Pastoral Care of the Sick

The church offers to the sick and the dying a variety of sacraments which go by various titles under the general heading "Rite of Anointing and Pastoral Care of the Sick": reconciliation, anointing, and communion. Reconciliation is encouraged throughout one's life.  Anointing is given to the sick and may be repeated when a sickness advances or returns.  Only a priest can anoint the sick. He first anoints the forehead, saying: “Through this holy anointing may the Lord in his love and mercy help you with the grace of the Holy Spirit”. The recipient responds: “Amen”. Then he anoints the hands saying: “May the Lord who frees you from sin save you and raise you up”. Again the recipient responds: “Amen”.

Communion may be brought to any of the sick who cannot attend church.  As death approaches, it should be given as "viaticum", the communion of the dying.  Apart from these sacraments, there are other prayers that are most appropriate for the sick, the dying, and the recently deceased.

Anointing of the Sick

Like all the sacraments, the sacrament of Anointing of the Sick is intended to be celebrated communally, that is, in the midst of a gathering of the church.  The members of the church offer the sick person(s) the support of shared faith and shared prayer.

Sometimes the community that gathers for the sacrament will be a full assembly, as when the anointing is celebrated at a parish Mass.  When someone about to enter hospital for major surgery is anointed during a weekday Mass, the gathered community is made up of those who come to Mass that day. For an anointing in a hospital setting, the assembly may consist only of those members of the family who can gather.  There will also be times when an emergency requires that the sacrament be celebrated with only the priest and the sick person present.  Such a celebration is still a valid sacrament, yet it should be the exception rather than the rule.

There still seems to be some confusion over who is eligible for the sacrament.  The appropriate recipients for the anointing of the sick are described in the General Introduction of the rite:

Great care and concern should be taken to see that those of the faithful whose health is seriously 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.

The sacrament may be repeated is the sick person recovers after being anointed and then again falls ill or if during the same illness the person’s condition becomes more serious.

A sick person may be anointed before surgery whenever a serious illness is the reason for the surgery.

Elderly people may be anointed if they have become notably weakened even though no serious illness is present.

Sick children are to be anointed if they have sufficient use of reason to be strengthened by this sacrament.  In a case of doubt whether a child has reached the use of reason, the sacrament is to be conferred. (#8-12)

This listing makes it clear that the anointing is intended for those who are seriously ill. The sacred and unique character of the sacrament is compromised if:

• it is viewed as some sort of insurance policy or inoculation against illness
• everyone present at a communal celebration comes forward to be anointed on the spurious grounds that ‘we are all sick in some way’
• it is used as a sacrament of forgiveness. That’s penance. Anointing of the Sick is the sacrament of physical and mental – not spiritual – healing

On the other hand, the list of appropriate recipients in the introduction to the rite makes it clear that the anointing is intended for all who are seriously ill, not just for the dying.  The proper sacrament for the dying is not the anointing but viaticum, or communion for the dying.

As with all things liturgical, good practice is a matter of striking the right balance, in this case between reserving Anointing of the Sick solely for those on their deathbeds and administering it to all and sundry.

Communion to the Sick

In most parishes, some of the Extraordinary Ministers of Communion are involved in the ministry of taking communion to those members of the parish who are unable to be present at the celebration of the Eucharist.

Lay ministers are authorised to take Holy Communion to those who are not able to attend Mass: the ill, the elderly, the housebound, and those in hospitals or nursing homes.

The 1973 instruction Immensae Caritatis referred to the need for special ministers to take communion frequently to the sick and aged when the ordinary ministers are unable, ‘so that the faithful may not be deprived of this sacramental help and consolation’. The introduction to Pastoral Care of the Sick: Rites of Anointing and Viaticum states that the sick and the aged need to be offered ‘every opportunity to receive the Eucharist frequently, and even daily during the Easter season’. (# 72)

Communion ministers make it possible to bring communion to the sick more frequently than would otherwise be the case. They also free the priest for his other responsibilities to the sick: visiting them and celebrating reconciliation and the anointing of the sick with them. In bringing communion to the sick, the minister of communion represents Christ and manifests faith and charity on behalf of the whole community. For the sick, the reception of communion is not only a privilege but also a sign of the support and concern of their fellow members of the Body of Christ.

Though special ministers may bring communion to the sick at any time, the sign value is enhanced when it is carried directly from Mass to the sick person. In this way, the communion is clearly related to the community table. At the conclusion of the Prayer after Communion, the celebrant calls the communion ministers to the altar and addresses them in these or similar words:

           Dear friends in Christ, you are now to carry the body of our Lord from this Eucharistic assembly

           to our brothers and sisters who are unable to be here with us.

