When should I receive Anointing of the Sick? Or, How sick is "sick"?

There has been, quite happily, a realization in recent years that the Anointing of the
Sick (i.e. Extreme Unction) is a sacrament of the sick and not of the dying. Last
week, we recognized that this sacrament (because it is not for the dying) is not
appropriate for those who are in serious and even immediate danger of death but
are not sick e.g. for persons about to enter war, those about to be executed, and
also those about to undergo serious surgery who yet have no serious illness.
What became clear in the comment box of the previous article is that there is no
little confusion about what the Church means by serious sickness and the sick.
How sick does one have to be before receiving Anointing? In what circumstances
does old age call for the sacrament of Anointing? In other words: How sick is sick?
Finally, we must also consider how often the sacrament of Anointing should be
repeated.
The nature of sacrament of Anointing of the Sick
As we have already discussed the nature of this sacrament in our previous article,
we will simply recap briefly here.
All the sacraments confer grace by means of physical (sacramental) signs. Baptism
washes and refreshes the soul by means of the physical washing of the body. The
Eucharist feeds the soul by means of a physical feeding of the body. So too, the
sacrament of anointing confers spiritual healing of the soul through the physical
healing of the body we recall that oil has always been understood to have a
medicinal purpose.
And, as the waters of baptism do not need to literally wash the body and the
Eucharist does not need literally to provide significant nutritional value to the body,
so too it is of no importance if the oil of Anointing does not actually effect a physical
healing. Still, the connection between physical healing and the sacrament of
Anointing is strong enough that only those in need of physical healing can receive
this sacrament hence, it is the sacrament of the sick and can be received only
by those whose health is compromised through either sickness or old age.
How sick? - What the Church teaches
In order to have a well formed belief on this matter, it is necessary that we consider
what the Church herself actually teaches. It will not be enough to simply invoke the
general opinion of the laity or, sadly, even of the priests since many are
profoundly confused on this point. Moreover, our own personal opinion (and even
our own personal experience) matters little in this question. The sacraments are
given to the Church by Christ himself, and he has entrusted to her the proper
understanding of the use of these sacraments.

Extreme unction, which may also and more properly 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 that person to receive this sacrament has certainly already
arrived. (Vatican II, Sacrosanctum Concilium 73)
The Sacrament of the Anointing of the Sick is given to those who are seriously ill.
(Paul VI, Apostolic Constitution Sacram Unctione Infirmorum, 30 Nov 1972)
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 of death by reason of
illness or old age. (Canon 1004.1)
Great care and concern should be taken to see that those of the faithful whose
health is seriously (periculose) impaired by sickness or old age receive this
sacrament. A prudent or reasonably sure judgment, without scruple, is sufficient for
deciding on the seriousness of an illness; if necessary a doctor may be consulted.
(General Introduction to the Roman Ritual, Pastoral Care of the Sick: Rites of
Anointing and Viaticum, par. 8)
What is serious illness?
First, we must note that the sacrament of the Anointing of the Sick (as we said last
week) is for the sick! It is not for those who are about to die due to some cause
other than sickness (or old age). Positively, neither is it to be restricted only to those
whose sickness has so progressed as to put them in immediate and proximate
danger of death. It is the sacrament of the sick, not of the dying it would do well
for us to keep this in mind. [The sacrament of the dying is Viaticum]
Still, the Church is quite clear that Anointing is not simply for anyone who is sick.
Rather, Anointing is to be reserved for those only who are seriously ill (Sacr. Unct.
Inf.) And who have begun to be in danger of death (Can 1004). This is not a
sacrament for illness which does not threaten life (at least remotely), nor is it a
sacrament for those whose sickness is not serious.
The United States edition of General Introduction to the current Roman Ritual for
Anointing contains a helpful footnote [this footnote is from the USCCB, not from the
Vatican, but the edition was approved by Pope Paul VI] The word periculose [i.e.
seriously ill] has been carefully studied and rendered as seriously, rather than as
gravely, dangerously, or perilously. Such a rendering will serve to avoid
restrictions upon the celebration of the sacrament. On the one hand, the sacrament
may and should be given to anyone whose health is seriously impaired; on the other
hand, it may not be given indiscriminately or to a person whose health is not
seriously impaired. (Footnote to paragraph 8)

