Rama P. Coomaraswamy, MD
"The Christian at least has the last sacraments administered a few hours in advance [of death]." Sigmund Freud
It is clear that we all must die, and indeed, in many ways this is the most important moment of our lives. Catholics and clergy who have embraced the new Sacraments in the belief that they are valid and efficacious, must recognize that the Sacrament of Extreme Unction no longer exists. What has replaced it is a “Blessing for the sick.” Conservative Novus Ordo priests now speak of the importance of the final confession. In this of course they are correct, for that is the best they can offer the dying - assuming they are themselves properly ordained. This is not to decry the “blessing of the sick,” for blessings are always good. It is simply to state that what is proffered, Confession apart, is not a Sacrament.
The seriousness of this defect cannot be exaggerated. Catholics have always had the security of knowing that, when in danger of death, the Church provided them with a saving Sacrament of a most powerful nature. Indeed, many a Catholic family is familiar with the story of some lapsed member, away from the Sacraments for years and even decades, who at the last moment asked for the priest in order to receive the "last rites." This is no longer a viable option.
What are the effects of Extreme Unction (usually provided after Confession and in association with the Holy Viaticum or the Sacred Species.)? They are as varied as they are potent. Their "end" or "purpose" is said to be "the perfect healing of the soul," and it surely has the inherent power to attain its end in those who pose no obstacle to the grace it conveys. As the Council of Trent explains, "this effect is the grace of the Holy Ghost, Whose unction blots out sins, if any remain to be expiated, and the consequences of sin, and alleviates and strengthens the soul of the sick person, by exciting in him a great confidence in the divine mercy, sustained by which he bears more lightly the troubles and sufferings of disease, and more easily resists the temptations of the demon lying in wait for his heel; and sometimes, when it is expedient for the soul's salvation, recovers bodily health." These effects are usually grouped under four headings.
The first effect is the Remission of sins which follows from the passage in St. James: "If anyone be in a state of sin, his sins are forgiven him," and which is indeed confirmed by the very "form" of the Sacrament which states "Indulgeat tibi Dominus... quidquid... deliquisti... (May God pardon thee whatever sins thou hast committed..."). Of course, it is true that mortal sins are forgiven by Confession, Absolution and Penance - but it is not unusual that a sick man, being weak or unconscious, cannot confess; yet providing he places no obstacle to the infusion of Grace into his soul (and implicitly has a proper intention), than through this Sacrament, even if he cannot confess, he is still washed clean of sin and regains his Baptismal purity. To such an individual Extreme Unction becomes the pillar of salvation. It can be argued that conditional Absolution obviates the need for this final Sacrament, but that would be to ignore its other effects.
Secondly, this Sacrament remits temporal punishment due to us for our sins. which of course ordinary Confession and Absolution cannot do. It was, as Father Kilker says, "instituted for the perfect healing of the soul with a view to its immediate entrance into glory, unless indeed the all-knowing master of Life and Death should deem the restoration of bodily health more expedient. Consequently, it must accomplish the removal of all disabilities, it must render us fit to enter our heavenly home without delay. Were this not so, it would be absurd to say that the Sacrament is "consummativum spiritualis curationis”; This doctrine must not however be construed to mean that when Extreme Unction is received, the remission of the entire temporal debt infallibly occurs. Often the subject blocks the completeness of the effect by defective and impeding dispositions. But, if the subject has in every way the correct disposition and devotion, it must be conceded that he receives the plenissimam poenarum relaxationem - the complete remission of temporal punishment.
