Pastoral Care of the Sick


259. There are extreme circumstances in which not even the continuous rite can be celebrated. These occur when the danger of death from injury or illness is sudden and unexpected or when the priest is not called to exercise his ministry until the person is at the point of death.

The introduction to the Rite for Emergencies begins.

Some people still delay making the call to the parish for a priest or other minister. Many do wait until the moment of death–or even afterward. This is a relic of poor pre-conciliar catechesis–I wonder how the SSPX-ers handle it these days.

Trust my advice from the inside of the parish office and in many years of working with clergy: clue us in on a serious illness from the beginning. It’s not a bother or imposition; it’s our ministry.

260. In such a situation of emergency the priest should offer every possible ministry of the Church as reverently and expeditiously as he can. He may be able to provide only the barest minimum of sacramental rites and forms of prayer, but even then he should add other appropriate prayers to help the dying person and those who may be present. 

Roman sensible shoes: do what can be done, when it can be done.

The rest of the continuous rite treats anointing, then viaticum. We’ve covered a lot of this territory before, and the rite itself refers back to previous rituals almost exclusively.

PCS 247-250 covers sacramental anointing. The first section instructs the priest to lay hands on the sick person in silence. The prayer over the oil is next, either a thanksgiving over blessed oil (see PCS 123) or the priest may bless the oil he has brought (see PCS 21). The anointing takes place as described in PCS 124. There is a brief prayer after anointing, which is to be omitted if viaticum takes place immediately.

The following four sections (251-254) lay out the brief viaticum liturgy. The Lord’s Prayer is prayed by all present. Loved ones may receive communion, as we read:

252. The sick person and all present may receive communion under both kinds. When the priest gives communion to the sick person, the form for viaticum is used, as described in (PCS) 193.

The priest cleanses the vessel, then may facilitate a period of silence before leading the concluding prayer (PCS 209 option A or C).

PCS 255-258 gives the concluding rites. The priest blesses all present. He also has the option of blessing the sick person silently with any of the Blessed Sacrament that remains. The text referenced for the former blessing is PCS 91, option A or C. PCS 256 provides for an optional sign of peace–the same location as we’ve seen before. It employs the peace as a gesture of leave-taking rather than as a reconciliation before approaching the altar.

The continuous rite concludes with these instructions:

257. If the person recovers somewhat, the priest or other minister may continue to give further pastoral care, bringing viaticum frequently, and using other prayers and blessings from the rite of visiting the sick.

258. When death has occurred, prayers may be offered for the dead person and for the family and friends. These are given (in PCS 221-222). This may be done in any suitable place, including a hospital chapel or prayer room. 

PCS 221 contains prayers for the dead. Do clergy usually offer these prayers in the presence of the deceased’s body? It probably depends on the circumstances, and the timing in the hospital, home, or hospice facility. In the next few posts,we’ll look at the “Rite for Emergencies.” Meanwhile, any comments?

As it is part of the Viaticum liturgy (PCS 190-191), the baptismal profession of faith and litany follow the Liturgy of Penance. If, that is, “the condition of the sick person permits.” A sprinkling rite may take place after the profession of faith.

PCS 245 suggests that “the litany may be adapted.” Option A reads:

You bore our weakness and carried our sorrows: Lord, have mercy.

R. Lord, have mercy.

You felt compassion for the crowd, and went about doing good and healing the sick: Christ, have mercy.

R. Christ, have mercy.

You commanded your apostles to lay their hands on the sick in your name: Lord, have mercy.

R. Lord, have mercy.

Option B reads:

Let us pray, dear friends, for our brother/sister N., whom the Lord at this hour is refreshing with the sacraments.

