Anointing of the Sick

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The Anointing of the Sick is the Christian rite in which a priest anoints a seriously ill or dying person with blessed oil while praying for healing, forgiveness, and strength. In the Roman Catholic and Eastern Orthodox churches it is counted among the sacraments — an act understood to do something, not merely to comfort — and for much of its history in the West it was known by a grimmer name: extreme unction, the last anointing, reserved for those thought to be dying.

The warrant in James

The rite reaches back to a few lines near the end of the Epistle of James. Anyone among you sick, the letter instructs, should call the elders of the church, who are to pray over the sick and anoint with oil in the name of the Lord; the prayer of faith will save the one who is sick, the Lord will raise him up, and any sins he has committed will be forgiven (James 5:14–15). The passage holds three things together that the later sacrament would keep bound: a summons to the ordained, an anointing with oil, and a single double promise — bodily raising and the remission of sin. It is a healing text before it is a death text. The forgiveness is appended almost as an afterthought, conditional on there being sin to forgive.

Early Christian sources treat the blessing of oil and its application to the ailing as ordinary, of a piece with the wider Christian use of consecrated oil for many purposes — a continuity with the broad biblical grammar of anointing that runs from the unction of priests and kings to the oil of baptism and confirmation. What distinguishes the sick-anointing of James from those is its object: not consecration, not initiation, but the body in extremity. The oil is not the same substance, either: where baptism and confirmation use chrism, balsam-scented and reserved to the bishop’s blessing, the oil of the sick is plain blessed oil, and the distinction is old. For the first centuries the oil was sometimes blessed by a bishop and then carried home and used by the faithful themselves on the ill — a fragment of this survives in the early Roman blessing of the oil of the sick, where the prayer asks that the oil be a defense of body, soul, and spirit for all who use it. The rite had not yet been drawn entirely inside the hands of the clergy, nor fixed to the threshold of death, nor counted as one numbered sacrament among a fixed set; it was a healing blessing, freely repeated, sitting alongside the lesser blessings the later tradition would call sacramentals rather than sacraments proper. The line between the two had not yet been drawn where it now runs.

The drift to the deathbed

What changed across the medieval centuries was the rite’s center of gravity. By the early Middle Ages anointing had migrated toward the deathbed, and a powerful logic pulled it there. Sin and sickness were read as kin; the oil that forgave came to be saved for the moment when forgiveness mattered most, and a sacrament once given to the merely ill became a sacrament of the dying. The Carolingian reform of liturgy gathered the scattered deathbed prayers into a defined order, and confession was made its precondition: one was shriven, then anointed, then communicated. The term that fixed the shift is extrema unctio, the last anointing — first used, so far as the record shows, by Peter Lombard in the twelfth-century Sentences, and the usual Western name by that century’s end. It was Lombard, too, who set the rite within the sevenfold scheme of sacraments — baptism, confirmation, Eucharist, penance, extreme unction, holy orders, and matrimony — that the scholastics would inherit and the Council of Trent would defend.

By then the anointing had become the final act in a sequence administered to the dying: confession, anointing, and a last communion called viaticum, provisions for the journey. The popular phrase last rites names that whole sequence — and the viaticum, not the anointing, is its climax and its most urgent member, the one rite that overrides all the others’ restrictions when there may be no later occasion. The two are constantly confused: people speak of “the last rites” and mean the oil alone. The confusion is itself a fossil of the medieval narrowing, the moment when an anointing for the sick became, in the common mind, the sacrament one received because one was about to die.

The narrowing was reinforced by a discipline that grew up around the rite. Once anointing trailed confession in the sequence, and once the schoolmen made penance its prerequisite, the oil came to be felt as a thing best not received twice — almost a seal upon a life ended, after which one was, in a sense, already counted among the dead. Recovery after anointing raised awkward questions about how the recovered person should now live, questions to which the medieval rite gave no easy answer. Fear of the sacrament followed: families summoned the priest late, when death was certain, lest the oil itself be taken as a sentence. The very name extreme unction hardened this. The “extreme” in it had once meant only that this was the last in the ordered series of anointings a Christian received across a life — baptismal, confirmational, and now final — but it came to be heard as the unction of the extremity, the oil of the end. A rite that James had framed as a summons toward healing had acquired, in its popular sense, the opposite valence: the priest at the door meant the doctor had given up.

Trent fixes the doctrine

The traditions that keep the rite hold it as more than medicine. Catholic teaching was fixed in its essentials at the Council of Trent in its fourteenth session, on the twenty-fifth of November 1551, in the same decree that treated penance — the two paired as the sacraments that restore the sinner. Trent declared extreme unction a true and proper sacrament instituted by Christ and promulgated through the apostle James, and bound its doctrine tightly to those lines of the epistle: the grace of the Holy Spirit, whose anointing wipes away whatever sins still remain and the very remnants of sin, and which raises and strengthens the soul of the sick, kindling confidence in the divine mercy and fortifying it against the temptations of the enemy at the last. Bodily health it may restore, the council added, but only when that restoration is expedient for the soul’s salvation — health subordinated to grace, never promised on its own terms. The recipient envisioned was one so dangerously ill as to seem near death; the minister, the priest, the presbyter whom James had called an elder. (Why ordination alone confers that power belongs to the question of holy orders.) The full canons survive in the conciliar acts of Session XIV.

