ON THE SACRED LITURGY
SOLEMNLY PROMULGATED BY
POPE PAUL VI
ON DECEMBER 4, 1963
73. "Extreme unction," which may also and more fittingly 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 him to receive this sacrament has certainly already arrived.
74. In addition to the separate rites for anointing of the sick and for viaticum, a continuous rite shall be prepared according to which the sick man is anointed after he has made his confession and before he receives viaticum.
75. The number of the anointings is to be adapted to the occasion, and the prayers which belong to the rite of anointing are to be revised so as to correspond with the varying conditions of the sick who receive the sacrament.
I was ten years old when Pope Pius XII lay dying behind the Vatican City walls in October 1958, and Catholics here in the U.S. naturally followed reports of his condition from the big networks like CBS and NBC. [Cable news was several decades in the future.] Reporters who generally did not cover Catholic affairs were not fully prepared for their on-camera reports, and one man breathlessly reported that Pope Pius was suffering from “extreme unctions.” My parents and relatives found this funny, and even I, armed with my Baltimore Catechism, caught the blunder. However, the mention of Extreme Unction on TV was recognized by informed listeners and viewers as an indication that the pope would be dead very soon.
Paragraph 73 of Sacrosanctum Concilium is an important theological and catechetical breakthrough for the Church, for it replaces the name “extreme unction” [from the Latin, “last anointing”] with the more inclusive “anointing of the sick.” The document states that this anointing is no longer reserved for those at the point of death, but also for those “in danger of death from sickness or old age.” In short, the sacrament engaged the ill, not just the dying. In the half century since the new rites for the sick were promulgated, A question for catechetics and pastoral practice is whether Catholics as a rule understand the broadening of sacramental opportunities for the ill and issues about the appropriate times and ways to celebrate this sacrament.
The history of the Sacrament of the Sick is quite complicated, but the sacramental historian Joseph Martos, in his Doors to the Sacred  indicates that late in the first millennium the anointing was a rite of physical healing and was not always performed by a priest. The anointing was granted to anyone who was ill or injured. The surviving lists of illnesses addressed by this sacrament include everything from fever to derangement. I suppose that with the medical care available in 800 A.D., most illnesses were potentially fatal. But Martos is careful to add that if an individual believed he was truly dying, he did not request the anointing. Rather, he sought sacramental reconciliation [or Penance] and the Eucharist. [p. 383]
There was a time in church history when pastoral practice included an anointing in the penitential rite to drive out evil spirits, such that anointing and absolution were for practical purposes indistinguishable. [Later, communion to the dying was called viaticum [Latin, “food for the road” or the journey]. Consequently, the anointing at death carried an almost entirely penitential cast into the twentieth century. The writings of the great high medieval doctors of the Church, St. Thomas Aquinas, St. Bonaventure, and St. Albert the Great agreed that the anointing, confession, and final reception of the eucharist composed the final acts of a human believer, and thus should be administered only at the moment of death. Again, Martos states that very few people in the Church ever received this triptych of sacramental experience in medieval times, due to geographic distances, cost, and the penitential acts they were bound to perform if they should-to their misfortune--recover.
The reform Council of Trent [1545-1563] continued to use the term Extreme Unction, and when this anointing was celebrated with confession and the final reception of communion, the collective term “last rites” came into use, and this term was widely used into my adulthood. In 1972 the post-Vatican II reformed rite referred to the sacrament as “The Anointing of the Sick.” Prior to 1972 the strengthening oil was viewed as a spiritual boost or strengthening for the journey to judgment; given that at various times in history one of the effects of Extreme Unction was believed to be the forgiveness of sins, the celebrant has always been a priest, though the two are separate sacraments.
The 1972 revision ordered in paras. 73-75 reflects the wisdom of considering greater pastoral application of this sacrament, i.e., that it does more good for a greater number of people. Specifically, the Church returned to its biblical roots where anointing brought physical as well as spiritual comfort. By the 1970’s the practice of holistic medicine raised awareness of the patient’s state of mind as a key component of recovery, remission, and/or reduction of pain. Those of us ordained in this era were generally comfortable with this interdisciplinary approach to pastoral care. When I graduated, I had formed a philosophy of celebrating this sacrament whenever illness or injury significantly altered the life of a baptized Catholic, regardless of whether death was imminent or not. The new ritual envisioned anointing with at least some members of the family and/or parish gathered round to hear the Word of God and to earnestly pray for the good of the sick individual as the priest performed the anointing with oil blessed at the Chrism Mass of Holy Thursday at the Cathedral.
For several decades afterward, parishes and institutions offered communal sacramental celebrations of the anointing of the sick. Such services were particularly appropriate in Catholic elder-care facilities where the danger of death was at least remotely more imminent and the pains of advancing age bringing mental and physical discomfort to the general population. I have no hard numbers, but my guess is that today fewer parishes have public sacramental anointings. To be honest, I haven’t heard a homily or public instruction on the Sacrament of the Sick in many years.
In one of those ironies of life, I became more theologically and clinically interested in the pastoral practice of this sacrament after I left the active priestly ministry and engaged in mental health practice. I was asked on numerous occasions in substance abuse facilities if recovering alcoholics, for example, could receive this sacrament. This was during the period when medical discussion of addiction started using the term “disease” to describe addiction and dependency. The Twelve-Step AA Program utilizes a secular progression to conversion, recovery, forgiveness, restitution and service that interfaces very well with existing Catholic sacraments and practices; use of the Sacrament of the Sick may be redundant unless there are other factors in play, such as grave illness.
Concurrently, while teaching sacramental courses for my diocese, I had to admit that “being old” is not a disease in its own right. [The chaplain of the Loyola of Chicago’s men’s NCAA basketball team is a 100-year-old Catholic religious sister.]
While the Church statements on this sacrament are clear enough, developments of full Catholic pastoral care of the sick cover multiple topics and needs and their development continues to this writing. My parish and others are developing pastoral support programs for care givers, many of whom are relatives caring for the ill and aged in their own homes with modest resources and little support. At this juncture it is probably best to say that the Sacrament of the Sick, the formal ritual extension of Christ’s healing ministry, is the summit of a multitude of pastoral services offered by the Church in a variety of places, needs, and settings.