April 17, 2000
Control, not pain, cited most
often in desire for euthanasia
___By Mark O'Keefe
___Religion News Service
___WASHINGTON (RNS)--Diagnosed with cancer of the mouth, the cigar-smoking genius with the larger-than-life ego persuaded his doctor to euthanize him when the time was right.
___When Sigmund Freud decided the time was right--16 years after the diagnosis--physician Max Schur gave him 21 milligrams of morphine. The father of psychoanalysis, the man who popularized such terms as "id" and "oedipal complex," died within hours.
___But the impact of Freud's final exit endures. As Congress grapples with a national anti-suicide bill, Maine prepares for a November referendum on legalizing physician-assisted suicide and Oregon continues its landmark experiment with doctor-aided death, Freud has emerged as a powerful emblem for the "right to die" movement.
___The pro-euthanasia authors of an article published in a medical journal have labeled Freud's 1939 passing "physician-assisted death" and "voluntary active euthanasia." Other anti-euthanasia physicians argue Freud's palliative care would be commended today as appropriate, compassionate and legal.
___Either way, the details illustrate an important but often overlooked point in the contemporary political, medical and moral debate over euthanasia and physician-assisted suicide. Most people, like Freud, choose doctor-aided death not to avoid pain, but to exert autonomy.
___This truth is confirmed in studies from the Netherlands, the only country where euthanasia is allowed nationwide, and from Oregon, the only U.S. state to legalize physician-assisted suicide.
___Yet as the U.S. Senate considers the Pain Relief Promotion Act, pain--not autonomy--remains on center stage. The bill would ban use of federally controlled substances, such as barbiturates and morphine, in assisted suicides. It overwhelmingly passed the House last October and awaits action in the Senate Judiciary Committee.
___Freud knew pain. It came with the malignant oral epithelioma first diagnosed in 1923, a consequence of the cigars he couldn't give up, the cigars he believed gave him creativity and productivity in his writing. Freud had to use crude prostheses to talk and eat, and he dealt with the pain of more than 30 surgical procedures. He also endured repeated, primitive X-rays and radium therapy.
___Yet in the years from diagnosis to death, he wrote 20 books and scientific articles as he directed the international development of psychoanalysis. He was indeed creative and productive.
___"Freud was a tough guy. To think that in his last hours he was overcome with pain is absurd," said Jack McCue, co-author with Lewis Cohen of "Freud's Physician-Assisted Death," published last year in the Archives of Internal Medicine.
___"Based on Schur's writings, reading between the lines, I think the reason Freud chose this type of death was control. He desired and achieved a reconciled death, what he would consider a good death," said McCue, a former member of the pro-euthanasia Hemlock Society.
___"It makes sense. I don't fear pain. I fear dependency. I fear the humiliation of losing my wholeness as an adult. I can relieve pain, but what I don't want to do is waste away, losing control of my bladder and my bowels, having to rely on people to take care of me when I have no future.
___"I want the most graceful exit possible, and I think that's what most people want."
___They want it in increasing numbers.
___In 1947, when a Gallup survey asked Americans if the law should allow doctors to end the lives of terminally ill patients who request such assistance, 37 percent said yes and 54 percent said no. In 1999, 61 percent said yes and 35 percent said no, revealing a significant historical shift.
___Last March, Gallup asked, "If you personally had a disease that could not be cured and were living in severe pain, would you consider committing suicide or not?"
___Forty percent said yes. But the key words, and the source of misunderstanding, are "severe pain."
___In February, an article in the New England Journal of Medicine examined an Oregon Health Division study of the 33 people who requested and received lethal medications in 1999. It came to this emphatic conclusion: "The patients requested assistance with suicide because of concern about loss of autonomy and control of bodily functions, not because of concern about inadequate control of pain."
___Widespread support for euthanasia depends on belief in autonomy, a value summarized in the United States as "my body, my choice." The word comes from the Greek "auto"--self--and "nomos"--law. "Personal autonomy" suggests a person who is a law unto himself.
___That describes Freud, who "gives us a model of modern autonomy," said Harold Vanderpool, professor of the history and philosophy of medicine at the University of Texas medical branch in Galveston.
___And the fact that he had no belief in God helps explain his openness to euthanasia, Vanderpool said.
___On a societal scale, the increasing desire for physician-assisted suicide corresponds with the increasing secularism of culture, Vanderpool said. Doctors also see the link between declining religious influence, autonomy and the increasing desire for assisted suicide.
___"Don't get me wrong," said Peter Goodwin, who co-sponsored the voter-approved Oregon law and has assisted in several suicides. "There are religious people who want aid in dying. I have many Catholic friends who want it. But in general, it is somebody who has a polytheistic belief or an agnostic belief or perhaps an atheistic belief."
___It's no coincidence then that the only state where assisted suicide is legal has the highest percentage of atheists and one of the lowest church-going populations. When compared to other European countries, the Netherlands is similarly non-religious.
Send this story to a friend
Contents/ Masthead / Why We're Here / Links / Archive / E-mail us/ SUBSCRIBE!