Wednesday, July 13, 2011

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]

21 comments:

ellen said...

Thank you for these valuable articles. Might I suggest for anyone undergoing a c-section that the most important thing is to make sure that there is someone who could perform an emergency baptism? When I had my first c-section over 40 years ago, most Catholic doctors and nurses were able and willing to baptize in an emergency. This was not the case for my last c-section 19 years ago and it is probably worse now, so try to have a relative close to the theatre and arrange that the person be able to have access to the baby. Do not rely on the hospital chaplain. Someone I know asked for the hospital chaplain to baptize a very sick baby and he just said some prayers. Fortunately, my son was present and he performed an emergency baptism. When I was a child I was taught that the main reason for Extreme Unction was that the person in danger of death was weak and fragile due to old age or illness and that is the time that the devil mounts his greatest assault on the soul. That is why we ask Our Lady to "pray for us now AND AT THE HOUR OF OUR DEATH". Of course, "hour of our death" is not literally the last hour, but rather the time of our death. I am 67 years of age and still in good health, thanks be to God. However, as I get older I will try to judge particularly my spiritual health so that I will know when I should receive the Sacrament of the Sick.

Reginaldus said...

ellen,
Very good! Thanks for pointing out the need to have someone who can do an emergency baptism!

Also, regarding the final line of your comment ... "I will try to judge particularly my spiritual health" -- remember, the question is not "am I spiritually in need of this sacrament" (if you have ever committed a sin, the sacrament is for you); the question is, "Am I feeble? Am I in danger of death due to illness or old age? Is my health seriously impaired?"
In other words: It is more about your physical health than your spiritual health.

Peace to you! +

Anonymous said...

What you have written here is what I was taught as a child and grew up believing. It wasn't until the past ten years or so when the pastor we had at the time started to have communal annointings of the sick during Mass that I began to question if what I had always thought is correct.

Thank you, Father, for clearing it up.

Veronica

Anonymous said...

Veronica's comment brought up a question.

Can there be anointings by a priest that are not the same as administering the sacrament of the sick? Could this be what the communal anointings have been but have been misunderstood by the laity to be the same as the sacrament?

I am also confused by what you said about Viaticum being the sacrament of the dying. Is the Eucharist received at the time of the Sacrament of the Sick not always considered Viaticum?

momor

Reginaldus said...

momor,
While there are certainly different "anointings" beyond the sacrament of Anointing, what Veronica mentions is (quite sadly) common practice.
It is not so much a bad thing that there are regularly scheduled Anointing Masses -- where the sacrament is given. What is dad is that the sacrament is often given indiscriminantly and without any proper catechesis so that many who are not seriously ill (or who have been recently anointed and have not become significantly more ill) receive the sacrament.

In any case, the practice of anointing prayers (i.e. anointing with oil which is not the sacrament of anointing) often brings much confusion to the faithful -- hence, we probably should be cautious about these.
Also, non-sacramental "anointings" should NEVER be given during the Mass.

Peace! +

Reginaldus said...

Momor,
Regarding Viaticum ...
This is a specific rite which includes quite a bit more than simply the regular "communion for the sick".
Now, I suppose that the last time a person receives communion, that is their Viaticum (by default) ... and this might happen to be accompanied by Anointing as well.
However, ordinarily, the reception of communion with the Anointing is not the rite of Viaticum itself.

I hope that's clear! +

RC said...

If an operation involves a significant risk of death, isn't it reasonable to figure that it is being undertaken due to a life-threatening illness? Otherwise undertaking the operation wouldn't be rational. Or am I missing something?

Thanks for your very helpful writings!

Reginaldus said...

RC,
Certainly, if the surgery is truly serious, then it is probably being done for a serious illness ... still, it is good to know that Anointing is done for the illness and not for the surgery.

However, many people think that any surgery -- even for removing tonsils or wisdom teeth -- is "serious" surgery. Of course, this surgery is not really that "serious" ... even though there may be some very slight risk of death.
Obviously, it would be rare that such would qualify for Anointing -- because there is no serious illness present.

As a priest immersed in parish ministry, I can testify that there is great confusion on this point and that many people are asking for Anointing [and a good number of priests are giving it] in situations where this is not really the appropriate sacrament.

Peace to you! +

Militia Immaculata said...

Question -- about 7 years ago I was in a really bad car accident. Praise God, the only injuries I had were a few scratches, bruises, and burns from the airbag. However, I knew there were some types of injuries that don't cause any pain but can kill you nevertheless (this was even before Natasha Richardson's skiing accident), and the paramedics apparently feared that possibility too, as they insisted on having me transported by helicopter. So I asked for a priest, who came to the emergency room and heard my confession, anointed me, and gave me Holy Communion. I mean, I knew that just because I didn't really FEEL hurt didn't mean I wasn't, so I wanted to "cover all my bases." Fortunately, I ended up being released from the hospital that evening. At any rate, was I wrong to ask for anointing and whatnot after my accident?

Reginaldus said...

Militia,
You did very well!
In a case of doubt, you consulted with medical personnel -- they obviously felt that the condition was serious, since they had you transported in a helicopter.
Whenever there is a real doubt (after consulting with a doctor and, of course, a priest), Anointing should be given.

Peace to you! +

Anonymous said...

The Ukrainian Greek Catholic Church gives the Mystery of Anointing to all during the Great Wednesday service before Easter.

Would not the fact that even one of the Catholic Churches does not restrict the Sacrament/Mystery on the basis of physical infirmity or age mean that any restrictions the Latin Church imposes on this sacrament are exclusively juridical and merely disciplinary and not theological or dogmatic?

Reginaldus said...