The Church gives us two indications which must be considered when we ask how
sick one must be in order to receive the sacrament of Anointing: One the one hand,
the individual must have begun to be in danger of death by virtue of the sickness
this would rule out any illness which is not life-threatening (at least remotely) at the
time of the Anointing itself. On the other hand, the illness must be serious; i.e. it
must seriously impair the individuals health.
On a practical level, we may ask two questions: Is there a real chance that this
illness could kill me? And, Is my health seriously impaired by this illness? If the
answer to both of these questions is yes, then the fitting time to receive this
sacrament has certainly already arrived. (Sacrosanctum Concilium 73)
When in doubt, give it out vs. When in doubt, check with a doctor
There is a very popular saying among priests, regarding the administration of
Anointing of the Sick: When in doubt, give it out. Certainly, there is some truth to
this remark. If there is a real doubt as to whether an illness is life-threatening (i.e.
whether the person has begun to be in danger of death) or whether the illness is
serious, the Church would have us err on the side of administering the sacrament.
However, in order to make an informed decision, it will often be necessary to
consult with a doctor and this is precisely what the Church herself recommends:
If necessary a doctor may be consulted. (General Introduction to the Rite of
Anointing, par. 8) Obviously, in case of an emergency, there will not be time to ask a
doctor however, we also point out that, in such a case, it would not seem that
there should be any doubt as to the seriousness of the illness. Thus, if it is a case of
true doubt, there will almost always be an opportunity to consult a doctor on the
matter (at least in developed nations, where doctors and hospitals are common).
To willingly expose a sacrament to nullity is a serious matter and, if done with
knowledge and consent, it is a mortal sin. To administer the sacrament of Anointing
of the Sick to a person who is not seriously ill (or suffering from the feebleness of
old age) is to expose the sacrament to nullity. While we certainly must avoid
scruples, we must also admit that, in many parts of the Church (at least, in the
United States), the tendency is toward a rather careless approach. Indeed, the
liberality with which the priests of the Church administer the sacraments is to be
highly praised, but this liberality must be joined with and guided by reason. It will do
NO GOOD to give the sacrament of Anointing to those who are not seriously ill.
Should the elderly receive Anointing of the Sick?
Having come to an understanding of what the Church means by the sick, it is
clear that many elderly persons should receive the sacrament of Anointing. Elderly
people may be anointed if they have become notably weakened even though no
serious illness is present. (General Introduction to the Rite of Anointing, par. 11)
Again, if there is doubt, a doctor should be consulted.

Hence, there is no clear age-limit at which the elderly may be anointed. Rather, we
must take a pastoral approach of dealing with each individual on a case-by-case
basis. If the elderly person is notably weakened and has begun to be in danger of
death, then the sacrament should be given. If, on the other hand, the elderly
person is in generally good health, is not weakened, and is not in any real danger of
death (at least, not insofar as can be perceived by doctors), the sacrament should
not be given.
Thus, there could be cases were seventy-year-olds ought to receive Anointing, and
there are certainly other cases were even ninety-year-olds ought not to receive the
sacrament (n.b. the oldest man to finish a marathon was ninety-eight, and the
oldest woman was ninety). It is not so much about the age of the individual, but
about his health if he is feeble and in danger of death, the sacrament is to be
given. If there is a real doubt about his condition, a doctor should be consulted. So,
an elderly person should ask: Am I feeble? Have I become notably weakened? Am I
in danger of death? If the answer to these three questions is yes, then the time for
Anointing has arrived.
How often should Anointing of the Sick be repeated?
Finally and very briefly we must consider when and how often the sacrament of
Anointing ought to be repeated. Again, we look first to the teaching of the Church:
This sacrament can be repeated if the sick person, having recovered, again
becomes seriously ill or if, in the same illness, the danger becomes more serious.
(Can 1004.2)
The sacrament may be repeated if the sick person recovers after being anointed
and then again falls ill or if during the same illness the persons condition becomes
more serious. (General Introduction to the Rite of Anointing, par. 9)
We point out that there can be no hard-and-fast rule as to how often a person may
receive Anointing. Certainly, any notion of once per month is far too facile, and
lacks true pastoral concern. Rather, we must look at each individual case and make
a prudent and reasonable judgment.
If the illness has become significantly worse, then Anointing should be given. In the
case of a person whose health is significantly compromised by old age, we must
consider whether the progress in years (since the last Anointing) has caused an
additional and significant loss of health.
On the one hand, we must recall that the sacrament of Anointing can and should be
repeated (in this respect, it is more like Confession than Baptism); on the other
hand, we add that the sacrament is to be repeated only when the individuals health
has become significantly more seriously impaired - or, when they have recovered
and fallen ill a second time.

[Obviously, the practice of regularly participating in a monthly Anointing-Mass is far

beyond what the Church envisions as a general norm, even for the elderly]
WHO RECEIVES AND WHO ADMINISTERS THIS SACRAMENT?
1514 The Anointing of the Sick "is not a sacrament for those only who are at the
point of death. Hence, as soon as anyone 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."130
1515 If a sick person who received this anointing recovers his health, he can in the
case of another grave illness receive this sacrament again. If during the same
illness the person's condition becomes more serious, the sacrament may be
repeated. It is fitting to receive the Anointing of the Sick just prior to a serious
operation. The same holds for the elderly whose frailty becomes more pronounced.
Anointing is not for everyone who is at deaths door
While Anointing is only for those who have begun to be in some real danger of
death, neither is it for all those who are in danger of death. The Church teaches that
it is Anointing of the SICK, which means that the danger of death must stem from
either sickness or old age.
Hence, if a soldier is going off to war, the proper sacrament is Confession, not
Anointing. Likewise, a man on death row who is not seriously ill cannot receive
Anointing of the Sick in preparation for his execution, because he is not sick! Again,
the proper sacrament is Confession (and, of course, Viaticum).
It is simply amazing how many of the faithful and even of the priests are confused
on this point.
However, Anointing is nevertheless only for those who have begun to be in danger
of death if a person is not dying, in the sense that they have some illness or
frailty (from old age) which puts them in a real though perhaps remote danger of
death (i.e. it really could kill them at some point), then they must not be anointed.
Indeed, if a person is not at least in remote but real danger of death through
sickness or old age, then they CANNOT validly be anointed.