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The complexities of eucharistic sharing in homes for the aged: a study in pastoral ecumenism.

The question of eucharistic sharing has been described as "one of the most vexing pastoral questions facing the churches today." (1) Restrictive policies on sharing can be the cause of a great deal of spiritual pain for those who are present and long to receive but are not permitted to do so. At the same time, open policies on eucharistic sharing can cause similar levels of discomfort. When people are offered communion but recognize that they must refrain from receiving because of the policies of their own denomination, a great deal of unease can arise. A further consideration is that, if core elements of the liturgy are unfamiliar, uncertainty and even anxiety may arise. Given today's varying philosophies on eucharistic sharing and a desire to reduce such feelings of unease as much as possible, what is the best pastoral approach to eucharistic sharing in ecumenical settings?

Nursing homes and homes for the aged face unique pastoral challenges with respect to eucharistic sharing. People come together in nursing homes from a variety of denominations at a time in their lives when many turn more fervently to prayer. Some homes are administered by particular faith groups; yet, when a person's health or strength deteriorates, he or she will often be placed in whatever home has a vacancy, regardless of the person's denominational affiliation. Worshiping among those of other denominations is, therefore, much more frequent in such settings than it would be in parish communities. Characteristics commonly associated with aging, such as communication difficulties, limited mobility, and dementia add to the pastoral challenge.

This essay examines the practice of eucharistic sharing within the Canadian context, with particular focus on nursing-home settings. The seven most populous Christian denominations in Canada are: Roman Catholic (43.2%), United Church of Canada (9.6%), Anglican Church of Canada (6.9%), Baptist (2.5%), Lutheran (2.1%), and Orthodox (1.6%). (2)

The Decree on Ecumenism states: "We must become familiar with the outlook of the separated churches and communities." (3) Such familiarity is particularly vital in ecumenical communities such as nursing homes; it is possible to have very good intentions and yet to act with insensitivity unless the beliefs and practices of other denominations are taken into account. This essay, therefore, begins with a review of the eucharistic-sharing policies found in the above-named Christian denominations and examines the policies in light of some of the pastoral challenges one might find in a nursing-home environment. It then explores a related issue that is very common in nursing homes: communion to the sick, or the practice of taking communion to residents in their rooms when they are not strong enough to gather with the community.

Given that Roman Catholicism is the most populous Christian denomination in Canada, the question of communion to the sick will be examined from a Catholic perspective. That is, we will explore the conditions under which Catholics might be permitted to offer communion to non-Catholic Christians outside of the eucharistic assembly by first examining how each denomination handles the question of communion to the sick for its own members. For some denominations communion to the sick is a very important and expected ministry. For others the practice is unfamiliar or even theologically problematic, and it is vital that pastoral-care workers be sensitive to such concerns. This examination will yield insights about whether to offer communion and, if so, how to offer it in ways that respect the beliefs of the non-Catholic recipient. We will find that, by modifying pastoral practice to meet the needs of non-Catholic denominations, it will be possible to make the rites fuller and richer for Catholics as well.

This analysis of eucharistic practice in Canadian nursing homes will draw attention to the complexities that must currently be navigated as a result of our continuing divisions. Most homes do not have large pastoral-care departments, and such complexities add to the workload and make it more difficult to meet the needs of all residents. Several principles that might be useful for guiding pastoral practice in such ecumenical situations will be outlined, but, ultimately, there is only so much that can be done from a pastoral perspective, given our continuing divisions. It is vital that church leaders treat ecumenical progress as a top priority.

Eucharistic Sharing

Paul Meyendorff, an Orthodox theologian, has commented, "The eucharist, and therefore full communion, is possible only in a visibly united church. To celebrate the eucharist together and then to return to our former (and continuing!) divisions would, in the words of Paul, be a failure to 'discern the body' (1 Cor. 1 1:29)." (4) When we consider how much unity is required before we are able to celebrate together, the answer yields a spectrum of responses, with some denominations favoring closed communion, others favoring open communion, and some seeking a middle position of communion under certain circumstances. In this section we will consider those in each of these categories in turn.

Closed Communion

Of the denominations addressed in this essay, the Orthodox churches and some Lutheran churches practice closed communion. For the Orthodox, this was stated succinctly in the Agreed Statement of 1984 that resulted from AnglicanOrthodox dialogue:
 For the Orthodox, "communion" involves a mystical and sanctifying
 unity created by the body and blood of Christ, which makes them
 "one body and one blood ... with Christ," and therefore they can
 have no differences of faith. There can be "communion" only between
 local churches which have a unity of faith, ministry and
 sacraments. For this reason, the concept of "intercommunion" has no
 place in Orthodox ecclesiology. (5)


The Lutheran Church in Canada (LCC) similarly does not welcome other Christians to the eucharistic table and does not participate at the eucharist of other denominations: "Our synodical position with respect to Holy Communion is one of close(d) communion. We believe this to be in accord with Holy Scripture and consistent with the historical practice of the Christian church." (6) Furthermore,
 we reaffirm the practice of closed communion, that is, restricting
 access to the Sacrament of the Altar to those who with one voice
 "proclaim the Lord's death until He comes" (1 Cor. 11:26). No
 precedent exists in the tradition of orthodox teaching and practice
 for unrestricted access to the Sacrament, even for the baptized.
 Rather, those called to be "stewards of the mysteries of God" (1
 Cor. 4:1) are entrusted with the duty to catechize those who have
 not yet been instructed in the truly orthodox rule of faith in
 order that they may boldly confess their faith in the midst of a
 faithful congregation, and to exclude those not yet properly
 catechized, as well as the manifestly impenitent. (7)


Open Communion

Many Christian denominations practice open communion, welcoming all the baptized to their table. This is the position of the Anglican Church of Canada and of the Evangelical Lutheran Church in Canada, for example. The United Church of Canada goes even further, not even treating baptism as a requirement: "While we normally expect that those who receive communion are baptized persons, the invitation to the table in our congregations is open to 'all who confess Jesus Christ as Savior and Lord'. We acknowledge, thereby, that the saving grace of God is not limited to those who have been baptized." (8) Among Baptists, there is diversity of practice. Baptists cherish the principle of openness to the Spirit and, therefore, shun liturgical worship in favor of spontaneous prayers. Many Baptists downplay the importance of baptism and the Lord's Supper, gathering for the Lord's Supper not as a sacrament but as an ordinance or act of obedience, in response to Jesus' command, "Do this in remembrance of me" (1 Cor. 11:24-25; Lk. 22:19). Others are coming to reappropriate the sacramental strands found within the Christian scriptures. (9) The celebration of the Lord's Supper is usually open, with the invitation to the table extended "to all who are believers in Christ, though this is not universal practice." (10)

