What the Anointing of the Sick Is and Isn’t

In his article in Crisis,The Anointing of the Healthy?,” Kevin T. DiCamillo contrasted a pre-Vatican II understanding of the sacrament of Extreme Unction with the rite now known as the Anointing of the Sick, stating that “of the seven sacraments of the Church perhaps none underwent more transformation.” Indeed, he claimed, “Extreme Unction became something almost altogether new: what was once reserved for the dying became a sacrament for those suffering from a severe or even chronic illness. These are two totally different things.”

The author illustrated the difference with two experiences, one with a priest from a “Tridentine chapel,” and the other with a priest from an ordinary parish. The first would not administer the sacrament unless a reasonable judgment could be made that the recipient is “dying.” The second would publicly invite “anyone who feels sick” in “body, soul, mind or spirit” to receive the sacrament. I will argue that both priests were wrong in their practices, and that this is the case whether one uses the relevant prescriptions of the pre-Vatican II Code of Canon Law from 1917 or the post-Vatican II Code of Canon Law from 1983. In arguing this way, I will also provide reasons why the present rite of Anointing of the Sick, including the name of the sacrament, should not be considered something “totally different” from Extreme Unction.

A Sacrament Not Exclusively for the Dying
Considering the 1917 Code, which governed the Latin Church until the 1983 Code came into force, the most relevant canon is the following.

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940 §1 Extreme unction is not to be extended except to the faithful who, having obtained the use of reason, come into danger of death from infirmity or old age.

For the cases under consideration, much depends upon the meaning of the phrase “come into danger of death.” We notice immediately that the canon does not say “who is dying.” Hence, the priest in the first scenario was using a standard that was more rigorous than the letter of the law required.

Looking to the pre-Vatican II interpretations of reliable theologians and canonists who operated under the 1917 Code, we find a consistent understanding that the “danger of death” necessary for receiving Extreme Unction is not the danger associated with the judgment that one is certainly or actually dying, but the danger that is recognized by a prudent judgment that one’s present infirmity or old age is serious enough that death could follow from it as a probable result. Hence, Fr. Dominic Prümmer, O.P. referred to this condition simply as “probable danger of death, whether from infirmity or senility.” (Vademecum Theologiae Moralis, 1934, page 451.)

In Moral and Pastoral Theology (1957), Fr. Henry Davis, S.J. taught, “the danger need not be obvious and certain; it is sufficient if the danger is probable, that is, if thought to be probable… It is not necessary to wait for imminent danger. Illness which, of its nature, is serious and dangerous justifies reception of this Sacrament.” Similarly, Fr. Nicholas Halligan, O.P., in his The Administration of the Sacraments (1962), also made clear that “the danger need not be imminent but it must be at least probable… The danger in the illness is morally probable when it is seriously probable that the sick person may survive or die. Any illness of its nature serious and dangerous (and not merely when it takes a fatal turn), is sufficient basis for the conferral of the sacrament. When the probable danger of death is first estimated Extreme Unction may be administered; when the danger of death is morally certain it must be administered.”

Finally, in his 1961 CUA doctoral dissertation titled The Recipient of Extreme Unction, Fr. Charles Renati concluded, “in fulfillment of the condition stated in canon 940, §1, regarding the presence of a danger of death it suffices that, from the attendant circumstances, some interested person reasonably judge that the sickness in the patient raises a real probability that death could follow from it.” (Page 173, original emphasis.) Perhaps most importantly, this author references two papal teachings in support of the understanding he shares with the other theologians. In his 1921 allocution to the Bona Mors Sodality, Pope Benedict XV encouraged the administration of the sacrament “when there is a prudent judgment about the danger of death.” Addressing the same Sodality in his 1923 Apostolic Letter, Explorata res, Pope Pius XI taught: “it is sufficient that there is a prudent or probable judgment concerning the danger [of death].”

A Sacrament for Serious Cases of Illness
Turning to the 1983 Code of Canon Law, and to the second scenario presented by Mr. DiCamillo, the most relevant canon is the following.

1004 §1: 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 by reason of infirmity or old age.

It is very clear from this traditionally formulated canon that no provision is made for reception of the sacrament by “anyone” who simply “feels sick” in “body, soul, mind or spirit.” Ordinary headaches, indigestion, and even anxiety about tomorrow’s job interview might fall under such a description; but they cannot prudently count as initiating danger by reason of infirmity or old age.

The post-Vatican II Rite of Anointing and Pastoral Care of the Sick, decreed by the Congregation for Divine Worship (December 7, 1972) and approved by Pope Paul VI, also makes clear the need for a reasonable judgment concerning the gravity of the bodily condition. Section 8 of this document states: “A prudent or probable judgment about the seriousness of the sickness is sufficient; in such a case there is no reason for scruples, but if necessary a doctor may be consulted.”

Hence, in cases of simple (i.e., not gravely dangerous) chronic illness, or cases where reasonable people would judge beyond a doubt that no serious and dangerous condition is present, the sacrament should not be administered. This is the case according to the new Rite of Anointing and the 1983 Code of Canon Law just as it was for the prior Roman Ritual and 1917 Code. Accordingly, the liberal practice of indiscriminate administration by the parish priest mentioned above is rightly seen as an abuse.

