Confession and Communion
in the Visitation of the Sick

The Rev. Philip H. Pfatteicher

Presented at the STS General Retreat, 14 October 2008

The last time I addressed this Society, I considered the topic of Pastoral Visitation. This time, since your distinguished Senior has done me the honor of inviting me back, I have been asked to deal with a specific kind of pastoral visitation, what earlier books and manuals called the Visitation of the Sick, and particularly the role of confession and communion in such ministry.

G. H. Gerberding, that wise and delightful son of the First English Lutheran Church in Pittsburgh and long-time professor at Chicago and at Northwestern Lutheran Seminaries, whom, you may remember, I quoted frequently the last time I addressed this Society, in his classic of 1902, The Lutheran Pastor, begins chapter XXI, "Visiting the Sick," with this observation. "Among the most delicate and sometimes the most difficult of the seelsorger's office is that of visiting the sick. To the true pastor it ought to be also among the most welcome."[1] [Seelsorge, for those who do not know that German word, may be translated "pastor of souls."]

Gerberding quotes the Evangelical Anglican vicar Charles Bridges (1794-1869) on The Christian Ministry: "This Divinely appointed work [James 5:14]—often the only kind of office we can do for some [originally "our"] people—is a Ministry of special responsibility. God himself is the Preacher, speaking [through the sickness] more loudly and directly to the conscience than the mere voice of man. Our work, therefore, is to call attention to the speaking voice. . . . Again, in the sinner's contact with 'Death—that terrible and thundering preacher'—a deeper impression is sometimes made in the sick chamber than in the pulpit. Most of all at this crisis the conscience is more or less awakened—the need of a refuge is acknowledged—the prospect of eternity without it is dreaded. How golden the opportunity to set forth the Saviour. . . ."[2]

Gerberding continues, "The pastor must know the general purpose of God in afflicting. He must also distinguish between the sickness that God sends and that which is brought upon the sufferer by his own special sin. Sickness that is brought on by needless exposure, by intemperance in eating or in drinking, by indulging in any way the sinful desires of the flesh, is not to be attributed to the mysterious dispensation of Providence. The laws of nature—including, of course, the laws of health—are the laws of God. They cannot be broken with impunity. Nature knows neither mercy nor forgiveness. She collects her debts to the last penny. Let these fundamental, fearful, and far-reaching truths be faithfully preached and taught, and a vast amount of sickness will be avoided. . . ."[3]

The ministry to the sick does not begin with a phone call or with finding out third-hand that someone is ill. Ministry to the sick is part of the on-going teaching and preaching by the careful pastor, preparing people for whatever life may have in store.

Gerberding quotes Heinrich Adolf Köstlin (Lehre von der Seelsorge): "Every serious chastening which comes upon the Christian is a Word addressed to him by the Father, an exhortation to be still, to look within himself, an essential means of divine pedagogy. . . . We have a right to speak of a 'school of sickness.' That Christian whom God takes apart by himself has something to learn."[4]

Before we dismiss such nineteenth-century approaches as out of fashion in the twenty-first century, we must understand something of great value in them.

On the basis of such understandings, Gerberding can refer to those who are sick as "those whom God has thus specially taken in hand."[5] (The phrase derives, perhaps, from Job 19:21, "The hand of the Lord has touched me.") It is therefore not out of pity or even sympathy that the pastor comes to the sick person, but in a spirit of a certain awe in approaching one whom God has "taken in hand."

There is an instructive exchange in the intensely spiritual novel The Diary of a Country Priest by George Bernanos. The wonderfully innocent country priest in a moment of anguish says to his friend the Curé de Torcy, "I would like you to bless me." The crusty and wise old priest responds, "You're in trouble. You must bless me."[6] The old man knows that ministry is not a one-way operation, not something we do to others. Especially those in some trouble or difficulty have a gift to give us because God has taken them in hand .

Therefore, Gerberding, quoting Theodor Harnack (Praktische Theologie) says, "The sick are entitled to special care on the part of the pastor, partly because the loss of the sanctuary service is to be made good for them and to those who wait on them [hospitals and nursing homes being much less common in the nineteenth century than now]; and partly because even with advanced Christians this is often the time of temptation, and, with those not yet Christians, it may become the turning point of their spiritual life; and finally because there is no more favorable point of contact for real soul-cure than sickness. From the sick-bed, especially if death seems to threaten, life appears in a far different light than heretofore."[7] Thus the sick are entitled to special pastoral care.

"In the day of judgment," Gerberding reminds us, "the Lord will say to the faithful pastors, 'I was sick and ye visited me.'"[8] That truth was brought home to me early in my ministry. I made a long journey to an inconvenient hospital to see a marginal member of the parish. When I got there, she was barely conscious and surely did not recognize me for she had never seen me before and probably was not even aware that I was there. Feeling resentful for having wasted an afternoon, I headed down the stairs to the exit. On a landing of the stair I passed a statue of our Lord (it was a Catholic hospital) with the inscription. "I was sick and you visited me." Suddenly I realized that my visit was not at all wasted.

