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In a recent post on the ministry of priests, there were a few comments that reflected both frustration and pain over the fact that a loved one had been in the hospital and, though the priest was called, he either never came or did not come at once. To be sure, it is lamentable that any priest would receive a request for a visit and do nothing in response to it. The Church as a whole, and pastors in particular, have obligations to the faithful who are seriously ill, especially if they are in danger of death. That said, there are very real difficulties that priests face in responding immediately and personally to all requests. In this post I would like to ponder some of the pertinent issues involved in sick calls, especially to the hospitalized.

Perhaps it is best to begin with a mini-catechesis on the Sacrament of Anointing of the Sick.

1. By the sacred anointing of the sick and the prayer of the priests, the whole Church commends those who are ill to the suffering and glorified Lord, that he may raise them up and save them. And indeed she exhorts them to contribute to the good of the People of God by freely uniting themselves to the Passion and death of Christ. (Catechism # 1499).
2. Scripture teaches that the sick are to be anointed by priests – Jesus sent the apostles forth two by two to proclaim the kingdom. The following description is given of their actions: So they went out and preached that men should repent. And they cast out many demons, and anointed with oil many that were sick and healed them. (Mk 6:12-13). We also read, Is any among you sick? Let him call for the presbyters [i.e. “priests”] of the church, and let them pray over him, anointing him with oil in the name of the Lord; and the prayer of faith will save the sick person, and the Lord will raise him up; and if he has committed sins, he will be forgiven. (James 5:14-15).
3. The Sacrament of the Sick is given to baptized Catholics who are seriously ill. Thus, a person with an ordinary virus, flu or injury is not usually anointed unless such illness or injury has a serious nature due to other pre-existing situations. Since most surgeries are presumed to involve serious maladies and involve significant risk, those scheduled for surgery (especially when general anesthesia is used) ought to be anointed before the surgery. A person is usually anointed only once in the course of an illness or injury. However those suffering from illnesses of a long duration or due to advancing age may be anointed periodically and especially if their condition takes a turn for the worse.
4. Children under the age of seven are not anointed. This is because the sacrament is related to the Sacrament of Confession and is designed to be a remedy against temptations and the effects of sin. Children under the age of seven are usually not presumed to have sufficient use of reason to be considered responsible for sins committed and hence have no need of this sacrament.
5. Those who receive this sacrament ought also to have recourse to confession if it can reasonably be offered and celebrated. While confession is not strictly required, anointing and confession both related to the problem of sin. Anointing is not just celebrated with the idea of physical cure in mind, but of spiritual strengthening and the avoidance of temptation that often comes with illness. Hence, confession and anointing are integrally related.
6. In the past, many often waited to the point of death before requesting this sacrament of the priests of the Church. Pastoral care today however emphasizes that this sacrament should be offered long before the final stages of dying set in. When physical illness of a serious or chronic nature sets in the sacrament should be administered sooner rather than later. Likewise, it is a good idea to celebrate the sacrament before surgery takes place. The Sacrament of Anointing of the Sick is meant foremost to help us experience healing and assist us to live gracefully with our illnesses, and not merely as a Sacrament that prepares us to die.
7. The purpose of the sacrament – One gift to be hoped for in this sacrament is the complete recovery of health. This is sometimes experienced. Miraculous cures are surely a sign of the power of the risen Lord and they were promised as a sign of the reign of God (cf. Mk 16:18). And yet this is not all that is meant by the “healing” that is given and experienced in this sacrament. The word “healing” however involves more than just the notion of cure. In his own day Jesus did not heal everyone. Christ also taught of the inevitability of suffering and the need to remain faithful: If any man would come after me, let him deny himself and take up his cross daily and follow me (Lk. 9:23). St. Paul too experienced the call to faithful endurance as he prayed for a cure of his own illness: Three times I besought the Lord about this, that it should leave me; but he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” (2 Cor. 12:9-10). Hence the healing that this sacrament offers is more often the grace to endure suffering with holiness, and faith. Hence, a grace of this sacrament is one of strengthening, peace and courage to overcome the difficulties that go with the condition of serious illness or the frailty of old age. This grace is a gift of the Holy Spirit, who renews trust and faith in God and strengthens against the temptations of the evil one, the temptation to discouragement and anguish in the face of death. (Catechism # 1590)

Especially to be noted in the mini-catechesis above is that the anointing of the sick is not primarily a sacrament for emergencies and should not be delayed until death is imminent, unless this cannot be avoided. There are certain circumstances that require an emergency administration of the sacrament, such as in the aftermath of a serious accident or when  one is suddenly stricken. However, as a general practice, anointing of the sick ought to be a more routine aspect of the lives of the chronically ill and the aged, or of those who have entered the various stages of serious illnesses. If death seems to be certainly approaching, one ought to be anointed well before the final stages, and surely before unconsciousness ensues. In no case should a family wait “for the last moment” to summon the priest. This is a Sacrament for the living, not merely for those on the very threshold of death. Those who are scheduled for surgery ought to be anointed before entering the hospital, preferably at the parish, if this can be arranged.

The goal is for every Catholic to be “up-to-date” on their Sacraments long before death or the danger of death ensues, or even the advent of sudden and unexpected death. Of every Catholic who faces death, whether sudden, or at the end of a long illness, we ought to be able to say they have very recently received Holy Communion, and that confession has been celebrated with a reasonable period prior to death. Further those who have not died suddenly and unexpectedly, ought to have been anointed at some time significantly prior to death. In such cases there is no emergency need to summon the priest, for the ordinary pastoral care has already been provided. Emergency anointing ought be reserved for those who are suddenly and unexpectedly stricken, or for those who are in accidents.

And that leads us to the concerns that some have expressed that a priest was sought, and no priest came, or did not come soon.

