Why do we have the Sacrament of Anointing of the Sick? A Historical Overview From The Old Testament to Vatican II

Scripture established the anointing of oil as a healing practice and a sign of God’s consecration. In the Old Testament, God commanded Moses to create a sacred anointing oil to consecrate the tabernacle, its furnishings, and Aaron and his sons for priestly service (Exod 30:22-33). Samuel anointed David with oil (1 Sam 16: 13), linking anointing to divine empowerment. In the Psalms, anointing represents God’s favor and blessing (Ps 23:5).

Catholic theology identifies the Epistle of James (5:-15) in the New Testament as the scriptural foundation for the Sacrament of the Healing of the Sick.[1] The Greek term translated as “presbyters” in James’s epistle does not refer to community elders by age, but rather to those ordained through the laying on of hands to serve the Church.[2] Spiritual believers are anointed by the Holy One (1 John 2:20). The New Testament also provides a scriptural basis for the sacrament, specifically Mark 6:13, where Jesus sent out the disciples. Notably, both Jesus and James attest to Christian care for the sick.

Little information survives on early anointing practices; however, evidence suggests they included a Christian leader’s prayers, anointing with oil, forgiveness of sin, and restoration of physical and spiritual health.[3] By the 1st century, Hippolytus described bishops consecrating oil for the sick. In the fifth century, Pope Innocent I clarified that bishops, priests, and all Christians could administer the sacrament of anointing.[4] 

Early Christian practice developed in two forms. During the first through fifth centuries, a private anointing could be performed by the sick person or by relatives seeking bodily cure. In contrast, a priest or bishop could anoint someone with a grave illness to pursue spiritual health. From the 9th century onward, anointing became one of the Church’s final rites, not intended for bodily cure but for spiritual effect, serving as a sacramental and spiritual aid for those in danger of death.[5]

The history of anointing the sick dates back to the third century, when oil was used to heal both body and soul. A letter from Pope Innocent I (416) outlines the proper way to handle the oil, which was allowed to all Christians in their afflictions. The bishop must consecrate the oil, but presbyters can anoint people. In the sixth century, Christians could anoint themselves and their families with blessed oil during illness. Beginning in the eighth century and especially from the ninth century onward, the anointing with oil became the Sacrament of Death. Until the thirteenth century, the anointing of the sick was held after confession and reconciliation and before Eucharistic viaticum.

From that point until Vatican II, it was given as the last sacrament for the sick. After the ninth century, the priest was responsible, though the rite was not uniform. In Scholastic theology, it was called “extrema unction, the last anointing, the sacrament of the dying.” It is counted among the seven sacraments accepted in the first half of the twelfth century. The common view became that it “eliminates the last obstacles to a person’s entry into heavenly glory and perfects the Church’s efforts for the salvation of souls.”[6].

There were centuries of magisterial teaching. Pope Innocent I’s Letter to the Bishop of Buggio in the fifth century clarified that both presbyters and bishops could serve as ministers of the sacrament.[7] In the ninth century, Emperor Charlemagne imposed Roman practices throughout the empire, including restricting anointing to the dead.[8] Peter Lombard, a medical theologian, coined the term for this concept as “extreme unction.” By the twelfth century, the term had become formalized as the sacrament for the dying. The Council of Florence (1439) established definitively that “the minister of this Sacrament is the priest.”

Before the Council of Trent, the anointing of the sick was seldom mentioned in official Church Documents. The Council of Trent considered defending the sacramentality of the anointing of the sick important and, in 1551, developed a Doctrine on the Sacrament of Extreme Unction.[9] It included four Canons. The Council of Trent emphasized the priest’s role and the anointing’s connection to preparation for death. The Council of Trent anathematized those denying that anointing is one of the seven sacraments or that only priests are its proper ministers.[10] The current canon law affirms that “every priest, and only a priest, validly administers the anointing of the sick.”[11]