Partially Open Communion--The Roman Catholic Position

The Decree on Ecumenism, issued at Vatican II by the Catholic Church, indicated that sharing communion with non-Catholics involved balancing two principles: a desire to share the means of grace, and a desire to safeguard the principle that communion implied union. The Catholic Church, therefore, adopts a position of partial communion, seeking to balance these two key principles: Eucharist reflects and fosters unity, and eucharist is a means of grace. "The expression of unity generally forbids common worship. Grace to be obtained sometimes commends it." (11)

Like the Orthodox and LCC churches, the Catholic Church believes that unity of faith and ecclesiastical governance must precede eucharistic celebration in common. In explaining this resistance to eucharistic sharing, Pope John Paul II wrote:
 Precisely because the Church's unity, which the Eucharist brings
 about through the Lord's sacrifice and by communion in his body and
 blood, absolutely requires full communion in the bonds of the
 profession of faith, the sacraments and ecclesiastical governance,
 it is not possible to celebrate together the same Eucharistic
 liturgy until those bonds are fully re-established. Any such
 concelebration would not be a valid means, and might well prove
 instead to be an obstacle, to the attainment of full communion, by
 weakening the sense of how far we remain from this goal and by
 introducing or exacerbating ambiguities with regard to one or
 another truth of faith. (12)


However, administration of communion to individual Christians who are not in full communion with the Catholic Church under certain conditions and in particular circumstances is not only possible but, in the words of John Paul II, is also a "source of joy." (13)

There has been considerable evolution since Vatican II on the conditions for the administration of these sacraments in particular cases. (14) The Ecumenical Directory, issued by the Secretariat for the Promotion of Unity in 1967, permitted non-Catholics to receive communion if they were in danger of death or in other cases of urgent necessity (such as persecutions), provided that certain other conditions were met. (15) In 1972, the requirement for "urgent necessity" was expanded to include not only suffering and danger but also "grave spiritual necessity." (16) In 1983, the Code of Canon Law relaxed the requirement that a person not have recourse to her or his own minister, omitting "for a prolonged period." (17) In 1993, the Directory for the Application of Principles and Norms on Ecumenism went one step further, acknowledging that, since non-Catholics married to Catholics are in a unique situation, diocesan bishops had the freedom to permit the non-Catholic spouse to receive eucharistic communion in exceptional cases. (18)

The current conditions under which a non-Catholic may receive communion from a Catholic minister are: (1) to be in danger of death or, in the judgment of the diocesan bishop or conference of bishops, some other grave necessity; (2) unable to approach a minister of their own community; (3) to ask for the sacrament of their own accord; and (4) to manifest Catholic faith in the sacrament and be properly disposed. (19) The Directory went on to say that "it is strongly recommended that the diocesan Bishop, taking into account any norms which have been established for this matter by the Episcopal Conference ..., establish general norms for judging situations of grave and pressing need and for verifying the conditions mentioned below (n. 131)." (20) Such norms may give special consideration in exceptional cases to non-Catholic spouses in mixed marriages. (21)

John Paul II, in his 1995 encyclical Ut Unum Sint, commented with enthusiasm:
 It is a source of joy to note that Catholic ministers are able, in
 certain particular cases, to administer the sacraments of the
 Eucharist, Penance and Anointing of the Sick to Christians who are
 not in full communion with the Catholic Church but who greatly
 desire to receive the sacraments, freely request them and manifest
 the faith which the Catholic Church professes with regard to these
 sacraments. (22)


The various conditions are open to interpretation, so diocesan policies are needed. In 1999, the Canadian Conference of Catholic Bishops approved a policy drawn up by the Episcopal Commission on Ecumenism, the "Policy on Cases of Serious Need in which the Sacraments of Penance, Eucharist, and Anointing of the Sick May Be Administered to Anglicans and Baptised Protestant Christians." This. policy was sent to all diocesan bishops to be promulgated by them if they so desired. (23) It was intended as a means to eliminate confusion and to foster uniformity of practice. (24) Diocesan policies are particularly important when defining the conditions: "grave need" and "manifest Catholic faith in the sacrament."

Canon 844 [section]4 states that the sacraments may be given to members of ecclesial communities only in danger of death or if another grave need would urge it. A "grave need" may include a spiritual need. In the policies currently in effect in the Dioceses of Calgary and Saskatoon, the following philosophy is at work: "Although canon law requires a 'grave need' for another Christian to receive reconciliation, Eucharist or anointing of the sick, this 'grave need' must be broadly interpreted in keeping with the standard canonical principle, 'favors are to be multiplied, burdens are to be restricted.'" (25)

The pastoral notes for the Saskatoon policy therefore indicate: "It is sufficient if they have some awareness that to receive a sacrament they must be in spiritual need that includes both personal and communal nature of the sacraments. Then asking for the sacrament directly or by approaching to receive the sacrament indicates real spiritual need." (26)

Similarly, the requirement that non-Catholics "manifest Catholic faith in the sacrament" is subject to interpretation, de Bhaldraithe argues that, given the numerous agreed statements on the eucharist with all the major churches and the convergence that the liturgical movement has generated, one can presume Catholic faith, unless the person indicates their disagreement. (27) The Calgary policy specified the following faith requirements: "[T]he believer should acknowledge that the sacrament is the body and blood of Christ given under the form of bread and wine. The believing Christian manifests faith in the Eucharist by responding 'Amen' to the minister who presents the sacred bread and saving cup." (28)

The proposed Canadian policy articulated a number of examples of grave need. For our purposes, the following are relevant:
 In institutions where they stay day and night and do not have
 regular access to their own minister, including prisons, hospitals,
 nursing homes, orphanages, and boarding schools.