The third and terribly important effect is what is called the comfortatio animae: or the "Comforting of the Soul." The approach of death with its distressing pains, its physical prostration and the associated mental disquietude, can truly be a most appalling experience. Man dreads few things as much as this "moment of truth." He reviews his past actions and, as it says in the Book of Wisdom, "they shall come with fear at the thought of their sins, and their iniquities shall stand against them to convict them." At the same time he recognizes that soon he must stand before the Judgment Seat of God. It is precisely at this time that the Devil uses all his powers and wiles to attack the soul. As the Catechism of the Council of Trent puts it: "although the enemy of the human race never ceases, while we live, to meditate our ruin and destruction, yet at no time does he more violently use every effort utterly to destroy us, and if possible, to deprive us of all hope of divine mercy, then when he sees the last day of life approach." Now the third effect of this Sacrament is "to free the minds of the faithful from this solicitude, and to fill the soul with pious and holy joy." It further provides "arms and strength... to the faithful... to enable them to break the violence and impetuosity of the adversary, and to fight bravely against him..." Who of us can be so presumptuous as not ardently to desire such assistance?
Fourthly, it is a doctrine of our faith that one of the effects of Extreme Unction is the restoring of bodily health, if recovery is expedient for the soul's welfare. As a physician in practice I can testify to this effect without hesitation.
Lastly, though not strictly speaking a theological effect, the administration of the Sacrament under traditional circumstances, made it perfectly plain to the individual concerned that he was facing death. He could no longer hide from himself the reality of his situation. He was forced, as it were, to the battlefield, and not allowed to drift away in some gently morphinized dream that "everything will be all right." And how often did physicians and relatives see the wonderful effects this Sacrament worked upon the souls of those who received it - turning as it were, their last moments on earth into a foretaste of that heavenly peace and glory that is in fact, offered to every soul.
EXAMINING THE CHANGES IN THE FORM AND MATTER OF THE SACRAMENT
According to Father Kilker, "the remote matter of Extreme Unction is oil of olives. The "proximate matter" is the oil of olives blessed by the Bishop. This the Council of Trent definitely defined. "Intellexit enim Ecclesia materiam esse oleum ab episcopo benedictum" (Session XIV). There is no doubt about what St. James meant when he said "oil of olives" (V:14). Initially the oil of the sick could be blessed by priests and even saintly laymen, but ever since the Council of Châlons in 813 canon law requires that it be blessed by a Bishop. In the Eastern Church it is customary for the oil to be blessed by the priest in the house of the sick person.
In the Latin church it has ever been the custom to employ pure unadulterated olive oil, to which a fragrant oleoresin called Balm or Balsam has been added. In some Eastern rites the practice of adding a little water as a symbol of Baptism, or of a little wine in memory of the good Samaritan, or even of the dust of the sepulcher of some saint, has long been in vogue.
Now this oil is blessed by the Bishop at the magnificent Mass of Maundy Thursday in Holy Week - a Mass so sacred that the Bishop is traditionally attended and assisted by twelve priests, seven deacons and seven sub-deacons in order to say it properly. The prayer reads: Emitte, quaesumus Domine, Spiritum sanctum tuum Paraclitum de coelis in hanc pinguedinem olivae, quam de viridi ligno producere dignatus es and refectionem mentis et corporis..." ("Send forth we pray, Your Holy Spirit, the Paraclete, from heaven into this rich substance of oil..." For Catholics the remote matter of Extreme Unction remains oil of olives and the proximate matter, "the anointing with oil blessed by a bishop.
What then is the "matter" specified by Paul VI? in his new Rite of Anointing and Pastoral Care of the Sick (promulgated November 30, 1972)?  The answer is any oil of plant origin - and pray - what oil is ultimately not of plant origin? Axle-grease, Vaseline and Mazola oil can satisfy the requirement. Further, the oil can be blessed by any priest who has the "faculty," and this faculty has been extended by the "Bishop's Committee on the Liturgy" to any priest "where didactic or catechetical reasons prompt it." The blessing has of course also been changed. No longer is the Holy Spirit invoked, but rather, it now reads: "May your blessing come upon all who are anointed with this oil, that they may be freed from pain and illness and made well again in body and mind and soul." Notice also that the emphasis is almost entirely on the healing of illness, and not on the forgiveness of sins.