That the Lord may look on our brother/sister and see in him/her the face of his own suffering Son, we pray:

R. Lord, hear our prayer.

That the Lord may help N. in this moment of trial, we pray:

R. Lord, hear our prayer.

That the Lord may watch over N., and keep him/her ever in his love, we pray:

R. Lord, hear our prayer.

That the Lord may give N. strength and peace, we pray:

R. Lord, hear our prayer.

246. It is highly appropriate that the initiation of every baptized by the sacraments of confirmation and the eucharist. If the sacrament of confirmation is celebrated in the same rite, the priest continues as indicated in “Christian Initiation for the Dying,” (PCS)290. In such a case, the laying on of hands which belongs to the anointing of the sick (see (PCS) 247) is omitted.

The Roman approach is eminently pragmatic. In the scope of a three-sacrament celebration with a dying person, what is important in a celebration of viaticum alone–the baptismal profession of faith–is less vital in light of the highlight moments: the active encounter with the sacramental Christ.

In the Liturgy of Penance (241-243) one of two options is provided. The priest may lead the sick person in either the sacrament of penance or a penitential rite:

241. If the sick person so wishes, the sacrament of penance is celebrated; in case of necessity, the confession may be generic.

We’ve encountered this “generic” confession earlier in the pastoral care rites. We’re probably talking about the confiteor or some similar formula.

The priest extends his hands over the penitent’s head (or at least extends his right hand) and says:

God, the Father of mercies,
through the death and reconciliation of his Son
has reconciled the world to himself
and sent the Holy Spirit among us
for the forgiveness of sins;
through the ministry of the Church
may God give you pardon and peace,
and I absolve you from your sins
in the name of the Father, and of the Son, +
and of the Holy Spirit.
Amen.

242. If there is no celebration of the sacrament of penance, the penitential rite takes place as usual. The priest invites the sick person and all present to join in the penitential rite using these or similar words:


And the brief invitations given next are followed by a reference to PCS 118, form A or C, as we discussed earlier.

243. At the conclusion of the sacrament of penance or the penitential rite, the priest may give the apostolic pardon for the dying, as described in (PCS) 201.

Commentary:

I find the placement of the penitential rite after the celebration of the word/instruction to be a little curious. In essence, it means the framers of this rite have conceded the Word is not essential to the continuous three-sacrament rite.

A bit more on the generic confession. The Church is clearly not concerned about scrupulosity with the “death-bed confession.” That said, many Catholics will want to confess in an ordinary way. It will take some judgment on the part of the priest to steer the penitent one way or the other as circumstances suggest.

Aren’t you glad for those pastoral care books with the multiple ribbon bookmarks? It is really important for a pastoral care minister to be prepared with these rites that refer to other sections for the detailed rituals and ritual texts.

As a practical aside, I’ve also found it helpful to pull about ten or so slips from the smallest post-it note pad, and stick it to the inside back cover of the PCS handbook. When I need to scratch a note or apply an extra bookmark, I can use that mini-pad rather easily. Sometimes it’s that extra page marker, and sometimes a memory-challenged person like me can use the reminder of the names of spouse, the children, or other important people.

Other thoughts?

These sections cover the introductory rites. In order, the priest leads the sick person and others present with a ritual greeting (239), and an instruction that includes a Scripture passage (240).

239. The priest greets the sick person and the others present. One of the following may be used as described in (PCS) 81.

If communion as viaticum is celebrated during the rite, the priest then places the blessed sacrament on the table, and all join in adoration.

240. If the occasion requires, the priest speaks to the sick person about the celebration of the sacraments.

Depending on the circumstances, he reads a brief gospel text or an instruction to invite the sick person to repentance and the love of God.

A Matthew 11:28-30

B John 6:40

C The priest may use the following instruction, or one better adapted to the sick person’s condition:

Beloved in Christ, the Lord Jesus is with us at all times, warming our hearts with his sacramental grace. Through his priests he forgives the sins of the prepentant; he strengthens the sick through holy anointing; to all who watch  for his coming, he gives the food of his body and blood to sustain them on their last journey, confirming their hope of eternal life. Our brother/sister has asked to receive these three sacraments: let us help him/her with our love and our prayers.