 An Anglican or Protestant party in a mixed marriage who has a
 serious spiritual need for the Eucharist may receive Communion on
 special occasions, such as principal anniversaries, funerals of
 family members, on Christmas and Easter if the family attends Mass
 together, and other occasions of ecclesial or familial
 significance. (29)


The Calgary policy indicates that it is ultimately up to the non-Catholic spouse to select the occasions of ecclesial or familial significance when they have a strong spiritual need for the eucharist. (30) The Saskatoon policy includes several examples when a spouse may request the eucharist, including "times of serious illness and/or approaching death," a situation commonly encountered in nursing-home settings. (31) It must be a special occasion; the policy is not intended to allow the non-Catholic spouse to participate in routine reception of communion every Sunday.

Roman Catholics are not permitted to receive communion at Anglican or Protestant eucharistic celebrations, because the Roman Catholic Church does not recognize the sacraments to be valid in those denominations. (32)

Pastoral Considerations in Nursing Home Settings

Given the above policies, there are several implications for nursing-home worship. Other Christians ought not to expect Orthodox, LCC, or Roman Catholic residents to want to receive communion from others, because those denominations restrict their members from doing so. While Baptists welcome other believers to their table, they would have serious reservations about receiving at the eucharistic celebrations of other denominations, especially more liturgical denominations, because of their differing beliefs about the Lord's Supper as an ordinance, not a sacrament. Presiders at Anglican, ELCIC, or United Church services risk creating unease in ecumenical settings by inviting all the baptized or all believers to receive when some of those present are not permitted to receive according to the teachings of their own church. (33) All these considerations need to be treated with care.

At a Roman Catholic Mass

Given the above interpretation of grave need and manifesting Catholic faith, it is quite possible that non-Catholic Christians in a nursing home may be eligible to receive communion at mass when they have a serious spiritual need to do so. Given the stress of being in an institution and the fact that many suffer from ill health, it is quite conceivable that some will at times have a strong desire for the consolation, strengthening, and spiritual nourishment that comes from reception of communion.

When eucharist is celebrated in the institution, those non-Catholics who have a grave need, who ask for the sacrament on their own, who do not have access to their own minister, who are baptized and properly disposed, and who manifest Catholic faith in the sacrament may receive communion. Even if his or her own minister visits on occasion, the non-Catholic resident may have a serious need to receive more immediately. Moreover, non-Catholic spouses of Catholic residents may also receive communion on occasions of familial or ecclesial significance, subject to diocesan policy.

This policy sounds rather straightforward until one considers that many of the elderly suffer from dementia, communications difficulties, or mobility impairments. Let us consider the requirement that those who wish to receive ask of their own accord. The principle behind this requirement is to prevent cases where somebody requests the sacrament because of pressure from others or because it is offered to them and they do not wish to appear ungrateful by declining. Extending an invitation to non-Catholics is forbidden because it may be seen as proselytism. They can be informed at some other time of the possibility of receiving but ought not to be explicitly invited during the mass.

Discerning a resident's desire to receive or not receive is not always straightforward. In parish settings where individuals express their desire to receive by walking forward in the communion procession, there is no need to try to guess a person's wishes. In many nursing homes, however, the majority of those in attendance at mass are in wheelchairs or using walkers. To facilitate distribution of communion, communion is brought to the residents. Moreover, some residents dose off and need to be awakened at this time. Others become confused and need to be reminded. It is not uncommon to hear an extraordinary minister of communion remind somebody: "Wake up. It's communion time. Do you wish to receive communion? Body of Christ! Open your mouth if you wish to receive. Body of Christ! Corpus Christi! Do you want to receive? Open up! Good! Amen." It can be incredibly satisfying when one elicits a spark of recognition, and the person eagerly opens his or her mouth to receive. While such persistence may be very appropriate with Catholic residents, it may create undue pressure on non-Catholics who may at heart have no real desire to receive. This situation is further complicated by the fact that the minister of communion may not know who are Catholics and who are not. (34)

This raises questions of freedom of choice. It is difficult to devise a system whereby residents ask for the sacrament of their own accord. Even if a system were adopted whereby all those who wished to receive were asked to raise their hand, there are some residents who will not have the ability to raise their hand and others who will not be awake to do so. Many indicate their wish to receive merely by opening their mouth when the communion minister presents them with the consecrated host. One could perhaps say that this is how residents manifest Catholic faith in the sacrament. Those who do not wish to receive would normally shake their head or simply refuse to open their mouths.

Saying "no thank you" or refusing to open one's mouth when presented with the Body of Christ may leave non-Catholic Christians feeling very unsettled. They may wonder: "Did I just say 'No' to Jesus?" To avoid such qualms, wherever possible, it would be prudent for pastoral-care volunteers and staff to try to become aware of those who usually do wish to receive and those who do not usually wish to receive, but this is difficult in large communities and in situations where many volunteer communion ministers assist on a rotating basis. Such communities yearn for the day when we will share not only the permission to receive at one another's table but also the burning desire to do so.

The Presence of a Non-Catholic Minister at a Catholic Mass

It is also important to make note of one other condition that must be satisfied in order for non-Catholic residents to receive. They may receive if they do not have access to their own minister. Clergy of various denominations often collaborate in ministry, so it is not uncommon for a non-Catholic ordained minister to visit the nursing home and to offer to attend the Catholic eucharist, possibly reading a scripture passage. (35) However, his or her presence would effectively mean that members of that congregation would no longer be allowed to receive communion at mass, regardless of their spiritual need, because it would no longer be true that they did not have access to their own minister. This is a very sad and ironic consequence of the non-Catholic minister's desire to foster better ecumenical relations by praying together with the Catholic community at its mass. Perhaps for the same reasons that a noneucharistic liturgy is recommended for the marriage of a non-Catholic and a Catholic, nonsacramental worship may be preferable in cases where there is a desire to worship together. (36)

Communion to the Sick

In Roman Catholic nursing homes, it may be common for volunteers or staff to distribute communion regularly to those who are bedridden or who lack the strength to attend mass. This may occur one-on-one, with the communion minister meeting individually with each resident, or it may occur in groups. For example, during a quarantine situation a significant number of residents may be unable to go to the chapel, and so a lay minister may offer communion to the sick to all those in a common area who wish to receive. (37) In this section we will explore whether it is appropriate for communion to the sick to be offered to non-Catholics and, if yes, under what circumstances.

