The sacrament of anointing of the sick, also called Extreme Unction, has become nearly synonymous with “last rites” and death.  Yet the Catechism of the Catholic Church and the practice of the Church over the last half a century have attempted to retake the sacrament from a context exclusive of death. 

In 1972, Pope St. Paul VI issued the apostolic constitution Sacram Unctione Infirmorum that modified the sacrament of the anointing of the sick into the form we know today.  The anointing by a priest is for the “dangerously ill,” done on the forehead and hands, and accompanied by a blessing.  In the previous rubrics of the rite, the sick person was anointed on their five senses.  He also clarified that the sacrament is not a one-shot deal, like baptism or confirmation.  Someone that recovers and falls ill again, or gets even more gravely ill, can receive the sacrament again.  Paul VI reminded the readers that the sacrament had been with the Church since its earliest days: St. James mentions it in his epistle (5:14), and St. Mark mentions its use by the twelve apostles on mission (6:12-13). 

Types & Usage of Oil

Four sacraments use holy oil: baptism, confirmation, holy orders, and anointing of the sick.  In those sacraments, three different types of oil are used.  The Oil of Catechumens is used for the first baptismal anointing; the Oil of Chrism is used for the second baptismal anointing, confirmation, and holy orders; the Oil of the Sick is used for anointing the sick.  The composition of the oils differs as well: while all use a base of olive oil, the Oil of Chrism has balsam mixed in, giving it a more scented aroma.  

Despite the protestations of non-Catholics, using oil to anoint the sick was not merely a medical intervention on the part of the ancient Church (see Catholic Encyclopedia article, “Holy Oils”)—though it is definitely true that olive oil was used as a treatment in the ancient world.  We have only to look at the story of the good Samaritan in St. Luke’s gospel.  Upon seeing the beaten traveler, the Samaritan “went to him and bound up his wounds, pouring on oil and wine.” (Luke 10:34, RSVCE; whole story 10:25-37)

St. James does recommend that the sick be anointed with oil, but with some important additions.  “Is any among you sick?  Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord” (James 5:14, RSCVE).  The anointing was to be done in the name of the Lord, in the midst of prayer from the priests (or elders).  The context of the mission of the twelve apostles also dispels the exclusively medicinal use of oil.  St. Mark is characteristically brief and to the point in describing the missionary activities of the apostles: “they went out and preached that men should repent.  And they cast out many demons, and anointed with oil many that were sick and healed them” (Mark 6:12-13, RSVCE).  The anointings and signs accompanied their preaching, and cannot be removed from their context. 

One of my great friends, a priest, offered a good piece of advice.  Yes, anointing of the sick is part of the “last rites.”  But note the plural of rites!  When someone is dying, the Church offers other death-specific rites like viaticum and the commendation of the dying.  When someone is sick, do not wait to ask for anointing! 

Healing

In this sacrament, only one person gets anointed.  Yet the effects of the sacrament reach to others as well; the new rite is even written with the presence of others in mind (see the step-by-step order of the current rite here).  This ministry of the Church is always communal in some way, and this sacrament is no different.  The communal aspect of the sacrament is important for the gathered family and friends.  My priest-friend remarked that the anointing often helps other family members to process the illness and/or imminent death.  It might be the first time in years that a person may have encountered a priest—and the experience can lead to a conversion.  

And regarding healing, the question usually pops up: why aren’t there more miraculous healings?  I think many people have that thought, most often out of concern for their loved one.  Illness and disease were never part of God’s original plan for humanity.  He can bring grace out of them, as with any suffering.  But to get to the heart of the sacrament of anointing, the Catechism has a list of the particular effects.  Before we start any discussion of bodily healing, it is important to emphasize the spiritual workings of the sacrament. 

1. “The first grace of this sacrament is one of strengthening, peace and courage to overcome the difficulties that go with the condition of serious illness or the frailty of old age” (#1520).  For as much as illnesses can tax our bodies, sin wounds our souls even more.  Wounds and sin stretch their tentacles into our memories, reactions, coping mechanisms, relationships—everything.  The sacrament of confession should precede the sacrament of anointing, if the circumstances permit. 
2. The second grace is unity with our crucified Lord.  “By the grace of this sacrament the sick person receives the strength and the gift of uniting himself more closely to Christ’s Passion” (#1521).  The key to thriving in suffering is unity with Jesus.  It is not meaningless or the actions of a vengeful “God” to punish us.  Together with Christ’s perfect sacrifice on Calvary, uniting our sufferings with his “becomes a participation in the saving love of Jesus.” 
3. Third, the grace of suffering well with Jesus benefits the individual but also benefits the Church as a whole (#1522).  The whole Church intercedes for the sick person, both the Mystical Body of Christ on earth and the saints in heaven.  In turn, the sick person, “through the grace of this sacrament, contributes to the sanctification of the Church and to the good of all men for whom the Church suffers” (#1522).
4. Finally, in the case of anointing for someone that is dying, the sacrament prepares them for the passing from this life.  “This last anointing fortifies the end of our earthly life like a solid rampart for the final struggles before entering the Father’s house” (#1523).  

Talking about these spiritual effects is difficult when the family of a sick person is also in pain.  I have been present for a few anointings, and the family’s side of the suffering can be significant.  Perhaps unresolved issues bubble to the surface; the thought of losing someone dear is heart-wrenching; maybe some of the family members have stress in other areas of their lives, changing a hospital visit to an overwhelming experience.  In situations like that, a miraculous healing feels like the easy way for God to relieve stress and make everyone happy. 

It’s exciting to be around a miraculous healing, and those should always be prayed for!  Who knows what God has in mind?  But God’s ways are not our ways; He simply does not throw in a healing miracle with every anointing.  The most detailed answer we can get is, the Lord knows something we do not.  He sees the entire body and soul of the sick person, whereas our view is limited to our eyes.  

Bringing to Completion

The sacrament of the anointing of the sick is oriented toward our eternal salvation.  It “completes the holy anointings that mark the whole Christian life: that of Baptism which sealed the new life in us, and that of Confirmation which strengthened us for the combat of this life” (CCC #1523).  Christ seeks to heal us.  And He gave humanity the divinely-founded Catholic Church as a means to that end.  If you or anyone you love is seriously ill, or having surgery, follow the advice of the apostle himself: “is any among you sick?  Let him call for the elders 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 has committed sins, he will be forgiven” (James 5:14-16).