With great anticipation, The Order of Anointing of the Sick and of their Pastoral Care has been published and has been available for use since February 11, 2026, and will be mandatory on Easter Sunday, April 5, 2026. Priests caring for those suffering from illness will find the revised Order much better suited for pastoral ministry and will also be grateful to know that the formula for Anointing of the Sick in English remains unchanged. In this article, I will explain the significant changes in the revised Order as compared with the Pastoral Care of the Sick, the ritual book used in the United States since 1983. These include: (1) a ritual book now primarily for priests; (2) the elimination of the rite known as “Anointing of the Sick in a Hospital or Institution”; (3) a specific ritual for the Order of Confirmation; (4) clearer provision for the Sacrament to be given to those suffering from serious mental illness; and (5) modifications to the formula for the Apostolic Pardon.

Ritual Book Specific to Priests

The previous edition of Pastoral Care of the Sick was for use by priests, deacons, and laity who minister to the sick, all within one ritual book. The revised Order is for use primarily by priests. Without having to decipher the different options for priests and laity, along with a clearer structure to the book, priests will be able to more easily and prayerfully engage the rubrics and texts. Deacons and laity will use a separate ritual book for their ministry to the sick and dying.¹ Many aids for ministry to the sick have been previously developed for Extraordinary Ministers of Holy Communion and these remain available; however, these should be updated to reflect the revised Order present in Holy Communion and Worship of the Eucharistic Mystery Outside Mass, published in 2024.

In Hospital or Institution

Perhaps the most common rite from the previous ritual book that I saw priests use while I was in seminary formation was the “Anointing of the Sick in a Hospital or Institution” (within Chapter IV of the previous edition) which provided a concise, straightforward version of the ritual consisting of only (1) the opening instruction, (2) the laying on of hands and the formula for anointing, (3) the Lord’s Prayer, and (4) a concluding prayer and blessing.² This is not present in the Latin typical edition, and therefore the revised Order does not include this form either.

I believe this is an important opportunity for priests to embrace “The Ordinary Rite,” which includes signs and symbols helpful for the sick while they are conscious and able to participate, to spiritually engage in the liturgy for fruitful reception, and to actively offer their suffering in sacrifice and worship to God the Father. For example, the reading of Sacred Scripture stirs into flame the faith of the sick person; the litany offers the sick person the opportunity to seek the Lord’s mercy; the Prayer of Thanksgiving over the Oil between the laying on of hands and the formula of anointing is an explicit prayer of praise to the Trinity as the sick person associates his life with the passion and death of Christ; and the Our Father unites those participating in the liturgy to the entire Mystical Body of Christ. Even a short homily can help the sick understand the nature of the Sacrament and their participation in the salvation of the world by being united to Christ through the grace of the Holy Spirit, offering their lives in worship of the Father as Christ did. The signs and symbols of the fuller Ordinary Rite are rich for the faithful.

Some priests may be uncertain which rite to use in the revised Order. The following guide is a helpful aid for determining which rite to use in specific situations:

The Church does recognize circumstances where an abbreviated form of the Sacrament is necessary. In those cases, the priest has the authority to omit certain aspects of the rite: reading from Sacred Scripture (no. 72), the Litany (no. 75), and the Prayer of Thanksgiving over the Oil (no. 75A).³ Chapter IV should not be used for those who are sick but not near death, although the abbreviated version just described would be similar in structure.

Confirmation in Danger of Death

According to canon 883 of the Code of Canon Law, a priest has the faculty by law to confer Confirmation in danger of death. In the previous edition of the Pastoral Care of the Sick, the formula for Confirmation was a possible insert in the “Continuous Rite of Penance, Anointing, and Viaticum” (PCS, 246). In The Order of Anointing of the Sick and of their Pastoral Care, the Church states, “If possible, Confirmation in danger of death and the Anointing of the Sick should not be conferred in a continuous rite, lest the different Sacraments be confused, since an anointing takes place in both” (OAS, 117). For this reason, in the revised Order, Confirmation has its own place in Chapter V. Priests should familiarize themselves with the introduction to the chapter. The revised Order states that when circumstances make it possible, the entire rite followed in The Order of Confirmation should be celebrated. However, in cases of urgent necessity, the Church provides the ritual present in the revised Order of Anointing of the Sick and of their Pastoral Care:

• The laying of hands over the sick person (hands extended) while offering the consecratory prayer of Confirmation.
• The priest then dips the tip of his right thumb in Chrism and makes the Sign of the Cross on the forehead of the one to be confirmed, saying: “N. BE SEALED WITH THE GIFT OF THE HOLY SPIRIT.”

Notice the necessity for Sacred Chrism; the Oil of the Sick is not valid matter and would not confer the Sacrament. The Church allows other preparatory and concluding rites from The Order of Confirmation to be added to this ritual. In these cases, the priest should prepare ahead to best meet the circumstances of the individual.

In cases where Confirmation and Anointing must occur at the same time, “Confirmation is conferred immediately before the Blessing of the Oil of the Sick [or Prayer of Thanksgiving over the Oil if the oil is already blessed], omitting the laying on of hands which pertains to the Rite of Anointing” (OAS, 117). Thus, the order is as follows:

• following the profession of baptismal faith and litany (OAS, 123), the laying of hands on the head of the sick person is omitted;
• the priest proceeds with extended hands and the consecratory prayer;
• the conferral of Confirmation follows;
• the priest then continues with the Blessing of the Oil of the Sick or the Prayer of Thanksgiving over the Oil to proceed to the Anointing (OAS, 126-127).

