In naming him one of its top 100 persons of the century, Time magazine said that Freud, "more than any other explorer of the psyche, has shaped the mind of the 20th century." Freud was born a Jew in what is now the Czech Republic, suffered persecution under the Nazis in Austria, and died an atheist in England. The fact that he had no belief in God helps explain his openness to euthanasia, Vanderpool says.

On a societal scale, he adds, the increasing desire for physician-assisted suicide corresponds with the increasing secularism of culture.

Doctors also see the link between declining religious influence, autonomy, and the increasing desire for assisted suicide. "Don't get me wrong," says Dr. 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 that the only state where assisted suicide is legal has the highest percentage of atheists and one of the lowest churchgoing populations. When compared with other European countries, the Netherlands is similarly nonreligious. "If you think God is lord of your life, you already believe in a check on autonomy," says Richard Doerflinger, the secretariat for pro-life activities for the National Conference of Catholic Bishops, which has aggressively lobbied Congress to pass the Pain Relief Promotion Act.

Hardly any of the discussion in Congress has been about choice and autonomy. With the exception of Congressman Barney Frank, the Massachusetts Democrat, no one has been politically willing to defend assisted suicide, especially on those terms. Instead, the focus has been on whether the bill will encourage or discourage physicians to provide pain relief.

In Freud's case, there's little doubt about the intent of his physician, who was never charged with a crime. Schur made the details known in his memoirs, which weren't published until 1972. According to Schur, Freud clasped the physician's hand during his final hours 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 anymore."

Schur indicated that he hadn't forgotten. Freud, he wrote, "sighed with relief, held my hand for a moment longer and said, 'I thank you.'" The giant of psychoanalysis exited with an autonomous death.