Most well-catechized Catholics can state with accuracy who can and should receive the sacraments with one sacrament as an exception. I often hear confusion regarding the Anointing of the Sick. In general, there are two extremes: the recipient is one for whom death is mere hours away, or the sacrament is to be given for any illness or surgery. I suspect that variations in the Church’s historical practice, coupled with a lack of sacramental catechesis explaining these changes, is largely responsible for the confusion.

To this end, we will present a brief overview of the history of the sacrament and the teachings of the contemporary Order of Anointing. As we will see, despite variations, the Church’s Magisterium has demonstrated consistency in its teaching. The Anointing of the Sick is a sacrament for those who begin to be in danger of death due to serious sickness or old age.

Development and Continuity

The question “Upon whom should the Anointing of the Sick be conferred?” is foundationally addressed in the Letter of St. James. We read in its fifth chapter: “Is any among you sick (asthenein)? Let him call for the elders of the Church, and let them pray over him, anointing him with oil in the name of the Lord; and the prayer of faith will save the sick (kamnonta) man, and the Lord will raise him up; and if he has committed sins, he will be forgiven” (5:14-15). The first Greek word designates a debilitating illness.¹ In fact, within the context of the letter, the illness has immobilized the sick person such that the priests must come to him. The second Greek word has the meaning of “sickness beyond hope.”² Thus, we are dealing with a person who is dangerously ill. Note too, there is a spiritual component to this danger, potentially necessitating the forgiveness of sins.

From the fourth century we find examples of prayers over the oil of the sick that continue this healing ministry for body and soul.³ By the end of the first millennium this concern for the gravely ill Christian who requires bodily and spiritual healing becomes increasingly expressed in the Church’s liturgical rites. In the ninth century, we witness the emergence of rich liturgies in Carolingian France and Germany. Additionally, these rites begin to link the Anointing of the Sick with the sacrament of Penance for those at the point of death.⁴ At this time, the sacramental ritual for those whose death is imminent follows this order: Penance, then Anointing, and finally Viaticum (reception of Holy Communion by the dying).⁵

The Anointing of the Sick is a sacrament for those who begin to be in danger of death due to serious sickness or old age.

During the next two centuries, pastoral and theological developments influence the question of the recipient of the sacrament. On a practical level, and for various reasons, the faithful began to postpone the sacrament of Anointing until the very end of life. Consequently, Anointing becomes a “sacrament of departure.” Also, during the scholastic period (12th to the 14th centuries) debate emerges regarding the sacrament’s effect. While both sides agreed that the sacrament was for those close to death, they disagreed on its purpose. In short, the Franciscans held that the main effect was the final remission of venial sin to prepare the Christian for entry into heavenly glory. The Dominicans, however, advocated that the principal effect was the removal of the remnants, or remains, of sin. This refers to the after-effects of original sin and personal sin that spiritually weaken the person, especially during times of serious illness or when facing death.⁶ As a result, at the end of the 12th century, under the influence of the Franciscans, the order of the last rites changes.⁷ The order of the sacraments for the dying became: Penance, Viaticum, and Extreme Unction.⁸ This will remain the order until Paul VI reformed the sacrament in 1972. We also see that, in the West, from the 12th century onwards the sacrament begins to be referred to exclusively by the name “Extreme Unction” (the final anointing).

The Council of Trent in 1551 provides the most comprehensive magisterial treatment of the sacrament up to this point. The debates surrounding the doctrine of the sacrament prove illuminating for the question of who receives. The first draft of the decree stated that the sacrament be administered “only to those who are in their final struggle and who have come to grips with death and who are about to go forth to the Lord.”⁹ Thus, the decree sought to enshrine the pastoral practice at that time of waiting until death is imminent.¹⁰ However, not all of the Council Fathers at Trent agreed with restricting the sacrament to those at the point of death. Among other reasons, these Fathers argued that the Letter of James referred to “the sick.” The final text established a middle path acknowledging that this was a sacrament for the seriously ill and for the dying. The Council of Trent thus decreed: “It is also declared that this anointing is to be applied to the sick, but especially to those who are in such danger as to appear to be at the end of life, whence it is also called the sacrament of the dying.”¹¹

Hence, the recipient of the sacrament is especially one in danger of death, although not exclusively. And, as such, it may also be administered to those who are seriously sick. The final question that will need to be settled is whether this danger of death must be immediate or can it be remote? The 1614 Rituale Romanum used language such as “immediate danger of death” and restricted the administration to within “one day” of death. Nevertheless, as we will see, “danger of death” will receive a broader subsequent interpretation from the Magisterium.

