14 Is any among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord; 15 and the prayer of faith will save the sick man, and the Lord will raise him up; and if he has committed sins, he will be forgiven. 16 Therefore confess your sins to one another, and pray for one another, that you may be healed. (Jas 5:14-16)
This sacred unction for the sick, however, was instituted by Christ our Lord as truly and properly a sacrament of the New Testament, alluded to in Mark [Mark 6:13], indeed, but recommended to the faithful and promulgated by James the Apostle and brother of the Lord. “Is any man,” he says, “sick among you?” “Let him bring in the 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 shall save the sick man, and the Lord shall raise him up; and if he be in sins, they shall be forgiven him.” [Jas 5:14,15]. In these words, as the Church has learned from apostolic tradition transmitted from hand to hand, he teaches the matter, form, proper ministration, and effect of the salutary sacrament. For the Church has understood that the matter is the oil blessed by the bishop, since the unction very appropriately represents the grace of the Holy Spirit, with which the soul of the sick person is visibly anointed; and that these words are the form: “By this anointing, etc.” (Council of Trent, Denzinger, 13th ed., no. 908, trans. Roy J. Deferrari, B. Herder Book Co., St. Louis, MO, 1957)
As noted above, the ecumenical Council of Trent (16th century) declared this passage from James as the apostolic source of our sacrament, called Anointing of the Sick, or Extreme Unction. The council also mentioned that Mark alludes to this sacrament:
12 So they [the Apostles] went out and preached that men should repent. 13 And they cast out many demons, and anointed with oil many that were sick and healed them. (Mk 6:12-13)
Jesus sent out His Apostles on their mission and they healed people by anointing them with oil. We understand such anointing resulted in healing people of their physical sicknesses. Yet in James, he says the purpose this anointing of the sick is for spiritual healing, of forgiving sins. The description is immediately followed by an admonishment to confess our sins, which sounds like the sacrament of Reconciliation. Let’s dissect.
Let’s first remove argument about v. 14: “elders of the church” vs. “priests of the church,” as Trent translates it. The Greek is presbyteros ecclesia; traditional Christians always understand presbyteros as priests; we don't see elders in the sense of generic authority figures. As we’ve noted elsewhere (here and here), the authority of the Church is in the gospel and the sacraments, provided by servant bishops, not in a committee of decision makers. In our ecclesiology, the bishop is tasked with these two roles; he has assistant priests to help him – these are the only meaningful elders in a sacramental church. The English word priest is derived from the Greek word presbyteros. Reformed Christians, on the other hand, do not hold to our image of the priesthood; as such, they often have a decision-making body of elders and they understand this Greek work to refer to that body.
Next, let’s look at the very idea of anointing with oil. The bible is filled with this image. Kings, priests and prophets were normally anointed with oil at the beginning of their vocations (cf. Ex 28:41, 1 Sam 15:1, 1Kg 19:16) – in all three cases, a vocation which helps others. As our text from Trent notes, this oil represents the Holy Spirit. Why? Oil was a very important commodity of the ancient Middle East, it being plentifully derived from common plants of that region (olive trees, etc.); as such, it had many uses, in cooking, medicine, grooming and lamps to light the darkness. Having a plentiful supply of oil was synonymous with abundance, while a lack was associated with poverty (cf. 1 Kg 17:11-16). In terms of anointing, we should not think of the ‘dab’ of oil we apply in baptism, confirmation, holy orders, and extreme unction; rather, the image is of an abundance of oil poured on the person:
1 Behold, how good and pleasant it is when brothers dwell in unity! 2 It is like the precious oil upon the head, running down upon the beard, upon the beard of Aaron, running down on the collar of his robes! 3 It is like the dew of Hermon, which falls on the mountains of Zion! For there the LORD has commanded the blessing, life for evermore. (Ps 133)
That’s a lot of oil anointing the high-priest, Aaron. Note the image is of abundance, oil overflowing. As the psalm says, this is related to “the blessing, life for evermore.” To an Israelite, this overflowing oil meant overflowing blessings of food, health, light, beauty, life. These physical things have their counterpart in the spiritual life, which is why this overflowing of oil in an anointing reflects the indwelling of the Holy Spirit, Who provides us with all spiritual goods in abundance. As we’ve seen elsewhere, this indwelling of the Holy Spirit inevitably moves us to help others; this is why this image of the Holy Spirit (anointing) is applied to the other-oriented vocations of priest, prophet and king in the OT. These same vocations are OT types, fulfilled in the Head of the Church, Jesus.
This gives us some insight into the meaning of our text from James. The words can indicate either a spiritual resurrection – the forgiveness of sins for a soul on the brink of death - or a physical resurrection – a healing from the bodily illness. Many have argued one or the other. But the use of oil and the mention of the Holy Spirit (plus the fact that this is a sacrament) should point us towards the spiritual understanding as primary. This leaves us, of course, with a physical healing as a secondary possibility, and it is known that sometimes the administration of this sacrament results in physical healing.
Last, let’s consider v.16: Is this reference to confession directing us to the sacrament of Reconciliation, or is this still related to Anointing of the Sick? We don’t know. In fact, our sacrament does not require confession, just the anointing and the words & prayers of the priest. St. Augustine saw in this verse a communal confession, the introductory rites of the Mass where we openly confess our sins to one another (“I confess to Almighty God and to you my brothers and sisters…”). This would be a fairly literal understanding, which is also a common understanding among Reformed Christians. St. Thomas Aquinas saw the sacrament of Penance in this verse. The Council of Trent references this verse in its declarations on the sacrament of Penance, but does so in a way that does not authoritatively define its interpretation this way. We can understand this verse however we want, but it’s a fact that James places it here, with his directives on Extreme Unction. This, again, implies our text and our sacrament is primarily related to the forgiveness of sins. Tying this idea to oil and the Holy Spirit tells us that our sacrament gives a special charism of the Holy Spirit to the soul who is in special need, the soul who needs a powerful remedy against sin as she approaches the eternal embrace of the Lord.