When should I receive Anointing of the Sick? or, How sick is "sick"?

There has been, quite happily, a realization in recent years that the Anointing of the Sick (i.e. Extreme Unction) is a sacrament of the “sick” and not of the “dying”. Last week, we recognized that this sacrament (because it is not for the “dying”) is not appropriate for those who are in serious and even immediate danger of death but are not sick – e.g. for persons about to enter war, those about to be executed, and also those about to undergo “serious” surgery who yet have no serious illness.

What became clear in the comment box of the previous article is that there is no little confusion about what the Church means by “serious sickness” and “the sick”. How sick does one have to be before receiving Anointing? In what circumstances does old age call for the sacrament of Anointing? In other words: How sick is “sick”?

Finally, we must also consider how often the sacrament of Anointing should be repeated.

The nature of sacrament of Anointing of the Sick

As we have already discussed the nature of this sacrament in our previous article, we will simply recap briefly here.

All the sacraments confer grace by means of physical (sacramental) signs. Baptism washes and refreshes the soul by means of the physical washing of the body. The Eucharist feeds the soul by means of a physical feeding of the body. So too, the sacrament of Anointing confers spiritual healing of the soul through the physical healing of the body – we recall that oil has always been understood to have a medicinal purpose.

And, as the waters of baptism do not need to literally “wash” the body and the Eucharist does not need literally to provide significant nutritional value to the body, so too it is of no importance if the oil of Anointing does not actually effect a physical healing. Still, the connection between physical healing and the sacrament of Anointing is strong enough that only those in need of physical healing can receive this sacrament – hence, it is the sacrament of the “sick” and can be received only by those whose health is compromised through either sickness or old age.

How sick? - What the Church teaches

In order to have a well formed belief on this matter, it is necessary that we consider what the Church herself actually teaches. It will not be enough to simply invoke the general opinion of the laity or, sadly, even of the priests – since many are profoundly confused on this point. Moreover, our own personal opinion (and even our own personal experience) matters little in this question. The sacraments are given to the Church by Christ himself, and he has entrusted to her the proper understanding of the use of these sacraments.

“‘Extreme unction,’ which may also and more properly 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 that person to receive this sacrament has certainly already arrived.” (Vatican II, Sacrosanctum Concilium 73)

“The Sacrament of the Anointing of the Sick is given to those who are seriously ill.” (Paul VI, Apostolic Constitution Sacram Unctione Infirmorum, 30 Nov 1972)

“The anointing of the sick can be administered to any member of the faithful who, having reached the use of reason, begins to be in danger of death by reason of illness or old age.” (Canon 1004.1)

“Great care and concern should be taken to see that those of the faithful whose health is seriously (periculose) 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.” (General Introduction to the Roman Ritual, Pastoral Care of the Sick: Rites of Anointing and Viaticum, par. 8)

What is “serious” illness?

First, we must note that the sacrament of the Anointing of the Sick (as we said last week) is for the sick! It is not for those who are about to die due to some cause other than sickness (or old age). Positively, neither is it to be restricted only to those whose sickness has so progressed as to put them in immediate and proximate danger of death. It is the sacrament of the sick, not of the dying – it would do well for us to keep this in mind. [the sacrament of the dying is Viaticum]

Still, the Church is quite clear that Anointing is not simply for anyone who is sick. Rather, Anointing is to be reserved for those only who are “seriously ill” (Sacr. Unct. Inf.) and who have begun to be “in danger of death” (Can 1004). This is not a sacrament for illness which does not threaten life (at least remotely), nor is it a sacrament for those whose sickness is not serious.

The United States edition of General Introduction to the current Roman Ritual for Anointing contains a helpful footnote [this footnote is from the USCCB, not from the Vatican, but the edition was approved by Pope Paul VI] – “The word periculose [i.e. “seriously” ill] has been carefully studied and rendered as ‘seriously,’ rather than as ‘gravely,’ ‘dangerously,’ or ‘perilously.’ Such a rendering will serve to avoid restrictions upon the celebration of the sacrament. On the one hand, the sacrament may and should be given to anyone whose health is seriously impaired; on the other hand, it may not be given indiscriminately or to a person whose health is not seriously impaired.” (Footnote to paragraph 8)

The Church gives us two indications which must be considered when we ask how sick one must be in order to receive the sacrament of Anointing: One the one hand, the individual must have begun to be in danger of death by virtue of the sickness – this would rule out any illness which is not life-threatening (at least remotely) at the time of the Anointing itself. On the other hand, the illness must be “serious;” i.e. it must seriously impair the individual’s health.

