The basis in Scripture for the Church’s understanding of the anointing of the sick is the following brief passage: “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” (Jas 5.14–15). Trent teaches that in this passage all of the essential elements of this sacrament are included (see DS 1695–96/908–9).

God answers all prayers of petition (29‑E). Evidently, the restoration to bodily health promised in this sacrament often is accomplished through death and resurrection. But the restoration to spiritual health is always accomplished at once in one who receives the sacrament and puts no obstacle in its way.

As the culmination of penance, the sacrament of anointing normally presupposes a recipient whose sins have been forgiven through the sacrament of penance. Thus, a seriously ill person in need of reconciliation should if possible confess before receiving the sacrament of anointing. However, children old enough to be comforted by the sacrament of anointing may be anointed even if they are not yet ready for the sacrament of penance. Likewise, a dying and unconscious adult, if not certainly dead, should be anointed if there is any ground to believe that he or she would have desired to receive the sacraments. In all doubtful cases, including persons apparently but not certainly dead, the sacrament is administered conditionally.

The Christian attitude toward suffering and death is at once totally realistic and completely mystical.³¹

On the one hand, suffering and death are recognized as unnatural, horrible, and final. They are consequences of sin; human persons and children of God should not have to endure them. Christian faith does not pretend that suffering and death are inherently natural, only conditionally evil, basically good, or remediable by cosmetics. The illusions of pagan mummification and secular humanist funeral practices are contrary to Christian realism.

On the other hand, Christian faith requires that suffering and death be accepted with hope. One must abandon oneself and one’s loved ones to the mercy of God, confident that he can unite the death of Christians with that of the Lord Jesus, and so bring glory in resurrection for all who die in him. Death is not to last, contrary to the belief of sinners (see Wis 2). Paul clings to Jesus, “that I may know him and the power of his resurrection, and may share his sufferings, becoming like him in his death, that if possible I may attain the resurrection from the dead” (Phil 3.10–11). The attitude of every Christian should be that of Paul in prison: “It is my eager expectation and hope that I shall not be at all ashamed, but that with full courage now as always Christ will be honored in my body, whether by life or by death” (Phil 1.20).

Someone might challenge the preceding interpretation of the sacrament of anointing by arguing that it is not only for the dying, but for the sick in general. The new rite, following a prescription of Vatican II, uses the phrase “anointing of the sick” rather than “extreme (last) anointing” to refer to the sacrament. Moreover, the text in James seems to treat the sacrament as one of healing rather than consecration of dying.

Yet it seems the Council’s action has been misinterpreted and the sacrament still ought to be regarded as a consecration of terminal suffering and dying. It is hardly likely that Vatican II wishes to contradict the solemn teaching of the Council of Florence: “This sacrament should not be given except to the sick whose death is feared” (DS 1324/700). Hence, Vatican II’s actual statement should be considered carefully: “ ‘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 appropriate time for him to receive this sacrament has certainly already arrived” (SC 73). What the Council wishes to exclude is the postponement of the sacrament until the very moment of death.

The Introduction to the new rite for the anointing of the sick repeatedly uses the words “danger,” “dangerous,” and “dangerously” in referring to the condition of the person to be anointed.³² It assumes that the illness must be judged serious when it says: “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.”³³ This provision clearly takes for granted that anointing for a minor illness or psychological problem is inappropriate.

Objectively, a person is dying only when he or she has some specific condition which probably will cause death. Psychologically, whenever a person is in a condition such that death can reasonably be feared as a personal prospect—not simply as a general aspect of the human condition—the person is suffering unto death from his or her own point of view and from the point of view of dear ones. The sacrament of anointing becomes appropriate at this point. Perhaps the reasonable fear of death is based upon a serious (even if usually nonfatal) illness; perhaps it is based upon old age; perhaps it is based upon major surgery. In any of these cases, a prudent individual contemplates death as a personal prospect. The help of the sacrament is needed, and its revelatory value to others is real.

What, then, about the text of James which refers so strongly to health? The answer is that the Greek word (egerei) sometimes translated “restore . . . to health” (Jas 5.15; NAB) also means “raise” as in “He has been raised (ēgerthē), exactly as he promised” (Mt 28.6; NAB). Readers of the Greek text hardly would have missed the resonances of the verb, for “health” considered in the light of Christian faith is a rather different concept than proponents of anointing as a healing sacrament have in mind. Ultimately, health is attained only by resurrection.

The sacrament is not a gift of miraculous cures, as experience shows. It is a sacrament of faith that God will cure if that is good, but more especially that he will save, as the Introduction to the new rite explains: “The anointing of the sick, which includes the prayer of faith (see James 5.15), is a sacrament of faith. This faith is important for the minister and particularly for the one who receives it. The sick man will be saved by his faith and the faith of the Church which looks back to the death and resurrection of Christ, the source of the sacrament’s power (see James 5.15), and looks again to the future kingdom which is pledged in the sacraments.”³⁴ The health to which the sacrament of anointing is primarily directed is that which never will fail, the wholeness of friendship with God which heals even death (see S.t., sup., q. 30, aa. 1–2; S.c.g., 4, 73).