Let us next consider the "Form" of the Sacrament, or the words that the priest uses when anointing the patient "in danger of death." The traditional words are: "PER ISTAM SANCTAM UNCTIONEM ET SUAM PIISSIMAM MISERICORDIAM, INDULGEAT TIBI DOMINUS QUIDQUID PER... DELIQUISTI" ("Through this Holy Unction or oil, and through the great goodness of His mercy, may God pardon thee whatever sins thou hast committed [by evil use of sight - smell, touch etc. - depending on the organ anointed.") Needless to say, this form also has been changed by the post-Conciliar Church to "PER ISTAM SANCTAM UNCTIONEM ET SUAM PIISSIMAM MISERICORDIAM ADIUVET TE DOMINUS GRATIA SPRITUS SANCTI, UT A PECCATIS LIBERATUM TE SOLVAT ADQUE PROPITIUS ALLEVIAT." The semi-official translation given out through the Holy See Press Office is: "Through this holy anointing and His most loving mercy, may the Lord assist you by the grace of the Holy Spirit, so that when you have been freed from your sins, he may save you and in his goodness raise you up." Another translation taken from Father Keating's article is closer to the original: "Through this holy anointing and His great love for you, may the Lord who freed you from sin, heal you and extend his saving grace to you..” The official translation provided in DOL 408 is "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."
Once again we must ask whether this change in the form is substantial - do the new words mean the same as the traditional formula?. Pre Vatican II theologians are virtually unanimous in stating that the essential words of the form - the words that convey its essential meaning and “power,”and are therefore "substantial" - are "INDULGEAT TIBI DOMINUS" - may God pardon thee. Most also insist upon "quidquid deliquisti" and "sanctam unctionem." After all, as Leo XIII said, "the sacraments... ought... to signify the grace which they effect" if they are to "effect what they signify." And in the present situation this is the health of the soul which is effected by strengthening of the soul through grace and by the remission of sins..." (Summa, III, Suppl. 29, 1). Now the new form OMITS all these critical words, and only asks that God "heal" one. While it is to be admitted that throughout history several valid forms have been in use, since the Council of Florence the form has been fixed. If some of these alternative forms used the word "parcat," "remittat," or even "sanat" in the place of "indulgeat," this in no way affected the substance of the form. However, to OMIT the critical phrase entirely is to remove from the "Form" its ability to absolve. What results is a change in "meaning," and to make a change of such a "substantial" nature almost certainly renders the form invalid. Even if the "blessing" is preceded by a valid absolution - which in many cases is also questionable - one is deprived of the other sacramental effects that are so important. Should an older priest desire to use the traditional form, he should know that it is specifically forbidden by Paul VI's Apostolic Constitution.
The post-Conciliar rite is named "Anointing of the Sick." Clearly then, if the post-Conciliar "blessing" is upon the sick, the ersatz sacrament should no longer be limited to those "in danger of death." Twice during the Second Vatican Council the Fathers rejected suggestions that the requirement of "danger of death" for the reception of the Anointing be omitted. As Father Keating points out however, "the new rite does what the Council was not able to do.” In contrast to the negative wording of Canon 940 which states "Extreme Unction is not able to be offered except to the faithful, who, having attained the use of reason, fall into the danger of death from illness or old age," the new rite can be administered to those who are ill, but in no danger of death whatsoever. Furthermore, in so far as the Constitution on the Liturgy stresses that "whenever rites, according to their specific nature, make provision for communal celebrations involving the presence and active participation of the faithful, this way of celebrating them is to be preferred, as far as possible, to a celebration that is individual and quasi-private." Thus it follows that officially, this new so-called "Sacrament" can be given communally. Indeed, in many parishes, it is the custom to gather all the mildly infirm and aged "senior citizens" together in the parish hall, and to bestow this "blessing" upon them - to be followed by coffee and cake!
