Strengthening of soul and willing co-suffering
with Christ are the most
important effects of anointing of the sick.

The Sacrament of the
Anointing of the Sick, why?

By David Delich

n In 1963, the year of my ordination, the sacrament of the anointing of the sick was called extreme unction. The name always brings a smile to my face because of a radio broadcast I heard minutes after the death of Pius XII. The newscaster, obviously not Catholic and winging it, reported that the dying pope was administered "extreme amounts of oxygen." The name of the sacrament was changed in 1964, but I'm not sure at this point in time that this was helpful. The only drawback with "extreme unction" is that "extreme" is more likely to bring to mind "in extremis" rather than "last" in the sense that this anointing ordinarily comes last in time, after the anointings of baptism, confirmation and possibly holy orders. The old name of the sacrament does carry some reference to death, but imminent death was never meant to be implied.

Two recent incidents prompted this article. The first occurred at a communal anointing service in an Indiana parish. I was one of the priest anointers and someone requested a proxy anointing for a relative. The second was a conversation I had with a priest chaplain in which he expressed his opinion that the sacrament was inappropriate for the dying since it was the sacrament of the sick. The name change to the sacrament of the anointing of the sick, however, was in no way meant to withhold the sacrament from the dying. Logically speaking, moribund is a subset of sick-dying and sick are in no way mutually exclusive. It is true that "last rites" in the Church is, strictly speaking, viaticum, but in practice very few patients receive viaticum today because of inability-either they are unconscious, too weak or unable to swallow. This being the case, three sacraments now comprise a practical last rites triad: reconciliation, anointing and Eucharist (viaticum).

In the remaining paragraphs of this article I will order my thoughts around what might be called expected results of the sacrament of anointing of the sick. These may or may not be reasonably expected and are: healing, forgiveness or removal of sin or its effects, strengthening of spirit and acceptance of a redemptive share in the sufferings of Christ. Healing in the context of this article means physical healing as opposed to spiritual healing which would be another name for strengthening of spirit. My experience and theological reflection lead me to the conclusion that healing is not an ordinary effect of anointing, that forgiveness of sin is still an important consideration, albeit an oblique one, and that the primary effects are strengthening of spirit and a willingness to share vicariously in the sufferings of Christ through the sufferings of illness, and possibly death, for the sake of others.

Let us begin with healing and a startling contention: Even though the name of the sacrament is the sacrament of the anointing of the sick, no official Church document, not even the new Catechism of the Catholic Church, mentions healing as one of the effects of this sacrament! Perhaps the name change, first introduced in Vatican II's Constitution on the Sacred Liturgy, is partially responsible for a concomitant expectation for healing, but this certainly was not the Council's intent. "'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 any one of the faithful begins to be in danger of death from sickness or old age, the appropriate time for him to receive this sacrament has certainly already arrived." Therefore, the reason for the name change was not to imply healing but to produce the effects of the sacrament while the sick person could profit from them. Over the centuries of the middle ages the practice arose of waiting until death was imminent before the priest was called; this practice continued until Vatican II. However, most patients on their last day of earthly life are too sick or unconscious to profit fully from the sacrament. The name change was to facilitate the moving back of the sacrament in time to that moment when the patient first realized that death might result from the illness. As we will discuss later, it is getting harder and harder for patients in hospital settings to realize this.

Notice in the Vatican II quotation above that danger of death is a condition for the administration of the sacrament. This cannot be over emphasized. All of the Church's instructions concerning the administration of the sacrament make it clear that serious illness is a prerequisite. The Latin word used for "serious" is "periculose" which means "dangerously." The context is clearly death. I disagree with the editorial footnote in Pastoral Care of the Sick : Rites of Anointing and Viaticum which states that "serious" may include anyone whose health is seriously impaired. However, an argument can be made that serious disability qualifies one for the sacrament on the grounds of need for spiritual strengthening. Certainly anesthesia by itself cannot be considered to be a part of serious illness, although in many Catholic hospitals all surgery patients are routinely anointed. Limiting the field of eligibility to those who are seriously sick would bring pastoral practice more in line with pastoral theology and the mind of the Church. It would also alleviate to some extent the difficulty more and more pastoral care departments without staff priest chaplains are experiencing, i.e., getting priests from outside to administer the sacrament.