Vatican II restored the original sequence for the three sacraments of the sick and dying: Penance, Anointing of the Sick, and the Eucharist as Viaticum.

Twentieth-century Reform

Leading up to the 20th century, canonists began to interpret “danger of death” more broadly than “imminent death.” This finds confirmation in the 1917 Code of Canon Law that does not mention the “point of death” for administration; rather it states only “danger of death.” The relevant canon reads thus: “Extreme unction is not to be extended except to the faithful who, having obtained the use of reason, come into danger of death from infirmity or old age” (can. 940 §1).¹² In fact, the Code encouraged priests to anoint while the infirm are still in full possession of their faculties (can. 944).

Two popes in the early 20th century both caution against waiting until the faithful are about to lose consciousness before anointing.¹³ Benedict XV and Pius XI taught that death need not be feared as immediate but only that there be prudent and probable danger of death.¹⁴

The teachings of the Second Vatican Council that ultimately operate as the principle of reform should be read in continuity with the doctrine of Trent and the magisterial teaching already mentioned. Sacrosanctum Concilium states: “‘Extreme unction,’ which may also and more fittingly 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 him to receive this sacrament has certainly already arrived” (no. 73). Note that this teaching utilizes similar language to the 1917 Code of Canon Law although it added the phrase “begins to be in danger of death.” In turn, this will influence the 1983 Code of Canon Law. Its canon clearly builds upon Trent and the 1917 Code, while developing its language in light of recent magisterial teaching. The relevant canon in the Code states: “The anointing of the sick can be administered to a member of the faithful who, having reached the use of reason, begins to be in danger due to sickness or old age” (can. 1004 §1, emphasis added).

It should be noted that Vatican II restored the original sequence for the three sacraments of the sick and dying: Penance, Anointing of the Sick, and the Eucharist as Viaticum. It therefore returned the Eucharist to its proper place as the sacrament of those departing from this life. We see in this restoration a symmetry between the sacraments of Initiation that begin the Christian life and those at the end of our pilgrimage on earth. Both begin with a sacrament of conversion (Baptism and Penance); then follows an anointing sacrament (Confirmation and Anointing of the Sick); and both are completed by the Eucharist.

Revised Order of Anointing

The current approved ritual in the US is titled, Pastoral Care of the Sick: Rites of Anointing and Viaticum (1983). However, as of February 11, 2026, a new definitive English translation based upon the principles of Liturgiam Authenticam and which more closely follows the structure of the Latin typical edition will come into use. As the author has not seen the final approved text, we will rely on the Latin edition and provide its paragraph numbers for reference. The Latin edition is the Ordo Unctionis infirmorum eorumque pastoralis curae or the Order of the Anointing of the Sick and their Pastoral Care. At the time of writing, it is not certain which of the previous US adaptations have carried over into the new translation.

In its Introduction, or Praenotanda, the Ordo Unctionis provides a comprehensive overview of the recipient under the heading: “Those on Whom the Anointing of the Sick May Be Conferred.” What follows is a summary of the main points related to the Church’s teaching on the recipient of this sacrament.

Danger of death due to sickness or old age

The Anointing of the Sick is a sacrament intended to raise up and save the faithful who are seriously ill due to sickness or old age (no. 8). One notes a difference in language between Sacrosanctum Concilium that states “begins to be in danger of death” (periculo mortis) and the Introduction referring to those who are “seriously ill” (periculose aegrotat). Nevertheless, the key point is that we are dealing with a sickness that is serious enough that it places the Christian in danger. First, the danger must be due to sickness and not simply danger in itself (e.g., people who undertake perilous journeys are in danger but this is not due to illness). This will become important for questions pertaining to surgery. Second, if a priest is concerned as to whether a sickness is grave, he should consult a doctor, but as long as there is a prudent judgment of probable danger, the priest can anoint. Third, the current US ritual warns that the sacrament should not be given indiscriminately or to those whose health is not seriously impaired.¹⁵ Regarding the communal celebration of the sacrament, the Code of Canon Law prescribes that the participants be “appropriately prepared and properly disposed” (can. 1002). Such a prescription would surely exclude “healing liturgies” in which any of the faithful are invited to be anointed regardless of whether the illness is serious, or whether they have been properly prepared pastorally and catechetically. Finally, according to the United States Conference of Catholic Bishops’ Newsletter that announced the implementation date for the new English Order of Anointing, one of the US textual adaptations that has been retained is the permission to anoint those with serious mental illness. The condition for anointing a person with mental illness is twofold: a) the mental illness itself must be serious (a professional should be consulted if there is doubt) and b) the Christian would be strengthened by the anointing (PCS, no. 53).