It is to be admitted that the Apostle James specified the "sick." "Is any man sick among you? Let him bring in the priests of the church and let them pray over him, anointing him with oil in the name of the Lord" (James V:14-14). But it is a matter of common sense that one cannot and should not call the priests for every trivial complaint. The standard practice of the Church throughout history has been to understand by the "sick," those in danger of death - those about to undergo major surgery, those who have had a heart attack etc. The application of the sacrament to a more general category cannot but trivialize it in the minds of the faithful. And indeed, one sees this in that nurses of presumably Catholic background rarely if ever bother to call a priest even when a patient in the hospital is truly in danger of death. Such is not to be wondered at when they are taught that "Anointing of the Sick is a ritual moment which makes visible and present to the sick and the whole community an image of who we are as Church, that is, a community of mutual healing and support.
In actual practice several other "modifications" are allowed for. According to one study, "the sick person and all those present may receive communion under both kinds... If the sick person is not confined to bed, he may receive the sacrament of anointing in the church or some other fitting place, where there is a suitable chair or place prepared for him and enough room for his relatives and friends to take part." The same document continues to state that "in hospitals the priest should consider other sick people": whether they should be included in the celebration, or if they are not Christians whether they might be offended." And so, even in its mitigated form the "president" is to be careful not to offend the Protestants, even if it means depriving a Catholic soul of what he believes (?) is a critical sacrament!
In the traditional rite the priest arrived in a subdued manner, carrying the Blessed Sacrament in his pyx, and spoke only when necessary. Those who knew and understood his function knelt before him (for he carried the Blessed Sacrament), and those caring for the patient prepared a table by the bed with lighted candles and a crucifix. Whenever possible the priest was accompanied by an acolyte who rang a bell so the faithful would not accidentally slight our Lord. When the Blessed Sacrament passes by, any healthy Catholic should get down on both knees until it has passed. On arriving he would say three short appropriate prayers, the Confiteor, (if appropriate, listen to the patient's confession and give him absolution), and then immediately administer the Viaticum. Then with his right hand extended over the head of the patient he said "In the name of the Father + and the Son + and the Holy Ghost +, be there quenched in thee all power of the devil, through the laying on of my hands, and through the invocation of the glorious and holy Virgin Mary, Mother of God, her illustrious spouse Joseph, and all the holy Angels, Archangels, Patriarchs, Prophets, Apostles, Martyrs, Confessors, Virgins, and all the Saints, Amen." Then with his thumb dipped in the Holy Oils, he anointed the sick in the form of the Cross on parts described in the rite above. This was followed with a short responsory prayer (including the Lord's Prayer) and three additional, highly specific prayers for the sick person. Because he was carrying Our Lord's Body, the priest did not stop to chat or have coffee, but returned as quickly as possible to the sacristy.
In the new rite the priest arrives - no longer necessarily even dressed as a priest - and greets one and all in a friendly manner. Then instead of doing what he came for, he makes a speech to let all know why he came. This is followed by a "penitential rite" in place of the Confiteor. According to the instructions "whenever possible, Viaticum should be received within mass" (which of course poses no difficulty as the Novus Ordo only requires a table). There follows a short litany which may be transferred to a time after the anointing, or "at some other point." Now he lays his hands on the sick person in silence, for the various above mentioned prayers are no longer required. As for the anointing, it is limited to the forehead and hands, and this is done with the new "blessing" of dubious sacramental efficacy. This is followed by a prayer "best suited to the person's condition." (Hutton Gibson suggests "Now I lay me down to sleep.") The service ends with the Lord's Prayer and a blessing.
Lest this description seem exaggerated, allow me to give the suggested manner of acting according to Father Richstatter, a well known expert on liturgical practice. After suggesting that Confession or the Viaticum (Eucharist) not be administered at the same time as the Sacrament for the Sick, he describes the new way of doing things: 
"The rite starts much as Mass does: with prayers to gather us into the presence of Christ and of one another, and to recall our continuing need for healing. Holy water may be used to remind us that we have been baptized into the Christ who suffered for us and has transformed our suffering into victory. All sacraments begin with readings from the Bible. The number and length of the readings (and of the homily and general intercessions) will depend on the circumstances. The rite is similar to the first part of Sunday Mass."