St. Augustine calls those pastors who neglect to visit the sick desolators instead of consolators.[9]

The whole Church at all times has therefore regarded the pastoral care of the sick as a special duty. The primary example is the Lord himself who healed and absolved the sick.

A classic text is Matthew 9:1-7. "And after getting into a boat he crossed the sea and came to his own town. And just then some people were carrying a paralyzed man lying on a bed. When Jesus saw their faith, he said to the paralytic, 'Take heart, son; your sins are forgiven.' Then some of the scribes said to themselves, 'This man is blaspheming.' But Jesus, perceiving their thoughts, said, 'Why do you think evil in your hearts? For which is easier, to say, "Your sins are forgiven" or to say "Stand up and walk"? But so that you may know that the Son of Man has authority on earth to forgive sins'—he said to the paralytic—'Stand up, take your bed and go to your home.' And he stood up and went to his home." [Also Mark 2:1-12; Luke 5:17-26]

We learn, among other things in this awkwardly-worded passage, that healing and absolution are two parts of one comprehensive process. One might almost say that healing and absolution are the same activity.

The second foundational text is St. James' admonition, "Are any among you sick? They should call for the elders of the church and have them pray over them, anointing them with oil in the name of the Lord." [James 5:14]

The Apostolic Constitutions [VIII.2.x] in a bidding prayer asks public intercessions for the sick. The Gregorian Sacramentary contains six prayers for those who are visiting the sick. The church orders of the sixteenth century continue the tradition and make provision for the Visitation of the Sick.

The pastor comes to the sick bed, Gerberding says in a notable phrase, "as the minister of the Word to bring the church into the house." Even the best of believers, he says, will often be perplexed with doubts and fears. The pastor should unfold and apply the Word that the sick person may see and find rest in the comforting truth that the case "is part of the counsel of love," intended for good, to yield fruit.[10]

The pastor is to bring the church into the house. Köstlin says much the same. The pastor is "to bring the Lord's Day with all its holy service into the sick-room. What is lacking in organ and song and solemn surroundings, the pastor's personal presence is to make up."[11] The spirit in which the pastor comes is of great importance, Gerberding notes. "He should not talk down to them from a superior elevation but as a fellow-pilgrim, encouraging and helping another over a hard place, and as himself a sinner in need of grace, desirous of serving another sinner. . . . Thus his very presence is to soothe, to calm, and to call forth that confidence which is necessary for soul-cure."[12]

As preparation on the part of the pastor is necessary before presiding at the liturgy and before preaching, so preparation is also necessary before visiting the sick. Köstlin says, "When the pastor is to go to the sick, let him impress upon himself what he owes to the sick whose case the Lord has laid on him."[13] He recommends reading and meditating on several biblical passages.
            Matthew 25. "I was sick and you visited me."
            Matthew 9:36. Jesus' compassion for the shepherdless crowds.
            Matthew 11:28-30. "Take my yoke upon you and learn from me. . . . For my yoke
                is easy and my burden is light."
            John 21:15ff.   "Feed my lambs. Tend my sheep."
            1 Corinthians 13:4. "Love is patient, love is kind. . . ."
An eighteenth-century south German pastor, George Conrad Rieger, when putting on his coat to visit the sick used to repeat aloud to himself Colossians 3:12-15.[14] "As God's chosen ones, holy and beloved, clothe yourselves with compassion, kindness, humility, meekness, and patience. Bear with one another and, if anyone has a complaint against another, forgive each other; just as the Lord has forgiven you, so you also must forgive. Above all, clothe yourselves with love, which binds everything together in perfect harmony. And let the peace of Christ rule in your hearts, to which indeed you were called in the one body. And be thankful." His practice is an interesting Protestant variant on the traditional prayers while vesting for the Eucharist. The practice reminds us that everything we do has meaning and that every action can be used to teach us and remind us of whose we are and what our obligations are.

The visitation of the sick lays an awesome responsibility upon pastors. We need to be reminded of that as we consider who we are and what we do. But fortunately we are not left to our own devices. If we were, it would be hopeless. But we have the treasures of the Church to help us, to guide us, to give us words to say and actions to do.

In a class in Pastoral Theology at Mount Airy Seminary, John Doberstein[15] gave this simple but profound advice for ministering to the dying: "Put a crucifix in his hand and preach the resurrection." In a broad sense, that is also true in the visitation of the sick, even as it is true in a still broader sense of the work of a pastor.