Communion to the sick or any communion given outside the context of a eucharistic gathering may be a problematic concept for some non-Catholics. It is important not to assume that all those who sometimes receive during mass will also wish to receive on days when communion is brought to their rooms. A significant point of divergence concerns belief in the duration of the Real Presence in the eucharist. This point of divergence was noted in the 1982 Lima document, Baptism, Eucharist, and Ministry: "Some churches stress that Christ's presence in the consecrated elements continues after the celebration. Others place the main emphasis on the act of celebration itself and on the consumption of the elements in the act of communion." (38)

The concerns associated with communion to the sick vary across denominations, so the theology and practice of each denomination will be examined separately. The Orthodox churches will be excluded because of their practice of closed communion. We will however look at LCC concerns because they form part of the spectrum within Lutheranism. After examining the concerns and beliefs of each denomination, we will be in a better position to evaluate the appropriateness in each case of inviting non-Catholics to participate in communion to the sick.

Anglican

The Book of Alternative Services, the official ritual book of the Anglican Church of Canada, includes a rite for "Communion under Special Circumstances." This may be used for ministry to the sick, or for those whose work schedules or other limitations prevent them from being present at a public celebration of the eucharist. The preference is that members of the community bring the consecrated elements to the person immediately upon completion of the Sunday celebration, so that the continuity between communion and community celebration is made clear. If this is not possible, communion may be brought from a weekday celebration or from the reserved sacrament. (39) The ritual format includes an opening greeting, a passage of scripture with an optional reflection based on the scripture, optional prayers, an optional confession of sin, an optional sign of peace, the Lord's Prayer, the invitation to communion, the giving of the sacrament under both species, a concluding doxology, and a blessing. This rite may be led by a priest, a deacon, or a layperson. (40)

If the person's absence from the eucharistic assembly is expected to continue for an extended period of time, it is encouraged that eucharist be occasionally celebrated in their presence with the participation of members of their family, the parish community, and friends, if possible.

United Church of Canada

The UCC worship book, Celebrate God's Presence, includes a rite for Communion in the Home, "a brief order for extending the table of the worshipping community into situations of pastoral need. The order provided ... may be used in the home, the hospital, or other institutional settings." (41) Communion is taken directly from the congregation's table to shut-ins. The rite may be led by elders or by lay persons. To further reinforce the connection between this rite and the congregation's celebration, one of the scripture readings for that day's service may be used. Given that many United Church congregations celebrate the Lord's Supper only quarterly, it is relatively rare for this rite to be used.

Lutheran

In Lutheranism, the traditional practice has been to consecrate the elements in the presence of the recipient, whether in a private home, a hospital, or a nursing home. Pastors have usually been the ones to visit the sick, so they normally celebrate an abbreviated eucharist in the person's presence. In recent years, this practice has been changing. Roland Ziegler, a Lutheran Church-Missouri Synod (LC-MS) minister, laments what he sees as a growing practice of having lay ministers take consecrated hosts to nursing homes or shutins. He argues based on Lutheran tradition and the pattern given by the Lord's Supper itself. His concerns include: the linkage between the Words of Institution and the reception of communion, the continuity between the community that is present during the Words of Institution and the community that is present at the reception of communion, and infringement on the rightful role of the pastor. (42) Ziegler appeals that the LC-MS strives to return to the practice of having the pastor consecrate the elements in the presence of the sick person. (43)

The Evangelical Lutheran Church in Canada (ELCIC) practices communion to the sick, provided that it is seen as an extension of the Sunday worship. The Occasional Services book contains a rite for "Distribution of Communion to those in Special Circumstances." Designated lay or ordained ministers are sent forth from the eucharistic gathering with consecrated bread and wine. (44) While some parishes do reserve some of the consecrated hosts for distribution to the sick during the week, this is a rare practice and one that is not encouraged. (45) Luther was not specific when it came to the duration of Christ's presence in the consecrated bread and wine, and many Lutherans continue to believe that Christ is present in the bread and wine only while the community is gathered. Hermann Sasse summarized the situation as follows:
 Luther and the early Lutheran Church avoided forming any theory
 about the "moment" when the Real Presence begins and the "moment"
 when it ceases. Some later orthodox theologians advanced the theory
 that Christ's body and blood are present only at the "moment" when
 they are being received. This is frequently regarded, within and
 without the Lutheran Church, as the genuinely Lutheran doctrine.
 Actually this view is only another attempt to determine a time that
 only "He knows who knows all things." As far as Luther himself is
 concerned, there cannot be the slightest doubt that he never did
 limit the Real Presence to the instant of distribution and
 reception. He never abandoned the view that by the words of
 consecration bread and wine "become" the body and blood of Christ.
 (46)


There continues to be a spectrum of belief among Lutheran congregations on the topic of the duration of the Real Presence. (47)

Baptist

Given that the Lord's Supper is usually considered an ordinance and not a sacrament, no strengthening effect is acknowledged. Therefore, there would effectively be no reason to share communion with the sick or shut-ins. They would be presumed to be excused from this ordinance.

Other

While only 0.39% of Canadians currently identify themselves as members of Reformed Churches, (48) it remains instructive to examine the concerns raised by John Calvin. Calvin favored the practice of communion to the sick on rare occasions, provided that it was truly a communion, with bread broken in a community of believers. He was adamant that it not be seen as a private communion, observing: "I regard it as desirable that it be observed only in the circle of believers and not without preaching the Word of God, exactly as it is observed publicly." (49) Moreover, he stressed that the real situation of the sick person be considered, for it was important not to encourage a superstitious outlook: "The Lord's Supper serves for the strengthening of faith, as a pledge that is received from the hand of Christ, which assures us of this that we belong to His body and are nourished by His flesh and blood unto the hope of eternal life." (50)

For churches in the Reformed tradition, the question is, therefore, not whether to separate distribution of communion from the eucharistic gathering; this would never happen. The question is whether to hold a eucharistic gathering, with ministers and elders, with the participation of a small group of people. Given the strong connection in Reformed theology between eucharist and community, some believe that it is inappropriate to hold a eucharistic gathering outside of the Sunday assembly. Communion of the sick never became the custom in Reformed Churches deriving from Zurich, Geneva, France, or the Netherlands, but it did become common practice in the Reformed Churches of Pfaltz, Strasbourg, Basel, Hungary, Poland, Scotland, and elsewhere. (51)

