The Pact of Dignity: Freud's Death between Medical Practice, the Sovereignty of the Subject, and the Economy of the Death Drive

     Prof. Alexandre H. Reis (Lysis/UFpel)

“On 21 September, while I was sitting at his bedside, Freud took my hand and said, ‘My dear Schur, you certainly remember our first conversation. You promised me then that you would not abandon me when my time came. Now it is nothing but torture and makes no sense any longer.’”

Max Schur's account of Sigmund Freud's final moments in Freud: Living and Dying goes well beyond a clinical note or a biographical account of an isolated event. It is a particularly revealing document in which three distinct yet deeply intertwined concerns come together in an exemplary, almost paradigmatic way. They are modern medical ethics confronting the limits of therapeutic paternalism, the radical affirmation of the subject's autonomy in the face of their own finitude, and, finally, the inscription in lived experience of one of the most unsettling hypotheses in Freudian metapsychology, namely the notion of the death drive.

To begin to grasp the full significance and complexity of this episode, we must return to the beginnings of Freud and Schur's relationship in the late 1920s. Freud was already severely affected by an invasive carcinoma in the maxillofacial region. Over the following years its progression would entail a succession of disfiguring operations, painful prostheses, and progressive deterioration of the most basic functions of everyday life, including speech and eating. It was against this background of prolonged suffering, which extended beyond physical pain and directly affected the subject's dignity as a speaking and thinking being, that Freud set Schur a condition that openly overturned the prevailing logic of medical practice. He expressly refused any concealment of his diagnosis and insisted, without qualification, that his life should never be artificially prolonged beyond the point at which, by the standards he himself deemed acceptable, it ceased to be livable.

This demand formalized a rigorous ethical position that went beyond an expression of individual will. Medical knowledge relinquished its position as sovereign authority and was recast as a means of serving a decision that ultimately remained the subject's alone. In accepting these terms, Schur made a commitment to his patient and bound himself to a pact whose normative force would endure throughout the following decade, turning the clinical relationship into a kind of alliance founded on truth, lucidity, and the rejection of any form of guardianship.

Sigmund Freud's study in his London home, now the Freud Museum, preserved with its original furnishings and objects. It was in this room, while living in exile and already in the advanced stages of carcinoma, that Freud spent his final months and reaffirmed with his doctor, Max Schur, the ethical pact that would guide the course of his death.

Source: FREUD MUSEUM LONDON. Freud’s Study. London, [n.d.]. Available at https://www.freud.org.uk. Accessed 17 June 2026.

Throughout this period Freud's conduct remained remarkably consistent with the principles he had set out. He systematically refused analgesics that could impair his intellectual activity, insisted on remaining productive despite mounting limitations, and preserved his psychic autonomy as far as possible, even under conditions that would have fully justified most people in relinquishing these demands. Exile in London, forced upon him by the rise of the Nazi regime, left this orientation essentially intact and even reinforced the centrality of intellectual activity as the organizing principle of his existence. When the necrosis advanced to the point at which his suffering went from intense to structurally unbearable, compromising his body and his very capacity to be in the world, his request to Schur in September 1939 put a prior commitment into effect. It was no impulsive or desperate gesture.

It is precisely here that Anna Freud assumes decisive importance. Her explicit inclusion in the decision-making process, “talk to Anna about it, and if she thinks it is right, put an end to it,” introduces a relational dimension that rules out any simplistic understanding of autonomy as absolute isolation. What we see is a complex interplay between individual sovereignty and the recognition of otherness. The decision about one's own death, although grounded in the will of the subject, takes shape within a network of emotional ties and shared responsibilities. Anna's consent, given after some hesitation, lends further legitimacy to the decision, moving it beyond a strictly individual act and into an ethics of care in which physician, patient, and family member participate in a shared economy of responsibility.

The singularity of this episode extends beyond its ethical and clinical dimensions and comes into sharper focus when viewed in light of Freud's theory of the death drive, as formulated in Além do Princípio do Prazer. There Freud challenges the primacy previously accorded to the life drives by positing a fundamental tendency in the organism to reduce tension absolutely, a tendency whose ultimate expression would be a return to the inorganic state. This hypothesis goes well beyond abstract speculation. In my reading, the final moments of Freud's life give it a kind of concrete enactment, in which the subjective experience of extreme suffering is bound up with the economic logic described in metapsychology.

When Freud says that his condition “makes no sense any longer” and has become “torture,” we see the collapse of the psychic apparatus's capacity to sustain a level of tension compatible with life through the binding operations characteristic of Eros. In this situation, Schur's intervention, administering successive doses of morphine that led to sleep, coma, and ultimately death, can be read as medical accompaniment of a process already underway, in which the organism's own dynamics tend toward cessation. The end need not be understood as imposed from outside.

It is important, however, to stress that this reading does not allow us to identify Freud's action outright with a pathological manifestation of the death drive. I think this point is especially important to the reflections we have been developing in our Lysis group. What distinguishes the case is precisely that the movement toward the end is mediated by an ego that remains active to the limit. It takes the form neither of destructive acting-out nor of melancholic capitulation. Freud goes beyond anticipating his death. He organizes it, negotiates it, and places it within a carefully defined ethical and relational framework. In this sense, his final gesture can be said to exemplify the maxim that runs throughout his work: extending the domain of the I (Ich) over processes that would otherwise remain subject to the opacity of the it (es).[i]

Schur's final description, with the expression of pain fading, peaceful sleep setting in, and the gradual transition into coma, inevitably evokes the ancient mythical association between death and sleep embodied in Thanatos and Hypnos. Without any dramatization, Freud's death appears as a silent passage free of spectacular violence. Medicine helps to ease that passage rather than resisting the end.

If there is a lesson to draw from this episode, perhaps it lies in the possibility of thinking about death as a moment that can, under certain conditions, be integrated into the very economy of psychic life and the ethics of the subject. The alternatives would be to treat it merely as a biological event or as an outrage to be averted at any cost. In facing his death without recourse to transcendent illusions or surrender to self-pity, Freud brings his end into continuity with his work. His last gesture becomes a kind of practical confirmation of his thought instead of a denial of it.

[i] The established rendering of Freud's terms Ich and Es as “Ego” and “Id,” consolidated primarily in the Anglophone tradition and repeated in Brazilian editions translated through English, introduces a layer of Latinization that tends to reify agencies which, in the original German, deliberately remain close to ordinary speech. Where Ich simply means “I” and Es means “it,” Freud preserves a fundamental ambiguity between subjective experience and psychic structure. “Ego” and “Id” give them the appearance of technical entities, potentially obscuring that constitutive indeterminacy and favouring a more topographical reading of the psychic apparatus at the expense of its dynamic and enunciative dimensions.

FREUD, Sigmund. Além do princípio do prazer. In: FREUD, Sigmund. Obras completas, volume 14: História de uma neurose infantil (“O homem dos lobos”), Além do princípio do prazer e outros textos (1917-1920). Tradução de Paulo César de Souza. São Paulo: Companhia das Letras, 2010.

FREUD, Sigmund. O mal-estar na civilização. In: FREUD, Sigmund. Obras completas, volume 18: O mal-estar na civilização, Novas conferências introdutórias à psicanálise e outros textos (1930-1936). Tradução de Paulo César de Souza. São Paulo: Companhia das Letras, 2010.

JONES, Ernest. Vida e obra de Sigmund Freud. Rio de Janeiro: Zahar, 1979. 3 v.

SCHUR, Max. Freud: living and dying. New York: International Universities Press, 1972.

STRACHEY, James (ed.). The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press, 1953-1974. 24 v.

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