"Put a crucifix in his hand and preach the resurrection." You need to know that, for all his low-church proclivities, Professor Doberstein was true to his German Lutheran roots. He displayed in his house an extensive collection of crucifixes. For him, the crucifix told of the central message of evangelical Christianity: Jesus Christ died for us. For him, despite his suspicion of liturgical forms and his discomfort with wearing a surplice, a tangible sacred object spoke as powerfully as a spoken or preached word. In the crucifix you can see the death. By the preaching you can look forward in hope to the resurrection to life.

How should one thus preach the resurrection? Here is how St. John Chrysostom did it.

"Have you seen the wonderful victory? Have you seen the splendid deeds of the Cross? Shall I tell you something still more marvelous? Learn in what way the victory was gained, and you will be even more astonished. For by the very means by which the devil had conquered, by these Christ conquered him; and taking up the weapons with which he had fought, he defeated him. Listen to how it was done.

"A virgin, a tree, and a death were the symbols of our defeat. The virgin was Eve: she had not yet known man; the tree was the tree of the knowledge of good and evil; the death was Adam's penalty. But behold again a virgin and a tree and a death, those symbols of defeat, become the symbols of his victory. For in place of Eve there is Mary; in place of the tree of the knowledge of good and evil, the tree of the Cross; in place of the death of Adam the death of Christ.

"Do you see him [Satan] defeated by the very things through which he had conquered? At the foot of the tree the devil overcame Adam; at the foot of the tree Christ vanquished the devil. And that first tree sent men to Hades; this second one calls back even those who had already gone down there. Again, the former tree concealed man already despoiled and stripped; the second tree shows a naked victor on high for all to see. And that earlier death condemned those who were born after it; this second death gives life again to those who were born before it. Who can tell the Lord's mighty deeds? By death we were made immortal; these are the glorious deeds of the Cross."[16]

Sickness, we may observe, does two things to us spiritually. First of all, it reminds us of the frailty of our nature, because of which, as an ancient collect says, "we cannot always stand upright." Sickness reminds us of the certainty of death—if not soon, then some day, surely. It brings home forcefully the temporary nature of our life in this world. We need to hear that, to know it, to come to terms with it. That recognition is surely upsetting, and it may well be frightening. Perhaps the very old and the very devout can sing with St. Francis,
                        And thou most kind and gentle death,[17]
                        Waiting to hush our latest breath,
                        O praise him.    [SBH 173]

For most of us, however, it is difficult to sing unreservedly the gentle saint's words. Sickness reminds us that we are mortal, and therefore we must one day die. Sickness is the powerful message of Ash Wednesday made even more intensely personal.

Secondly, sickness isolates us. It pulls us back into ourselves as we become preoccupied with our intimate personal concerns, our own pain and suffering. That is to say, sickness does what sin does to us by curving us inward so that we focus more and more exclusively on ourselves. Therefore it is entirely appropriate and accurate to speak of the connection between sin and sickness.

We must of course be careful here. Older pastoral approaches to sickness stressed the connection often is personal terms, sometimes suggesting that your sickness is your fault because you brought it on yourself by your own sin. This unhelpfully added guilt to the existing suffering.

It is of course true that there is an intimate connection between sin and sickness. In a general sense, as Genesis 3 vividly teaches, it is our human sin, our rebellion against God's rule, which has brought sin into the world and corrupted God's good creation. Sometimes one's own sinful actions are indeed the cause of illness: overindulgence in food or alcohol, for example. But in most cases to make the close connection between a person's personal sins and that person's sickness is pastorally irresponsible. "Pastor, why do I have cancer?" "Because you have sinned" is almost always the wrong answer.

Remember the exchange reported in John 9:1-3. "As he walked along, he saw a man blind from birth. His disciples asked him, 'Rabbi, who sinned, this man or his parents, that he was born blind?' Jesus answered, 'Neither this man nor his parents sinned; he was born blind so that God's works might be revealed in him.'" (Jesus' reply lays to rest one old question while raising another perplexing question that we will not attempt to address here.)

To the question "Why do I have cancer," a better answer is, "I don't know why you have contracted cancer, but I do know that you are a part of the body of Christ, the Church, that you need to remember that you have been baptized into his death and resurrection, and that we know the end of the story. The end is not death; the end is God. That last phrase was the conclusion of the funeral sermon for my father. Dr. William O. Moyer, pastor of the Church of the Holy Communion in Philadelphia, concluding his eloquent sermon said with rising emotion, "At the end, at the end there is not death," and I thought to myself, thinking I knew exactly where he was going, that's lovely, that's perfect, at the end there is not death; at the end there is life. But the great preacher was not into comparative mythology and world religion. He was a Christian, and his even more powerful conclusion was, "At the end there is not death. At the end there is God." That's what we have to say to the dying, and that's what we have to say about the dead.

Because we share in the sinfulness of the human race, we are all of us mortal, and sickness reminds us of that. Because sin and sickness isolate us, focusing us inward on our own immediate concerns, we need to be drawn out of ourselves and made aware of our part in the body of Christ, the Church.

