A hospice team member is called to the home and the patient or family requests for last rites to be administered. Multiple calls to local parishes produce zero results and the dying process is progressing. What are the next steps? This article will explain last rites (also referred to as the Sacrament of the Sick), explore reasons for last minute requests, identify barriers to accomplishing this goal, and offer options that will bring peace, unity, and a sense of closure to the patient, the family, and the professional.
For faithful Catholics, receiving last rites is crucial. Consisting of final prayers and blessings, last rites are considered a final cleansing which allow the dying to denounce their sinful nature and prepare their soul to enter heaven. Priests must be flexible in performing last rites based on the medical condition of the patient and his/her ability to participate.
“The sacrament consists of readings from the Scriptures, the laying on of hands, the blessing of the oil and the anointing on the forehead and hands, the communal recitation of the Lord’s Prayer, and the dismissal. If the sick person is able to receive Communion, the Eucharist may be offered just after the Lord’s Prayer.”Fr. Don Miller
Although last rites are significant to Catholics, multiple issues exist which may contribute to the initial rejection of receiving the Sacrament of the Sick. Factors include denial of the terminal illness and emotional separation from the Catholic Church.
It is not uncommon for patients and/or families to hold out hope when faced with evidence to the contrary. Moreover, acceptance of the prognosis does not mean that the Catholic patient will be ready for last rites. It is when patients are at their most vulnerable, when death is imminent and undeniable, that the request for last rites is often made. The fulfillment of the request then becomes a challenge for the hospice professional.
Issues created by the sexual abuse crisis in the Catholic Church are partially to blame for the distance many Catholics have placed between themselves and the religion of their youth.
“As the Catholic church responds to more allegations of sexual abuse of young people by priests, an increasing percentage of Catholics are re-examining their commitment to the religion. Thirty-seven percent of U.S. Catholics, up from 22% in 2002, say news of the abuse has led them to question whether they would remain in the church.”Jones
Furthermore, the retirement or resignation of priests, combined with fewer priests entering the priesthood, contribute to difficulty in meeting requests for the Sacrament of the Sick. Additionally, reduced attendance at mass has led to the consolidation of churches, thus shrinking the volume of available priests. For example, St. Anne’s Church in Waterbury, CT is one of two Catholic worshipping centers left in the city when 6 churches were combined into one in June 2017. It was subsequently renamed as All Saints Parish to formalize this massive merger and impart a sense of unity. The statistics cited for Waterbury were staggering.
“According to the archdiocese, there was little choice. Mass attendance was 395,000 in 1965; it is now 123,500 in the archdiocese. Active priests have declined from 535 in 1965 to 186.”Feuerherd
In cities and towns where smaller Churches have not yet consolidated, priests have joined and developed an on call schedule, necessitating the coverage of a larger geographic area. This has compromised the hospice team’s ability to meet their patients’ religious needs.
If the professional has confirmed that a priest will not be available soon and death appears to be nearing, the patient and/or family may need support with grieving the lack of religious closure. Subsequently, the hospice team member can assist with developing a ritual or ceremony to honor the patient in a very personal and individualized manner. A ritual can bring a sense of calm, unity, focus, and shared responsibility.
“Ritual frames significant moments and important new realities. It is often used to effect transition from one state of being to another, as in weddings, funerals, or graduations.”Magnus
While ritual is often passed down through generations, cultures, nations, and religions, a spontaneous ritual at the end of life may bring a sense of peace, deepen relationships, and provide strength during a time fraught with fear and uncertainty.
If the patient is unable to participate in the formation of a ritual or ceremony (because of decreased ability to communicate, for example), the family can be interviewed to identify the patient’s passions, skills, hobbies, and personal details which may be important to acknowledge and include in the ritual. The use of prayer, songs, readings, letters, and photographs can form the body of the ritual. Candles, flowers, scents, lighting, and music can set the tone and ambience. Working together to share love and mutual support will make the formation of the ritual a rich and meaningful experience.
Some case examples may be helpful in demonstrating these ideas. Jason was a 58-year-old man at the end of his life. While he was in an unresponsive state, his adult children joined to request last rites. Unfortunately, it was midnight and after making a valiant effort, the on-call hospice social worker was unable to reach a priest. Rather than leave the family in despair, the creation of a ritual was proposed. Immediately, the family began planning. Jason lived near the beach and found comfort in the ocean. His daughter sent a family friend to the shore to gather seaweed, seashells, and salt water. Jason was a veteran and an Army friend arrived with an American flag pin. Jason’s granddaughter dipped a cloth in salt water, wrapped the seaweed in it, and placed it on Jason’s forehead. The seashells were placed around his pillow. While Jason’s Army friend sang a patriotic song, his son pinned the American flag onto his pajamas. This beautiful ritual allowed the family to celebrate Jason’s life.
Despite not being able to receive last rites, another patient and family found comfort and joy in a ceremony created with the help of the hospice social worker and nurse. Darius, a hospice patient, was awake, alert, and in pain. The social worker and nurse made a joint visit to address his request for last rites and to improve his comfort level. During the visit, it became clear that a priest would be unavailable to provide last rites. Undaunted, the nurse suggested a ritual to celebrate the patient’s life. Darius requested the nurse to help him dress in his best pajamas. His 18-year-old son provided a background beat on a drum while his family expressed their love and devotion to Darius. Darius, in turn, shared his deep feelings of joy and pride. The ending requested by the patient consisted of the group singing many of his favorite church songs.
Hospice professionals have no control over the issues related to the Catholic Church nor when the patient or family make their requests for last rites. However, the ability to help does not need to end with the failed attempt to locate a priest. While a family created ritual may not meet the religious needs of the patient, embarking on a collaborative, compassionate effort to design a ritual can bring immediate positive results. Ritual provides a forum to honor the patient’s life, express feelings, and move both patient and family toward the final transition in the end-of-life journey.
Feuerherd, P. (2018, January 4). All Saints Parish, formerly six churches, carries on after consolidation: Hartford Archdiocese’s merger process centralizes Catholics in Waterbury. National Catholic Reporter. Retrieved from https://www.ncronline.org/news/parish/all-saints-parish-formerly-six-churches-carries-after-consolidation
Jones, J. M. (2019, March 13). Many U.S. Catholics question their membership amid scandal. Gallup. Retrieved from https://news.gallup.com/poll/247571/catholics-question-membership-amid-scandal.aspx
Magnus, S. S. (2009, February 27). Ritual in the United States. Jewish Women’s Archive: A Comprehensive Historical Encyclopedia. Retrieved from https://jwa.org/encyclopedia/article/ritual-in-united-states
Miller, D. (n.d.) Sacrament of Anointing of the Sick. Franciscan Media. Retrieved from https://www.franciscanmedia.org/sacrament-of-anointing-of-the-sick/
The significance of a dying Catholic’s Last Rites (2018, September). Beyond the Dash. Retrieved from https://beyondthedash.com/blog/cultural-spotlight/the-significance-of-a-dying-catholic-s-last-rites/7233