The brief passages from the gospels are helpful. Omitting them doesn’t seem particularly thrifty in terms of time or the stamina of the dying person. The instruction here is also good, and again reinforces Church teaching on the nature of the Eucharist, in part, as food for the believer.

Keeping the sacraments untangled, celebrated with dignity, is the point of these particular instructions for the clergy. Also, the rite provides choices for adaptation. A priest must be aware of not only the substance of the pastoral care rites, but also the theory behind each rite. An ability to judge where to shorted or adapt is essential if people are to be served and the dignity of the sacraments maintained in emergency situations.

237. The priest should be guided by the condition of the dying person in deciding how much of this rite should be celebrated and where it should be appropriately shortened or adapted. If the dying person wishes to celebrate the sacrament of penance, this should take place before the anointing and reception of communion as viaticum. If necessary, the dying person may confess at the beginning of the celebration, before the anointing. Otherwise the penitential rite should be celebrated.

The priority: viaticum, then anointing, then penance, even thought he ordering in the continuous rite is exactly the opposite:

If the danger of death is imminent, the priest should anoint immediately with a single anointing and then give viaticum. If the circumstances are extreme, he should give viaticum immediately (see PCS 30), without the anointing. The “Rite for Emergencies” has been designed for this situation. Christians in danger of death are bound by the precept of receiving communion so that in their passage from this life, they may be strengthened by the body of Christ, the pledge of the resurrection.

We read again that in celebrating the Eucharist for the sick the stress is on the sacrament as food for the journey. This doesn’t negate the notion of Eucharist as sacrifice. Far from it. Instead, one of the most important aspects of Communion is drawn out in the rite and texts for the pastoral and spiritual benefit of the dying person. One might say that many dying people are very much aware of the notion of sacrifice.

A practical note about confirmation:

238. It is preferable not to celebrate the sacrament of confirmation and the sacrament of anointing of the sick in a continuous rite. The two anointings can cause some confusion between the two sacraments. However, if the dying person has not been confirmed this sacrament may be celebrated immediately before the blessing of the oil of the sick. In this case, the imposition of hands which is part of the liturgy of anointing is omitted.

I suppose it is conceivable that four sacraments would be celebrated in a single rite: penance, confirmation, anointing, and viaticum–in that order. Any priest reading here ever done this? Anybody ever seen or heard of it?

Thoughts?

Penance, Anointing, and Viaticum celebrated together is the first exceptional circumstance treated in Chapter VIII of the Pastoral Care Rites. Let’s start reading the three-section introduction:

236. This rite has been provided for use when sudden illness, an accident, or some other cause has placed one of the faithful in danger of death. It makes possible the reception of the three sacraments of penance, anointing, and viaticum in a single celebration. It is not only for use at the point of death, but even possibly a day or so before when time or the condition of the dying person will not allow a more developed celebration of these sacraments over a period of time. In its pastoral ministry the Church always seeks to be as complete as possible, and with this continuous rite those who are in danger of death are prepared to face it sustained by all the spiritual means available to the Church.

The Church is careful that the final hours or few days of a person’s life is not crammed with sacraments to the point where it seems less than serious or prayerful. I have not witnessed these three sacraments celebrated in one liturgy, but I would suppose the presider walks a knife’s edge in avoiding a slightly rushed utilitarianism and a too-slow prayerful pace. In the next post, we’ll see how the choices are trimmed if there is time for only two sacraments, or one.

It should be noted that the arbitrary or personal preferences of the priest are not taken into account in these “exceptional circumstances.” The rite states the strong preference for a “developed” celebration, which would include the appropriate participation of the person, family, and faith community in aspects of these three sacraments–ground already covered in our earlier posts on the PCS.

Comments here?

In these next sections, the rite briefly outlines what is to come  in chapter VIII, the last three major topics in the rite itself. First, the Continuous Rite:

233. A “Continuous Rite of Penance, Anointing, and Viaticum” has been set out so that these sacraments may be given together in a single celebration. If the person is unable to receive holy communion, the priest can use this rite, omitting the liturgy of viaticum.