The Church's traditional ministry to the sick consists of a series of actions that together form one continuous whole. These actions are (1) confession and absolution; (2) lessons, that is, readings from the Bible, and prayers for the sick; (3) the imposition of hands and anointing with the oil of the sick; and (4) the Holy Communion.[18] That was the ancient understanding, and it is reflected, for the first time in Lutheran circles, in Occasional Services 1982.[19] I hesitate to speak of the forthcoming ELCA Occasional Services until such are actually published; I do not know what the Lutheran Church—Missouri Synod is doing in this regard.

It is essential that we understand the purpose of the ministry to the sick. Older books, as we have heard, suggest that sickness is a correction, a chastisement, a rebuke from God, not an evil to be combated. They seemed to suggest that it was the duty of the sick patient to remain ill and to suffer patiently what was doubtless God's discipline. A healthier and more responsible view, however, would encourage the patient to glorify God by recovering.[20] Of course it is the duty of the pastor to instruct the people to prepare for possible death—the Ash Wednesday theme—but in most cases the patient ought to expect recovery. If that recovery does not occur, the faithful pastor must combat the reaction that it is the patient's weakness that has prevented recovery, that continued sickness is the patient's fault. The proper focus of the ministry to the sick is life, health, and recovery. If these do not occur in this life, they surely will in the next where there is no sorrow or pain or grief. So Occasional Services 1982 was right in changing the heading of such rites from "the Visitation of the Sick" to "the Ministry of Healing."

The goal of such ministry of healing is the health of the whole person, the mental, spiritual, and bodily health. In the early days of Christianity, as the Gospels make clear (remember the healing of the paralytic), it was understood that at the Incarnation our Lord came to be the physician and savior, not of the soul alone but of the entire person. The view was sound and practical. It is also in accord with the present understanding of the unity of the human person, soul and body being parts of one organic whole.[21]

In early Christianity, beginning with our Lord and with the advice of St. James, the chief healing actions were laying on of hands, anointing, and exorcism. Secondary therapeutic effects were attributed to Baptism, to Absolution, and to the Holy Communion. Repentance, followed by absolution and communion, enabled the penitent sinner to participate in the healing work of the Incarnation.[22]  As the centuries passed, what was originally secondary, confession and communion, became primary in Lutheran and in Anglican practice.

First, Confession and Absolution. The practice of confession before communion has its roots in St. Paul's admonition that used to be referred to in the Exhortation in the Preparatory Service before the celebration of the Lord's Supper: "Examine yourselves, and only then eat of the bread and drink of the cup." [1 Cor. 11:28] The Exhortation began with words impressed upon me from childhood, "Dearly beloved! Forasmuch as we purpose to come to the Holy Supper of our Lord Jesus Christ, it becometh us diligently to examine ourselves as St. Paul exhorteth us. For this Holy Sacrament hath been instituted for the special comfort and strengthening of those who humbly confess their sins, and who hunger and thirst after righteousness."[23] The Augsburg Confession in Article 25 also reflects St. Paul's understanding: "Confession has not been abolished in our churches. For it is not customary to administer the body of Christ except to those who have been previously examined and absolved."

In the nineteenth century Edward Traill Horn in The Evangelical Pastor explains, "Nearly all the Kirchen-ordnungen of the XIV. century require that everyone who wishes to receive the sacrament shall personally give notice of his wish to the pastor, who may then discover whether he needs special instruction, and comfort him with the absolution. The normal method was to have a service in the church on the Saturday afternoon before the communion, after which the communicant came to the minister; and often the service was appropriately closed after this Beichte or confession."[24]

G. H. Gerberding comments, "Thus we see that private confession was the rule and custom in our Church after the Reformation. It is still so in a large part of the Lutheran Church. It has its place and is explained in Part IV. of  Luther's Small Catechism."[25] Gerberding, however, is aware of the actual practice of the church in America when he was writing at the beginning of the twentieth century, a practice that continues to this day. He admits, "In nearly all of our English Lutheran churches in America, private confession has fallen out of use, while public confession and absolution have taken its place. It is an open question whether we have not lost by giving up this old Lutheran custom. Where properly conducted, by an earnest and conscientious pastor, we can easily see that it could be a mighty power for good. Think of the advantage to the pastor, in his care of the individual soul, if he could have a private and confidential interview with each communicant every few months on the particular needs, trials, temptation, sins, and sorrows of the soul. If everyone would thus confidingly and fully open up his heart and his private thoughts to his pastor, what a help to the pastor in administering the specially needed instruction, reproof, warning, encouragement, and consolation."