The Council of Trent’s revised language shifted from a sacrament for only the dying to one administered to the dangerously ill, which emphasized that the recipients were sick rather than dying.[12] The Council of Trent systematized the essential elements of the sacraments: the faithful seriously ill as recipients, the priests as the exclusive ministers, the blessed oil as the material substance, the minister’s prayer as the form, and salvific grace, with the forgiveness of sins, as its effect. The council declared the divine institution of the anointing and taught that James 5:14-15 established the sacrament, which Jesus initiated and commended to the faithful through the Apostle James.[13] The council discussed the grace of the Holy Spirit in relation to the anointing’s removal of sins, strengthening the sick person’s soul, arousing confidence in divine mercy, and, when beneficial for spiritual well-being, the possible restoration of bodily health. The council clarified that a priest should administer the anointing to the sick, particularly near death, as the proper minister of the sacrament.[14]

The canon did not develop new dogma, reject the Reform opinion, lay out the historical facts, or protect the sacramental order. It emphasized the Extreme Unction at the end of life. The council did not limit anointing exclusively to the dying and stated that it may be received more than once if the sick recover after being anointed and then become ill again.[15]

Change began with Vatican II, which designated “anointing of the sick” as the sacrament's appropriate title. The Council’s Constitution on the Liturgy[16] and Constitution on the Church[17] insisted that the sacrament was not reserved for the dying but for the ill, so that the Church might commend the suffering to Jesus for salvation.[18] The anointing is given when a Christian begins to be in danger of death because of sickness or old age.[19] Pope Paul VI formalized the decision in 1972, issuing the new rite titled “Pastoral Care of the Sick: Rites of Anointing and Viaticum,”[20] which restored the pastoral function and clarified that viaticum (Holy Communion) serves as the final sacramental gesture for the dying.[21]

Other changes made by Vatican II include the ordering of the sacraments as confession, anointing, and the Eucharist.[22] The versions are included in the new “Order for the Consecration of Chrism, the Oil of Catechumens, and the Oil of the Sick” (1970).[23] The bishop blesses the oil, but in real need, a priest can bless it. The prayer of blessing was revised to name the effects of anointing. An introductory rite and service of the Word are followed by a silent imposition of hands by the minister; then comes a praise of the blessed oil. The minister anoints the forehead and hands with a specific prayer. The anointing of the sick is given when anyone is ill, before an operation, or is weak due to old age. It can be given to several people at the same time in a Church or an appropriate place. It can be repeated for a different illness or if the condition worsens. [24]

Remedial suffering holds that believers undertake suffering alongside Jesus’ redemptive, sacrificial suffering rather than passively receiving the suffering. In Pope John Paul II’s Apostolic Exhortation, Reconciliatio et Paenitentia,[25] he describes the anointing of the sick as “a sign of definitive conversion to the Lord and of total acceptance of suffering and death as penance for sins.” This transforms the sick person’s experience from isolated affliction into participation in salvation history itself, as their pain becomes participation in Jesus' saving work.

The Magisterium’s teaching on the Sacrament of the Anointing of the Sick has developed significantly, with a focus on the sacrament’s purpose, timing, and theological meaning. As aforementioned, the Council of Trent identified the elements of the sacrament as the seriously ill as the subject, priests as the minister, the blessed oil as the substance, the minister’s prayer as the form, and saving grace and forgiveness as the effects.[26] The Council of Trent rejected the medieval understanding of anointing as only for the dying and stated that anointing should be administered to the sick, “especially those in danger of death. Interestingly, they described the recipients as “sick” rather than “dying” in three statements. [27]

Fr. Peter Fink, Jesuit priest, theologian, and author, explained the transformative shifts introduced by the Second Vatican Council that changed the rulings of the Council of Trent. The Second Vatican Council renamed the sacrament from “Extreme Unction” to “Anointing of the Sick,” clarifying that the rite should be administered when the recipient can participate, rather than only when they are in the process of dying. The council also introduced a Christological emphasis on the sick persons’ union with Jesus’ suffering; thus, it commended the ill to Jesus and exhorted them to contribute to God’s people by uniting themselves to Jesus’ passion and death.[28] The Apostolic Constitution Sacram unctionem infirmorum[29] was established following the Second Vatican Council, highlighting the appropriate recipients, the priest’s method, the material, and the prayer (see footnote 29 for the prayer).

