The seventh sacrament of the Catholic Church used to be referred to in the English-speaking world as "Extreme Unction," but now it is called "Anointing of the Sick." Some say that this change marked a change in sacramental theology. Joseph Arias discusses whether this is the case in his Crisis Magazine article, "What the Anointing of the Sick Is and Isn’t."
Arias talks about two extreme opposite errors concerning the sacrament of anointing. One is that this sacrament may be given to the healthy. The other is that it is reserved for the dying. The truth is somewhere in between.
[According to] many of the best theologians...the supernatural invigoration of the soul in view of impending death is the chief end and effect of extreme unction,
says the Catholic Encyclopedia. Indeed, since the main purpose of this sacrament is to prepare a Christian for death, the proper recipient of this sacrament is one with a mortal illness or wound, or advancing old age.
Yet while the dying certainly do have a mortal condition, that proposition is not convertible - those with a mortal condition are not necessarily dying. At least not yet. And it is possible that they may even recover.
That a person be in danger of death from some internal cause, as opposed to death from an external cause is one of the criteria traditionally understood for the validity of this sacrament since according to the Catechism of the Council of Trent.
only those suffering from disease need a cure.
Any attempt to administer this unction to one who is healthy, therefore, simply cannot take - even if this person is about to be executed at the electric chair, though certainly after execution a person is eligible for the sacrament, since the exact point of death cannot be known. Similarly, a chronic illness or broken bone alone does not make one a valid recipient of this unction.
On the other hand, a priest need not wait until a person with a terminal illness is actually at death's door to administer this sacrament.* The mortal condition alone is enough to make that person a proper recipient of this sacrament.** The Catechism of the Council of Trent says,
It is, however, a very grievous sin to defer the Holy Unction until, all hope of recovery being lost, life begins to ebb, and the sick person is fast verging into a state of insensibility...Though this heavenly medicine is in itself always salutary, pastors should be careful to apply it when its efficacy can be aided by the piety and devotion of the sick person.
Waiting until near death to administer the sacrament is an abuse because that risks the subject's diminished ability to merit from the sacrament.
From this we see there does seem to be some grey area. One is not always certain that a condition is mortal. A broken bone can become infected and then be deadly. On the other hand, old age can extend for many years. So when does a priest judge internal causes to be serious enough to warrant the Sacrament of Anointing?
This is where Canon 1005 comes to the rescue:
If there is any doubt as to whether the sick person has reached the use of reason, or is dangerously ill, or is dead, this sacrament is to be administered.
So a priest must not wait until death is about to occur, but should administer the Sacrament of Anointing as soon as a person has an internal condition that might be dangerous.
Any condition which in itself has been known to lead to death, including advancing old age, might induce "doubt" which justifies the sacrament. Further, certain other circumstances might warrant that this sacrament be performed more readily than usual. One example is in a third-world country where a mission priest's own experience tells him that people there are less likely to survive an illness or a wound which is routinely healed in a first-world country. In these cases the priest may judge these conditions "mortal," in that statistically those persons may not be able to survive that condition.
The fact that a person receiving the sacrament is not necessarily about to die also means the Sacrament of Anointing may well be repeated. Canon 1004 §2 states:
This sacrament may be repeated if the sick person, having recovered, again becomes seriously ill or if, in the same illness, the danger becomes more serious.
One thing more that I'd like to point out is that when a priest arrives at the scene, after a person has breathed his or her last, it is not necessarily too late for him to give this sacrament. P. St. John Paul II made it clear in an address that we cannot determine the exact moment of death, but can only judge by signs after the fact that death has taken place. The cessation of heartbeat and breathing are not equated with death (which is why there is an ongoing debate about brain-death in relation to organ transplant.) Hence, a priest is also right to give the Sacrament of Anointing soon after presumed death, all other conditions being met.
As far as the name of this sacrament, "unction" is just an archaic English word for anointing. In Latin both the term "Extreme Unction" and "Anointing of the Sick" (unctio infirmorum and extremis unctio) use the word for anointing, unctio. Since there may be several different anointings in a person's spiritual life, for example in Confirmation, there needs to be a modifier to distinguish this particular sacramental anointing from other anointings. To preface the word "unctio" with "extreme" or to tack on "of the sick," neither changes the reality nor confuses a right understanding. This sacrament of unction, i.e. anointing, is reserved for those in an extreme condition of an internal bodily nature, which is mortal sickness.
This is why many appellations have been used by the Church throughout the centuries for this same sacramental reality, including "Extreme Unction" and "Holy Anointing of the Sick," as well as "Sacrament of the Sick" and "The Holy Oil," among others. The important thing to remember though, is that "the Sick" in these terms refers to the mortally sick.
For more on this question, Arias quotes some authoritative writers from times past. Click below to read his article.
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