"But," Gerberding frankly admits, "there is an if in it. If we had all ideal pastors, sincerely and prayerfully solicitous for the spiritual welfare of every soul; if we had always that full and unreserved confidence between the pastor and every communicant; if every communicant were prayerfully solicitous about his own spiritual welfare, and would thus fully disclose the state of his heart and life; if, in a word, we could always have on both sides that spiritual earnestness and that realization of responsibility, yes, then it would be an unmixed blessing."[26]

Gerberding, the wise pastor, can see both sides of the matter. While honoring the tradition of private confession, he can see certain good in the situation as it exists in America and warns against any superficial attempt to restore the old ways. "[L]ooking at man as he is," he observes, "remembering that the old Adam is a formalist, who likes to flatter himself that when he has repeated a certain form of words he has done his whole duty, it is easily seen how private confessions may become a real source of danger."[27]

It needs to be noted, however, that that same observation may and indeed ought to be made about the present orders for confession and forgiveness. Just using the form, whether general or individual, does not guarantee much. An unfortunate result of Luther's healthy and wise insistence that one need not enumerate all one's remembered sins in confession has been noted by an Anglican priest Charles Harris. "Lutheranism . . . in its early days laid far less stress than Roman Catholicism on the complete enumeration of all remembered sins; consequently the tendency was for Lutheran [private] confession to degenerate into mere formality, and finally to disappear."[28] A similar observation may be made about the degeneration of general confession into mere formality.

Nonetheless, illness can raise troubling questions and anxieties for those who must endure it (both patients and caregivers as well), and confession and absolution is one of the treasures of the Church by which the Gospel may be applied to troubled consciences. That is why Absolution has rightly been called a sacrament, "the sacrament of repentance" or "penance" in the language of the Apology of the Augsburg Confession, Article XIII.

There is a further benefit of confession that is often, indeed usually, overlooked. In her Nobel Prize address, Mother Teresa said, "One evening we went out and we picked up four people from the street. And one of them was in a most terrible condition. And I told the sisters, 'You take care of the other three. I take [care] of this one who looked worse.' So I did for her all that my love can do. I put her in bed, and there was such a beautiful smile on her face. She took hold of my hand, and she said one word only: 'Thank you.' And she died. I could not help but examine my conscience before her, and I asked what I would say if I were in her place. I would have tried to draw a little attention to myself, I would have said that I am hungry, that I am dying, I am cold, I am in pain, or something, but she gave me much more—she gave me her grateful love."[29] Mother Teresa was taught by the one to whom she was ministering and moved to an examination of her own conscience. Hearing confessions, I think, can, and perhaps should, do that also for the confessor.

The most copious source of information about Lutheran practice at the time of the Reformation is the Brandenburg Church Order (1549). This order devotes a long and instructive section to the visitation, absolution, and communion of the sick. We may make eight observations about it.

(1) If a sick person desiring communion is too weak to attend the long public Mass yet strong enough to come to a short private service later in the day, the priest (the usual term used in this order) is to reserve at the public Mass sufficient consecrated bread and wine, apparently on the altar, and from these to communicate the sick person "privately" at "a fitting time" (that is, not later than noon) with brief accompanying devotions. The priest is not directed to receive with the sick person, the service being understood as an extension of the longer public service. The order does not say whether healthy people unavoidably prevented from participating in the public Mass were permitted to receive Communion in the same way.

(2) If the sick person is so weak that it is necessary to carry the sacrament to the house, then the priest, wearing the surplice (Korrock), with fitting reverence, carries it out of the church from the altar, the sacristan going in front with a bell and a lantern with a lighted candle. At the house the priest places the Sacrament on a table covered beforehand with a white linen cloth. He is to exhort, comfort, and instruct the sick person, reciting at least Psalm 25 ("To you, O Lord, I lift up my soul") and reading John 3:16 and prayers. He is to hear the person's confession, give absolution, and commune the person in both kinds. The service concludes with the Aaronic benediction and, if requested, Psalm 91 ("He who dwells in the shelter of the Most High, abides under the shadow of the Almighty") and Psalm 108 ("My heart is firmly fixed, O God, my heart is fixed; I will sing and make melody").

In a letter to Joachim II, Elector of Brandenburg 1535-1571, Luther approved such reservation of the sacrament for the sick, "provided it be taken from the altar at Mass, and not placed in the tabernacle [sacrament house]; provided also that no superstition is involved." [Define "superstition" as you will.] Luther assumed communion in both kinds, although he recognized that this presented problems. The reservation of the chalice, he said, is an "innovation causing the whole world to open its mouth and eyes and giving occasion to the Papists to mock." The Roman Church then and now does not reserve the consecrated wine. Carrying the chalice a long way was inconvenient, to say the least; carrying the host alone, Luther said, is a "mockery of God and only half a sacrament—indeed no sacrament at all." On the whole he seems to prefer that reservation be practiced quietly and unostentatiously and that controversy and criticism be avoided by saying nothing about it in the published service books.[30]

(3) In the case of an unexpected emergency, such as a sudden call to give viaticum during the night, the priest is to go to the church, pray the Lord's Prayer, consecrate the elements by reciting the words of institution, and, preceded by the sacristan carrying a lantern, go to the dying person and administer communion. Continuous reservation for the purpose of giving viaticum, it may be noted, is not contemplated here, but, it may also be noted, it is not expressly forbidden.

