Anointing the sick, including the dying, is one of the traditional seven sacraments of the Catholic Church. The Reformers denied that the rite qualified as a sacrament. Formally, this was because anointing did not have a direct authorization from Jesus; more theologically, it was not one of the marks that distinguished the members of the church from others, and so did not count as a “sign of the covenant.”

The biblical ground for the practice is James 5:14-15, where James instructs the sick to call for elders, who will pray and anoint in the name of the Lord. It uses a material sign (anointing with oil) and comes with a promise of healing. While denying that it qualifies as a sacrament, many Protestant churches practice anointing.

James says that the “prayer of faith shall save (sozo) the sick, and the Lord will raise (egeiro) him up” and that might be taken as a promise of healing. If so, it’s not an absolute promise because not everyone who is anointed gets better. It may be better to take “save” and “raise up” in their full theological sense. The sick person is assured by this rite that he will be saved from death because at the last the Lord will raise him from the grave.

When I have performed anointings, I have always included something I learned from Alexander Schmemann: Not everyone who is anointed is healed, but that doesn’t mean the anointing is useless. It accomplishes something regardless of the aftermath, and that something is the act of anointing itself. Just as a baptized person is, ex opere operato, a baptized person, so a sick person who is anointed is, literally and unquestionably, anointed with oil (the verb in James 5:14 is not chrio but aleiph0). That is a memorial of the fact that the sick person is, still in his sickness, a christened member of Christ, and that his suffering is not in vain, not stupid dumb luck, but somehow a share in the suffering of Christ. That is a great assurance to the sick person. The anointing, laying of hands, and prayer give him hope that, whatever the outcome of his illness, whether he lives or dies, he is Christ’s own possession, and Jesus will keep him.

That might seem a stretch: Is the leukemia of a young child, the diabetes of a middle-aged man, the ovarian cancer of a woman suffering in Christ? Doesn’t suffering have to be somehow related to the gospel to be a participation in the sufferings of Christ? In my view, any suffering can be caught up into the redemptive suffering of Jesus. All suffering, weakness, loss, sickness presents an opportunity for Christlike ministry to the people of God. The child with leukemia edifies the body if he or she trust the Father during the long drudgery of illness; the diabetic proves the power of the gospel by rejoicing in the midst of pain, inconvenience, and frailty. The woman with cancer is called to demonstrate in her life that the power of God is perfected in weakness. Even someone who has slipped into a coma can still unwittingly serve the church by being an object of service and care. This is what the anointing means: It means that the sickness is not dumb, stupid luck, but a vocation; the anointing deputizes the sick to a unique ministry in the body of Christ. By anointing, their baptismal induction to Christ’s royal priesthood is memorialized: Their sickness is made one of the things they offer in priestly sacrifice to the Father; their weakness becomes one of the weapons of their royal arsenal.

The Reformers were not convinced of this. In his commentary on James 5, Calvin tied the anointing with the temporary gift of healing. He admitted that anointing was a “sacrament” in the apostolic age, but “as the reality of this sign continued only for a time in the Church, the symbol also must have been only for a time. And it is quite evident, that nothing is more absurd than to call that a sacrament which is void and does not really present to us that which it signifies. That the gift of healing was temporary, all are constrained to allow, and events clearly prove: then the sign of it ought not to be deemed perpetual.” He uses the text as an opportunity to attack the “apes of the Apostles” among the Papists, who want to make permanent what was unique to the first century. (There is the beginning of a Master’s Thesis here, investigating to what extent Protestants viewed Catholics as primitivists and restorationists!)

Yet, some Reformation traditions retained the anointing of the sick. The Book of Common Prayer includes a rite for “Ministration to the Sick” that includes an application of James’s instructions to lay hands and anoint the suffering. The PCUSA Book of Common Worship includes an optional anointing in its rite of communion for “those unable to attend public worship.” Lutheran churches have retained the practice since the Reformation (see the rite in the LCMS Lutheran Service Book).

Protestants are undecided about a rite of anointing in their services for the dying. The earliest editions of the BCP ritualized the pastor’s ministry to the dying, but it was an oil-free rite. Today, some Anglicans do include anointing in ministry to the dying.) The Book of Common Worship provides prayers, readings, and blessings to be spoke to a dying person, but again there is no anointing, and some Lutherans include a rite of anointing for the dying.

Is it appropriate to anoint the dying? That does not seem to be what James is talking about. It might seem that anointing should be used only when there is a chance of recovery, when there’s a chance that the person can be “saved” and the Lord might “raise him up.” But that interpretation runs into problems. For starters, as I suggested above, “save” and “raise up” don’t necessarily refer to recovery from illness; besides, who and how are we to determine when the person is “beyond hope” of healing? A pastor who visits a member in the final stages of cancer, when the doctors have given up treatment, will surely still pray for a miracle. And if he is willing to pray for a miracle, why not anoint for healing too?

In that case, though, the rite still seems to be used with the intent of pleading for the continuation of life. What about a member who, knowing he is in his last hours, calls the pastor to be with him as he expires? Should the pastor be willing to anoint him in those circumstances? Should he be willing to anoint for death?

Anointing the dying is certainly not necessary. It’s not a sacrament. It’s not identical to the rite that James gives us. Admittedly, there is no direct biblical evidence for this practice. Jesus’ body was “anointed” and perfumed, but only after He died, in preparation for His burial (John 19:38-42). The woman who anoints Jesus in the home of Simon the leper anoints Him before, and in preparation fro, His burial (Matthew 26:6-13; Mark 14:3-9; in John 12:1-8, she is identified as Mary). That is the closest thing we have to a “proof text” for a rite of anointing for the dying.

But a more modest case can be made indirectly. Anointing the dying is  in the same category of other edifying customs of the church. All such customs can be abused. They can encrust the sacraments themselves, so that the places of God’s self-offering become hidden behind a load of extraneous ceremonies. Carefully done, however, edifying customs are, well, edifying. And they are inevitable in any case, since no church is without extra-biblical customs of some sort or another. If smearing ashes on the forehead can mark the beginning of a period of focused penitence, if lifting hands marks the exaltation of praise and kneeling the moment of confession, if raising the loaf is a sign that it is heavenly bread, if lighting a candle enhances our delight in the Advent of the Light  – if these and other unnecessary practices can be edifying, so can a rite of anointing for the dying.

With these qualifications, it seems that the logic of anointing that I offered above applies to the dying too. The dying person faces his greatest danger, the decisive illness that falls on all of us. He stands face to face with the enemy, and needs assurance that the Jesus who passed through death for him will also pass through death with him, and be waiting for him on the other side of the grave. Every pastor offers assurance in word and prayer, in benediction and commendation. But a physical sign that communicates the same thing – a sign of anointing, a sign that the dying person remains Christ’s because he is in Christ – seems to be an appropriate gesture. It is also the case that the dying person still has something to offer to edify the church: Who can express how encouraging, invigorating, humbling it is to watch a believer go joyfully, thankfully, fearlessly to his death? Anointing in Scripture was part of the making of priests and kings. As the sick and dying are anointed, they are commissioned to lift their afflictions as part of their final earthly offering of praise, coronated to be more than conquerors in Christ who loved us.

By anointing the dying, the church says that this too, like all the slings and arrows of outrageous fortune, is a moment, a crowning moment, in the life of faith. By receiving anointing, the dying man or woman embodies Paul’s claim: We live to the Lord, we die to the Lord. Whether we live or die, we are the Lord’s.

Peter J. Leithart is President of the Theopolis Institute.