Anointing of the Sick, I: Theology of

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Formerly called Extreme Unction, this sacrament is conferred upon Christians in serious illness or in old age. This article discusses the existence of the sacrament: its history, effects, and administration.


That Jesus exercised a ministry of healing is recorded (Mt 9.35) and that He enjoined this ministry on the Apostles is recorded (Mt 10.1, Mk 6.7, and Lk 9.1). In speaking of their fulfillment of it, Mark alone adds the significant detail: "And they anointed with oil many sick people, and healed them" (6.13). Mark does not explicitly state that the employment of this rite was at Jesus' command. There is certainly no question here of a Christian sacrament, but the Council of Trent sees in the text a foreshadowing of the sacrament of Anointing of the Sick (H. Denzinger, Enchiridion symbolorum [Freiburg 1963] 1695).

Scriptural evidence. Since anointing with oil had a recognized therapeutic value among the Jews, and oil was staple for many domestic and medicinal purposes in Antique Mediterranean cultures, it is entirely plausible that the Apostles should have elected this as the sign ready-at-hand to signify the conferring of a special grace on those in a state of sickness just as an ablution was made a "new Baptism" when it was constituted a sign of Christian regeneration by the annexing to it of Christian grace. In ch. five of his Epistle, St. James, in a context of counseling norms of Christian conduct in several life situations, recommends a special remedy in time of sickness. "Is any among you sick? Let him bring in the presbyters of the Church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the sick man, and the Lord will raise him up, and if he be in sins, they shall be forgiven him. Confess your sins, therefore, to one another, that you may be saved" (1416).

The subject of this rite described by James is a Christian who is not moribund, but seriously ill (σθενει; cf. Jn 4.46; 11.16; Acts 9.37). The presbyters of the Church are not the miracle-workers of 1 Cor 12.10, but the official leaders of the local Church, for the rite is not charismatic but hierarchic; the use of the plural need not designate that many presbyters be summoned, for it is a categorical plural. The rite itself is one of prayer accompanied, as the aorist participle λέιψαντες implies, by anointing with oil. This is performed "in the name of the Lord," an expression that scarcely implies a command of the Lord, but rather ascribed the efficacy of this rite to His power of healing (Lk 10.17; Mk 9.38; Acts 3.6, 16; 4.710; 9.34). The Christian is anointed in the name in which he was baptized (Acts 2.38; 8.16; 10.48). The explicit invocation of the powerful name of Jesus excludes any notion of a magical healing power.

The "prayer of faith" spoken in verse 15 may mean prayer said in confidence or prayer inspired by faith. In this second acceptation, which in the context is the more probable, the ritual prayer of the community is designated. The effect of this rite is expressed by three verbs, all in the future tense. There is a parallelism between the first two "will save" (σώσει) and "will raise up" (γερε[symbol omitted]). Though σώσει can refer to spiritual healing and does so in Jas 1.21; 2.14; 4.12; 5.20, it never in New Testament usage bears this meaning in contexts of sickness, death, or their danger. Because of the above parallelism, it should be here accepted in the sense of restoration to bodily health, as the meaning of [symbol omitted]γερε[symbol omitted] suggests. The notion of spiritual healing need not be excluded; indeed, it is expressly, although conditionally, stated as the third effect of this rite, but it is the physical effect that is emphasized. The purpose of the rite looks principally to the physical sickness that is certainly present and only secondarily to the sin that may possibly be present. μαρτία implies grave sin, and the conditional reference to its forgiveness may be interpreted in three ways: (1) that not only those who are now in sin may receive this anointing; (2) that there is no necessary connection between sin and sickness; (3) that the eschatological effect of the rite is related to the forgiveness of sin.


The monuments of tradition witnessing to this sacrament fall into three categories: patristic references to the ministry for the sick; texts of the liturgy employed in the blessing of the oil; mentions, in the biographies of saints, of the actual use of this oil.