While the Anointing of the Sick does not impart an indelible character, the grace of the sacrament endures for the duration of the illness.

When can the sacrament be repeated?

The sacrament may be repeated should the Christian recover and fall ill once again or, if in the same illness, a serious relapse occurs (no. 9). Thus, whether a Christian recovers and falls sick again, or if during the same illness the condition becomes more grave, the sacrament can be newly administered due to a worsening state of health.¹⁶ While the Anointing of the Sick does not impart an indelible character, the grace of the sacrament endures for the duration of the illness. In fact, some theologians maintain that Anointing bestows upon the recipient a “title” to grace from which the Christian may draw throughout the illness.¹⁷

Anointing and surgery

One may be anointed prior to surgery if a serious illness is the cause for the procedure. For example, while some people require general anesthetic to have their wisdom teeth removed, the removal of teeth would not be considered a serious illness; neither would a kneescope. Thus, while undergoing general anesthetic can be dangerous, it is not, in itself, reason to be anointed. Some priests have also anointed pregnant women prior to giving birth, yet this would imply that pregnancy is a serious illness. If a Christian is concerned that he could die (whether in surgery or travelling), the sacraments that he should receive are Penance and the Eucharist. The Anointing of the Sick is for the seriously sick and any danger must originate from the illness and not from external causes (no. 10).

The elderly

Those who have been greatly weakened through advanced age may also be anointed even when serious illness is not apparent (no. 11). The condition required is that the strength of the Christian be significantly diminished due to his age even if there is no suspicion of grave illness. One of the graces of this sacrament is to help persevere with the difficulties of old age (CCC, n. 1520). However, this does not mean that Christians should automatically be anointed once they reach a certain age.¹⁸

It is important that Christians who are seriously sick express their wish to be anointed to family and caregivers.

Children

Children who have attained the use of reason may be anointed (no. 12). This is due to the fact that one of the effects of the sacrament is the forgiveness of sin. If a dying person is unable to confess his sins (e.g., he is unconscious), Anointing of the Sick will forgive mortal sin, assuming that the person had an implicit desire to receive the sacrament.¹⁹ A child below the age of reason, however, is not considered capable of committing mortal sin. Therefore, should such a child face death or serious illness, he should receive Confirmation (can. 891) and, if possible, the Eucharist. In general, in danger of death, the faithful are canonically bound to receive Holy Communion as Viaticum (can. 921 §1). In fact, this obligation is so important that the Code of Canon Law states that the faithful should receive Holy Communion daily while the danger of death lasts (can. 921 §3). If a dying or seriously sick child can distinguish the body of Christ from ordinary food and receive communion reverently, he should receive Communion (can. 913 §2).

Those who have lost consciousness

If a Catholic has lost consciousness or the use of reason but it was known that he would have desired the Anointing of the Sick, he may receive the sacrament (no. 14). It is important that Christians who are seriously sick express their wish to be anointed to family and caregivers.

If the person has already died

If the person has already died when the priest arrives, the priest should not anoint. None of the Church’s sacraments may be administered to the dead as they are sacraments for the living.²⁰ If it is known that the Christian has died, then the priest should beseech God to forgive the recently departed (no. 15). However, there are instances when death is not certain. Perhaps the person’s heart has stopped or he appears to no longer be breathing, yet it is not known if the soul has truly left the body. In these cases, and based upon the priest’s prudential judgment, he can anoint using a specific rite provided by the Ordo Unctionis (no. 135).