First Holy Communion in the form of Viaticum ought to also be considered when the individual has not received that Sacrament in order to complete Christian Initiation.

Confirmation thus described is distinct from the “Shorter Order of Adult Initiation to Be Used in Near Danger or at the Point of Death” found in the Appendix of the revised Order. The rite of Confirmation in Danger of Death is for those who have already been baptized but not received the Sacrament of Confirmation. For example, for a previously baptized sick child who is in danger of death, the Sacrament of Confirmation ought to be conferred. Especially when a priest may be tempted to offer the Sacrament of Anointing, the Church does not permit Anointing of the Sick to be conferred on the child prior to reaching the use of reason due to Anointing’s connection to the forgiveness of sins. Thus, Confirmation can become a very moving pastoral aid to family members and further initiate the child.

Serious Mental Illness

There is a subtle but pointed pastoral emphasis present in the revised Order: the availability of the Sacrament for those who suffer from mental illness is now present within the General Instruction: “this Sacred Anointing is to be conferred on the faithful who because of sickness, mental illness, or age are seriously ill” (OAS, 8). Previously, the Pastoral Care of the Sick had placed this allowance for mental illness within the introduction to the first part of “Pastoral Care of the Sick” (PCS, 53). Instead of mention of mental illness being a peripheral note as in the previous ritual, the revised Order places mental illness within an integral description of the proper recipient within the General Instruction, emphasizing it as a serious infirmity. While a “prudent and probable judgment” must be made concerning the “seriousness” of the mental illness, pastors do have the opportunity to offer the Sacrament of Anointing of the Sick in cases where mental illness is severely impairing a person’s life and health. Keeping in mind “the grace of the Holy Spirit, by which the whole person is helped toward salvation, is lifted up by the faithfulness of God, and is strengthened against temptations of evil and anxiety of death” (OAS, 6), one can understand how this Sacrament offers great aid to those plagued by serious mental illness to patiently bear their sufferings for their salvation and the welfare of the entire Mystical Body of Christ. With increasing awareness and understanding of mental illness, this development demonstrates the Church’s pastoral care for those suffering from this form of sickness.

Formula for Apostolic Pardon

There is great devotion among both priests and laity regarding the Apostolic Pardon. As the Manual of Indulgences states, “A priest who administers the sacraments to someone in danger of death should not fail to impart the apostolic blessing to which a plenary indulgence is attached.”⁴ Some may find difficulty with the change in the first option of the formula which now states, “By the authority given to me by the Apostolic See, I grant you a plenary indulgence [previously stated, ‘a full pardon’] and the remission of all your sins, in the name of the Father, and of the Son, and of the Holy Spirit” (OAS, 122). This small change is a more accurate description for both the priest and the person in danger of death to recognize what is being offered to them, namely, a plenary indulgence. Often, I find both priests and laity seeking the Apostolic Pardon as an “automatic ticket” to heaven, placing its power even higher than reception of Penance and Viaticum. The Apostolic Pardon itself does not forgive sins. The sick person ought to seek the Sacrament of Penance before the Apostolic Pardon to receive this indulgence free from all attachment to sin and requesting remission of the temporal punishment incurred through their sins.⁵

The priest should note that there are two places in the ritual book where the Apostolic Pardon is appropriately administered: when administering Viaticum (Chapter III) and when offering the sacraments to a person in imminent danger of death (Chapter IV). It is not to be administered while offering the Ordinary Rite of Anointing of the Sick (Chapter II). This is because the Apostolic Pardon is offered to those who are approaching death in the same way in which Viaticum is offered to the dying differently than Holy Communion to the Sick.

Reinvigorated Reverence

As we have experienced in recent years, it takes time to gain knowledge of and familiarity with revised rituals. At the same time, it offers us an opportunity to reinvigorate our reverence for the sacred liturgy and examine our pastoral practice with the mind and heart of the Church. If we prayerfully and thoughtfully engage the General Instruction and the revised rites, priests will experience the greatest fruits of this sacred liturgy in which they accompany the sick in their suffering and the dying in their final surrender to the Lord.

1. Editor’s note: the September 2025 Newsletter of the USCCB Committee on Divine Worship clarifies further: “Throughout the new editions, the subject of the rites is ‘Priest,’ not ‘celebrant’ or ‘minister.’ As provided in the editions, however, a deacon may celebrate the rites in Chapters I and III, and both deacons and lay persons may use Chapter VI and Appendices I-III; however, for Communion and Viaticum to the sick, lay persons must use Holy Communion and Worship of the Eucharistic Mystery outside Mass (cf. Order of the Anointing of the Sick and of their Pastoral Care, no. 29).”
2. Pastoral Care of the Sick: Rites of Anointing and Viaticum (New Jersey: Catholic Book Publishing, 1983), 154-160 (hereafter, PCS; numbers here and in the OAS below refer to numbers within the ritual, not page numbers).
3. “The Order of Anointing of the Sick: The Ordinary Rite,” The Order of Anointing of the Sick and of their Pastoral Care (Magnificat, 2026), 67 (hereafter, OAS).
4. Manual of Indulgences, fourth edition (USCCB, 1999), no. 12 §1.
5. For a short discussion on the Apostolic Pardon, see Father Ryan Rojo’s article “Last but not Least: A Liturgical Look at Holy Communion as the Sacrament of the Dying” (Adoremus Bulletin, November 2018).