Pastoral Summary of Communion to the Sick

Given the diversity of practices and beliefs, it seems preferable always to seek the cooperation of the minister of the person's denomination. For example, if a Lutheran pastor is called to offer communion to a Lutheran resident, he or she will be able to plan the visit in a way that respects that tradition. The prayers will be familiar to the person, and this familiarity is important, given the very nature of worship. "Communities find and express their own identity--ecclesial, theological, as well as cultural--primarily through worship. We all feel comfortable and at home within our own traditions, and we all feel some discomfort in stretching our horizons, be they ecclesial, theological, or cultural." (52)

However, if the non-Catholic minister is not available and if a non-Catholic resident who meets the conditions for eucharistic sharing expresses a desire to receive communion, the above survey of practices offers a number of principles that ideally should be taken into account. The following guiding principles would be beneficial:

1. Communion should be distributed directly after mass, so that communion to the sick is seen as an extension of the community's worship. (53)

2. Communion to the sick should always include a scripture reading. This is consistent with recommended Catholic practice but is sometimes omitted due to time constraints. For many non-Catholics the unity of word and sacrament is so strong that it would be unthinkable to receive communion without first listening to the Word of God. For some, preaching would also be expected.

3. Some denominations place a strong value on reception of communion under both species. The Roman Catholic ritual also anticipates that communion will be distributed under both species, but this seems to be rare in actual practice in nursing homes, perhaps given the effort involved. (54)

4. Reception of communion on Sundays is far more common than on weekdays, preserving the Lord's Day as the Day of the Lord. It would be preferable to have communion to the sick scheduled for Sundays.

5. Communion to the sick ideally involves a community of believers. If a non-Catholic desires to receive communion, rather than keeping it a relatively private event with just the communion minister and the sick person, it would be preferable to invite others to be present. This may include other members of that person's family or members of their congregation.

In all cases, being more attentive to the needs of non-Catholics during communion of the sick (use of scripture, the presence of a community, communion on the Lord's Day, communion directly proceeding from the Sunday eucharistic gathering, and a preference, wherever possible, for the eucharist to be celebrated in the presence of the one who is ill) fosters practices that Catholics would also consider good pastoral practice.

Particular care is warranted when communion to the sick is offered in a communal setting. Some may receive communion at mass but may not be comfortable with the idea of communion from the tabernacle. (55) It is important not to put people in a situation where they feel they must say "no, thanks" when offered the Body of Christ. If possible, it would be good to ascertain in advance which non-Catholics in a communal setting wish to receive communion.

Conclusion

We are called to be one. Sadly, we have not yet reached this goal, and divisions remain--divisions that limit our ability to share communion openly without attention to many conditions and considerations. Some ask, "What would Jesus do?" assuming that Jesus would not be so restrictive about welcoming others to the table, but as One Bread, One Body articulated, "unity in Christ is unity both in truth and in love." (56) Moreover, "common worship must be honest." (57) Nursing-home residents deserve worship opportunities that are honest and respectful of church teaching. (58)

This essay has noted many diverse approaches and philosophies concerning eucharistic sharing and communion to the sick, including a number of pastoral recommendations, which may maximize the spiritual care possible, given our current divisions. Each denomination must avoid imposing its way of thinking on others and must seek to understand the beliefs and practices of others. Attentive preparation and respect are key ingredients for effective pastoral practice, and good pastoral care is a central component of the quality of life of residents. However, there are limits on how far pastoral solutions will take us.

Theologians and church leaders must take note of the very difficult pastoral reality that exists in light of our continued lack of agreement on eucharistic theology and practice, particularly in ecumenical institutional settings. We have made tremendous progress in the past forty years--we have seen growing interconfessional agreement about eucharistic prayers, fueled by the ecumenical movement, the liturgical movement, and biblical scholarship. (59) While there is reason to rejoice in the progress made to date, the sad reality is that divisions still remain. All churches must strive ever more diligently to find ways to achieve Jesus' vision--that we may all be one. (Jn. 17:21).

(1) Gilbert Ostdick, "Who's Invited?" Word & Worm 17 (Winter, 1997): 67.

(2) These figures refer to the percentage of the overall population who describe themselves as belonging to a given group. While 74% of Canadians report affiliation with a Christian denomination; 17% report no religious affiliation, and the balance belong to non-Christian faiths. Source: Statistics Canada, "Religion (95) and Sex (3) for Population, for Canada, Provinces, Territories, Census Metropolitan Areas 1 and Census Agglomerations, 2001 Census--20% Sample Data," available at: http://www12.statcan.ca/english/census01/home/index.cfm.

(3) Catholic Church--Second Vatican Council, "Decree on Ecumenism" [Unitatis redintegratio (November 21, 1964)], in Austin Flannery, ed., Vatican Council II: The Basic Sixteen Documents (Northport, NY: Costello Publishing, 1996), [paragraph]9.

(4) Paul Meyendorff, "Christian Perspectives on Worship," in Thomas F. Best and Dagmar Heller, eds., Worship Today." Understanding, Practice, Ecumenical Implications, Faith and Order Paper 194 (Geneva: WCC Publications, 2004), p. 291.

(5) Agreed Statement, "Anglican-Orthodox Dialogue, 1976-84, Dublin, Ireland," [paragraph]20 in Jeffrey Gros, Harding Meyer, and William G. Rusch, eds., Growth in Agreement II: Reports and Agreed Statements of Ecumenical Conversations on a Worm Level, 1982-1998 (Geneva: WCC Publications, 2000), pp. 87-88.

(6) Lutheran Church-Canada, "Guidelines for Congregational and Pastoral Practice," April 2001, available at http://www.lutheranchurch.ca/resources/guidelinesCAPP.pdf. The LCC was established in 1988 by the merger of the Canadian congregations founded by the Lutheran Church-Missouri Synod. The LCC does not welcome even members of the Evangelical Lutheran Church in Canada (ELCIC) to its table. At the LCC's 2002 synod, an invitation from the ELCIC to adopt a policy of interim eucharistic sharing was rejected. The ELCIC had entered into full communion with the Anglican Church of Canada (ACC) in 2001. Since the LCC did not consider the doctrine and practices of the ACC to be in accord with the Lutheran confessions and considered that "unity of faith in the Gospel ... is a precondition for Eucharistic sharing," the invitation to interim eucharistic sharing was declined. See Resolution 2.01.03, Lutheran Church-Canada, "2002 Synodical Convention Resolutions," June, 2002, available at http://www.lutheranchurch-canada.ca/synod2002/rescoml.pdf.