Anonymous,
First, if you want to have an intelligent discussion, you will have to use at least a pseudonym (as we ask in the comment box just above where you left your anonymous comment).

Second, I would like to see some evidence that this 'practice' of all receiving Anointing of the Sick is truly approved by the Church ... something from Eastern Canon Law would suffice.

There are many many many abuses in the West ... so much so that most Latin Rite Catholics also think that anyone can receive Anointing ... and yet the teaching is the same ... in any case, the ECUMENICAL Council of Trent specifies that Anointing is for physical healing and is given to the sick -- the dogmatic teaching of this Ecumenical Council would extend to the Eastern Rites.

Reginaldus said...

Well, I don't know what is going on in particular churches, but it is clear from the Eastern Code of Canon Law, that the discipline of the Eastern Rites is the same as that of the Latin Church:

------------

Canon 737
1. By the sacramental anointing of the sick with prayers of a priest, the Christian faithful who are gravely ill and sincerely contrite receive grace, by which, strengthened by the hope of eternal reward and absolved from sins, they are disposed to correct their lives and are helped in patiently enduring their infirmity and suffering.


and Canon 738
The Christian faithful freely receive anointing of the sick whenever they are gravely ill; pastors of souls and persons who are close to the sick are to see to it that they are supported by this sacrament at an opportune time.

--------------------

They must be "gravely ill" and "sincerely contrite" ... hence, they must BOTH be physically sick and spiritually sick (i.e. have committed at least some venial sin for which they are sincerely contrite).

Anonymous said...

Apologies for missing the requirement to sign posts.

I will draw your attention to the CCEO 737 section 2, which is "In the Churches in which it is the custom that the sacrament of anointing of the sick be administered by several priests, it should be seen to inasmuch as it is possible that this custom is preserved."

This refers at least to the Great Wednesday unction liturgy, as well as in some Sui Iuris Churches to unction liturgies after every fast, where ideally seven priests perform the service where seven epistles, seven Gospels, and seven prayers are sung and then every person present who is preparing for Easter is offered Sacramental Anointing by all seven priests. You are correct that in general practice, Anointing is reserved for physical infirmity and so forth as found in the canons, but on Great Wednesday and possibly at the end of other fasts, the universal custom (“Lex orandi, lex credendi,” after all), which the most august Second Vatican Ecumenical Council in Orientalium Ecclesiarum tells us to preserve, tells us to Anoint all who desire physical and spiritual healing as described by the form for the prayers of Anointing.

-Chris

Reginaldus said...

Chris,
Again, I don't know what is going on in particular circumstances ... but the CCOE is quite clear (as is the rite of Anointing itself, in the East),
The sacrament is for those who are "gravely ill and sincerely contrite" (CCOE 737) and individuals may receive Anointing "whenever they are gravely ill" (CCOE 738).

The words for Anointing in the Eastern form refer explicitly to the need for physical healing ...

Any practice of general Anointing (as a true sacrament) seems to be contrary to the CCOE, and it is most definitely contrary to the tradition of the Church ...
Again, I'm not sure what is happening in the situation to which you refer ... perhaps it is not the Sacrament of Anointing? Perhaps there is something else? Perhaps it is an abuse that has cropped up?

What I do know is that, in East and West, the Sacrament of Anointing of the Sick is reserved to those only who are "gravely ill" and who have attained the use of reason (i.e. who have sinned and are sorry for their sins).

[your problem is with your own Code of Canon Law (which is very clear), not with my post]

LR said...

I hope it's not too late to ask a question here, this is a topic I've never been very clear about. My question, Father, is this: what about chronic serious, life threatening conditions? For example, I've had three totally different cancers, all very serious and all in remission as I write this. If there is a general "healing service" in my parish which includes the Sacrament of the Sick, may I receive the sacrament again? I did receive it for each separate cancer before. Also, my husband suffers from a serious heart condition, which he has had for fifteen years. He was anointed once for that, is the teaching that he cannot be anointed again for the same illness?
Thanks in advance for your reply!
LR

Father Ryan Erlenbush said...

LR,
If the illness gets significantly worse, then it would be good to receive the sacrament again.
If the cancer has not progressed much and your general health is staying the same, then it does not seem like another Anointing would be appropriate.

Likewise, if your husbands heart condition gets worse -- or if his general health gets worse so as to make the heart condition significantly more complicated -- it would be good for him to receive Anointing again ... otherwise not.

The main point is this: Anointing isn't something we just repeat regularly ... it is given specifically when we become seriously ill (i.e. "begin to be in danger of death") or when this serious illness gets significantly worse.

Hope that helps! I will say an extra prayer for you and your husband. +

Anonymous said...

What about chronic illness? And severe anxiety?

ReaderLA said...

There is an Anointing of the Sick service soon to be held at our church. Another website I read said that someone facing surgery requiring anesthesia "qualifies" for being anointed. I have cancer but I feel good (thank God). In about a month's time I will have a surgery that requires anesthesia and *may* have complications, but is a procedure performed regularly by oncologists and I am praying there are no complications. The article above here leads me to think that unless I feel that I am extremely unwell (not the case, thank God), or the surgery will be life-threatening because of feebleness (not the case) that I should reserve the anointing for a time when I am more in need. Is that how I should I think about the upcoming opportunity to have the Anointing - since I don't feel imminently unwell should I pass on the opportunity? Yes, exactly, how sick is sick?

P. K said...

Please can a non baptized Catholic receive anointing of the sick during a church crusade?

Father Ryan Erlenbush said...

PK,
There is no such thing as a "non baptized Catholic" -- one isn't catholic until they have been baptized.
But, no non baptized person can receive anointing or any other sacrament (but baptism).

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