           Give them our greetings and our love, read today’s scripture with them,

           pray with them and minister to them this most precious sacrament.

The priest then hands the pyxes containing the consecrated bread to the Communion Ministers. After the Final Blessing and Dismissal, they may process out with the celebrant and proceed to their destinations. Alternatively, the ministers may remain until the end of Mass, interact with other members of the community, and then take the prepared pyxes from the tabernacle to the sick.

At other times, special ministers may go to the tabernacle, place the required number of hosts into a pyx and take Communion to people in their homes.

Communion to People in Hospitals and Institutions

Some Extraordinary Ministers of Holy Communion take communion to people who are confined to hospitals or to institutions such as nursing homes. Whilst the principles and procedures involved with taking communion to the sick in their own homes apply in these circumstances, there are other factors to be considered by those who undertake this ministry.

Ministers visiting hospitals need to be familiar with hospital routines and the particular practices of the hospital’s chaplaincy service. They need to use their powers of observation in order to be aware of each person’s particular circumstances. It is important to take note of signs on the patient’s door or over the bed, to enquire of the patient or nursing staff if the patient is tolerating food, to look for indications of pain or tiredness, and to assess the situation if visitors are present.

Particularly in institutions such as nursing homes, consideration should be given to making appropriate adaptations and arrangements so that the Rite of Communion is not diminished to the absolute minimum. Perhaps the residents or patients could be gathered together in one place so that Communion may be distributed in the context of a Liturgy of the Word. 

Where it is not possible to celebrate the full Rite of Communion, the rite for Communion in a Hospital or Institution may be used. The minister may however add elements from the rite for ordinary circumstances, for example a scripture reading.

The rite begins with the recitation of the eucharistic antiphon in the hospital chapel or in the first room visited; then the minister gives communion to the sick in their individual rooms. There the minister begins with one of the liturgical greetings given in the rite, places the Blessed Sacrament on the table, leads the sick in the Lord’s Prayer and gives communion in the usual way. The concluding prayer may be said in the hospital chapel or last room visited. No blessing is given.

Priests and other ministers entrusted with the spiritual care of the sick are required to do all they can to ensure that those in danger of death receive the body and blood of Christ as viaticum. The celebration of the Eucharist as viaticum, food for the passage through death to eternal life, is the sacrament proper to the dying Christian, the “last rites” and may be ministered by lay ministers as well as the ordained.

 Viaticum: Communion of the Dying

From the earliest years of the Christian Church, people who are dying have received absolution and communion. This final communion is called viaticum, from the Latin word meaning ‘provision for a journey’. It is food for the journey from this world to eternity.

According to Canon Law, “Christ’s faithful who are in danger of death, from whatever cause, are to be strengthened by Holy Communion as viaticum”. (Canon 921)

The Catechism says of viaticum: “Communion in the body and blood of Christ, received at this moment of ‘passing over’ to the Father, has a particular significance and importance. It is the seed of eternal life and the power of resurrection.” (CCC 1524)

Whenever it is possible, dying Christians should be able to receive viaticum within Mass. In this way, they share fully, in the final moments of their life, in the eucharistic sacrifice which proclaims the Lord’s own passing from death to life. However, circumstances such as physical location or medical condition often make the celebration of Eucharist impossible, in which case the rite for viaticum outside Mass is appropriate.

This rite follows a similar pattern to that of Communion in Ordinary Circumstances: Introductory Rites, Liturgy of the Word, Liturgy of Viaticum and Concluding Rites.

A distinctive feature of the celebration of viaticum, whether within or outside Mass, is the renewal of the baptismal profession of faith by the dying person. This occurs after the homily and replaces the usual profession of faith. The form echoes the Christian’s first profession of faith which is renewed every Easter. In the context of viaticum, it is a renewal and fulfilment of initiation into the Christian mysteries, with baptism leading to the Eucharist.

The rite includes a litany after the baptismal profession of faith which consists of three invocations to Christ each followed by, “For our brother/sister, Lord, we pray”.

As an indication that the reception of the Eucharist by the dying Christian is a pledge of resurrection and food for the passage to death, the special words proper to viaticum are added when communion is given: “May the Lord Jesus Christ protect you and lead you to eternal life”.

The dying person and all present may receive communion under both kinds. In some cases, the sick person may not be able to swallow the host but can receive Christ under the form of wine alone. In this case, the precious blood is carried to the sick person in a container which avoids all danger of spillage. Any precious blood remaining after communion is consumed by the minister.

‍

The rite of viaticum concludes with the sign of peace. The minister and all present embrace the dying Christian. This and other parts of the liturgy openly embody both a sense of leave-taking and the joy of Christian hope which is the comfort and strength of the one near death.