The Fathers. Some of the earliest references to the ministry for the sick are so brief or their historical context so obscure that we cannot invoke them as certain witnesses to this sacrament (Tertullian, De praescriptione haereticorum 41 [Patrologia Latina 2:56] Aphraates the Syrian (Demonstrationes 23.3 [Patrologia syriaca ] 2.6); Athanasius (Epistola ad episcopos encyclica 5 [Patrologia Graeca 25:234]). Other references imply a rite of anointing and invoke James as authority, but in a context suggesting penance and reconciliation rather than sickness (Origen, Hom. 2 in Leviticum 4 [Patrologia Graeca 12:419]); John Chrysostom (De sacerdotio 3.6 [Patrologia Graeca 48:644]). Still others speak clearly of anointing the sick in fulfillment of James' command (Cyril of Alexandria, De adoratione et cultu in spiritu et veritate 6 [Patrologia Graeca 68:472]; Victor of Antioch, Catena in evang. S. Marcae 6.13, ed. J. Cramer, Catenae Graecorum Patrum [Oxford 1840] 1:340). A letter of Innocent I (d. 417) to Decentius (Epist. 25.8 [Patrologia Latina 20:55960]) is a further witness to the evolving anointing of the sick. Innocent cites the Epistle of James and explains that it refers to the faithful who are sick and make use of the oil blessed by the bishop. This oil is used "not only by priests, but also by all Christians for their own need or the need of their families." Innocent further explains to Decentius that ministry to the sick should not be reserved just to presbyters but also includes the bishop. He also advises Decentius that the anointing is genus sacramenti and thus is reserved for those in full communion with the Church; those in the order of penitents may not be anointed.

That pastors urged the practice of anointing the sick with oil we know (Caesarius of Arles, Sermones 50.1, 52.5 [CCL 103:225, 232]; Eligius of Noyon, De rectitu-dine Catholicae conversationis 5, among the works of Augustine Patrologia Latina 40:117273]). Possidius (d. after 437), the contemporary and first biographer of St. Augustine (d. 430), informs us that the saint "was accustomed to visit the sick who desired it in order to lay his hands on them and pray at their bedside" (Vita S. Aug. 27; Patrologia Latina 32:56). Since Augustine incorporated Jas 5.1416 into his Speculum (Patrologia Latina 34:1036) as one of the counsels of Christian life, it is probable that on such occasions he personally anointed them with oil.

Liturgical books. Significant witness to this sacrament is found in the early rituals containing formulas for consecrating the oil for the sick. Their inclusion in these rituals manifests that the oil had to be blessed before it was used and offers the presumption that its use was widespread. The earliest extant formula that clearly applies to oil of the sick is found in the Apostolic Tradition (5; B. Botte, La Tradition apostolique de saint Hippolyte: Essai de reconstitution [1963] 1819). It is noteworthy that in this liturgy the blessing of oil takes place toward the end of the Eucharistic prayer (anaphora), a position it retains in the present Roman liturgy of Holy Thursday. In the Euchologian of Serapion (d. after 362), we find a blessing entitled "Prayer for the Oil of the Sick or for Bread or for Water." Despite the ambiguity of the title, the prayer is almost exclusively concerned with oil, upon which God is entreated to bestow a curative power "so that it may become a means of removing every disease and sickness unto health and soundness of soul and body and spirit, unto perfect well-being" (29 F. X. Funk, Didascalia et constitutiones apostolorum 2:191193). Another blessing is found in the gelasian sacramentary (1.40; ed. K. Mohlberg 61). This formula remains substantially unchanged in the present Roman Pontifical.

Biographies of saints. In the Dialogues (3.3; Patrologia Latina 20:213), Sulpicius Severus (d. 430?) tells of the wife of a certain Count Avitus who asked St. Martin of Tours to bless "as is the custom" a vessel of oil intended as a remedy in illness. A similar, but more revealing incident, is related of St. Genevieve (Vita b. Genovefae; in Monumenta Germaniae Historica: Scriptores rerum Merovingicarum [Berlin 1926] 3:236). She was accustomed to anoint with blessed oil the sick for whom she cared. One day, when the oil was urgently needed, the vessel containing it was found empty. The saint was deeply disturbed at this "because there was no bishop within reach to bless it [the oil]."