(7) Lutheran Church-Canada, "Closed Communion in Contemporary Context," 1999, available at http://www.lutheranchurch.ca/CTCR/closecom.html (in the summary statement).

(8) "United Church of Canada," in Max Thurian, ed., Churches Respond to BEM: Official Responses to the "Baptism, Eucharist, and Ministry" Text, vol. 2 (Geneva: World Council of Churches, 1986), p. 280.

(9) Barry D. Morrison, "Tradition and Traditionalism in Baptist Life and Thought: The Case of the Lord's Supper," in David T. Priestley, ed., Memory and Hope: Strands of Canadian Baptist History, Editions SR (Waterloo, ON: Wilfred Laurier Press, 1996), 19:39-51. Morrison highlights in this article the diversity of Baptist views with respect to the Canadian Baptist response to BEM. See also Arthur B. Crabtree, "The Eucharist in Baptist Life and Thought," in Leonard Swidler, ed., The Eucharist in Ecumenical Dialogue (New York: Paulist Press, 1976), pp. 106-113.

(10) "American Baptist Churches in the USA," in Thurian, Churches Respond to BEM." Official Responses to the "Baptism, Eucharist, and Ministry" Text, vol. 3 (Geneva: World Council of Churches, 1987), p. 261.

(11) Decree on Ecumenism, [paragraph]8.

(12) John Paul II, The Church and the Eucharist [Ecclesia de Eucharistia] (Sherbrooke, QC: Mediaspaul, 2003), pp. 44--45, [paragraph]44.

(13) John Paul II, "Ut Unum Sint: On Commitment to Ecumenism," 1995, available at http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/ hf_jp-ii_enc_25051995_ut-unum-sint_en.html. Gerard Austin commented on the increasingly common practice of U.S. priests' announcing at weddings and funerals: "Only Roman Catholics can come to communion." He pointed out that such statements are blunt and unnuanced. Numerous exceptions are indeed possible. See Gerard Austin, "Identity of a Eucharistic Church in an Ecumenical Age," Worship 72 (January, 1998): 2635; see especially p. 26.

(14) In this section the analysis is limited to sharing with non-Catholic Christians in Western churches. More open sharing of communion is permitted with those in the Eastern churches, but this is usually moot, because the Orthodox churches, as mentioned above, have a closed communion.

(15) Secretariat for Christian Unity, Directoire Pour L'oecumenisme [Ad totam ecclesiam] (Montreal: Fides, 1969), [paragraph]55.

(16) Secretariat for the Promotion of Christian Unity, "Instruction on Admitting Other Christians to Eucharistic Communion," Acta Apostolicae Sedes, vol. 55 (1973), pp. 616--619.

(17) John P. Beal, James A. Coriden, and Thomas J. Green, eds., New Commentary on the Code of Canon Law: Study Edition (New York and Mahwah, NJ: Paulist Press, 2000), pp. 1024-1027, Canon 844.

(18) Pontifical Council for Promoting Christian Unity, Directory for the Application of Principles and Norms on Ecumenism (Liberia Editrice Vaticana, and Washington, DC: United States Catholic Conference, 1993), [paragraph]159-160, 129-131 (hereafter, PCPCU Directory); R. Kevin Seasoltz, "One House, Many Dwellings: Open and Closed Communion," Worship 79 (September, 2005): 413-414.

(19) Code of Canon Law, pp. 1024-1027, Canon 844[section]4; PCPCU Directory, [paragraph]129-131.

(20) Ibid., [paragraph]130.

(21) Ibid., [paragraph]160-161. The recognition that spouses may warrant special treatment may flow from an appeal by Cardinal Willebrands at the 1980 Synod of Bishops on the Family. He stressed that a valid marriage between baptized persons is a true sacrament that gives rise to a domestic church. Each domestic church is a spiritual community that needs the spiritual nourishment that is the eucharist. He appealed that the question of admitting the non-Catholic partner in a mixed marriage be revisited. See Johannes Willebrands, "Mixed Marriages and Their Family Life: Cardinal Willebrands's Address to the Synod of Bishops, October, 1980," One in Christ, vol. 17, no. 1 (1981), pp. 78-81; Myriam Wijlens, Sharing the Eucharist: A Theological Evaluation of the Post-Concciliar Legislation (Lanham, MD: University Press of America, 2000), pp. 346-354; Seasoltz, "One House, Many Dwellings," pp. 414-415.

(22) John Paul II, "Ut Unum Sint: On Commitment to Ecumenism.," [paragraph]46. These words are repeated verbatim in John Paul II, "Ecclesia de Eucharistia," 46, [paragraph]46. It is intriguing that this encyclical omits entirely the requirement concerning access to one's own minister. Some have concluded that the applicable legislation governing eucharistic sharing has, thereby, been broadened so that access to one's own minister is no longer a relevant condition. It is also noteworthy that neither encyclical mentions the approval of the diocesan bishop, although his approval might be presumed.

Kevin Seasoltz goes so far as to say: "It should be clear now that there are only three basic conditions for non-Catholics to receive the eucharist, penance and anointing of the sick in the Roman Catholic Church: they must greatly desire to receive these sacraments, freely request them, and manifest a faith which the Catholic Church professes with regard to these sacraments" (Seasoltz, "One House, Many Dwellings," p. 415). Also see Eoin de Bhaldraithe, "Intercommunion," The Heythrop Journal 43 (January, 2002): 78. However, an encyclical cannot change canon law. If John Paul II had really wanted to change the legislation, he would have issued a legislative order.

(23) John M. Huels, "A Policy on Canon 844 [section]4 for Canadian Dioceses," Studia Canonica, vol. 34 (2000), p. 91. Policies based on the CCCB policy have been promulgated in the Dioceses of Calgary and Saskatoon. It is unknown the extent to which other dioceses have policies in place.

