholic professionals involved to see to it that the priest is called immediately.

6) The pastor involved is bound by a most serious responsibility to respond as quickly as possible to the dying Catholic, even if it has been made clear to him that the patient is in public rebellion against God or the Church. Whether to absolve and anoint become a matter of pastoral discretion.

7) If the patient or (as is often the case, in the event of an accident or emergency room trauma case) the victim is unconscious and there is a well-founded concern that the patient is dying, and his or her religion is not known due to lack of family or identification, the priest is the family. That is, the priest, if reasonably available, and taking into account prudent respect for the consciences of all concerned, can be present to the unfortunate John or Jane Doe to pray, and if there is a reasonable possibility that the patient is Catholic, the priest must be present to absolve and to anoint.

8) If the family of the dying Catholic patient, conscious or unconscious, is opposed to the priest's visiting or anointing the patient, the priest must use every means possible to confess and anoint the conscious patient and to anoint the unconscious patient, using pastoral concern and discretion and following the stipulations of Canon Law if it appears that the unconscious patient is publicly opposed to God or the Church.

9) [In areas where aggressive proselytizing by fundamentalists has been taking place] If the dying, unconscious patient is declared to be non-Catholic but there is good reason to suspect (1) that the patient is actually Catholic; and (2) that a family member [usually younger] who has turned to some fundamentalist sect simply wants to have nothing to do with the priest, the pastor involved has a responsibility to quietly see to it, if at all possible, that the patient is anointed.

10) If it is not clear whether real death, as opposed to apparent death, has taken place, the pastor involved must anoint.

I realize that there are many important pastoral considerations regarding the sick other than the administration of the Sacrament of Anointing. There is an abundance of excellent material available in regard to these other topics.

But the position of the Church is clear: the Catholics' right to receive and the priests' responsibility to make available the sacraments of the sick and the dying stand head and shoulders above all other considerations and must be given, all other factors taken into consideration, first priority. n