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Editor's Correspondence
January 10, 2000

Freud's Death—Reply

Arch Intern Med. 2000;160(1):118. doi:

In reply

All 3 letters responding to our article1 that was recently published in the ARCHIVES reveal an appreciation of the semantic issues and strong emotional currents that are evident when one tries to label Freud's death a physician-assisted suicide, euthanasia, or terminal sedation. The title of our article was carefully chosen to provoke the reader to think about these issues. We recognize that the differences between these terms have crucial importance, and we believe that the text Schur provided leaves things somewhat ambiguous. If he performed a physician-assisted suicide, then it was the European (the Netherlands) form of this procedure and not the American (Oregon) approach (that entails writing a prescription permitting the patient to end his or her life). Many readers may be more comfortable with viewing Freud's death as an example of terminal sedation. By today's standards, this is an acceptable form of palliative care that is offered to help relieve unendurable suffering. However, even this approach is not without controversy, and when Billings and Block2 described terminal sedation as being slow euthanasia, they were pummeled by an unexpected onslaught of commentaries and replies.3