"After the litany of intercessions the priest will lay his hands on your head. Together with all present he will pray silently for your healing. Next he will bless God for the gift of oil: "God of all consolation... make this oil a remedy for all who are anointed with it; heal them in body, in soul and in spirit, and deliver them from every affliction.' Then the priest will anoint you with the blessed oil. First he will make the sign of the cross with the oil on your forehead, saying: 'Through this holy anointing may the Lord in his love and mercy help you with the grace of the Holy Spirit.' All respond: 'Amen.' the priest will ask that you present the palms of your hands to him and he will anoint them with the sign of the cross: 'may the Lord who frees you from sin save you and raise you up.' All respond: 'Amen.' You may find it helpful to rub your hands together and pray that as the oil penetrates and soothes your skin, so may the healing of Christ penetrate and heal any weakness or affliction."
Yet another change! In former times the priest would anoint and administer Extreme Unction "conditionally" to a person who was already dead - up to a limited time of about three hours. This was only reasonable because the patient could die while awaiting the arrival of the priest, and because no one presumed to know at just what point the soul departed from the body. I became aware of this when working on accident victims in the emergency room. Priests would not come if the patient was already dead, even if he or she had just died - or they would offer to come to console the family. Now, in accord with the instruction, "when a priest is called to attend those who are already dead, he should not administer the Sacrament of anointing. Instead, he should pray for them, asking that God forgive their sins and graciously receive them into the Kingdom." One would think that even if the president didn't personally believe in the sacramental effects produced, he would administer the rite to console the next of kin. In any event, those who believe in the efficacy of this new rite better be sure they call the president in time.
It is interesting in passing to quote Paul VI's description of the new rite. According to him "the celebration of this sacrament consists especially in the laying on of hands by priests of the Church, the offering of the prayer of faith, and the anointing of the sick with oil made holy by God's blessing." But have no fear, for Paul VI continues: "This rite signifies the grace of the sacrament and confers it." Despite his assurances, one may reasonably be allowed to doubt if the new rite conveys anything more than a blessing.
It should not be thought that the Church has any objection to the blessing of the sick. Indeed the Roman ritual contains three such blessings: There is an extended blessing with a relic of the true Cross in honor of St. Benedict and St. Maurice, and there is an "ordinary" blessing for both adults and for children. This is but further evidence that there was no need to change the Sacrament into yet another such blessing.
Clearly, these changes either reflect a lack of belief in the Sacrament, or else are made to mollify the Protestants who deny the Sacraments that are dependent upon a validly ordained priest. One other argument put forth is that the traditional administration of Extreme Unction frightens the patient. As a surgeon of some 30 years of active practice, I have never known a patient who was not aware of his imminent end, and I have never known one who was frightened by the arrival of a priest for this purpose. On the contrary, patients that believe, have often expressed their anxiety at the delay of the priest’s arrival. Even patients whose faith is weak to the point of not fully believing in the efficacy of the Sacrament, greatly benefit.
Returning to more serious considerations, let us remember that none of us can escape the possibility of facing death. If we are to believe in the "effects" of the Sacrament, then it behooves us also to believe in the need for its "validity." Validity in turn demands a certain integrity in Matter and Form and hence it is our right to have this integrity retained by the Church that claims to be founded by Christ and the Apostles. No traditional Catholic admitted to the emergency room "in extremis" and asking for a priest, would settle for a Baptist minister - even if he should say the proper words of the form. Yet in fact, of what more use is a priest who uses an incorrect and doubtful form.? If a form is doubtful, Catholics are forbidden to use or partake of it. One must further express great wonderment at the new breed of priest who feels free to "play around" with such a powerful Sacrament. Certainly, the bestowal of Extreme Unction is one of the most satisfying aspects of a priest's life, and is moreover something which in charity and in justice he is bound to provide. And what is one to think of a "Church" that would dupe its obedient and faithful followers, rob them of this pearl, and pay them off with a facile blessing? Indeed, we live in dangerous times and the world itself is in extremis. Unless we take a stand on such issues, we will have little grounds for complaint when on our own death beds we prepare to face our Lord and Judge without the assistance of these necessary graces.
