The Church needs to clarify the administration of the sacrament of the anointing of the sick for a number of reasons.
In 1974, when I was a deacon in Texas, a priest from Fort Worth came to Holy Trinity Seminary in Dallas to speak to the deacon class about ministry to the sick and dying. I remember only one thing he told us that day, because it indicated to me that the administration of the sacrament of the anointing of the sick was in some quarters going amuck. This was only a few years after Pope Paul VI’s promulgation of the apostolic constitution revising the Pastoral Care of the Sick and how this sacrament was to be administered. Because we had read this document prior to this talk, it struck me as quite an abuse when the priest stated that he had established the practice of administering this sacrament to all who reached the age of fifty-five.
At first I thought it was a joke, but it turned out that he was quite serious. When someone asked him how this practice was justified by the norms of the Holy See, he simply shrugged it off and told us that the theology of the sacrament had evolved, and was no longer restricted to any particular degree of sickness. Additionally, he said that he thought fifty-five was the proper time for its administration due to “old age.”
“But why fifty-five?” I asked. He simply replied that because a lot of people retire by that age, administration of the sacrament is appropriate. I guessed that if the speaker could propose this bit of illogic, and gross misreading of the norms, at this fairly conservative seminary, abuses of the sacrament were likely much broader in the rest of the country. Over the years, my suspicion has proven to be an unfortunate fact.
While I personally have not encountered this particular abuse again, I have witnessed a number of other quite common practices that are also difficult to square with the norms in Pope Paul VI’s Sacram Unctionem Infirmorum (On the Sacrament of the Anointing of the Sick) and the subsequent Ordo regarding Pastoral Care of the Sick (PCS).
For instance, there is the abuse of so-called healing liturgies in which anyone in attendance who is ill may receive the sacrament of the anointing of the sick without qualification. There is often no requirement stated that the illness must be serious in the objective sense proposed in the Ordo, and regardless, there would be no way of checking even if that norm were stated. Anyone can be anointed whether they have a terminal illness, chronic back pain, or headache. The norms are, in any meaningful sense, simply by-passed.
Then, there is the abuse where the priest simply anoints all the Catholics in a hospital or in a nursing home, regardless of their medical condition. I once had a pastor who went to the local nursing home every thirty days and anointed all the Catholics. He told me that it saved him from getting up and anointing the dying since they had already been anointed within the past thirty days, a norm which I could not locate in any place but his own mind.
Following Vatican II, the significance of the change in the name of the sacrament, and the timing of its administration, was drilled into the thinking of seminarians and priests alike. It was no longer called “extreme unction” (the sacrament for the dying), and it was now to be administered as soon as possible in any serious illness. Thus, the sacrament was, practically speaking, reduced to anointing the sick, and it became the “sacrament of the anointing of the sick.” In reality, the norms were very clear that in the phrase, “the sick,” is meant the seriously ill, or those whose health is seriously impaired due to old age. (PCS §9) Unfortunately, the USCCB decided to add their own little footnote to this number 9, which argues that periculose, in the original Latin text, must be translated as “seriously,” rather than “gravely,” “dangerously,” or “perilously.” Then it simply states without any further qualification that the sacrament “should be given to anyone whose health is seriously impaired.”
Obviously, the good intention of the note is to assure that the sacrament is not reserved until the imminent death of the sick person, which would effectively undo the revision of the rite. But still, there is no indication as to how one is to determine, in some objective sense, what constitutes “seriously impaired” in matters of health. The pastor I mentioned made his own determination—you were seriously impaired if you reached age fifty-five!
There is, in fact, a clarification of this rather ambiguous phrase, found in Sacram Unctionem Infirmorum itself, which calls for the administration of this sacrament prior to the “point of death.” It states clearly, “Hence, as soon as anyone of the faithful begins to be in danger of death 1 from sickness or old age, the fitting time for that person to receive the sacrament has certainly already arrived. 2
Thus the “danger of death” situation is what makes the illness periculose, regardless of how you translate that term. Obviously, this does not mean immediately or imminently in danger of death, or else the whole idea of not waiting until the “point of death” would be undone. Rather, it means that this illness must be of the nature that it could lead to a terminal situation for that person, such that it honestly raises the specter of death by its very nature. It is the kind of illness that can kill, even if it doesn’t always do so, and it can shake the faith of the patient.
Consequently, a knee injury or broken arm, a cold, or even the flu would not normally be the kinds of health problems the Church has in mind. The former two would not be considered illnesses in the sense of the document, as we shall see a bit further on. A cold or the flu would be considered illnesses, but not life-threatening, unless they evolved into pneumonia or a serious infection threatening the immune system. The serious sickness needs to be a true physical or even grave mental condition (PCS §53) that could lead to death.