It should be noted as well that the Code of Canons of the Eastern Churches, promulgated by Pope Saint John Paul II in 1990 to have the force of law for all Eastern Catholic Churches, always speaks of the recipient of the anointing of the sick as one who is gravely ill (see canons 737 §1; 738; and 740).

So far I have presented evidence of a continuity between the pre- and post-Vatican II legislation regarding the condition of serious sickness in the recipient of the sacrament of Anointing. I am not claiming that there are no differences whatsoever between the two Codes regarding the administration and reception of the sacrament. There are differences, which would require another study to treat adequately. Nevertheless, the similarities, as we have seen, allow us to conclude that the practices of both priests mentioned above are wrong according to either Code, and that there is no warrant for thinking that we have an altogether new official rite of “anointing the healthy.”

Origins of the Name
It will be useful to conclude with a consideration of the terms used for this sacrament, as some think that the very name of the sacrament has changed into something non-traditional, thereby perhaps indicating a change in the reality.

In his comprehensive study of the sacrament, Extreme Unction: A Canonical Treatise, published in 1927 (decades before a second Vatican council was a thought in the mind of any pope), Fr. Adrian Kilker records some of the names used in the Latin Church over the centuries: “the holy oil of the infirm/sick” (sanctum oleum infirmorum), “the anointing of holy oil” (unctio sacrati olei), “the holy anointing of oil” (sacra olei unctio), “the holy anointing of God” (sacra unctio Dei), “the anointing of the infirm/sick” (unctio infirmorum), “the service of anointing” (unctionis officium), etc. According to the Manuale Ambrosianum, in Milan at the time of St. Ambrose the sacrament was known as “the imposition of the hands upon the infirm.” Pope Innocent I (d. 417) referred to it simply as “chrisma”; while the second Council of Aachen in the Middle Ages called it “the sanctified oil” (oleum sanctificatum). There are various traditional names for the same sacrament in the eastern churches (e.g., “the holy oil,” “the prayer oil,” even “the office of seven priests,” indicating the custom of administering this sacrament by seven priests, etc.).

Accordingly in preferring the name Unctio infirmorum, the Fathers at Vatican II (see paragraph 73 of Sacrosanctum concilium) made no break with a traditional understanding. Rather, they simply applied an appellation already known in tradition.

The term Extreme Unction was used as early as the ninth century, and has been in general use in the west since the twelfth century. It received its highest approval by being employed in the declarations and canons of the Council of Trent, which also called it the “sacrament of the departing” (sacramentum exeuntium). This last name, the Council noted, is a consequence of the fact that since the anointing is to be used for the sick, then it is “especially” (it does not say “exclusively”) for “those who are so dangerously ill that they seem to be about to depart this life.” Similarly the Catechism of the Council of Trent (1907 Latin Pustet edition) states: “Since, therefore, only those suffering from disease need a cure, on that account to those also (idcirco iis etiam) should this sacrament be given who seem to be so dangerously ill that it is feared that the last day of life is near.”

It must not be forgotten as well that at the same time that the Council of Trent used the designations “Extreme Unction” and “Sacrament of the Departing,” it also used the name “Holy Anointing of the Sick.” Canon 2 on the Sacrament of Extreme Unction reads: “If anyone says that the holy anointing of the sick (sacram infirmorum unctionem) does not confer grace, nor remit sins, nor alleviate sick persons, but has now ceased because it was formerly only a grace of healing: let him be anathema.”

Finally, it can be asked: what is the significance of the term “extreme” in Extreme Unction? The term itself means “last” or “final.” But in what sense? Many are surprised to know that there is a long historical controversy concerning why this unction is termed “last.” Indeed, Fr. Kilker (on page 5 of his work noted above) notes that, “The reason for the name … has ever been an unsettled question.” William Estius (1542-1613) maintained “extreme” was due to the fact that this unction is the last in point of time of all anointings associated with sacramental or ecclesial rites: the first given to catechumens before Baptism; the second after the baptismal washing; the third being the sacrament of confirmation itself; the fourth being the anointing of the hands at priestly ordination; the fifth (although not associated with a sacrament) is that given to secular princes; and the last being the sacrament of the sick. In The Sacraments (1937), Pohle and Preuss write: “Extreme Unction is called the last anointment in a purely liturgical sense, because it is preceded by the anointments conferred in Baptism, Confirmation, and Holy Orders).” However, others (see, for example, Toner’s entry in the 1913 Catholic Encyclopedia) think the name more probably comes from “unction of those in extremis,” (i.e., those who are dying).

Perhaps there is truth in both theories of origin; they are not mutually exclusive. Either way, it is clear that while the sacrament is definitely for the dying, according to traditional teaching it is not for them alone.

Editor’s note: Pictured above is “Extreme Unction” painted by Ferdinand Georg Waldmuller in 1846.


  • Joseph Arias

    Joseph Arias is Assistant Professor of Theology and Dean of Students at the Graduate School of Christendom College in Alexandria, VA, where he serves as faculty advisor for students concentrating in moral theology. He is also an adjunct professor for the Department of Theology at Christendom College in Front Royal, VA.

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