Rama Coomaraswamy, M.D. +
ãR. Coomaraswamy, 2001
 Letter to Fliess, quoted in Paul Vitz, Sigmund Freud's Christian Unconscience, Guilford: N.Y., 1988.
 The Reference is to Genesis 3:15
 The Church has suggest that we pray to be alert at the time of death. Dying in one’s sleep, so much approved by public sentiment, does not allow for confession, and absolution, and if rigor mortis has set in, Extreme Unction cannot be conditionally used. Pertinent information is also available in my article Death, Dying and Assisted Suicide, Conn. Medical Journal, Vol 58, No. 9, p. 551.1994
 Rev. Adrian Kilker, Extreme Unction, A Canonical Treatise, London: Herder, 1927. The Latin is from St Thomas Aquinas, Summa Contra Gent., lib. 4., c. 73 de Ext. Unct. (trans. "the perfect healing of the soul.")
 As a patient, I have received Extreme Unction three times. I have also administered it and can personally testify to ins beneficial effects on myself as well as on others.
 ) Sacram Unctionem infirmorum, AAS 65(1973).
 Charles J. Keating, The Sacrament of Anointing the Sick, Homiletic and Pastoral Review, June, 1974.
 Extreme Unction is usually preceded by Confession and Absolution.
 Many will find the insistence upon proper wording is unimportant This indeed is true for many people who have succumbed to modern patterns of thought. . However it is to forget that words have meaning, and as such have been sanctioned for use by the Church for centuries. The come to us through Tradition which represents what is timeless, stable, correct (con-right). Tradition is not a question of past and future, but of what is timeless and True. It is not to be confused with fashions and habits which were new in their day, but are now passe. A study of Sacramental theology would lead to some understanding of the principles involved. The changing of the wording (meaning) of sacramental forms is a mortal act (such as changing the words of Christ in the Consecratory form-ula of the Mass). Catholics are forbidden to become involved in doubtful sacramental forms.
 Paul VI in his Apostolic constitution quotes the Council as saying: "Extreme Unction, which may also and more properly be called '"the 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 arrived." Once again we have the use of doublespeak. Again, we are told "The Sacrament of the Anointing of the Sick should not be a last Sacrament any more than Baptism, confirmation, Matrimony or Holy Orders... We used to have some notion that it could effect a forgiveness of sin, and on occasion, might even restore physical health. Today we see the Sacrament NOT (his emphasis) as a preparation for death but as an aid to a more beautiful life - first and immediately on earth." (The Messenger, Sept. 12, 1982)
 This was the practice in my erstwhile parish.
 The reader is reminded that the author has been a practicing surgeon for some 30 years. It is pertinent to quote the comments of Father Baumann, Director of Marydale Diocesan Retreat House and Chairman of the committee for the Continuing Education of Priests:
 If the patient is incapacitated, the priest will ask him/her if they have sinned against any of the commandments and then list each of them in turn. All the patient has to do is nod his head or even blink his eyes.
 Father Thomas Richstatter, O.F.M., The New Rite for Anointing the Sick, Catholic Update, St. Anthony Message Press, 1984. Father Richstatter is a recognized authority and his texts are fairly standard teaching sources in today's seminaries.
 The physician can certify that the body has died. The older medical and theological literature gave ample testimony to the fact that patients occasionally would recover after being pronounced dead by competent physicians. Rigor mortis which occurs 3 to 6 hours after apparent death was considered a point of no possible return. Current medical practice has the technology to refine the point of body death with greater accuracy - absence of electrical activity in the brain and heart. However, this is still to speak of the body and not the soul. (Cf. Rev. Juan B. Ferreres, S.J., Death, Real and Apparent in relation to The Sacraments, Herder: St. Louis, 1906.)
 There is even a blessing for sick animals.
 Catholics who cannot get a Roman Catholic priest to administer the Sacrament, can call upon a Greek Orthodox priest for this service.