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Editor's Correspondence |

Freud's Palliative Care and Natural Death

David W. Kissane, MD
Arch Intern Med. 2000;160(1):117. doi:.
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I read with interest the article by McCue and Cohen1 that was recently published in the ARCHIVES and believe there is a grave danger of misinterpreting the recorded comments of Freud and Schur in the current discourse on physician-assisted suicide. The historical facts warrant careful examination.

First, published sources debate the actual dosage and frequency of morphine that Freud received.2 Regardless of whether Freud was given 2 or 3 cg of morphine and whether the dose was repeated once (12 hours later) or twice, 36 hours unfolded before Freud subsequently died. This period strongly suggests that Freud died as a result of his disease process and not from receiving morphine. It is the size of the dose and the rate of the subsequent increase that determines whether morphine causes or hastens death. In pain management, a gradual dosage escalation of 50% to 100% is the usual practice, although substantially higher increases may be well tolerated by patients who are not new to the drug.3 Freud received what was then the common dosage of morphine given to relieve the pain of acute myocardial infarction.

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