We are all sick. . . The dying are not just sick. . .

The shift from Extreme Unction to Unction, from Last Rites to the Anointing of the Sick, represented more than a mere change in emphasis.  It is as if there were two different sacraments being suggested under the one premise of unction or anointing.  A recent article on the First Things web site laments the loss of Extreme Unction with its solemn focus on death for the happier version of Anointing of the Sick.  I would not be surprised to find many Roman Catholics echoing the sentiments of the author. I would also think that this shift is thoroughly at home with the whole move toward a medical model of our ills, with the nearly universal expectation of life as pain free and happy, and with the ideal of a fix for what ails us (either pharmaceutical or spiritual).  It is certainly consistent with the transition of pastoral care into spiritual and the focus away from God and onto self.

But the dying are not just sick.  They are dying.  That seems to be the thing that we have trouble admitting most of all.  I have known many doctors who refused to give up on their patients long after the patients and their families were resigned to death.  It is a common malady among health care professionals -- oncologists never lose patients to cancer but to cardiac or respiratory arrest or whatever.  Cardiologists likewise hide their defeats as do the many specialists -- all in an attempt to mask the face of death.  Extreme Unction (Last Rites) is unusual because it confronts what most want to hide -- death is near.  This is not some happy death we manufacture to distract us but the real death of pain, sorrow, loss, and lament from which there is no real distraction.  The solemn confrontation of sin, the prayers and their rehearsal of what is surely coming, and the anointing in the last hours of life all combine to comfort in a way that all our happy talk cannot.

Lutherans are not without our own Last Rites.  We have a rite entitled the Commendation of the Dying.  The title says it all.  With the Psalms, prayers, and Scriptures, come the canticles (especially the Nunc Dimittis but also the Kyrie and Agnus Dei).  I love the inclusion of Martin Schalling's hymn Lord, Thee I Love with All My Heart, the final stanza:

Lord, let at last Thine angels come,
To Abram's bosom bear me home,
That I may die unfearing;
And in its narrow chamber keep
My body safe in peaceful sleep
Until Thy reappearing.
And then from death awaken me
That these mine eyes with joy may see,
O Son of God, Thy glorious face,
My Savior and my Fount of grace,
Lord Jesus Christ,
My prayer attend, my prayer attend,
And I will praise Thee without end.

I would not suggest that we lose the Anointing of the Sick but neither can we omit the solemn duty to be honest with the dying.  They are, almost, two different rites (sacraments for Rome).  In our case, the anointing of the sick is used not simply for the hospital room but also for those who face chronic ills and who will not improve but will continue to decline.  I think of those with degenerative arthritis that is slowly stealing their mobility or those with diseases like MS, ALS, or one of the many other nerve disorders whose progress may be slowed a bit but which will eventually steal their lives.  I think of those with cognitive and memory disorders (from dementia to Alzheimer's) that may not now affect the body but who will eventually turn their dearest loved ones into remote strangers.  The grace of God is surely for these as well.  But it is a very different focus.  As long as we do not trivialize this anointing, there should be room for its use for those who daily wrestle with ongoing ills such as I have mentioned.  It is not for healing only that we anoint but for the ultimate healing of salvation and for the acknowledgement of God's presence even in their weakness.

Yet to anoint the dying is to get straight to the point.  They are not just sick.  They are dying.  In contrast to the palliative care of hospice designed to relieve pain (in my opinion  a little too aggressive with the pain relievers), we do not want to mask the reality of death but prepare the dying to meet the end of this life in Christ.  So were I a Roman Catholic, I would also lament the loss of Extreme Unction.  As a Lutheran Pastor, the pastoral care provided the dying does not ignore death but confronts the subject honestly yet with the the hope into which we were baptized.  Far from being casual or chatty, the whole character of this rite is serious.