One of the questions I often ask couples preparing for marriage is “Do you remember what the seven Catholic sacraments are?” Most of them do quite well with this old school catechism question. Almost everyone remembers that matrimony is one of the seven. The one sacrament they often have trouble with is “the sacrament of the sick.” About 80% of the time it will be called “the last rites.” Those of us of a certain age will remember when this sacrament was called “extreme unction,” but we have never had a sacrament in the Catholic Church called “the last rites.” I think we can attribute their familiarity with the phrase “the last rites” not to their Catholic education but to the fact that they heard it used at home. It is an understanding of the sacrament of the anointing of the sick that the Catholic Church has been trying to get rid of for over four hundred years!
Going back to the beginnings, we know that anointing with oil for the purpose of healing was a part of Christ’s own ministry and that of his apostles. By the time the Epistle of James was written about 30 years after the Resurrection, a standard ritual had already emerged. “Are there people sick among you? Let them send for the presbyters of the Church, and let the presbyters pray over them, anointing them with oil in the name of the Lord. The prayer of faith will save the sick persons, and the Lord will raise them up. If they have committed any sins, their sins will be forgiven” (James 5:14-15).
Scholars tell us that the phrase “raise them up” in the original Greek can refer either to physical recovery or to being raised to eternal life. Thus, in biblical times the sacrament had three potential benefits: physical healing, forgiveness of sins, and final perseverance. That remained the case for many centuries. In the late Middle Ages the Church issued a universal Latin Ritual for celebrating the sacraments. The ritual of anointing happened to be placed in the book right after “deathbed confession.” Hence, the two rituals came to be joined in practice. Theologians also began parsing the Sacrament of Anointing: What is the real purpose of the sacrament? Since by this time the practice of private confession was well established, the real purpose could not be forgiveness of sins. Since not everyone experienced a physical recovery after receiving the sacrament, its real purpose could not be physical healing. Hence, the one and only real purpose of the sacrament was final perseverance (and thus it became, by default, the last rites).
Ironically this understanding of the sacrament was never officially adopted by the church. The landmark Council of Trent in the sixteenth century, an attempt by the Church to regroup following the Protestant Reformation, restated the original three-fold aim of the sacrament, adding in the strongest possible terms that we should not delay administering the sacrament “until all hope of recovery is lost.” Yet this official teaching seems to have been largely ignored for the next 400 years. It was customary in Catholic parishes large enough to merit two or more priests (which was most all of them), one priest would always be “on call” to rush out and offer the sacrament whenever word reached the rectory that a parishioner was about to die. The Vatican Council of the 1960’s, which changed so much in our liturgy and sacramental practice, really just restated the teaching of the Council of Trent. “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.” The Church now provides a ritual for both the private celebration of the sacrament in a home or hospital and for a communal celebration in church within or outside of Mass. We have tried to have such a communal celebration each year—either in connection with St. Peregrine’s feast or the World Day of the Sick in February. By the way, the Catholic Church really does have a ritual called “the last rites.” But it is not a separate sacrament. The last sacrament we are supposed to receive before death is the Eucharist. This is called viaticum or “food for the journey”.