There are a number of factors that affect the availability of the parish priest. And while these factors do not excuse a complete lack of pastoral care, they ought to be considered as we look to a solution to the problem. These factors include:

1. There are far fewer priests than years ago. Until about 25 years ago, most parishes had more than one priest. Many larger parishes which had as many as four or five priests, back in the 1960s, have only one priest now, and that priest has many, many duties.
2. Fewer hospitals have assigned and full time chaplains. Here in DC only the largest hospital centers have regular and full-time chaplains. The smaller hospitals and nursing homes depend on local parishes for pastoral care.
3. Most Catholics no longer go to neighborhood hospitals near the parish. Rather they are assigned to hospitals that specialize in their issues. For example, in my own parish, I may have parishioners in as many as 6 or 7 different hospitals spread all throughout the area (Providence, Georgetown, Johns Hopkins, Southern Maryland, PG Hospital, Adventist Hospital, Holy Cross, Washington Hospital Center, Children’s Hospital, Veterans, and so forth). Some of my parishioners are taken as far away as Baltimore. Regular visits to hospitalized members may not be possible when they are in such varied locations. Pastors often need to depend on clergy more local to the hospital in question. This leads to concerns that “my pastor never came and saw me.” But some parishioners simply do not realize how unrealistic this is for pastors, often without assisting clergy, with dozens of parishioners in as many as half a dozen different and often distant hospitals.
4. Pastors and priests also have serious duties at the parish which cannot always be dropped at a moment’s notice. A pastor may get an urgent call to come at once, yet he is just getting ready to celebrate a wedding. He cannot simply say to the couple they will have to have their wedding another day. Calls may come in as well in the middle of a Sunday Mass, or other significant function where a priest cannot reasonably dash off. A priest may also be teaching a class or bible study involving thirty or more people and it may not be reasonable for him to rush out in the middle of a class. He may be completely away from the parish teaching or filling in for another priest. It is simply not possible for a parish priest to be 100% available at every moment for a possible sick call, even an emergency. Sometimes the best he can do is to ask a parish staff member or the hospital to find another priest. It is not always right to allow the urgent to wholly eclipse the important.

Towards a solution. The care of the sick is important and reasonable urgencies need to be addressed by the Church. What are some of the things that can be done to realistically address the needs of Catholics given the factors seen above?

1. Large hospital centers should have full time chaplains if this is possible. This is especially true if the hospital has a shock and trauma unit that routinely receives accident victims and those suddenly stricken. The chaplain would also need to a coordinate with local parishes to cover any gaps caused by his day off or vacation. Here in Washington, we are often able to depend on priests from religious orders. Other dioceses are less blessed with options.
2. If a full time chaplain really cannot be found, the parishes near the larger hospitals need to develop a carefully coordinated plan to cover the hospitals and field emergencies. The plan should make sure that gaps are properly covered and emergency calls can be quickly handled. Further, parishioners and hospital staffs should be well aware of how to contact the priest on duty.
3. Smaller hospitals and nursing homes still need coverage from the local parishes. The diocese should have a carefully crafted plan on who covers them and when. Emergency clergy numbers for each hospital and nursing home should be easily available to all the priests and staff of the parishes in each diocese; for it often happens that a brother priest near the hospital will need to be contacted by a priest or staff member from across town who cannot reasonably make a visit.
4. Some teaching on the nature of a true sacramental emergency needs to be made to both the faithful and to hospital staffs. When death is clearly imminent we usually have an emergency. However, just because some one has gone to an emergency room does not mean that death is imminent, and that a priest is needed at once. Sometimes it is fine to wait for the next day when a priest routinely visits. Even when death is imminent, it is sometimes the case that a priest gave sacraments just the day before. It is not necessary for the priest to return and be there at the moment of death, when a person has been receiving ordinary pastoral care given to those who are seriously ill. It is sufficient in such cases that the person has recently received the sacraments and there is no reason to summon the priest to come at once or in the middle of the night. True sacramental emergencies usually occur for those who are suddenly and unexpectedly stricken or who are in an accident and are, for these reasons, in immediate danger of death.
5. Parish priests should well instruct their staff how to field emergency calls, assess their importance, and know options to pursue if the parish priest cannot be reasonably reached.  Families should not simply be told, a priest cannot be found, they must be helped to find a priest in an authentically urgent situation.
6. To the degree possible, hospital staffs should also be able to know how to contact a priest quickly. Their phone lists should be up to date and include several options.
7. The faithful may have to accept that a priest will not always be found in time. In such cases they ought to remember that God does not reject any who call on him. And, though anointing is surely helpful, it is not absolutely necessary for salvation. Even confession in dying moments should not be thought of as magic. If a person seeks a priest and a priest cannot be reasonably found in time, it suffices for the person to make an act of contrition – no one who calls on the Lord will he ever reject. If a person is unconscious, a priest saying absolution over them, will only have effect if they had some contrition and openness to receive the sacraments prior to the unconscious state. Even when a priest rushes he does not always get there in time. In such cases, we have to trust in God.
8. Again, an important goal for every Catholic is to be up to date on their sacraments and in a state of grace. Sacraments are to be part of ordinary pastoral care and an ordinary part of the life of a Catholic. They are not to be merely postponed to the moment of death.

It is surely an added grief when a priest cannot be found in cases of true emergency or when proper pastoral care is not reasonably extended to the chronically ill. And while it may be an explanation that parish priests are sometimes overwhelmed, it is not an excuse. Parishes and dioceses need to work together with the faithful to see that the sick and the dying are properly cared for, that emergencies are covered, and that the faithful are properly instructed on the nature of the sacraments and how to secure the ministry of a priest when such needs arise.

As always, I am interested in your experiences in this regard. It is most helpful if you can suggest how the Church might better help in such matters.