(24) Similarly, in 1998, the Bishops' Conferences of England & Wales, Ireland, and Scotland jointly issued a teaching document on this subject, One Bread, One Body, available at http://www.catholiccommunications.ie/pastlet/onebread.pdf.

(25) See Diocese of Saskatoon, "Sacramental Sharing: Pastoral Directives for Sacramental Sharing in Particular Circumstances between Catholics and Baptized Christians of Other Denominations," January, 2005, available at http://www.saskatoonrcdiocese.com/documents/Pastoral%20 Notes% 20on%20Sacramental%20Sharing.pdf; Diocese of Calgary, "Policy on Cases of Serious Need in which the Sacraments of Penance, Eucharist, and Anointing of the Sick May Be Shared with Anglican, Lutheran, and Protestant Christians," December 23, 1999, available at http://www.rcdiocesecalgary.ab.ca/PDF/sacramental-policy.pdf; note that throughout this text, the phrase "grave need" and not "grave and pressing need" is used. "Grave and pressing need" appeared in the E.T. of the Directory on the Application and Norms of Ecumenism, but John Huels has argued that this is a mistranslation of the Latin and that the Latin text takes priority (see Huels, "A Policy on Canon 844 [section]4," pp. 96-98.

(26) Diocese of Saskatoon, "Sacramental Sharing Policy."

(27) de Bhaldraithe, "Intercommunion," p. 78.

(28) Diocese of Calgary, "Policy"; see also Diocese of Saskatoon, "Sacramental Sharing Brochure," January 2005, [paragraph] 11, available at http://www.saskatoonrcdiocese.com/pages/documents/ Sacramental%20Sharing%20Brochure%20back.pdf and at http://www.saskatoonrcdiocese.com/pages/ documents/Sacramemtal%20Sharing%20Brochure%20front.pdf. Cardinal Kasper has noted a similar significance to one's "Amen": "One must be able to say this 'Amen' with an honest heart and in union with all the assembled community, both at the end of the eucharistic prayer and when one receives communion, and one must bear witness with one's life to this 'Amen.'" See Walter Kasper, Sacrament of Unity: The Eucharist and the Church (New York: Crossroad Publishing Co., 2004), pp. 71-72, cited in Seasoltz, "One House, Many Dwellings," p. 416.

(29) Huels, "A Policy on Canon 844 [section]4,'" p. 94. The policy for spouses reflects the fact that one may have a serious spiritual need for the sacrament, and, while one may be able to approach his or her own minister at some other time, one may not be able to do so during this special family occasion.

(30) Diocese of Calgary, "Policy"; see also John M. Huels, "Sacramental Sharing in Mixed Marriages: The Policy for Canadian Dioceses," Celebrate! 39 (July-August, 2000): 25. A spouse's viaticum would presumably be an occasion of both ecclesial and familial significance.

(31) Diocese of Saskatoon, "Sacramental Sharing Brochure," [paragraph] 18.

(32) Canon 844 [section]2.

(33) For example, if the minister says, "We welcome all believers in the Lord Jesus Christ to join us at the table," those of other denominations may fear that they will appear to be denying their belief in Christ by not coming forward.

(34) Some residents attend mass as a form of recreation or entertainment, especially if there is music present or if the homilist is known to be particularly witty. There may be a desire to listen to scripture and to pray together, but these residents may not have any real desire to receive communion.

(35) Non-Catholics may read scripture at mass "on an exceptional basis and for a just cause" only with the approval of the diocesan bishop. See PCPCU Directory, p. 69; [paragraph]133.

(36) Ibid., p. 76; [paragraph]159. In exceptional circumstances, such as when there is a desire for a mass to commemorate a major anniversary of the nursing home, the diocesan bishop should be consulted to see if one-time exceptions can be made that would allow the participation of non-Catholic clergy without confusing those non-Catholic residents who might wish to receive communion.

(37) Catholic Church, Pastoral Care of the Sick: Rites of Anointing and Viaticum (Ottawa: Canadian Conference of Catholic Bishops, 1983), pp. 50-71.

(38) Baptism, Eucharist, and Ministry, Faith and Order Paper No. 111 (Geneva: World Council of Churches, 1982), p. 16, [paragraph]32. Among Catholics, too, priority is given to participation in the eucharistic action; hence, Catholic residents would likely prefer to be present at mass rather than receive communion in a setting separate from the worshiping community, whenever this is possible.

(39) The acceptance of the idea of communion taken from the reserved sacrament reflects a shift in theology in the past thirty-five years. As recently as 1972, there was considerable debate in the Church of England about whether it was proper to take communion from the reserved sacrament, or whether it was preferable always to send a priest to consecrate the elements or to ensure that extended administration was possible by mandating laypersons to take communion to the sick directly from the community's worship. There may still be some individuals in the Anglican communion who have lingering doubts about Christ's enduring presence in the consecrated elements. For a collection of articles on this topic, see Colin O. Buchanan, ed., Reservation and Communion of the Sick (Bramcote, UK.: Grove Books, 1972).

(40) Anglican Church of Canada, The Book of Alternative Services of the Anglican Church of Canada (Toronto: Anglican Book Centre, 1985), pp. 256-260. The Book of Common Prayer of the Episcopal Church is more explicit in stating a preference for communion under both species while allowing that one is sufficient: "If the sick person cannot receive either the consecrated Bread or the Wine, it is suitable to administer the sacrament in one kind only" (The Episcopal Church, The Book of Common Prayer and Administration of the Sacraments and Other Rites and Ceremonies of the Church [New York: Church Hymnal Corp., 1977], p. 457).

(41) United Church of Canada, Celebrate God's Presence: A Book of Services for the United Church of Canada (Etobicoke, ON: United Church Publishing House, 2000), p. 240.

(42) The person may wish an opportunity for private confession, but that would not be possible with a lay minister. The pastor may also need to be attentive to the question of admission to the Lord's Supper: "The question of admission to the Lord's Supper is too often seen only as a question of church membership, instead of a question of spiritual care if communion is beneficial for this person at that specific time" (Roland F. Ziegler, "Should Lutherans Reserve the Consecrated Elements for the Communion of the Sick?" Concordia Theological Quarterly 67 [April, 2003]: 147).

(43) Ibid., pp. 131-147.