"Danger of death from . . . old age" needs some explication. Does being seventy of itself qualify one for the sacrament? I don't think so-there are seventy-year-olds and there are seventy-year-olds. It all depends on one's general health and, more importantly, on one's mental attitude toward death and dying. If one is seventy, is somewhat frail and/or has a fear of dying, then the sacrament is appropriate. The practice of anointing all the Catholic residents of a nursing home is, in my opinion, a pro forma unwarranted practice.

Back to healing. The very practice of the Church of not conferring the sacrament on infants under the age of reason is proof that healing is not an ordinarily expected result of the sacrament. If healing were one of the principal goals of the sacrament, what could possibly be a reason for denying the sacrament to a five-year-old with terminal cancer? The practice of anointing only those who are seriously ill is also an argument against healing-it would be much easier to heal a minor illness than a serious illness. I recently read in a diocesan paper a strange answer to a question about the anointing of infants. The columnist admitted that the Church does not anoint infants, but he suggested that the parents should be anointed because of the mental turmoil they were undergoing because of their child's illness-so much for the criterion of serious illness.

Current expectations of healing in the context of the sacrament of anointing may be due in part to Francis MacNutt's book, Healing, which appeared in 1974, the year the sacrament was revised. This enormously popular book encouraged belief in the sacrament's power to heal and was widely read even by many non-charismatics. No doubt, the charismatic renewal and its emphasis on healing is also a factor. Having worked in the charismatic renewal, especially in a ministry of inner healing for over ten years, I am not in a position to deny that divine healing takes place. But it must be remembered that ministerial healing in charismatic circles is always thought to be the result of the operation of charismatic gifts in the minister-it doesn't come from the ex opere operato world of the Catholic sacramental system. Physical healing is miraculous or borders on the miraculous. How can one expect it to happen every time a sacrament is celebrated in the institutional Church?

The effect of anointing on sin is also startlingly missing from the Catechism's list of effects. The effect was of prime importance in the theology of St. Thomas and others right up to the revision of 1974. St. Thomas argued with Franciscan theologians over whether the primary effect of the sacrament was the forgiveness of venial sins or the removal of the remnants of sin-St. Thomas argued for the latter (ST, Suppl, q30, a1).

Given the present popular disregard of the sacrament of reconciliation, even in its relationship to mortal sin, it is no surprise that the sacrament of anointing of the sick would be discounted as an antidote for sin-if sin is a problem, the sacrament of reconciliation is more than adequate to deal with it. What does come as a surprise is that the Catechism makes no reference to the Thomistic teaching that the sacrament has the ability to remove mortal sin obliquely, as in the case of one who is not conscious of being in the state of mortal sin or even in the case of one who is unconscious (ibid.). St. Thomas also attributed this oblique power to other sacraments of the living, namely, confirmation and Eucharist (ibid., q72, a7; q79, a3).

This teaching of St. Thomas explains why Catholics of my generation and older are often so anxious to have anointing conferred on their unconscious (or even dead) relatives. However, if the present avoidance of the sacrament of reconciliation continues and Catholics more and more seek reconciliation with God extra-sacramentally, the mortal sin forgiving ability of anointing will be less valued in the future.

This leaves us with only two possible effects of anointing. The first is that anointing strengthens the soul of one who is seriously ill, i.e., one who is dying or in danger of dying. This effect of the sacrament was treated at length by the Council of Trent and is, to my mind, still the most important effect of the sacrament.

When one is seriously ill it is so easy to fall prey to negative thoughts-sometimes temptations, to disbelieve in God's goodness, his personal love, his forgiveness and his promise of eternal life. What a comfort the grace of this sacrament can be to one who is discouraged , fearful and possibly in pain. The anointing is meant to be preceded by the sacrament of reconciliation, if needs be, but currently hardly anyone asks for it.