Roman economy and practicality suggests the Church provide for a situation in which time is of the essence. Keep in mind these practical rites will be employed rarely. For study purposes, they do indicate what the Church considers vital in these pastoral care rites.

234. If death seems imminent and there is not enough time to celebrate the three sacraments in the manner given in the continuous rite, the priest should proceed with the “Rite for Emergencies.”

The Church foresees an unbaptized person may be dying, and wishes to be initiated. There is a ritual for this:

235. This chapter also includes “Christian Initiation for the Dying,” which contains the rites for baptism, confirmation, and viaticum. It is to be used when ministering to an uninitiated or partially initiated person.

Note that the priest is not to celebrate penance–remember baptism is the primordial sacrament of reconciliation, providing the new believer with forgiveness of sin. The “partially initiated” would include young people not yet confirmed or who have not yet celebrated First Eucharist. Anointing is not provided for in these emergency rites.

Chapter VIII will wrap up Part II of the Pastoral Care Rites, but be warned: it is a long one, running from section 232 through 296. One section serves as an introduction, and here it is:

232. The rites contained in this section are exclusively for use in exceptional circumstances. In all other cases, the more developed forms of pastoral care ought to be employed for the greater benefit of those members of the community who are dying and for the greater consolation of those who are close to them. 

The exceptional circumstances for which these rites are provided arise when there is a genuine necessity, for example, when sudden illness or an accident or some other cause has placed one of the faithful in proximate or immediate danger of death.

I’m reminded of a story a parent told me recently. My new parish does not have holy water dishes at the doors of the building. Instead, holy water is available in the font. My friend mentioned that her child immediately knew a baptism was in the offing the other week when the font water was warm.

Sacraments often celebrate a reality of faith and grace that has already taken place in the recipient/celebrant. The public rituals may serve to deepen and reinforce this faith, and remind us of Christ’s grace. But the Church’s sacramental rituals are also for the community, to reinforce their faith, to invite an openness to Christ’s presence. An excess of privacy in penance, anointing, and viaticum impoverishes the faith community. Wise pastoral ministers know that loved ones and parishes have their own process of mourning that needs to be respected and that needs the sacramental outlet and expression.

That said, we will delve in to the pastoral necessities laid out in times of exceptional circumstances.

The brief liturgical outline is as follows:

Greeting (226)
Prayer (227)
Reading (228)
Litany (229)
Lord’s Prayer (230)
Prayer of Commendation (231)

The ritual greeting may be used “in these or similar words,” and two examples are given, one based on Saint Paul’s greeting in 2 Corinthians 1:3ff. The opening prayer is taken from PCS 221. The readings are suggested to be taken from PCS 297-298, but two are suggested: Luke 23:44-46 (the death of Jesus) and John 11:3-7, 17, 20-27, 33-36, 41-44 (the raising of Lazarus).

The Litany is, of course, of the saints, with the suggestion of a shorter prayer or one in which patron saints of the deceased, the family, or the community are added. The following prayer is added:

God of mercy,
  hear our prayers and be merciful
  to your son/daughter N., whom you have called from this life.
Welcome him/her into the company of your saints,
  in the kingdom of light and peace.
We ask this through Christ our Lord.
Amen.

The Lord’s Prayer, addressed to the Father, is followed by the Prayer of Commendation, addressed to Christ:

Lord Jesus our Redeemer,
  you willingly gave yourself up to death
  so that all people might be saved
  and pass from death into a new life.
Listen to our prayers,
  look with love on your people
  who mourn and pray for their brother/sister N.

Lord Jesus, holy and compassionate:
  forgive N. his/her sins.
By dying you opened the gates of life
  for those who believe in you:
  do not let our brother/sister be parted from you,
  but by your glorious power
  give him/her light, joy, and peace in heaven
  where you live for ever and ever.
Amen.

For the solace of those present the minister may conclude these prayers with a simple blessing or with a symbolic gesture, for example, signing the forehead with the sign of the cross. A priest or deacon may sprinkle the body with holy water.