(4) The Brandenburg Order assumes that in large towns the sick are to be communicated in all cases by reservation after the public Mass. In rural areas, however, where distances would usually be long and the roads poor, rendering the carrying of the chalice perilous, the priest is directed to celebrate Mass privately with the sick person, using a simplified form of the public service.

(5) The early Lutherans, it is important to note, treated the smallest remains of the consecrated elements with scrupulous reverence. (There are the stories that Luther, and Melanchthon too, would kneel down and lick up any spilled consecrated wine.[31]) The Brandenburg Order, like most sixteenth-century orders, prescribes careful ablutions. "After giving Communion, the priest shall wash his fingers over the chalice, and give the ablution to the sick person, or some other communicant," suggesting that the priest was not expected to commune himself at such a Mass.

(6) Practically all the early Lutheran church orders not merely recommend but require the sick person to confess to the priest and receive absolution before communicating.

(7) Not a few Lutheran orders require that all persons who desire to communicate with the sick person shall first make their confession to the priest or pastor and receive absolution. Even when this is not expressly ordered by the office for the Visitation of the Sick, it is often to be inferred from the rubrics given elsewhere in the Order, that communicants must in all cases confess privately and be absolved before they receive the Eucharist.

(8) The Lutheran Church, unlike the Calvinists, communicated its sick members freely and frequently, either by reservation or by special consecration in the sick person's house. The latter soon came to be the more usual method, except in certain quarters where many medieval practices were retained. No Lutheran form expressly forbids reservation, although the great majority prescribe a celebration in the house of the sick person or at the bedside.

Gerberding is thus on solid Lutheran ground when he directs, "Those who cannot, on account of bodily infirmity, come to the Lord's house, should not be deprived of the holy communion. They need it even more than those who are well and strong."

Gerberding perhaps remembered the observation of St. Ignatius of Antioch, who died probably in the Coliseum in Rome about the year 107, when he wrote to the Ephesians, "Give ear to the bishop and to the presbytery with an undivided mind, breaking one Bread, which is the medicine of immortality, the antidote against death, enabling us to life forever in Jesus Christ." [Ephesians 2:20] That memorable description of the Holy Communion as the "medicine of immortality" has impressed itself on the mind of the Church.

It is rooted in the glorious Eucharistic passage in the 6th chapter of St. John, especially the extraordinary verse, "Eat this bread and live for ever." That verse, incomprehensible on the face of it, requires reflection and explanation, of course. Yet is also part of our Lutheran tradition. Remember the marvelous post-communion hymn by Johann Rist, "O living Bread from heaven," that, in Catherine Winkworth's translation, has us sing in the second stanza,
                  My Lord, thou here hast led me
                      Within thy holiest place,
                  And there thyself hast fed me
                      With treasures of thy grace;
                  And thou hast freely given
                      What earth could never buy,
                  The Bread of Life from Heaven,
                      That now I shall not die!     [SBH 285]

Then, reflecting the nineteenth and twentieth century practice of celebrating the Eucharist infrequently, Gerberding says of the sick, "They should be visited beforehand and informed of the time when they also may partake of the heavenly feast. They should be admonished and instructed as to proper preparation, and encouraged to trust in the dear Savior. At the appointed time the pastor should carry the elements to them."[32]

The important concern throughout Christian history is the unity of the Church. It was expressed and safeguarded by the principle of "the one Eucharist." At Jerusalem (Acts 2:46) and in the Pauline churches (Acts 20:7), "the Breaking of Bread" was the center of worship and life. St. Paul especially stresses this point.  "The cup of blessing that we bless, is it not a sharing in the blood of Christ? The bread that we break, is it not a sharing in the body of Christ?" (1 Cor. 10:16)

In the next generation, St. Ignatius of Antioch about A.D. 107 urged the Philadelphians, "Take care to have but one Eucharist (for there is one flesh of our Lord Jesus Christ, and one cup that leads to unity through his blood; there is one altar, just as there is one bishop, together with the council of presbyters, and the deacons, my fellow servants)."[33]

The idea of a private celebration of the Eucharist, at least as a normal practice, is plainly out of keeping with such a corporate conception of the Holy Eucharist. It is therefore not surprising that we learn from the earliest description of the Eucharist that we have, that of Justin Martyr about the middle of the second century, that the sick and absent were communicated from the one celebration at the one altar. "When the president has given thanks, and all the people have expressed their consent [by saying the Great Amen], then those whom we call deacons give to each of those present to partake of the bread and the wine mixed with water over which the Thanksgiving has been pronounced; and they carry away [a portion] to those who arte absent." And again, "The distribution and partaking of those things over which the Thanksgiving has been pronounced is made to each one, and [they] are sent to the absent by the hands of the deacons."[34] The Eucharist was to be celebrated in the church, at the one altar, and any celebration elsewhere than in the church was rare indeed.