Lay anointing. It was always the rule, although one does find exceptions, that the oil for this sacrament had to be consecrated by a bishop. It is important to note that the intervention of the Church was indispensable in the blessing of this oil. The oil itself appears to have been regarded as a permanent sacrament, in much the same way as the Eucharist today, and so its confection could be separated from the administration of the sacrament. If this is so, the practice of lay anointing is easily understood. The use of the oil, either by drinking it or applying it to the sick was a religious gesture that invoked the healing power of God over whatever ailment, evil, or sin afflicted the person. The practice of lay anointing gradually fell into disuse from about the beginning of the 8th century in the Frankish kingdom and probably at an earlier date in Celtic lands. The reform councils of the Carolingian era witness to this, while at the same time encouraging the clergy to provide greater ministerial care for the sick and the dying.

During the Carolingian period, the anointing of the sick became increasingly associated with spiritual healing and the forgiveness of sin. The clergy took further responsibility for the sacrament, and people increasingly put the sacrament off until they were close to death.

Scholastic era. With the rise of the scholastics in the 12th century, two views of the purpose of this sacrament become evident. The first of these continues the early view and regards it as a sacrament of the sick. The proper effect, therefore, is the cure of the body even though its more noble effect is the forgiveness of sins. This tradition is represented by Hugh of Saint-Victor (d. 1141), Roland Bandinelli (later Alexander III, d. 1181), Omnebene (d. 1185), and William of Auxerre (d. 1231). The second view stresses the spiritual effect of the anointing, the forgiveness of sin, and tends to see it as a Sacrament of the dying. This view is represented by the unknown author of the Epitome theologiae christianae and the author of the Summa sententiarum. It is the view adopted by Peter Lombard (d. 1160), who was among the first to employ the term Extreme Unction. The first to speak of this anointing as a preparation for the beatific vision was Master Simon, author of the De septem sacramentis. This opinion was further developed by William of Auvergne (d. 1249) and is the one adopted by the great scholastic doctors, including St. Albert the Great (d. 1280), St. Thomas Aquinas (d. 1274), St. Bonaventure (d. 1274), and Duns Scotus (d. 1308).

Although the Franciscan and Dominican schools agreed in viewing this sacrament as a preparation for glory, the former saw this effected by the remission of venial sins, while the latter regarded the reality of this sacrament as the purification of the soul of those remnants of sin that impeded its transit to glory. In either view, however, the sick person was only to be anointed when death was imminent and recovery despaired of. In this period, Anointing displaces Viaticum as the final sacrament. In the older rituals the order of administering the sacraments to the dying was Penance, Anointing, and Viaticum. The rituals of this period give the order as Penance, Viaticum, and Anointing. In our own time the Holy See has restored the earlier order of administration.

Responsible for this changed attitude toward the purpose of this sacrament was an inability to appreciate how a physical effect, the recovery of health, could be the effect of a sacrament. Sacraments are means of grace, and grace is a supernatural perfection of man. Again, if sacraments always produce their effect in a disposed subject, how could the recovery of health, an effect so seldom realized, be the effect of this sacrament? These difficulties were obviated by concluding that the remission of sin was the sacrament's principal effect. But since two sacraments, Penance, and Baptism, already had this purpose, it was logical to see this one as destined for the removal of sin's last remnants, to delay its reception to the last moments of life, to see it as Extreme Unction. Several non-theological factors abetted the popular acceptance of the view that this sacrament was to be delayed until life's final moments (e.g., that one who had received it and recovered could never again enjoy marriage.)

Council of Trent. There is no evidence of change in the theological attitude toward the effect of this sacrament in the period leading to the Council of Trent. Indeed, the first draft of the schema on Extreme Unction presented at this council might well stand as its epitome. It is to be administered "only to those who are in their final struggle and have come to grips with death and are about to go forth to the Lord" (Acta genuina ss. oecumenici concilii Tridentini, ed. Theiner 1:590). The statement of the decree that was finally adopted states: "This anointing is to be used for the sick, but especially for those who are dangerously ill as to seem at the point of departing this life" (H. Denzinger, Enchiridion symbol-orum [Freiburg 1963] 1698). While this is not a forthright recapture of the primitive view, it is certainly an amelioration of the medieval position. In coming to this conclusion, the Council of Trent did not endorse one school over the other, but left open the question of the effects (DS 1696), including bodily health.