Comments?

Chapter VII of the Pastoral Care rites is titled, “Prayers for the Dead.” It’s a brief chapter, only nine sections (223-231), but a very important pastoral outreach to the mourners of the dead. A three-section introduction:

223. This chapter contains prayers for use by a minister who has been called to attend a person who is already dead. A priest is not to administer the sacraments of penance or anointing. Instead, he should pray for the dead person using these or similar prayers.

224. It may be necessary to explain to the family of the person who is dead that sacraments are celebrated for the living, not for the dead, and that the dead are effectively helped by the prayers of the living. 

225. To comfort those present the minister may conclude these prayers with a simple blessing or with a symbolic gesture, for example, making the sign of the cross on the forehead. A priest or deacon may sprinkle the body with holy water.

Commentary:

The time and place of death is not the place for a stern lesson in who gets sacraments. Obviously, the priest or minister cannot give sacraments to the dead, but the rituals offered are for the living. A shrug of the shoulders will not comfort the loved ones. The prayers must be offered, and the gestures and symbols must be added whenever the family and friends are expecting spiritual comfort. The priest or deacon must be prepared with holy water.

In the next post, we’ll look at these prayers and assess how the minister can best serve the mourners with liturgy. Meantime, any comments?

220. When the moment of death seems near, some of the following prayers may be said:

Go forth, Christian soul, from this world
in the name of God the alnighty Father,
who create you,
in the name of Jesus Christ, Son of the Living God,
who suffered for you,
in the name of the Holy Spirit,
who was poured out for you,
go forth, faithful Christian.

May you live in peace this day,
may your home be with God in Zion,
with Mary, the virgin Mother of God,
with Joseph, and all the angels and saints.

The rite gives four other options: another commendation prayer and this litany:

Welcome your servant, Lord, into the place of salvation which because of your mercy she/he rightly hoped for. (“Amen” or “Lord, save your people.”)
Deliver your servant, Lord from every distress.
Deliver your servant, Lord, as you delivered Noah from the flood.
Deliver your servant, Lord, as you delivered Abraham from Ur of the Chaldees.
Deliver your servant, Lord, as you delivered Job from his sufferings.
Deliver your servant, Lord, as you delivered Moses from the hand of the Pharoah.
Deliver your servant, Lord, as you delivered Daniel from the den of lions.
Deliver your servant, Lord, as you delivered the three young men from the fiery furnace.
Deliver your servant, Lord, as you delivered Susanna from her false accusers.
Deliver your servant, Lord, as you delivered David from the attacks of Saul and Goliath.
Deliver your servant, Lord, as you delivered Peter and Paul from prison.
Deliver your servant, Lord, through Jesus our Savior, who suffered death for us and gave us eternal life.

Option D, a shorter prayer, and E, Hail H0ly Queen, round out the choices.

PCS 221 gives six choices for a prayer after death. You know the prayer “Saints of God.”  Psalms 130 and 23, too. PCS 222 gives two prayers for the family and mourners present.

222. … For the solace of those present the minister may conclude these prayers with a simple blessing or with a symbolic gesture, for example, signing the forehead with the sign of the cross. A priest or deacon may sprinkle the body with holy water. 

 219. When the condition of the dying person calls for the use of brief forms of prayer, those who are present are encouraged to pray the litany of saints–or at least some of its invocations–for him or her. Special mention may be made of the patron saints of the dying person, of the family, and of the parish. The litany may be said or sung in the usual way. Other customary prayers may also be used.

The Litany of Saints is another tradition that links the dying person to the time of baptism. The response to the invocations of saints is “pray for him/her.” Two forms of the litany are given, the first being the full Easter Vigil formula plus extra invocations for the responses, “Lord, save your people” and “Lord, hear our prayer.” The starred invocations are not used at baptism:

Lord, be merciful
From all evil
From every sin
*From Satan’s power
*At the moment of death
From everlasting death
*On the day of judgment
By your coming as man
*By your suffering and cross
By your death and rising to new life
*By your return in glory to the Father
By your gift of the Holy Spirit
*By your coming again in glory

Be merciful to us sinners
*Bring N to eternal life, first promised to him/her in baptism
*Raise N on the last day, for he/she has eaten the bread of life
*Let N. share in your glory for he/she has shared in your suffering and death
Jesus, Son of the Living God 

The rite offers the minister the option of a briefer form.