On a practical level, we may ask two questions: Is there a real chance that this illness could kill me? And, Is my health seriously impaired by this illness? If the answer to both of these questions is “yes,” then the fitting time to receive this sacrament “has certainly already arrived.” (Sacrosanctum Concilium 73)

“When in doubt, give it out” vs. “When in doubt, check with a doctor”

There is a very popular saying among priests, regarding the administration of Anointing of the Sick: “When in doubt, give it out.” Certainly, there is some truth to this remark. If there is a real doubt as to whether an illness is life-threatening (i.e. whether the person has begun to be in danger of death) or whether the illness is serious, the Church would have us err on the side of administering the sacrament.

However, in order to make an informed decision, it will often be necessary to consult with a doctor – and this is precisely what the Church herself recommends: “If necessary a doctor may be consulted.” (General Introduction to the Rite of Anointing, par. 8) Obviously, in case of an emergency, there will not be time to ask a doctor – however, we also point out that, in such a case, it would not seem that there should be any doubt as to the seriousness of the illness. Thus, if it is a case of true doubt, there will almost always be an opportunity to consult a doctor on the matter (at least in developed nations, where doctors and hospitals are common).

To willingly expose a sacrament to nullity is a serious matter and, if done with knowledge and consent, it is a mortal sin. To administer the sacrament of Anointing of the Sick to a person who is not seriously ill (or suffering from the feebleness of old age) is to expose the sacrament to nullity. While we certainly must avoid scruples, we must also admit that, in many parts of the Church (at least, in the United States), the tendency is toward a rather careless approach. Indeed, the liberality with which the priests of the Church administer the sacraments is to be highly praised, but this liberality must be joined with and guided by reason. It will do NO GOOD to give the sacrament of Anointing to those who are not seriously ill.

Should the elderly receive Anointing of the Sick?

Having come to an understanding of what the Church means by “the sick”, it is clear that many elderly persons should receive the sacrament of Anointing. “Elderly people may be anointed if they have become notably weakened even though no serious illness is present.” (General Introduction to the Rite of Anointing, par. 11) Again, if there is doubt, a doctor should be consulted.

Hence, there is no clear age-limit at which the elderly may be anointed. Rather, we must take a pastoral approach of dealing with each individual on a case-by-case basis. If the elderly person is “notably weakened” and has “begun to be in danger of death,” then the sacrament should be given. If, on the other hand, the elderly person is in generally good health, is not weakened, and is not in any real danger of death (at least, not insofar as can be perceived by doctors), the sacrament should not be given.

Thus, there could be cases were seventy-year-olds ought to receive Anointing, and there are certainly other cases were even ninety-year-olds ought not to receive the sacrament (n.b. the oldest man to finish a marathon was ninety-eight, and the oldest woman was ninety). It is not so much about the age of the individual, but about his health – if he is feeble and in danger of death, the sacrament is to be given. If there is a real doubt about his condition, a doctor should be consulted. So, an elderly person should ask: Am I feeble? Have I become notably weakened? Am I in danger of death? If the answer to these three questions is “yes,” then the time for Anointing has arrived.

How often should Anointing of the Sick be repeated?

Finally – and very briefly – we must consider when and how often the sacrament of Anointing ought to be repeated. Again, we look first to the teaching of the Church:

“This sacrament can be repeated if the sick person, having recovered, again becomes seriously ill or if, in the same illness, the danger becomes more serious.” (Can 1004.2)

 “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.” (General Introduction to the Rite of Anointing, par. 9)

We point out that there can be no hard-and-fast rule as to how often a person may receive Anointing. Certainly, any notion of “once per month” is far too facile, and lacks true pastoral concern. Rather, we must look at each individual case and make a prudent and reasonable judgment.

If the illness has become significantly worse, then Anointing should be given. In the case of a person whose health is significantly compromised by old age, we must consider whether the progress in years (since the last Anointing) has caused an additional and significant loss of health.

On the one hand, we must recall that the sacrament of Anointing can and should be repeated (in this respect, it is more like Confession than Baptism); on the other hand, we add that the sacrament is to be repeated only when the individual’s health has become significantly more seriously impaired - or, when they have recovered and fallen ill a second time.

[obviously, the practice of regularly participating in a monthly Anointing-Mass is far beyond what the Church envisions as a general norm, even for the elderly]