Although strengthening is an ex opere operato effect of the sacrament of anointing, the prayer of the priest is important here. He should give vocal and generous attention to this effect as the sacrament is conferred since, as with all of the sacraments, grace is given according to the dispositions and desire of the one receiving. The priest's vocal prayer should enkindle a great desire for that peace from God which "surpasses all understanding." I think that strengthening is the effect that is addressed in James 5:15: ". . . the prayer of faith will save the sick person, and the Lord will raise him up."

The last effect, a generous willingness to participate in the sufferings of Christ, is also of great importance, but not yet being a part of the ordinary thinking of Catholics, there is a great need for catechesis in its regard. This idea is not new to Catholic mystical tradition, but it is new to the theology of this sacrament. It comes from Vatican II's Dogmatic Constitution on the Church. "By the sacred anointing of the sick and the prayer of her priests, the whole Church commends those who are ill to the suffering and glorified Lord, asking that He may lighten their suffering and save them (cf. Jas. 5:14-16). She exhorts them, moreover, to contribute to the welfare of the whole People of God by associating themselves freely with the passion and death of Christ (cf. . . . Col. 1:24 . . . )." The latter reference can't be improved: "Now, I rejoice in my sufferings for your sake, and in my flesh I am filling up what is lacking in the afflictions of Christ on behalf of his body, which is the Church." The idea here is that our patient acceptance of suffering can by grace be united to the sufferings of Christ to win salvation and grace for others. Over the years, in my work in the ministry of inner healing and intercessory prayer, I've come to the belief that our own suffering plays the greatest role in our prayer for others. Valuable catechesis can be given by the priest if he incorporates the idea of vicarious redemptive suffering in the vocal prayers he says as he administers the sacrament.

In summary we find that strengthening of soul and willing co-suffering with Christ are the most important effects of anointing of the sick. This does not mean that we shouldn't pray for healing-in fact, when one encounters a sick person it is next to impossible not to offer a prayer for healing. The anointing rite itself includes prayers for healing. The litany of intercessions (which may be adapted or shortened) includes a final healing prayer: "Give life and health to our brother/sister N. on whom we lay our hands in your name." Also, five of the seven concluding prayers (from which the priest picks one) include petitions for healing. However, it is one thing to pray for healing within the sacramental rite and another to base the need for the sacrament on the need for healing or to expect healing to follow from the sacrament itself. When chaplains encounter Catholic patients who are in need of healing but not seriously ill, instead of asking if they would like anointing, they should ask if prayer for healing is desired. When chaplains routinely encounter Catholic patients about to undergo not-so-serious surgery, rather than succumbing to the temptation of wholesale anointing, they should offer to say a prayer and/or to give a blessing for a successful surgery and rapid recovery.

It is true that "sacraments are made for human beings," but this does not mean that we are free to change the reality of the sacrament. I stand in awe at the Church's skeptical posture with regard to new ideas. The recurring idea that the sacrament heals has been around for 20 years, yet we find no mention of it in any Church documents. "Seeing is believing" sounds cynical, but it must be a necessary slogan for any institution that has been around for two thousand years-the Church included.

If the sacrament of anointing is only for those who are dying or those who are seriously ill (in danger of dying), then all the members of the healthcare team in the future will have to be much more honest with patients concerning their mortality. Only recently a husband of a dying patient asked me not to see his wife because he thought that my presence would scare her (see accompanying photo). I also know of chaplains who refer to anointing as a blessing rather than a sacrament so as not to upset patients. Recently I encountered a patient whose doctor told her that she had metastatic bone cancer-I had to persuade her that she qualified for the anointing for the sick. The above illustration is ironic in the extreme. If we succeed in shielding patients from their mortality, we eliminate the primary need for anointing them-strengthening them in the face of death. n