Friday, October 3, 2014

Freud's Death by Physician-Assisted Suicide

Dude, those cigars are going to kill you.

 The Atlantic

Freud informed the young internist (40 years his junior) about two elements of the doctor‑patient relationship that he considered essential. The first was that they always tell each other the truth. The second was “that when the time comes, you won't let me suffer unnecessarily.” Schur readily agreed to these conditions.
Although Freud continued to see a few analytic patients, his condition markedly deteriorated, and Schur moved into his home. Freud adored his pet dog, a chow named Lün, but now the smell of necrotic bone from his jaw was so repulsive that the animal howled and refused to stay in the same room as the master. During the final six months, Anna attended her father constantly, and she woke several times each night to apply a local anesthetic. He was confined to bed and entirely dependent on her care.
Over a span of 16 years, Freud had undergone 30-some operations and several courses of radiation therapy. During much of this time, Freud was reduced to wearing a hideous, denture-like prosthesis to keep his oral and nasal cavities separated, and this device prevented him from eating and speaking normally. Following the first series of surgeries in 1923, he became deaf in his right ear and shifted his analytic couch from one wall to the other so that he could listen with his left ear. Nevertheless, he continued to see patients. In London, he had four patients in treatment, and he only disbanded his clinical practice two months before his death. During the final days, Freud requested that his bed be brought down to the study so that he could be near his books, desk, and beloved collection of antiquities.
On September 21, according to Schur’s first-person account, Freud reached out, grasped him by the hand, and said, “My dear Schur, you certainly remember our first talk. You promised me then not to forsake me when my time comes. Now it's nothing but torture and makes no sense any more.”
Schur said he had not forgotten. He wrote that Freud “sighed with relief, held my hand for a moment longer, and said ‘I thank you,' and after a moment of hesitation he added: ‘Tell Anna about this.' All this was said without a trace of emotionality or self‑pity, and with full consciousness of reality.”
Schur continued, “I informed Anna of our conversation, as Freud had asked.” She reluctantly agreed, thankful her father had remained lucid and able to make this final decision.
Schur wrote, “When he was again in agony, I gave him a hypodermic of two centigrams of morphine [approximately 15 to 25 mg]. He soon felt relief and fell into a peaceful sleep. The expression of pain and suffering was gone. I repeated this dose after about 12 hours. Freud was obviously so close to the end of his reserves that he lapsed into a coma and did not wake up again.”
Freud quietly died at three in the morning of September 23, 1939, 75 years ago.

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