(44) See the Order for "Distribution of Communion to Those in Special Circumstances," in Lutheran Church in America, Occasional Services: A Companion to Lutheran Book of Worship (Minneapolis, MN: Augsburg Fortress Press, 1983), pp. 76-87. This practice is also supported and reported in Evangelical Lutheran Church in America, "The Use and Means of Grace: A Statement on the Practice of Word and Sacrament" (hereafter, UMG), August 19, 1997, Application 48A, available at http://www.elca.org/dcm/worship/worship/sacraments/umg.html.

(45) Maxwell E. Johnson, "Eucharistic Reservation and Lutheranism: An Extension of the Sunday Worship?" in his Worship: Rites, Feasts, and Reflections (Portland, OR: Pastoral Press, 2004), pp. 142-143. UMG Application 47B asks that any food remaining be consumed reverently after the service. There is no mention in UMG of reservation.

(46) Hermann Sasse, This Is My Body: Luther's Contention for the Real Presence in the Sacrament At the Altar (Minneapolis, MN: Augsburg, 1959), p. 173.

(47) Maxwell Johnson argues that Lutherans do believe in the Real Presence and suggests that there is no dogmatic reason preventing Lutheran churches from extending the practice of eucharistic reservation, so that communion could also be offered to the sick during the week, but this is not currently the official practice. See Johnson, "Eucharistic Reservation and Lutheranism," pp. 161-162.

(48) Statistics Canada 2001 Census data; see note 2 above.

(49) John Calvin, "Calvinus Oleviano," in Guilielmus Baum, Eduardus Cunitz, and Eduardus Reuss, eds., Opera Quae Supersunt Omnia, Corpus Reformatorum (Brunsvigae: Apud C. A. Schwetschke et Filium, 1879), 20:201-202; see also John Calvin, "Calvinus Ministris Monsbelgardensibus," in Guilielmus Baum, Eduardus Cunitz, and Eduardus Reuss, eds., Opera Quae Supersunt Omnia, Corpus Reformatorum (Brunsvigae: Apud C. A. Schwetschke et Filium, 1873), 11:623-624;

and W. de Greef, The Writings of John Calvin: An Introductory Guide, tr. Lyle D. Bierma (Grand Rapids, MI: Baker Books, 1993), pp. 214--215.

(50) Calvin, "Calvinus Oleviano," p. 201; Calvin acknowledged that the church in Geneva had chosen not to offer communion to the sick, stressing its community dimension, and he accepted that, not seeing it as something to quarrel over.

(51) L. W. Bilkes, "Restricting the Celebration of the Lord's Supper to Worship Services," September, 2004; at http://www.frcna.org/Messenger/archive.asp? Issue=200409&Article=1099430750.

(52) Meyendorff, "Christian Perspectives on Worship," p. 290.

(53) This practice is also praised and preferred in the Roman Catholic Church. The official ritual states: "The links between the community's eucharistic celebration, especially on the Lord's Day, and the communion of the sick are intimate and manifold.... The obligation to visit and comfort those who cannot take part in the eucharistic assembly may be clearly demonstrated by taking communion to them from the community's eucharistic celebration. This symbol of unity between the community and its sick members has the deepest significance on the Lord's Day, the special day of the eucharistic assembly" (Catholic Church, Pastoral Care, p. 51; [paragraph] 73).

(54) The Pastoral Care ritual book does not suggest that the reception of the consecrated wine is optional or exceptional. On the contrary, the ritual calls for the minister to say "'The body of Christ," and the sick person answers "Amen" and receives communion. The minister then says: "The blood of Christ," and the sick person answers "Amen" and receives communion. The rubrics do not indicate that either is optional. See Ibid., p. 61. Moreover, the rubrics provide directions on how the consecrated wine may be transported: "Sick people who are unable to receive under the form of bread may receive under the form of wine alone. If the wine is consecrated at a Mass not celebrated in the presence of the sick person, the blood of the Lord is kept in a properly covered vessel and is placed in the tabernacle after communion. The precious blood should be carried to the sick in a vessel which is closed in such a way as to eliminate all danger of spilling" (ibid., p. 51, # 74).

(55) This is also a reason to stop the lamentable practice of distributing communion from the tabernacle during mass. The Roman Catholic Church teaches: "It is most desirable that the faithful, just as the priest himself is bound to do, receive the Lord's Body from hosts consecrated at the same Mass and that, in the instances when it is permitted, they partake of the chalice (cf. no. 283), so that even by means of the signs Communion will stand out more clearly as a participation in the sacrifice actually being celebrated" (General Instruction on the Roman Missal [paragraph] 85). For the same reason, Good Friday is particularly problematic from an ecumenical perspective, because the Good Friday liturgy includes distribution of communion using hosts consecrated at the Mass of the Lord's Supper on Holy Thursday evening. Many who may receive at mass may have discomfort receiving preconsecrated hosts.

(56) One Bread, One Body, [paragraph] 119.

(57) Meyendorff, "Christian Perspectives on Worship," p. 292.

(58) Jeffrey VanderWilt has reflected on the cumulative effects of ecclesial disobedience. In some cases, disobedience may be prophetic, but generally it is problematic, for it conveys a lack of respect of the institution to which one belongs. Ecumenical dialogue consistently calls upon all believers to respect the customs and traditions of one another. Open disobedience by a member of the clergy can lessen the respect that others have for his or her denomination. See Jeffrey VanderWilt, Communion with Non-Catholic Christians: Risks, Challenges, and Opportunities (Collegeville, MN: The Liturgical Press, 2003), pp. 196-201. Similarly, Bishop Tobin describes open invitations to receive as "improper and theologically unsound." He highlights the awkward situation that this creates for priests who try to follow the law of the Catholic Church. Such liturgical inconsistency "causes confusion for the faithful, scandal within the Church and a real morale problem among priests. In short, it's just not fair!" (Thomas J. Tobin, "Receiving Holy Communion," The Priest 54 [June, 1998]: 31).

(59) See Horton Davies, Bread of Life and Cup of Joy: Newer Ecumenical Perspectives on the Eucharist (Grand Rapids, MI: William B. Eerdmans Publishing Co., 1993), pp. 257-266; and Austin, "Identity of a Eucharistic Church in an Ecumenical Age," p. 28
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