The Tridentine doctrine was given its liturgical body half a century later. The Rituale Romanum promulgated by Paul V in 1614 gathered the rites of the parish priest into one official book, and its Title VI ordered the visitation and care of the sick — the anointing set amid the seven penitential psalms, the litany of the saints, the apostolic blessing, and the commendation of the departing soul. For three and a half centuries this was the shape of a Catholic death: the priest summoned, the confession heard, the forehead and hands signed with oil, the host given for the road, the soul commended in the old imperatives. The rite that James had pointed at the sick now pointed, almost entirely, at the dying.

The Eastern office

The Eastern churches never let it narrow so far. The Orthodox office of the euchelaion — the word joins euchē, prayer, to elaion, oil: prayer-oil — is celebrated, in its full form, by an assembly of priests, traditionally seven, with seven readings from the epistles and gospels, seven prayers, and seven anointings, the oil blessed in the course of the service itself; the Slavic churches call it soborovanie after the sobor, the gathering of clergy it ideally requires. Its frame is healing and the remission of sins for the living faithful, not a viaticum withheld for the end. The sevenfold structure carries its own weight of meaning — seven a number of completeness, and the manifold prayer of the assembled presbyters answering directly to the plural “elders” of James, where the West had collapsed the rite onto a single priest. In Greek and Antiochian practice the whole congregation may be anointed together on Great and Holy Wednesday, the sick and the well alike, on the eve of the Passion — anointing as a regular recourse of the Christian life rather than its last station. The oil is even carried home from such a service and kept; some is, by custom, reserved to be poured upon the body at burial, so that the same substance attends both the living body and the dead one without ever becoming, as in the West, the rite of dying as such. Where the Latin church, by the high Middle Ages, had made the oil a sign that death was near, the Christian East kept it a sign that the body, ailing, was being prayed over and healed. The divergence is one of the cleaner illustrations of how a single scriptural warrant can grow two different rites in two different liturgical cultures of the one Christianity — the same lines of James, read by Eastern Orthodoxy toward healing and by Rome, for a long age, toward death.

The Protestant set-aside

The Reformation cut the sacrament away entirely. Martin Luther, in The Babylonian Captivity of the Church of 1520, reduced the seven sacraments to the two — at most three — that he held instituted by Christ with a divine promise attached, and extreme unction was not among them. His argument turned on the very warrant Trent would lean on: an apostle, even James, cannot institute a sacrament, for only Christ can bind a promise to a sign; a rite resting on apostolic counsel rather than dominical command is a pious custom, not a means of grace. The medieval extrema unctio, moreover, seemed to the reformers a thing overgrown — the healing prayer of James buried under centuries of accretion and reserved, in defiance of the text, for the moment past which it could no longer heal. Most Protestant bodies set the sacrament aside, though some retained a ministry of anointing and prayer for the sick, returning, in their fashion, to the plain sense of the epistle they had used against Rome.

The 1972 recovery

In 1972, following the Second Vatican Council, the Roman church revised the rite and pressed a deliberate change of emphasis. Paul VI’s apostolic constitution Sacram Unctionem Infirmorum, issued on the thirtieth of November, renamed the sacrament: no longer extreme unction for the dying but anointing of the sick, offered to anyone gravely ill or weakened by age, and repeatable as illness returns or deepens. The accompanying Ordo Unctionis Infirmorum, in force from the start of 1974, recast the order to match. The change was framed as a recovery rather than an innovation — the argument being that the older healing rite of James had been narrowed across the medieval centuries into a sacrament of death, and that the narrowing was a historical accident worth undoing. The deathbed sequence was not abolished; the viaticum remains the sacrament of the dying, and anointing keeps its place within the rites of death. But its primary address was turned back toward the sick who might yet live.

Texts and scholarship

The decisive doctrinal text is the decree of the Council of Trent’s fourteenth session of 1551, whose canons on extreme unction — instituted by Christ, promulgated by James, conferring grace and remitting sin — survive in the conciliar acts. Its modern counterweight is Paul VI’s Sacram Unctionem Infirmorum of 1972, the constitution that reframed the rite; read together, the two mark the long arc from death-sacrament to healing-sacrament. The scriptural seed of both is the short passage at James 5:14–15. On the medieval transformation, Thomas M. Izbicki’s study of Saint Geneviève and the anointing of the sick (The Catholic Historical Review 104, 2018) traces how the parish rite hardened around the deathbed; Frederick S. Paxton’s Christianizing Death (Cornell, 1990) maps the Carolingian liturgies of dying within which the sequence took form; and the Cambridge History of Medieval Canon Law gathers the legal shaping of confession, penance, and extreme unction into one account. For the Reformation rupture the primary witness is Luther’s On the Babylonian Captivity of the Church (1520); for the standard reference outlines of doctrine and practice across the confessions, F. L. Cross and E. A. Livingstone’s Oxford Dictionary of the Christian Church (3rd ed. rev., 2005) remains the convenient synthesis.

What the rite has carried throughout, under either name, is a particular hope: that the moment of bodily extremity is also a moment open to grace, and that the oil traced on a failing body marks the body as still held within the church’s care. Whether it heals the flesh is left, in the prayers themselves, to God.

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