These two sections respectively give short Scriptures (single sentences) and longer passages of up to 22 verses. PCS 217 suggests in order Romans 8:35, Romans 14:8, 2 Corinthians 5:1, 1 Thessalonians 4:17, 1 John 3:2, 1 John 3:14, Psalm 25:1, Psalm 27:1, Psalm 27:13, Psalm 42:3, Psalm 23:4, Matthew 25:34, Luke 23:43, John 14:2a, John 14:2b-3, John 17:24, John 6:40, Psalm 31:5a, Acts 7:59.

Now for one of my rare criticisms of the PCS rites. It’s not that I find these brief passages lacking in any way. In fact, they are ideal material for prayer, and even for musical composition. My comment is that the framers of this rite didn’t seem to do much more than browse the funeral lectionary. These examples are exclusively from the psalms and the New  Testament. Nothing from the prophets (like Isaiah 43:2-3) or the Wisdom literature (Wisdom 5:15 or Sirach 18:9-10).

The hallmark of pastoral flexibility continues in PCS 218 with thirteen suggestions for readings, noting also that selections from Part III of the Rite (PCS 297-298) may be used instead. The selections: Job 19:23-27a, Psalms 23, 25, 91, and 121, 1 John 4:16, Revelation 21:1-5a, 6-7, Matthew 25:1-13, Luke 22:39-46 or 23:44-49 or 24:1-8, John 6:37-40, and John 14:1-6, 23, 27.

Again, Lectionary offerings that mostly ignore the bulk of the Old Testament possibilities.

The pastoral care rites give the minister more guidance on how to proclaim Scriptures and other texts with and to the dying. See what you think:

214. The minister may choose texts from among the prayers, litanies, aspirations, psalms, and readings provided in this chapter, or others may be added. In the selection of these texts, the minister should keep in mind the condition and piety of both the dying person and the members of the family who are present. The prayers are best said in a slow, quiet voice, alternating with periods of silence, If possible, the minister says one of more of the brief prayer formulas with the dying person. These may be softly repeated two or three times.

Commentary: The minister is accorded full flexibility, charged with using what is given, or adding other texts that may be appropriate and more meaningful to the dying person and companions.

Note that the physical condition of the dying person and the piety of all present are sound considerations for the minister.

I recall hearing once that music played for the dying (music thanatology) should adjust its tempo to the rhythm of the dying person’s body, breathing and all. This advice on proclamation strikes me in a similar way, but the experience and awareness needed seem substantial. It certainly goes way beyond just saying the right words. The art and discipline of the musical outreach to the dying has fascinated me, though I’ve never been called upon to provide it.

Repetition and silence: good virtues to commend, but difficult ones to practice.

215. These texts are intended to help the dying person, if still conscious, to face the natural human anxiety about death by imitating Christ in his patient suffering and dying. The Christian will be helped to surmount his or her fear in the hope of heavenly life and resurrection through the power of Christ, who destroyed the power of death by his own dying.

Even if the dying person is not conscious, those who are present will draw consolation from these prayers and come to a better understanding of the paschal character of Christian death. This may be visibly expressed by making the sign of the cross on the forehead of the dying person, who was first signed with the cross at baptism.

This sense of touch is lost somewhat in modern culture. The signing of the forehead would seem laudable even if the dying Christian is conscious. 

216. Immediately after death has occurred, all may kneel while one of those present leads the prayers given (in PCS 221-222).

And with this final instruction, the introduction for the commendation of the dying concludes. In the next posts, we’ll look at the shorter and longer Scripture passages, and peek at some of the prayers offered in the rite.

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