From the sixth century on, it was at least the frequent, if not the usual, practice in cases that were not urgent, for the priest first to celebrate in church a Mass for the Sick and then, laying aside the chasuble, to carry in his hands the paten and the chalice directly to the sick person's house and communicate that person from the altar, exactly as Justin Martyr has described.

As early as the middle of the third century the clergy of Alexandria were accustomed to reserve the Eucharist continuously for the purpose of giving viaticum at any hour of the day or night, so important was the giving of Holy Communion to the dying as their "food for their [last] journey." The understanding has its roots in the story of Elijah. "Ahab told Jezebel all that Elijah had done, and how he had killed all the prophets with the sword. The Jezebel sent a message to Elijah, saying, 'So may the gods do to me, and more also, if I do not make your life like the life of one of them by this time tomorrow.' Then he was afraid; he got up and fled for his life, and came to Beersheba, which belongs to Judah,; he left his servant there. But he himself went a day's journey into the wilderness, and came and sat down under a solitary broom tree. He asked that he might die: 'It is enough; now, O Lord, take away my life, for I am no better than my ancestors.' Then he lay down under the broom tree and fell asleep. Suddenly an angel touched him and said to him, 'Get up and eat.' He looked, and there at his head was a cake baked on hot stones, and a jar of water. He ate and drank, and lay down again. The angel of the Lord came a second time, touched him, and said, 'Get up and eat, otherwise the journey will be too much for you.' He got up, and ate and drank; then he went in the strength of that food forty days and forty nights to Horeb the mount of God." [1 Kings 19:1-8] So the viaticum is food for the last journey and an assurance of resurrection to life eternal. As Christians left this world the medicine of immortality took on still deeper meaning.

Even as modern Roman Catholic understanding has broadened anointing from a preparation for death (what was misleadingly called "Extreme unction"[35]) to a more general anointing of the sick, so the seventeenth century Latin hymn, O esca viatorum (1661), prays to the Lord under the forms of bread and wine,
                  O Bread of Life from heaven
                  O Food to pilgrims given. . . .            [LBW 222][36]
The hymn recognizes that even those who are not in immediate danger of death need the refreshing food of pilgrims to strengthen them on their way through this passing world to the land of the living.

Reservation of the Blessed Sacrament for communing the sick is a worthy and useful custom, with ancient lineage, that may well be restored more commonly in our churches. The presence of a tabernacle, sacrament house, or aumbry in a church, to those who have been taught its meaning and purpose, can serve as a useful reminder of the church's continuing concern for those who are prevented by illness or infirmity from gathering with the assembled congregation. Extending the congregational Eucharist to them through the reserved sacrament teaches that they too remain part of the congregation, part of the body of Christ.

Sickness isolates. It is the work of the Church to overcome that isolation in part by including the sick person in the communion of the community. One might well say that there is no such thing as "private communion," as common as that term has been in our history. Every communion, even a celebration at the bedside with no one but the pastor and the sick person present, is a sharing in the communion of the Church, a participation in the body of Christ. It is not a private and exclusively personal reception for the consolation of the sick person. It is always a celebration "before your whole Church on earth and the holy company of the redeemed," as the liturgy of the Syrian Jacobites declares. It is always, even when the preface is not used, "with the Church on earth and the hosts of heaven," that we offer thanks and praise to the "holy Father through Christ our Lord." The Holy Communion breaks the sick person out of isolation and self-absorption, reminds us all of the community of the Church, and renews our incorporation into the Body of Christ our Lord, the company of all faithful people both in this world and in the next.

These ideas are summed up gracefully in a post-communion prayer written for the Service Book and Hymnal and continued in the Lutheran Book of Worship (p. 48, no. 209) and in Occasional Services 1982 for the communion of the sick (pp. 79, 86) . "Almighty God, you provide the true bread from heaven, your Son Jesus Christ our Lord. Grant that we who have received the Sacrament of his body and blood may abide in him and he in us, that we may be filled with the power of his endless life, now and for ever."

