THE ANOINTING OF THE SICK - The National Association of ...



MINISTRY TO THE SICK AND

ANOINTING OF THE SICK:

HISTORY AND REFLECTIONS

by

James Buryska, S.T.L.

(unpublished manuscript)

MINISTRY TO THE SICK AND

ANOINTING OF THE SICK:

HISTORY AND REFLECTIONS

In fifty-plus years of ministry as a Roman Catholic priest I have anointed more people than I can count, under a wide variety of circumstances. To begin near the beginning: indelibly etched in my memory are two back-to-back events, both of which occurred one humid Friday evening in August, long ago when I was a young priest and the Anointing of the Sick was routinely called - by Roman Catholics and many others - “Last Rites,”

The first call came to the rectory in the early evening – about 7:00, as I recall. It was the Head Nurse of the Emergency Room at the local hospital, asking urgently that a priest come to give Last Rites to a young girl who had just been injured in a bicycle accident. Arriving at the Emergency Room a short time later, I learned that the little girl had in fact died in the accident. I spent some time comforting her parents, and anointed her, as they asked me to do. Within a few minutes our conversation was interrupted by the Head Nurse beckoning me to the phone, and it fleetingly occurred to me to wonder, “Who even knows I’m here except the people in this room?” I had forgotten that on my way into Emergency I had practically brushed elbows with a police officer on his way out.

The voice on the phone belonged to a police lieutenant – a parishioner – I knew, and he requested that I come to an address across town to give Last Rites to a gunshot victim. As gently as I could, I took leave of the girl’s parents, also parishioners, as it happened, promising to return if possible. (In the event, I did manage to return and it was a great relief to do so, for reasons that will become clear.) Although the tension in the officer’s voice had been palpable, nothing in our brief exchange prepared me for what I would find at the scene: a middle-aged man who had evidently taken his own life by inserting the barrel of a high-powered rifle into his mouth and then contriving to trip the trigger. I remember swallowing hard and stepping carefully to avoid the blood, bone shards, bits of brain matter, and the solitary eyeball that littered the floor. I cautiously applied the Oil of the Sick to the victim’s chin; it was the only part of his face that looked solid enough to touch. The man had no family and apparently no friends; the “community” consisted of the coroner and investigating officers, who stepped aside for me and then went about their business.

By beginning with these two examples from my early years in ministry, I do not mean to imply that anointing always took place under such dramatic circumstances. The truth is, most of the anointings in which I have participated have been comparatively leisurely and benign, some even celebratory. Nor do I mean to suggest that the whole of the church’s ministry to the sick and dying is encompassed in the sacrament we identify as Anointing of the Sick. In fact, Christianity in general and the Roman Catholic and Eastern Orthodox traditions specifically, have a long tradition of attending in a variety of ways to those who are ill and suffering, taking their example from the life and ministry of Jesus. We will take note of this tradition insofar as it forms the broader basis for sacramental and other specific actions that address the needs of the sick.

On the other hand, certain aspects of the two events described above do reflect a characteristic understanding and practice of Extreme Unction, as we Roman Catholics called it then, notably: the sacrament was associated with death, and was sometimes administered even after death had occurred; its principal purpose was seen as the forgiveness of sins, with no particular expectation of healing other than in a spiritual sense; and there was little place in the ritual for the involvement (except through anxious attentiveness) of anyone other than the priest and the recipient: the sacrament was not “prayed” or “celebrated;” it was “administered.” Each of these features reflects assumptions about the Anointing: its purpose, its meaning, to whom, by whom and the circumstances under which, it is properly offered. And the theological assumptions about Extreme Unction that were in place in the mid-1960’s were only the then-current part of a long and interesting history that was soon to change in several significant ways.

CARE FOR THE SICK AND ANOINTING OF THE SICK: A HISTORICAL OVERVIEW:

From its beginnings Christianity has seen care of the sick and suffering as one of the responsibilities and privileges of the believing community. Although it has taken a variety of forms over the centuries – including the founding of hospitals for the care of those too poor or too dangerously ill to be cared for by their own – the Christian community’s sense of the importance of extending God’s care and healing to the sick, has made this one of the major ministries of the church, transcending sectarian differences and crossing religious boundaries. Thousands of women and men have devoted their lives to it, often by joining religious orders whose principal ministry is care of the sick. Within this larger context, the specific sacramental form that ministry to the sick has taken, is the Anointing of the Sick. This is not to exclude Reconciliation, Communion and other rituals that also sustain those who are ill; but the particular focus of anointing is to pray for healing of body and spirit. For that reason, we will focus most of our attention in this paper on Anointing of the Sick, dealing with other rites more briefly.

The tradition of anointing the sick with oil as a way of praying for healing pre-dates the usage of ancient Christianity; Judaism in Jesus’ time occasionally – not routinely – practiced anointing the sick for healing, and it was apparently this practice from which the first generation of Christian believers drew the inspiration for their own prayer for the sick: the classic passage in the Letter of James (5:14-15) that lays the foundation for subsequent Christian theology and practice, clearly did not emerge fully formed from a vacuum, but rested instead on a foundation that was familiar to the Jewish Christian community to some degree. The Jerusalem Bible’s Introduction to the Letter of James, speaking more generally of the influence of James, puts it this way: “James is a Judeo-Christian sage who has re-thought the maxims of the Jewish Wisdom tradition in the light of his Master’s teachings, and is able to re-present them in an original way.” (Jones, 1966) However, in light of later theological developments that tended to spiritualize the meaning of the sacrament, it seems appropriate at this point to ask, “To what sort of healing does James refer? What did the early Jerusalem Christian community believe about anointing for healing, and what did its members expect when they prayed for healing?”

The phrasing of James 5:15 is, “The prayer of faith will save the sick man and the Lord will raise him up again;” In context the use of the Greek ‘sosei’ for ‘save’ suggests that it is bodily healing that is primarily expected and prayed for (Marthaler, Donohue, & McClain, 2003), not remission of sins, as came to be thought subsequently in the Western church; forgiveness of sins is identified separately and later in the same sentence: “…and if he has committed any sins, he will be forgiven.” In characteristic Hebrew fashion, bodily and spiritual well-being are not separated. In addition, the understanding that bodily healing was being sought, was supported by the healing ministry of Jesus, which provided both example and motivation to his followers. Finally, there is Jesus’ command (Mark 16:18) that his disciples lay hands on the sick, “who will recover.”

There are two other features that offer insight into early Christianity’s practice of anointing the sick: the blessing of the oil to be used for this purpose was seen as an action of the Church, performed by the local bishop; the actual anointing of the sick person was done typically, but not exclusively, by “the elders” of the community, as directed by James. Lay persons also anointed the sick, either in conjunction with anointing by the elders or independently (Marthaler et al., 2003). This practice is documented in a letter of Pope Innocent I as late as the beginning of the Fifth Century. (Harakas, 1990) Both these features underline the understanding that the ministry of healing was a function of the community – a function whose practice was not strictly limited to those ordained. After the power of God, it was the faith of the community that validated the sacrament and gave it power, more so than authority conferred upon any one individual through ordination. In the West this belief was to change in later centuries, as we will see: a development that moved in parallel with other changes in practice and understanding of Baptism, Orders, and the nature of the Church itself.

It is not easy to identify any particular decade or century as the time when the Anointing of the Sick moved away from what is described above. The sweeping changes in Christianity that occurred between the Fourth and the Tenth Centuries are well known, even to the casual reader, and extensively documented. Suffice it to say that the Anointing of the Sick was tossed by the same storms, carried by the same currents and driven in directions similar to those of the other sacraments of the Roman tradition. For our purposes, we will examine the status of the sacrament at the time of the Carolingian reform, which offers a temporary respite, somewhat calmer waters after the constant gales of earlier centuries. By the time of Charlemagne’s Ninth-Century legislation, (and influenced by it) the following can be said about anointing the sick: (Marthaler et al., 2003)

First, a pronounced shift in belief about the purpose and effects of the sacrament had taken place. An earlier faith in the possibility of bodily healing had all but disappeared, replaced by the belief that the ‘healing’ being sought was purely a spiritual one – the forgiveness of sins mentioned in the second half of James 5:15. In view of the fact that life was short, medicine had little to offer, and serious illness or injury quickly and almost inevitably ended in death, such a shift is understandable; praying for something that is likely to happen only rarely, accomplishes nothing except to shake the faith of the believer.

Note that I am not suggesting any cynical, or even conscious, authority-driven motivation for this change in belief about what the effect of the sacrament is supposed to be. Truthfully, in over fifty years of ordained ministry – the last forty of which have been spent in hospital chaplaincy – I have felt the same tension and watched others struggle with it also: what healing are we praying for? The fact that today medicine has much to offer and being healed of even critical illness is a very real possibility – some would say likelihood, or even entitlement – does not change the reality that eventually each of us will succumb to the forces of time, friction and gravity: bodily life as we experience it will end, and this is unlikely to change anytime soon. The contemporary believer in the sickbed or at the bedside still faces the same question as that presented to the Christian believer of the Carolingian era and all eras: When is it time to change our expectations about what healing we are praying for? At what point does our belief in the afterlife motivate us to give over our expectations about continuing this life? In that respect, we find ourselves in the same quandary as did our ancestors of a millennium ago, and able – one would hope – to identify with their situation insofar as it influences our beliefs about the Anointing of the Sick.

In any event, as forgiveness of sins became the sacrament’s principal purpose, the rubrics of how the sacrament was actually administered also changed in step with its new focus; the senses – eyes, ears, nose, mouth, hands and feet – were individually anointed, with a prayer for forgiveness accompanying each anointing: “Through this holy anointing may the Lord forgive you any sins you may have committed by your sense of sight, hearing, etc.” (Marthaler et al., 2003) This is the form of the sacrament – in Latin – with which I became familiar as a newly-ordained priest in the mid-1960’s.

A second change in the practice of Anointing that is discernable by – presumably as an effect of – the Carolingian legislation: the time for administering the sacrament shifted to the deathbed, whereby it came to be known as one of “the last sacraments” along with Penance and Communion (called “Viaticum” when received in anticipation of death). As we consider the times, this change also makes sense. The course of illness was typically short; a person who fell ill in the morning would probably be either recovering or dead by nightfall. Besides, if the purpose of the sacrament is seen as forgiveness of sins, it is sensible to have such forgiveness be conveyed as near the end of life as possible, lest the recipient under the influence of intractable pain give way to despair, or else recover sufficiently to fall into some other sin. (Marthaler et al., 2003)

A Greek Orthodox colleague offered me this related insight about how anointing came to be seen differently in the Eastern and Western churches: in the East the focus of Holy Unction was and remained medicinal, whereas in the West the emphasis became a more legal one – remission of sins. It was this preoccupation with remission of sins that moved the sacrament nearer the deathbed, whereby it became Extreme Unction, part of “Last Rites.” In contrast, in the Eastern churches Holy Unction has never been seen as “Last Rites.”

The third change in how the Anointing of the Sick was administered in Carolingian times, is that the participation of laypersons as ministers of the sacrament had fallen into disuse. One supposes that this came about partly out of ignorance (At a time when even many of the clergy were little educated, lay people were unlikely even to consider such participation, much less know how to perform it.) and partly out of administrative expediency: promulgating and enforcing legislation pertaining to the activities of the clergy would certainly be more manageable than attempting to apply the same laws to the whole populace.

But the most compelling reason why the ministry of anointing came to be restricted to the clergy, was the gradually evolving theology of the priesthood. In the ancient Church the priesthood existed to serve the liturgical, teaching and authority needs of the believing community – in other words, Holy Orders existed for functional reasons. By the Ninth Century a theology was developing – primarily in the Western church – which saw the priesthood as an entity unto itself, not dependent upon any particular function within the community, and having its own privileges and obligations which might, or might not, relate directly to the organic needs of the broader community of believers. (Komonchak, 1978) As part of this development and supporting it, the notion of what came to be called ‘ontological change’ also became prominent – the view that Holy Orders confers an indelible mark and brings about an invisible but essential change in the recipient which makes him different, singling him out even within the community of the baptized. As we consider the change in thinking that saw the purpose of anointing primarily as forgiveness of sins, and couple it with the developing theology of the priesthood as a distinct (and, some believe, superior) caste, it is a small and logical step to restrict the ministry of anointing to those ordained to the priesthood. This line of thinking is reinforced by the (within the Roman Catholic tradition) classic interpretation of Matthew 16:19-20 as conferring the power to forgive sins (“the power of the keys”) on Peter, his companions and their successors – in short, on ordained priests.

To summarize: in the Latin church by Carolingian times, anointing was thought to be primarily for forgiveness of sins rather than for any benefits of bodily healing; it was administered exclusively by priests, not by laypersons; it was given as part of “Last Rites,” in the expectation that death would soon follow. As we view this portrait of the sacrament after eight centuries and contrast it with that of the First Century, we can see that the change is striking indeed.

In succeeding centuries the Carolingian synthesis was expanded and consolidated; Scholastic theologians continued the trend toward an almost exclusively spiritual interpretation of the benefits of the sacrament. This approach remained in force through the high Middle Ages and up to the time of the Protestant Reformation. In fact, a theological opinion that held that Extreme Unction had become defunct and was no longer a true sacrament (presumably because bodily healing so rarely followed) apparently was sufficiently robust that a proposal to that effect was raised for discussion at the Council of Trent in 1551. A second body of opinion held in response that Extreme Unction remained a genuine sacrament because no bodily benefits were to be looked for, since the effects of the sacrament were spiritual only, not physical. (Marthaler et al., 2003)

The Council – wisely, in view of later developments – took what was for that time a moderate view, maintaining that bodily healing might be brought about by the sacrament “when expedient for the welfare of the soul.” (Council of Trent, Session XIV, On the Sacrament of Extreme Unction, Chapter II). In a second statement – contained in a series of canons condemning certain opinions about Extreme Unction held to be in error – the Council sheds light on how the argument must have proceeded: “If anyone saith that the sacred unction of the sick does not confer grace, nor remit sin, nor comfort the sick; but that it has already ceased, as though it were of old only the grace of working Cures; let him be anathema.” (Council of Trent, Session XIV, On the Sacrament of Extreme Unction, Canon II) Thus the Council steered a middle course, emphasizing the spiritual effects of Extreme Unction, while still leaving open the possibility of beneficial physical effects “when expedient for the welfare of the soul.” (Waterworth, 1995)

In other matters touching upon Extreme Unction, Trent reiterated what had become the orthodox teaching of the Western church: the proper minister of the sacrament was the priest, made so by the essential change brought about in him through ordination, “the laying on of hands.” In the rubrics for administering the sacrament, the priest was directed to lay hands on the sick person and then use the Oil of the Sick to anoint the senses as described above, praying for forgiveness with each anointing. (Marthaler et al., 2003) Some sources even note that the loins were also to be anointed in the same fashion. (Waterworth, 1995) Given then-prevailing attitudes about the connection between sexuality and sin, such a development is believable; those same attitudes and the possibility of various abuses no doubt account for this practice not surviving the test of time.

As with most other liturgical, sacramental and canonical aspects of the Catholic Church’s life, the work of the Council of Trent was sufficiently cogent and authoritative that it endured for a very long time – up to the decrees of the Second Vatican Council, in this case. The Tridentine theology and rubrics of Extreme Unction were still in place when I was ordained in 1965; but that was soon to change, with the promulgation of a restored rite of Anointing of the Sick in 1972.

MINISTRY TO THE SICK TODAY

I ask the reader to be patient with the following rather extensive series of citations, taken from the current edition of Pastoral Care of the Sick, issued by the United States Conference of Catholic Bishops. I know of no better way to provide a succinct and currently authoritative framework for understanding the Catholic Church’s concern for the sick, and its ministry to them; it also situates specific present-day rituals within that framework. Finally, members and ministers of other sacramental churches will find many points in common, even though our practices are not identical.

1. Suffering and illness have always been among the greatest problems that trouble the human spirit. Christians feel and experience pain as do all other people; yet their faith helps them to grasp more deeply the mystery of suffering and to bear their pain with greater courage. From Christ’s words they know that sickness has meaning and value for their own salvation and for the salvation of the world. They also know that Christ, who during his life often visited and healed the sick, loves them in their illness.

2. Although closely linked with the human condition, sickness cannot as a general rule be regarded as a punishment inflicted upon each individual for personal sins…

3. Part of the plan laid out by God’s providence is that we should fight strenuously against all sickness and carefully seek the blessings of good health so that we may fulfill our role in human society and in the Church. Yet we should always be prepared to fill up what is lacking in Christ’s sufferings for the salvation of the world…

Moreover, the role of the sick in the Church is to be a reminder to others of the essential or higher things. By their witness the sick show that our mortal life must be redeemed through the mystery of Christ’s death and resurrection.

4. The sick person is not the only one who should fight against illness. Doctors and all who are devoted in any way to caring for the sick should consider it their duty to use all the means which in their judgment may help the sick, both physically and spiritually. In so doing, they are fulfilling the command of Christ to visit the sick, for Christ implied that those who visit the sick should be concerned for the whole person and offer both physical relief and spiritual comfort…

8. The letter of James states that the sick are to be anointed in order to raise them up and save them. Great care and concern should be taken to see that those of the faithful whose health is seriously impaired by sickness or old age receive this sacrament…

9. 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.

10. A sick person may be anointed before surgery whenever a serious illness is the reason for the surgery.

11. Elderly people may be anointed if they have become notably weakened even though no serious illness is present.

12. Sick children are to be anointed if they have sufficient use of reason to

be strengthened by this sacrament. In case of doubt…the sacrament is to be conferred…

14. The sacrament of anointing is to be conferred on sick people who, although they have lost consciousness or the use of reason, have, as Christian believers, at least implicitly asked for it when the were in control of their faculties.

15. When a priest has been called to attend those who are already dead, he should not administer the sacrament of anointing…

16. The priest is the only proper minister of the anointing of the sick…

42. The rites…of Pastoral Care of the Sick: Rites of Anointing and Viaticum are used by the Church to comfort the sick in time of anxiety, to encourage them to fight against illness, and perhaps to restore them to health…

43. The concern that Christ showed for the bodily and spiritual welfare of those who are ill is continued by the Church in its ministry to the sick. This ministry is the common responsibility of all Christians, who should visit the sick, remember them in prayer and celebrate the sacraments with them. The family and friends of the sick, doctors and others who care for them, and priests with pastoral responsibilities have a particular share in this ministry of comfort…

46. Those who visit the sick should help them to pray, sharing with them the word of God proclaimed in the assembly from which their sickness has separated them…

51. Because the sick are prevented from celebrating the eucharist with the rest of the community, the most important visits are those during which they receive holy communion. In receiving the body and blood of Christ, the sick are united sacramentally to the Lord and are reunited with the eucharistic community from which illness has separated them.

52. The priest should be especially concerned for those whose health has been seriously impaired by illness or old age. He will offer them a new sign of hope: the laying on of hands and the anointing of the sick accompanied by the prayer of faith (James 5:14)…

99. The priest should ensure that…the celebration of the sacrament takes place while the sick person is capable of active participation. However…the sacrament…should be celebrated only when a Christian’s health is seriously impaired by sickness or old age.

102. The sacrament of anointing may be repeated:

a) when the sick person recovers after being anointed and, at a later time, becomes sick again;

b) when during the same illness the condition of the sick person becomes more serious.

In the case of a person who is chronically ill, or elderly and in a weakened

condition, the sacrament of anointing may be repeated when in the pastoral judgment of the priest the condition of the sick person warrants the repetition of the sacrament.

104. There are three distinct and integral aspects to the celebration of this sacrament: the prayer of faith, the laying on of hands and the anointing with oil.

163. The Christian community has a continuing responsibility to pray for and with the person who is dying. Through its sacramental ministry to the dying the community helps Christians to embrace death in mysterious union with the crucified and risen Lord, who awaits them in the fullness of life…

176. Priests and other ministers entrusted with the spiritual care of the sick should do everything they can to ensure that those in proximate danger of death receive the body and blood of Christ as viaticum…

212. …Through the prayers for the commendation of the dying…the Church helps to sustain this union until it is brought to fulfillment after death.

213. Christians have the responsibility of expressing their union in Christ by joining the dying person in prayer for God’s mercy and for confidence in Christ. In particular, the presence of a priest or deacon shows more clearly that the Christian dies in the communion of the Church…If the priest or deacon is unable to be present…other members of the community should be prepared to assist with these prayers…(Pastoral Care of the Sick: Rites of Anointing and Viaticum, 2004)

We will now consider the specific expression of ministry to the sick which is found in the sacrament of anointing and in other rituals.

ANOINTING OF THE SICK TODAY: THE RITUAL

Utilizing the scholarly approach known as ressourcement - return to the sources – and thereby equipped with a more extensive appreciation of the sacrament’s history than had previously been readily available, Vatican II directed a restoration of Extreme Unction to a form and a theological approach more closely resembling that of the ancient Church: the Anointing of the Sick as a prayer for healing of body and spirit. Happily, this also draws the Latin church and Eastern Orthodox Christianity closer to a common understanding of the sacrament’s meaning and purpose. The Vatican II promulgation serves as the beginning point for our present-day theology and practice of the sacrament, and it guided my own perception of the Anointing of the Sick when I began hospital ministry in 1976.

Ironically, the setting that typically affords the most frequent need and opportunity to celebrate the Anointing – the acute-care hospital – is not the most natural one. Since the sacrament is seen as a prayer of the believing community for its members in need of healing, its most fitting venue is the gathered community: parish, family or other assembly of worshippers. Thus, what happens in the hospital room, Emergency Department or ICU is already a compromise between ideal and necessity.

In the best of situations, the sick have both time and inclination to approach their pastor and arrange to be anointed at home or during a parish liturgy. Alternatively, many pastors routinely schedule a service of communal anointing two or more times a year, thus providing an opportunity for the acutely or chronically ill to receive the sacrament in a setting of community worship. In the process the needs of the sick are brought to the attention of the worshipping faithful and awareness of anointing as a prayer for healing is raised.

The Roman Catholic sacramental rite proceeds according to the following outline, adapted as circumstances require.

Introductory Rites

Greeting

Sprinkling with Holy Water

Instruction

Penitential Rite

Liturgy of the Word

Reading

Response

Liturgy of Anointing

Litany

Laying on of Hands

Prayer over the Oil

Anointing

Prayer after the Anointing

The Lord’s Prayer

[Liturgy of Holy Communion]

Communion

Silent Prayer

Prayer after Communion

Concluding Rite

Blessing

(Pastoral Care of the Sick: Rites of Anointing and Viaticum, 2004)

As noted above (#104) there are three “distinct and integral” parts to the rite: the prayer of faith, laying on of hands, and anointing. In the most hurried of situations, a very brief form of each of these is typically used. Beyond that, I offer the following comments based on my own pastoral practice.

The “Greeting” can be a ritual one, but also an opportunity to become acquainted with the patient’s situation and with whatever community is assembled; it can be a time for introductions and getting a sense of the relationships of those gathered.

“Sprinkling with Holy Water” is optional, often omitted (by me), but nevertheless a reminder of the water of baptism and of our bond as members of the human family and the family of faith.

The “Instruction” is actually a brief prayer, important because it gives the scriptural basis of the sacrament. It references James 5:14-15, tying the present occasion to the long history of the sacrament, and the community gathered in the present to the historical community. Except in the most hurried of circumstances, I never omit it.

The “Penitential Rite,” (omitted when Reconciliation has been celebrated separately), retains the part of the sacrament’s history that focuses on forgiveness of sins, and serves as a reminder that forgiveness is one form of healing that all of us need, whatever our other needs may be.

“Reading” and “Response” offer an opportunity to connect the present occasion with instances of healing in the Scriptures. When circumstances permit, I inquire if the patient has a favorite passage or example of healing from the Gospels. Otherwise, the ritual has a number of healing narratives from which to choose.

The “Litany” resembles what most Roman Catholics today have come to know as the “Prayer of the Faithful” – a series of intercessions that touches the needs of the patient but also reaches out to others such as loved ones, health care workers and others who are ill. Again, it reminds those present that no one is alone in need, in suffering, or in the capacity to help others.

“Laying on of Hands” follows immediately. Some people join in quite naturally, others with hesitation. In either case, it presents an occasion for the sick person to be touched both physically and psychologically, giving permission to those who need it and opportunity to those who don’t. In my experience, this is often the most moving part of the rite, counteracting in part the emotional and physical isolation that illness so often brings.

“Prayer over the Oil” provides occasion to bless the oil (if it has not already been blessed) or to recall that the oil, already blessed by the bishop, unites the sick person to the prayer and intention of the broader church.

The “Anointing” lies at the heart of the ritual. The soothing touch of oil on forehead and hands offers tactile comfort; the accompanying prayer is (I believe by design) fruitfully ambiguous in the sense that it does not in so many words ask for either physical or spiritual healing, but is open to both – in contrast to the Tridentine rite, which prayed specifically for forgiveness and only tangentially for healing.

The “Prayer after the Anointing” identifies needs that the sick person – or any of us –might have under similar circumstances, and leads to

“The Lord’s Prayer,” which marks the conclusion of the Anointing and – if Communion is to be received – serves as a bridge to reception of the Eucharist.

The “Blessing” concludes the rite.

Taken as a whole, the impression/effect conveyed by the Anointing of the Sick is quite different from that created by “Extreme Unction.” Some might view the difference as theologically undramatic, which in a sense it is – a shift in emphasis more than meaning. However, this shift does bring about a dramatically different “public” perception of what the sacrament is about: specifically, the wording of its prayers conveys a new and hopeful tone; the occasions when it is considered proper to receive the sacrament have tended to move it away from the deathbed; the participation of whatever community is available is encouraged, even assumed; and the priest, though still the proper minister of the sacrament, is its “celebrant” rather than one who “administers” it. I have had the privilege of observing as this changed perception has gradually taken root in the daily faith life of the Catholics and others who have been touched by it – either as recipients or as part of the supportive community gathered around the one who is being anointed.

As a footnote I would add that the change, as it has been absorbed, has been almost universally welcome. It is no secret that many of the liturgical changes brought about by the Second Vatican Council have met with mixed acceptance, disappointment, and even resistance. In my experience this has not been true of the restored rite of the Anointing of the Sick; I can not recall anyone saying to me, “I wish it were still Last Rites.”

On the other hand, I continue to be astonished at the number of devout and apparently well-informed people who, even after the restored rite has been in use for more than forty years, still speak of “Last Rites” and continue to associate anointing with the approach of death. I have several opinions – none conclusive – about why this is so. It is tempting to blame the lag in perception on delayed or ineffective catechesis; but on balance I do not believe this is a determining reason. I have heard too many heartening stories about people’s parish experiences in communal healing services, and the enthusiasm with which Orthodox Christian, Catholic, Lutheran, Episcopal and Evangelical pastors offer anointing in its current forms; as a result I do not believe that more effective and up-to-date “teaching” is the answer.

In my view a more believable explanation lies in the inherent awesomeness of approaching death and the power of the sacrament as a respectful ritual to mark the boundary between this life and the next. Until recently (in church time), “Last Rites” was the understood (some would say obligatory) way that Catholic Christians did this. Moving anointing away from the deathbed – albeit for legitimate theological and pastoral reasons – did not rob the occasion of its awe-filled character, but it did create a vacuum. Put bluntly: in a church with sacramental sensibilities, if there isn’t a ritual for this situation, there should be.

Certainly it is theologically correct to say that Viaticum (Communion in the face of approaching death) is best understood as the “last sacrament” (#176). Unfortunately, the physical condition of many dying persons does not permit reception of Viaticum; both within and outside the hospital setting, the patient’s death is often preceded by the inability to swallow, and/or by a considerable period of lost or diminished consciousness. It is my thesis that Catholics grasping for a prayerful way to deal with the occasion often fall back on the familiar idea of “Last Rites” because it is what they have heard of or known in the past, even if they have never personally participated in it, even if they are too young ever to have experienced the sacrament as “Extreme Unction.” The challenge for the pastoral minister is to use the appropriate and available resources such as blessing with holy water and/or Prayers of Commendation (#212, 213) (Pastoral Care of the Sick: Rites of Anointing and Viaticum, 2004) in a manner that is creative, liturgically and psychologically robust enough to address the emotional and spiritual needs of the dying person and those gathered around the bedside. In my own pastoral practice, I have found prayer, in conjunction with laying-on of hands (by all those at the bedside) to be meaningful. As in other sacraments (Baptism, Confirmation, Orders) that include the laying-on of hands, the recipient is being called to a (new) role or purpose. This explanation appears to make sense to loved ones gathered around the dying person.

I alluded earlier to the fact that Eastern Orthodox Christians have maintained over the centuries a consistent practice of anointing the sick for healing. Holy Unction is considered an essential sacrament, as evidenced by the elaborate ritual that it entails (Vaporis. N. M., Greek Orthodox Archdiocese of North and South America, 1993) when celebrated in its full form. Also, as noted above, its theological focus has remained primarily one of healing rather than the forgiveness so prominent until recently in the Latin rite.

Among the Protestant reformers “Extreme Unction” as a sacrament disappeared, but its spirit is being revived; today both main-line and evangelical Christians occasionally anoint the sick and pray for healing, inspired by James 5. To my knowledge, the most complete form of prayer for the sick outside the Eastern Orthodox and Roman Catholic traditions is found in the Book of Common Prayer. (The Book of Common Prayer, 1979)

In the Lutheran tradition, a service of “Laying on of Hands and Anointing the Sick” is found in Occasional Services, a companion volume to the Lutheran Book of Worship.

(Association of Evangelical Lutheran Churches, 1982).

SOME COMMENTS FROM THE PRACTITIONER’S PERSPECTIVE:

After more than forty years of pastoral experience in the health care setting, I have had more opportunities than most to observe and appreciate the depth and power of the Anointing of the Sick. I also continue to be impressed by the variety and richness of belief that recipients and their loved ones bring to the celebration of the sacrament. Anyone who doubts the efficaciousness of the sacrament should accompany me in a typical pastoral visit that includes the Anointing of the Sick. “I feel better. Thank you!”, is a near-universal response from the one who has been anointed. Clearly, such a sense of well-being is not always (not even usually) an indication of bodily improvement; on the other hand, who am I not to take the patient’s words at face value? Emotionally and spiritually, the power of the sacrament – to encourage, to help patients re-connect with their spiritual resources, to assure them that they are not facing their illness alone, to gather a loved and loving community around the sufferer – has been demonstrated countless times in my experience.

The following observations are made partly as commentary on the above citations from Pastoral Care of the Sick, and partly as reflections on my own experience. They are not in any particular order of importance. Nor are they necessarily in sequence with the sections of the document, though I will reference the parts of the text as much as possible. I will refer to the document throughout as Pastoral Care. (Pastoral Care of the Sick: Rites of Anointing and Viaticum, 2004)

First, Pastoral Care accepts as given that sickness and suffering are part of the human situation (#1). This does not mean that illness is to be understood as a punishment for personal sins (#2); nor does it suggest that it should be accepted passively(#3,4). The document is clear in stating that we have a responsibility to care for our own health, and that physicians and other professionals are to care for the health of others “by all the means which in their judgment may help the sick both physically and spiritually.” The phrase “physically and spiritually” is of interest, implying as it does: that medicine is to treat the whole person; and that decisions about means of treatment are to be evaluated in light of both physical and spiritual benefits. In my world, this also militates for the direct involvement of pastoral professionals in the care of the patient, since when treatment decisions are being made it is their specific (though surely not exclusive) task and contribution to ensure that spiritual, relational and ethical concerns are not overlooked. Such a role goes beyond what is sometimes seen as the traditional contribution of “the chaplain”: providing comfort through prayer, rituals and other actions easily identified as “religious.”

Secondly, the sick are seen as having a role within the human family and the community of faith (#3). In my experience, one of the greatest obstacles to sick persons’ well-being is the belief that they are of diminished value as persons because of being unable – temporarily or permanently – to participate through work, relationships or other ways in a manner that may previously have been taken for granted. In our utilitarian and production-oriented culture such an inference of dis-value is not surprising. Further, “being a burden” is a concern I have heard patients voice many, many times. Finally, the very idea of being dependent upon others is devastating to many – so much so that studies have documented it as a major concern and motivation of those considering physician-assisted suicide. (Sullivan, Hedberg & Fleming, 2000)

Pastoral Care is countercultural in offering the sick a place of worth and dignity, which it does in several ways: it reassures the sick that their suffering has meaning when joined to the suffering of Christ (#1, 3) (This insight is probably less compelling to us in contemporary times – when much suffering can be eased – than it was to believers in times past, when most suffering was unavoidable, and seen as such. Still, it remains an insight firmly based on Scripture, part of the Christian way of viewing the mystery of suffering.); and it eases the sense of isolation that illness often brings, by mobilizing the believing community to visit, to pray and to bring Communion.