Those in obstinate and manifest grave sin

The Anointing of the Sick may not be conferred on those who obstinately persevere in manifest grave sin (no. 15). The Church has always excluded from her sacraments (especially the Eucharist), those who persistently remain in public sin (c.f. Matthew 16:19, 18:17-18; 1 Corinthians 5:4-6; 11:27–28). This prohibition serves a threefold purpose: 1) it calls the sinner to repentance through the Sacrament of Reconciliation; 2) it prevents the further spiritual harm of receiving a sacrament sacrilegiously; and 3) it prevents scandal of the faithful.

Opportunity for Encounter

As we have seen, from the beginning, Anointing of the Sick is a sacrament for the Christian who is seriously ill and in danger of death. It is not only for those at the point of death although neither is it to be given indiscriminately and for any illness. Rather, this is a sacrament that “commends those who are ill to the suffering and glorified Lord, that he may raise them up and save them” (CCC, n. 1499). It therefore becomes an opportunity for the seriously sick in danger of death and the aged to encounter the Lord and to be united to his death so as to rise with him.

1. John R. Donahue and Daniel J. Harrington, Sacra Pagina: The Gospel of Mark (Collegeville, MN: Liturgical Press, 2002), 266-267.
2. Martin Dudley and Geoffrey Rowell, The Oil of Gladness: Anointing in the Christian Tradition (Collegeville, MN: Liturgical Press, 1993), 58.
3. For example, see The Apostolic Tradition and Euchologion of Serapion.
4. James Monti, A Sense of the Sacred: Roman Catholic Worship in the Middle Ages (San Francisco, CA: Ignatius Press, 2013), 236.
5. This is seen in the Romano-Germanic Pontifical (950 A.D.), quoted in Monti, Sense of the Sacred, 237.
6. Thomas Aquinas, Sent IV, D. 23, Q. 1, A. 2, Response to Quaestiuncula 1.
7. Paul F. Palmer, “The Purpose of Anointing the Sick: A Reappraisal,” Theological Studies 19, no. 3 (1958): 343.
8. Palmer, “The Purpose of Anointing the Sick,” 343.
9. Palmer, “The Purpose of Anointing the Sick,” 336.
10. Charles George Renati, The Recipient of Extreme Unction (Washington, D.C.: The Catholic University of America Press, 1961), 31.
11. Council of Trent, Session 14, “Teaching Concerning the Most Holy Sacraments of Penance and Last Anointing, 25 November, 1551,” in Decrees of the Ecumenical Councils: Trent to Vatican II, ed. Norman P. Tanner, vol. 2 (London: Sheed & Ward, 1990), chap 3.
12. The 1917 or Pio-Benedictine Code of Canon Law: in English Translation, with Extensive Scholarly Apparatus, Edward N. Peters curator (San Francisco, CA: Ignatius Press, 2001) (emphasis added).
13. John C. Kasza, Understanding Sacramental Healing: Anointing and Viaticum (Mundelein, IL: Hillenbrand Books, 2006), 65.
14. See Benedict XV, Sodalitatem Nostrae Dominae (1921); Pius XI, Explorata res (1923).
15. Pastoral Care of the Sick: Rites of Anointing and Viaticum Approved for Use in the Dioceses of the United States of America (Totowa, NJ: Catholic Book Publishing, 1983), 21n8.
16. Bronislaw Wenanty Zubert, “Title V: The Sacrament of the Anointing of the Sick,” in Exegetical Commentary on the Code of Canon Law, Prepared under the Responsibility of the Martín de Azpilcueta Institute, Faculty of Canon Law, University of Navarre, Volume III/1, English edition, ed. Ernest Caparros (Chicago, IL: Midwest Theological Forum, 2004), 888.
17. Joseph A. De Aldama, et al., Sacrae Theologiae Summa IVA On the Sacraments in General: On Baptism, Confirmation, Eucharist, Penance and Anointing, trans. Kenneth Baker (Ramsey, NJ: Keep the Faith, 2015), 613.
18. Zubert, “Sacrament of the Anointing of the Sick,” 886.
19. CCC, n. 1532. See also Colman O’Neill, Meeting Christ in the Sacraments (Revised Edition) (Staten Island, NY: St Pauls, 2019), 287-288.
20. Zubert, “Sacrament of the Anointing of the Sick,” 890.