Post-Tridentine era. From the Council of Trent to the Second Vatican Council, one notes a progressive leniency in the theologians' interpretation of the danger of death required for anointing and a consequent reassertion of Extreme Unction as a sacrament of the sick. Theologians suggested that the danger of death need not be proximate, but remote; that a probable judgment of danger of death, even if an objective and real danger is not actually present, sufficed for both validity and licitness. This view received support from the Apostolic Letter Explorata Res of Feb. 2, 1923 [Acta Apostolicae Sedis 15 (Rome 1923) 105], which says: "It is not necessary either for the validity or lawfulness of the Sacrament that death should be feared as something proximate; it is enough that there should be a prudent or probable judgment of danger." The Second Vatican Council marks the culmination of the movement to restore this sacrament as a sacrament of the sick. Sacrosanctum concilium, nos. 72 through 74, providing directives for the reform, instructed that this sacrament "may also and more fittingly" be called "Anointing of the Sick." The emergence of the reformed rite of the anointing of the sick, as it appears in the Pastoral Care of the Sick: Rites of Anointing and Viaticum (1983), is the result of adaptations made by the international commission on english in the liturgy (ICEL) to the 1972 Latin editio typica of Ordo Unctionis infirmorum eorumque pastoralis curae, which itself was a revision of the Ordo ministrandi sacramentum extremae unctionis, found in Title VI, chapter ii of the Rituale Romanum (1614).

Pastoral care of the sick, 1983. For its part, the General Introduction to the Pastoral Care of the Sick indicates that this sacrament is provided for the seriously ill who need the special help of God's grace in their time of anxiety, lest they be broken in spirit, and under the pressure of temptation, perhaps become weakened in their faith (no. 5). Detailing the effects of the sacrament, the General Introduction (no. 6) maintains that the sacrament gives the grace of the Holy Spirit to those who are sick: "By this grace the whole person is helped and saved, sustained by trust in God, and strengthened against the temptations of the Evil One and against anxiety over death. Thus the sick person is able not only to bear suffering bravely, but also to fight against it. A return to physical health may follow the reception of this sacrament if it will be beneficial to the sick person's salvation. If necessary, the sacrament also provides the sick person with the forgiveness of sins and the completion of Christian penance."


While the priest is recognized as the only proper minister of this sacrament (no. 16), all baptized Christians share in this ministry to the sick by helping the sick return to health, by showing love for the sick, and by celebrating the sacraments with them. In particular, family members and friends of the sick person, and those who take care of the sick, share in this special ministry of comfort and mutual charity (nos. 3334).

The rite of anointing, proper, contains three distinct and integral aspects: the prayer of faith, the laying on of hands, and the anointing with oil (no. 104). Through the prayer of faith, the Church, which is made present in this community of at least the sick person, the priest, and the family, friends, and others, responds to God's word and, in a spirit of trust, asks for God's help for the sick person (no. 105). Restored to major significance in the reformed rite, the laying on of hands has several meanings. In the first place, it indicates that this person is the object of the Church's prayer of faith. Second, it is a clear sign of blessing that by the power of God's healing grace, the sick person may be restored to health, or at least strengthened in time of illness. Third, the laying on of hands is also an invocation through which the Church prays for the coming of the Holy Spirit upon the sick person. Finally, it is a biblical gesture of healing that recalls Jesus' own manner of healing (no. 106). For its part, the practice of anointing with oil signifies: (1) healing, through comfort and restoration of the tired and the weak; (2) strengthening to fight against the physically and spiritually debilitating effects of illness; and (3) the presence, power, and grace of the Spirit (no. 107). In light of these significations, the rite specifies that a generous amount of oil should be used so it will be seen and felt as a clear sign of the Spirit's healing and strengthening presence (no. 107).