Finally, Pastoral Care makes it clear that care of the sick is a ministry of the entire Christian community, not just of those designated or ordained for the task (#43, 46, 51). Once again, this is countercultural, challenging our societal propensity to compartmentalize, to delegate and thus to shield our individual selves from any sense of communal responsibility for the sick. In Pastoral Care’s more communitarian view, the entire body of believers has a stake in the physical and spiritual health of each member. Various members contribute to that well-being by visiting, praying, bringing Communion, anointing, providing Viaticum, and being present at the bedside of the dying person.

This last – attending the dying – presents a particularly strong witness and challenge to a death-denying culture such as ours. In The Troubled Dream of Life: Living with Mortality Daniel Callahan (1993) points out that one of the unfortunate effects of modern medical technology has been a loss of acceptance of the time and manner of one’s dying – creating what French historian Philippe Aries called a “wild” death, in contrast to the “tame” death of earlier times – a death that was “tolerable and familiar, affirmative of the bonds of community and social solidarity, expected with certainty and accepted without crippling fear.” (Callahan, 1993) As Pastoral Care urges us to join in presence and prayer with the dying, it supports the conditions for a “tame” death: a death that is simple, familiar and public.

Still, as much as it challenges contemporary society’s attitudes about illness and suffering, Pastoral Care of the Sick does not entirely escape present-day first-world assumptions about medicine and the healing enterprise generally. As an example I point out the use of the word “fight” (# 3, 4, 42). There is no doubt that the metaphor of combat (and its connected language) is thoroughly woven into our modern Western understanding of how illness is to be confronted – so much so that hardly any conversation about “how the patient is doing” is without some allusion to “fighting” the disease. This is not entirely a bad thing; combat is an energizing metaphorical framework, encouraging everyone involved to mobilize all available resources and to give all to the effort. However, one weakness of the metaphor is that it cannot accommodate defeat; death is the ultimate failure, both for the physician and for the patient – a view that provides wonderful drama and fits well in M*A*S*H or Code Black, but not so well in reality, nor in most Christian theologies (# 163, 212).

A second weakness of the combat metaphor lies in the character and attitude it promotes – even assumes – in the healer: a certain aggressiveness toward the task at hand which can easily exclude or obscure other characteristics that are also needed, such as compassion, patience and relational capacity. In Iron John: A Book About Men, commenting on the maturing process of the human male, Robert Bly (1990) quotes a Celtic proverb: “Never give a sword to a man who can’t dance.” His point is that a true warrior – anyone who would wield a sword (for our purposes, a scalpel) well – must first have known and been influenced by grace and beauty. It is encouraging to note that present-day medical education is beginning to address this issue more consciously and explicitly than it has in the past. (Puchalski, 2001)

By making this excursion into the language of metaphor, I am not suggesting that the Christian community is responsible for the character of the physician or the quality of medical education; I am suggesting that the believing community is inescapably influenced by the assumptions and attitudes of our shared culture; I am further suggesting that the ways in which these assumptions and attitudes may clash with our religious belief system can easily go unexamined, especially in an endeavor such as medicine, whose importance and urgency are regarded as self-evident, and whose practices and priorities are thus presumed to need no justification.

Fortunately combat is not the only metaphor to shed light on how one faces sickness and suffering. Seeing illness as a journey, for instance, is one possible alternative. In such a framework the patient, far from being simply the passive recipient of medicine’s ministrations, becomes an active participant, undertaking a task of purification, exploration or transformation, with the condition of illness as the vehicle for this process. In doing so, the sufferer develops personally and at the same time performs a valuable service to the community: becoming a scout or explorer of territory not well charted, documenting and mapping a landscape of challenge and eventual diminishment that most of us will someday traverse in one way or another.

I believe that among pastoral ministers to the sick it is a near-universal experience to be impressed, instructed, humbled and inspired by the attractive qualities we encounter in our patients every day, highlighted as they are by the condition of illness: courage, patience, gratitude and humor are abundantly and consistently on display. It is difficult – at least for me – to imagine walking away from such exposure without being a wiser and better person for it. In fact, I would venture to say that, whatever blessings the Anointing of the Sick may provide to the sufferer, its power to bless the surrounding community is equally important, if not more so.

As the woman who was my mentor, friend and former boss lay dying, a visiting acquaintance commented on the serenity with which she was facing her situation. Her response was, “I’ve taught others about death and dying. I should know how to face it myself.” Though weary, she was cheerful and matter-of-fact in saying this, with no hint of bitterness or self-pity. I hope that when I come face-to-face with suffering and death, I do so with comparable equanimity. If I do not, it is not for want of good examples.

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