The same understanding is expressed by John Chrysostom in his characteristic unrestrained style, with which we may conclude. "Therefore, in order that we may become his body, not in desire only, but also in very fact, let us become commingled with that Body. . . . It is for this reason that he has shared himself with us and has brought his body down to our level, namely, that we might be one with him as the body is joined to the head. . . . Christ has done this to spur us on to greater love. And to show the love he has for us he has made it possible for those who desire, not merely to look upon him, but even to touch and consume him, and to fix their teeth in his flesh and to be commingled with him; in short, to fulfill all their love. Let us, then, come back from that table like lions breathing out fire, thus becoming terrifying to the devil, and remaining mindful of our Head and of the love which he has shown for us."[37]

The purpose of the visitation, absolution, and communion of the sick, one might say, is so to strengthen those to whom we minister that they become lions breathing out fire to terrify the devil and to proclaim convincingly the eternal life in which they, together with the whole Church on earth and in heaven, now live. Such is the strength of the medicine of immortality.



[1] George Henry Gerberding, The Lutheran Pastor 2nd ed. (Philadelphia: Lutheran Publication Society, 1902), p. 416)

[2] Charles Bridges, The Christian Ministry with an Inquiry into the Causes of Its Inefficiency with Especial reference to the Ministry of the Establishment (New York and Boston, 1831 first American edition from the second London edition), p. 343. There was another American edition published in New York by Robert Carter in 1847. Bridges identifies the quotation about death as from "Bishop Hopkins."

[3] Gerberding, p. 417.

[4] H. A. Köstlin, Lehre von der Seelsorge (Berlin, 1895), p. 299.

[5] Gerberding, p. 418.

[6] George Bernanos, Diary of a Country Priest trans. Pamela Morris (New York: Carroll & Graf, 1983), p. 212. Originally published in English by Macmillan in 1937.

[7] Theodor Harnack, Pracktische Theologie vol. II (Erlangen, 1878), p. 530; quoted in Gerberding, pp. 418-419.

[8] Gerberding, p. 419.

[9] Gerberding, p. 419, quoting Bridges p. 384. Bridges also notes that "The strict law of the Scotch Kirk punished habitual negligence by deposition."

[10] Gerberding, p. 420.

[11] Köstlin, p. 301; quoted in Gerberding, p. 420 .

[12] Gerberding, pp. 421-422.

[13] Köstlin, p. 308; quoted in Gerberding, p. 422.

[14] Köstlin, p. 308; quoted in Gerberding, p. 422.

[15] John Walter Doberstein (1905-1965) is perhaps best known as editor of Minister's Prayer Book. Philadelphia: Muhlenberg, 1959; rev. ed. Philadelphia: Fortress, 1986.  

[16] A homily by John Chrysostom, From the Fathers to the Churches ed. Brother Kenneth CGA (London: Collins, 1983), p. 807; quoted in For All the Saints ed. Frederick J. Schumacher and Dorothy Zelenko vol. III (Delhi, NY: 1995), p. 1067.

[17] Revised to "And even you, most gentle death" in the Hymnal 1982  no. 400

[18] Philip H. Pfatteicher, Commentary on the Occasional Services (Philadelphia: Fortress, 1983), p. 59. See the whole section, pp. 57-138.

[19] Occasional Services. Minneapolis: Augsburg and Philadelphia: Board of Publication, Lutheran Church in America, 1982.

[20] Charles Harris, "Viaticum and Reservation," Liturgy and Worship (London: SPCK, 1964), p. 552.

[21] Harris, pp. 541-542.

[22] Harris, pp. 542-543.

[23] Common Service Book, p. 241; Service Book and Hymnal, p. 250.

[24] Edward Traill Horn, The Evangelical Pastor (Philadelphia: G. W. Frederick, 1887), p. 100; quoted in Gerberding, pp. 330-331.

[25] Gerberding, p. 331.

[26] Gerberding, pp. 331-332.

[27] Gerberding, p. 332.

[28] Harris, p. 576 n.2.

[29] Given in Philip H. Pfatteicher, New Book of Festivals and Commemorations. A Proposed Common Calendar of Saints (Minneapolis: Fortress, 2008), pp. 433-434.

[30] Harris, p. 577.

[31] Harris p. 576 gives as a reference, Herman Adalbert Daniel, Codex Liturgicus vol. IV, p. 444.

[32] Gerberding, p. 344.

[33] Ignatius of Antioch to the Philadelphians 4; see also Smyrnaeans 8.

[34] Justin Martyr, Apology I.65, 67.

[35] The term was intended to describe the anointing of the extremities—hands and feet (as well as the mouth and ears and eyes)—but it was misunderstood to refer to those who were in extremis, near death.

[36] LBW 222, ELW 480; Hymnal 1982 308/309. The hymn is not in LSB.

[37] Commentary on St. John  the Evangelist by John Chrysostom, From the Fathers to the Churches ed. Brother Kenneth CGA (London: Collins, 1983), pp. 342-343; quoted in For All the Saints III, pp. 169-170.

Society of the Holy Trinity

Copyright © 2008 Society of the Holy Trinity. All rights reserved.
Posted — 4 November 2008
Last revision — 15 December 2010

Home Page: