Who should be anointed?

The sacrament of the sick is an important part of priestly ministry, which means the question of who should be anointed is not merely theoretical — every so often every priest is confronted with a situation where he has to make a judgement call “to anoint, or not to anoint”. The usual conclusion is to anoint, simply because there isn’t enough time to do a complete theological-pastoral-medical analysis on the spot. While I am comfortable with the idea of having to make these kind of judgement calls — after all, the Lord gave each of us a brain for a reason — I do think that there is a subsequent responsibility to reflect on what just happened, to see if the judgement call was the right one. These kinds of decisions need to be made as a “function of something,” and that is where theological reflection comes in.

Let’s start with the easy stuff. To receive this sacrament there are at least 3 conditions that have to be met:

1. You have to be alive. This one sounds obvious, but often enough a priest gets called to administer the sacrament even after a person has died. Sacraments, however, are meant for the living, not the dead. It is possible to administer the sacrament conditionally if death has seemingly just occurred and we are not 100% sure if the person is alive or dead, but if it is clear that the person has died then the sacrament makes no sense. It’s the sacrament of the *sick*, not the sacrament of the dead.
2. You have to be baptised. Every sacrament, apart from baptism, is meant to involve a renewal and strengthening of the grace received at baptism. If a person hasn’t actually been baptised (whether in the Catholic Church or another Christian denomination that has valid baptism) then the sacrament makes little sense. In such cases I would most certainly pray with the sick person for healing and strength, and I would even offer them a blessing if they wished, but to offer the sacrament of the sick in such cases would go contrary to the truth of the sacrament itself.
3. You have to be sick. Again, this one sounds obvious, but again priests often enough encounter people who want the sacrament who are not, in fact, sick. A few times I’ve visited the hospital to anoint someone and the relatives nearby wanted the anointing as well, just out of solidarity with the sick person. I’ve also had people come for the anointing in order to receive the forgiveness of sins — partly because they didn’t want to go to confession! But while a person needs to be sick to be anointed, how sick do you have to be?

Prior to Vatican II the Anointing of the Sick was called Extreme Unction, and it was administered to those who were dying. There was actually a bias in some cases to administering the sacrament in the very last hours (or even minutes) of someone’s life, which gives rise to the image of the priest being called to the bedside of the sick person to administer the “last rites”.

Vatican II addressed this situation as follows:

“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 fitting time for him to receive this sacrament has certainly already arrived. (Sacrosanctum Concilium, no. 73)

The phrase “in danger of death” would mean that the sickness in question does not, in fact, need to be actually deadly, but that it would be if it continues its natural course. For example, a person can have an operable but cancerous tumour. If the tumour were allowed to continue to grow according to its natural inclination, the person would eventually die from cancer. In my estimation this makes the person a candidate for the anointing even though the person is soon scheduled for an operation to have the tumour removed.

What is particularly interesting about the passage from Sacrosanctum Concilium is the inclusion of old age as a reason for the anointing. You see, old age is not a disease! No one actually dies of “old age”. With time, however, age brings a certain frailty which makes it harder to heal and to fight off infections. It is this frailty that is the real question — there is no “magic birthday” after which a person can start to receive the anointing. Theoretically a person could be much younger, but if they are experiencing a frailty which parallels the frailty of old age they could very well be anointed as well.

When the ritual book for the pastoral care of the sick was issued in 1972, it added a couple of circumstances for possible anointing. One was prior to surgery, which is also interesting because, while surgery can be a dangerous time, the person has not actually gone under the knife yet…so what, exactly, are they receiving the anointing for? The underlying disease? But if so, why have a special prayer for cases of surgery?

The second circumstance that the ritual added was for “certain serious mental illnesses”. This is also very interesting, because the ritual leaves these illnesses undefined. To be sure there are mental illnesses which have a physical component — caused by chemical imbalances in the brain, for example — but what about illnesses that are purely psychological in origin?

Finally, when the ritual was translated into English, the Latin phrase “dangerously ill” (used to refer to how sick one needed to be) was translated as “seriously ill”, with a special footnote added to indicate that this was a purposeful choice ADD REASONS. This opens up the question of “anointable illness” to a whole new level. What if someone has a chronic but non-fatal illness, such as arthritis? What if a person is born with a severe but non-fatal genetic disorder, such as Down’s Syndrome? What if a person suffers from not a disease but from a handicap, such as loss of an eye in an accident?

The Council of Trent declared that “This sacrament should be given only to the sick of whose death there is fear.” (Decree for the Armenians, 1439). Vatican II never really went beyond this, simply reminding us that we can anoint at the start of that reasonable fear, not just at the end of it. It is possible that the translators of the ritual book are leading the Church in an authentic development of doctrine, but this is difficult to say. Without a doubt, however, the prevailing theological movement has been to expand the use of the sacrament. The real question is whether or not such a move is legitimate — and to be honest, I am not sure.

It seems to me that what is at stake here is our understanding of the place of sickness (and of health!) in God’s plan. How are we live our part in that spiritual drama? My experience of the prayers for healing of the Charismatic Renewal has led me to believe that, if nothing else, we need more prayers for healing as part of our devotional life. I suspect part of the pressure to place so much on the sacrament of Anointing comes from a lack sources of confident non-sacramental prayer for healing — we seem to have little confidence in our own prayer, so we turn to something “ex opere operato” in the hopes that healing can happen. My pastoral contribution to the theological debate, therefore, is to encourage prayers for healing in its many forms — perhaps by placing the sacrament of the anointing in a wider context of devotions and sacramentals, we can truly discern its proper place.