But the critical issue here is really that this sacrament, like all the sacraments, has a specifically spiritual purpose that is spelled out nicely in both documents. In Sacram Unctionem Infirmorum, Paul VI details the spiritual purpose and effects of this sacrament by stating that the spiritual reality signified by “the anointing” is the grace of the Holy Spirit, who is “the anointing” in the deepest sense. He first mentions the power of this sacramental anointing to “take away sins…and the remnants of sin.” But then he goes on to link this sacrament to the condition of grave illness:
This anointing also raises up and strengthens the soul of the sick person, arousing a great confidence in the divine mercy; thus sustained, the sick person may more easily bear the trials and hardships of sickness, more easily resist the temptations of the devil ‘lying in wait for his heel’ (Gen. 3:15), and sometimes regain bodily health, if this is expedient for the health of the soul.
The context for this spiritual “medicine” should be clear. The fact that the sacrament is intended to provide “great confidence in the divine mercy” and help to “bear the trials and hardships of sickness” suggests one is dealing with a truly grave illness that at least potentially could lead to death, even if death does not occur. Thus the document first mentions giving this sacrament to the dying, setting its true context, and only then states that it should be given at the outset of the condition of the serious illness that could lead to death. Seriously ill people do not wait until death is imminent to become afraid, or suffer doubts and temptations. The outset of the illness is the time to begin what could well be a series of anointings, the final being extreme unction.
However, does one really need to be strengthened with “great confidence in the divine mercy” if one is not facing death from this health problem, at least potentially? Does one really need a special infusion of grace to bear the kinds of “trials and hardships” that are connected to a rotator cuff problem or bad knee problem? Does the devil have a special opening to tempt us if we have a sprained ankle or a bad cold?
As St. Thomas says, “the sacraments are spiritual remedies for the healing of wounds inflicted by sin.” 3 This sacrament, like all the others, then, is a remedy for sin, and the consequences of sin, through the spiritual gifts, graces, and virtues that are communicated through this sacred sign. The wounds they “heal” would not have existed in the state of “original rectitude” but we sinners very much need them to live a “spiritual” life. Two of the wounds caused by original sin are suffering, from disease and the breakdown of the body’s vital organs, and, of course, death itself. These wounds affecting man’s body are, not surprisingly, quite capable of impairing the spiritual health of the soul. When suffering intensely from some disease, mental or physical, or when fearing such suffering before it happens, it becomes most difficult to maintain, let alone grow in, one’s prayer life, patience, and other like virtues, including faith, hope, and charity. Moreover, it is not surprising that the Evil One would take advantage of this seriously weakened condition to undermine our whole relation to God and neighbor.
Now it is clear that St. Thomas himself definitely held that this sacrament was intended as “the last remedy that the Church can give, since it is an immediate preparation for glory.” Moreover, neither the Council of Trent 4 nor Vatican II, in any way denied this ultimate purpose. Instead, they had a broader vision of the sacrament as intending to accomplish the spiritual healing from the beginning of the serious health problem, regardless of whether it actually ended in death. St. Thomas himself, in fact, provides a most helpful insight into this rationale of the councils for expanding the application of this great sacrament. In Question 30 of the Supplement to Part III, he says that this sacrament is a remedy:
…for such defects as weaken man spiritually, so as to deprive him of perfect vigor for acts of the life of grace or of glory; which defects consist in nothing else but a certain weakness and unfitness, the result in us of actual or original sin, against which weakness man is strengthened by this sacrament. 5
Thomas pinpoints the object to be healed as the defects in the soul, magnified by the great suffering, or fear of death, as a kind of catalyst, which deprive the sick person of “perfect vigor of the life of grace or of glory.” Notice the “or” between the “life of grace” or “life of glory.” His rule, following the practice of his day, was to limit the reception of this sacrament to being “an immediate preparation for glory.” 6 But the logic of his explanation leaves it open to a wider application, since the whole course of serious illness is clearly subject to the defects that deprive one of the full vigor of the life of grace. That is why Trent was careful in speaking about the circumstances that called for this sacrament to be administered:
It is also declared, that this unction is to be applied to the sick, but to those especially who lie in such danger as to seem to be about to depart this life: whence also it is called the sacrament of the departing. Session XIV, Ch. 3.
The words, “to those especially” (who are dying), indicates that the sacrament could also be given to the sick. The rest of the text makes it clear that Trent is speaking about the gravely ill. The council declares that this sacrament is the completion of the sacrament of penance, and was so regarded by the Fathers. It then states that “the whole Christian life…ought to be a perpetual penance.” Suffering during the illness certainly is a form of penance for sins.