In the Apostolic Constitution on the Sacrament of the Anointing of the Sick (Nov. 30, 1972), Paul VI noted that olive oil, which had been prescribed until this date for the valid celebration of the sacrament, is unobtainable or difficult to obtain in some parts of the world. Hence, at the request of a number of bishops, Paul VI indicates that, according to circumstance, another kind of oil can also be used, provided it is derived from plants, and is thus similar to olive oil. While ordinarily the priest uses the oil blessed by the bishop on Holy Thursday, the priest may, in case of necessity, bless oil to be used within the celebration of the sacrament (no. 21).

The General Introduction to the Pastoral Care of the Sick holds that "great care should be taken to see that those of the faithful whose health is seriously impaired by sickness or old age receive this sacrament" (no. 8). In a footnote, it states that the Latin word periculose has been carefully studied and rendered as "seriously," rather than as "gravely," "dangerously," or "perilously." Such a rendering serves to avoid restrictions upon the celebration of the sacrament, which may and should be given to anyone whose health is seriously impaired. Further, the General Introduction specifies the following subjects for anointing: a sick person, before surgery whenever a serious illness is the reason for surgery (no. 10); elderly people, if they become notably weakened even though no serious illness is present (no. 11); sick children, if they have sufficient use of reason to be strengthened by this sacrament (no. 12); sick people who, although they have lost consciousness or the use of reason, have, as Christian believers, at least implicitly asked for anointing when they were in control of their faculties (no. 14); and a sick person whose death is in doubt (no. 15). Canon 844 in the 1983 Code of Canon Law also indicates that members of the Eastern Churches, which do not have full communion with the Catholic Church, and members of other Churches, which in the judgment of the Apostolic See are in the same condition in regard to the sacraments, may receive Anointing of the Sick if they seek it on their own accord and are properly disposed. Further, if in danger of death or if, in the judgment of the diocesan bishop or conference of bishops, some other grave necessity urges it, the sacrament may be ministered to Protestants, who cannot approach their own minister and who seek Anointing of the Sick on their own accord, provided they manifest Catholic faith in respect to this sacrament and are properly disposed. The sacrament of the Anointing of the Sick may be repeated: when a sick person recovers after being anointed and, at a later time, becomes sick again; when during the same illness the condition of the sick person becomes serious; and when, in the case of a person who is chronically ill, or elderly and in a weakened condition, the priest judges it to be pastorally warranted (nos. 102103). Finally, the General Introduction specifies that the priest should not administer the sacrament to anyone who remains obdurately in open and serious sin or to one who is already dead. In the case of the latter, the priest and gathered community should pray for the dead person, asking God to forgive the deceased person's sins and to welcome him or her into the kingdom (no. 15).

Bibliography: Sources. Pastoral Care of the Sick: Rites of Anointing and Viaticum. The Roman Ritual Revised by Decree of the Second Vatican Ecumenical Council and Published by Authority of Pope Paul VI, Approved for Use in the Diocese of the United States of America by the National Conference of Catholic Bishops and Confirmed by the Apostolic See, Prepared by the International Commission on English in the LiturgyA Joint Commission of Catholic Bishops' Conferences (New York 1983). Literature. a. chavasse, Étude sur l'onction des infirmes dans L'Église Latine du III eau XI esiècle, v. 1 Du III esiècle à la Réforme Carolingienne (Lyons 1942). p. murray, "The Liturgical History of Extreme Unction," Furrow 11 (1960) 572593; this article has special importance because the author saw, in MS, the unpub. 2d v. of Chavasse. j. l. empereur, Prophetic Anointing: God's Call to the Sick, the Elderly, and the Dying, Message of the Sacraments, v. 7 (Wilmington, Del. 1982). c. gusmer, And You Visited Me: Sacramental Ministry to the Sick and the Dying, Studies in the Reformed Rites of the Catholic Church, v. 5, rev. ed. (New York 1984, 1989). j. m. huels, "Who May Be Anointed," in Disputed Questions in the Liturgy Today (Chicago, Ill. 1988). The Pastoral Care of the Sick, ed. m. collins and d. n. power, Concilium 1991/92 (Philadelphia, Pa. 1991). k. rahner, The Church and the Sacraments (New York 1963). j. j. zeigler, Let Them Anoint the Sick (Collegeville, Minn. 1987).

[j. p. mcclain/

j. m. donohue]