The Catechism of the Catholic Church (CCC 1499-1532) outlines the official doctrine, and the Code of Canon Law (959-957) clarifies matters concerning the sacrament, the celebration, the minister, and the recipient, among other matters.[30]

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[1] Congregation for the Doctrine of the Faith, Note on the Minister of the Sacrament of the Anointing of the Sick (Vatican City State: Libreria Editrice Vaticana, 2005).
[2] Ibid.
[3] Herbert Vorgrimler, Sacramental Theology, trans. Linda M. Maloney (Collegeville, MN: The Liturgical Press, 1992),
[4] Ibid.
[5] Ibid.
[6] Ibid.
[7] Vorgrimler, Sacramental Theology, 226-236.; Pope Pius II, "Letter to the Bishop of Buggio," in Select Letters of Pope Pius II, ed. John Doe (New York: Academic Press, 2020), 45.
[8] Komonchak, Collins, and Lane, New Dictionary of Theology, 876-877; Catholic Church, Penance and Reconciliation (Vatican City: Libreria Editrice Vaticana, 1982).
[9] Council of Trent, "Doctrine on the Sacrament of Extreme Unction," Session 14 (November 25, 1551), in Decrees of the Ecumenical Councils, ed. Norman P. Tanner (Washington, DC: Georgetown University Press, 1990), 2:706–708.
[10] Ibid.
[11] Ignatius Press, The Companion to the Catechism of the Catholic Church: A Compendium of Texts Referred to in the Catechism of the Catholic Church (San Francisco: Ignatius Press, 2002).
[12] Komonchak, Collins, and Lane, The New Dictionary of Theology, 24-25.
[13] “The Catholic Letters,” The Navarre Bible (Dublin, New York: Four Courts Press: Scepter Publishers, 2008)
[14] Congregation for the Doctrine of the Faith, Note on the Minister of the Sacrament of the Anointing of the Sick (Vatican City State: Libreria Editrice Vaticana, 2005).
[15] Vorgrimler, Sacramental Theology, 226-236; Congregation for the Doctrine of the Faith, Note on the Minister of the Sacrament of the Anointing of the Sick.
[16]  Second Vatican Council, Sacrosanctum Concilium.
[17] Second Vatican Council, Lumen Gentium.
[18] Congregation for the Doctrine of the Faith, Note on the Minister of the Sacrament of the Anointing of the Sick.
[19] Second Vatican Council, Sacrosanctum Concilium.
[20] Catholic Church, Pastoral Care of the Sick: Rites of Anointing and Viaticum (New York: Catholic Book Publishing, 1983),
[21] Congregation for the Doctrine of the Faith, Note on the Minister of the Sacrament of the Anointing of the Sick.
[22] Second Vatican Council, Sacrosanctum Concilium.
[23] United States Council of Catholic Bishops, The Order of Blessing the Oil of Catechumens and of the Sick and of Consecrating the Chrism, (International Commission on English in the Liturgy, Washington, D.C., United States.)
[24] Vorgrimler, Sacramental Theology, 226-236.
[25] John Paul II, Apostolic Exhortation, Reconciliatio et paenitentia [On Reconciliation and Penance] (Holy See, December 2, 1984), vatican.va.
[26] Komonchak, Collins, and Lane, The New Dictionary of Theology, 24-25.
[27] Ibid.
[28] Fink, in The New Dictionary of Sacramental Worship, 1038; Catholic Church, Penance and Reconciliation (Vatican City: Libreria Editrice Vaticana, 1982).161-1162.
[29] Pope Paul VI, Apostolic Constitution Sacram unctionem infirmorum (Vatican City: Libreria Editrice Vaticana, 1972); CCC 1513: The sacrament of Anointing of the Sick is given to those who are seriously ill by anointing them on the forehead and hands with duly blessed oil - pressed from olives or from other plants - saying, only once: "Through this holy anointing may the Lord in his love and mercy help you with the grace of the Holy Spirit. May the Lord who frees you from sin save you and raise you up." (CCC Can. 847 § 1).
[30] Code of Canon Law: Latin-English Edition (Washington, DC: Canon Law Society of America, 1999)