In the event, it makes theological and pastoral sense to administer this sacrament at the beginning of grave illness, when the fear of death is quite natural, and when one anticipates or is already undergoing significant suffering. That was the decision of Vatican II, which restored the broader application of the early Church. But it does not make theological sense to apply this spiritual remedy for a grave impediment to the “vigor for acts of the life of grace” to less than truly serious illness, or the seriously weakened aged. Both of these situations place the person in a true, if remote, possibility of death due to the illness, or a true, immediate possibility of death in the case of the aged. How does one know if there is a remote possibility that this person will succumb to this illness? One asks the doctor.
Finally, there is this most widespread abuse of anointing everyone who is undergoing anesthesia during an operation. The truth is that one is far more likely to be in danger of death whenever one uses an automobile than when anesthesia is administered. The real point is that this sacrament’s objective is to treat internal spiritual defects as shown in the natural effects and accompaniments of serious illness, and in the weakened state of the elderly. Both these catalysts are the remains or effects of sin. Additionally, this sacrament’s objective is to treat spiritual conditions that already exist, here and now, due to organic causes that also exist, here and now.
Although anesthesia and automobiles may cause death, they are not the consequences of sin, nor do they have a natural relation to one’s spiritual powers. On the other hand, grave illnesses of the body or mind obviously do. Moreover, the threat from anesthesia is a future event that may cause, in extremely rare cases, a complication that threatens death. If a priest were standing by, he would be quite right in administering the sacrament in that situation, even if the operation were for an ingrown toenail. But one does not administer this sacrament in case a future condition might arise from the medicine, otherwise the sacrament should be administered whenever we take any other medicine. Many can kill us if the complications become severe due to a bad mix—that is why we have all those warnings on the bottles. But future contingencies in the area of health are not the object of this sacrament.
In point of fact, the Pastoral Care of the Sick has a provision for anointing before surgery which is quite specific: “A sick person may be anointed before surgery whenever a serious illness is the reason for the surgery.” (§ 10). Notice that it says nothing about anesthesia when it gives the reason for the anointing because anesthesia almost always helps to alleviate the pain involved in surgical procedures. It specifies only “whenever a serious illness is the reason for the surgery.” A knee replacement is not a serious illness, as understood either by medicine or by the Church, when dealing with illness in this context. Nevertheless, both medicine and common sense tell us that surgery on the seriously ill always presents complications, is often riskier for the elderly, and whether young or old, tends to weaken the person at least temporarily.
The Church needs to clarify the administration of the sacrament of the anointing of the sick for a number of reasons. First, the validity of the sacrament is certainly in question when the element of serious illness is absent. Second, the practice of anointing where the necessary conditions are absent can easily lead to greater fear of death when, in fact, it is most unlikely. If I were a doctor, I would pray that Catholic priests would stop instilling a fear of anesthesia, and even minor surgery, in their people. Third, the failure to differentiate between grave illness, and minor illness, or simply the normal effects of aging (remember the priest who anointed all who reached age fifty-five) can lead to a false understanding of this sacrament and, paradoxically, to the eventual loss of the true purpose of the sacrament. More people today go to healing Masses, I suspect, than call for the priest when they are dying. Others show a definite tendency to look for, and even desire, a physical cure from the sacrament, a possibility to be sure, but rare indeed, compared to the spiritual effects of this sacrament. At one time, the sacrament was limited to imminent death, but today it seems to be asked for more often because of a fear of death alone. Maybe that is why fewer people call for the priest for the anointing at the death of a loved one; they figure they are probably no longer in a conscious condition to be afraid, and that is what they think the sacrament is really all about.
When people are suffering from a minor illness and are afraid of dying, or they are having some minor surgery and are afraid of the anesthesia killing them, they need some compassionate medical and spiritual counseling to help them overcome their inordinate fear of death, not the sacrament for the seriously ill. We surely do not want to contribute to the growing, almost neurotic, fear of death in our society.
- Interestingly, the noun form of periculose is used right here in connection with the phrase “danger of death”: “incipit esse in periculo mortis propter infirmitatem uel senium…. ”One wonders why it then cannot be translated “dangerously” rather than, “seriously.” ↩
- Footnote to Vatican II, Constitution on the Liturgy §73. ↩
- Summa, P. III, Q. 61, Art. 2, sed contra. ↩
- Trent, Session XIV, Extreme Unction. ↩
- In the same passage, St. Thomas states that while it is not, like Baptism or Penance an antidote for Mortal or Original Sin, in order that this healing grace may be conferred, it will remove even Mortal Sin if there is no obstacle to that absolving on the part of the recipient. ↩
- Supplement, Q. 32, Art. 2, answer. ↩