678. Who Gets to Choose a “Good Death”?
Episode
50 min
Read time
2 min
Topics
Productivity, Health & Wellness, Relationships
AI-Generated Summary
Key Takeaways
- ✓Legal landscape and momentum: Twelve U.S. states plus Washington D.C. now permit some form of assisted dying, with Oregon first in 1997. New York's 2025 law requires a mental health evaluation, an in-person physician visit, a five-day waiting period, and a patient-recorded audio or video request — among the most restrictive frameworks enacted anywhere in the country.
- ✓Canada as a policy warning: Roughly one in twenty Canadian deaths — five percent — now runs through the government-assisted dying program. Critics like Georgetown's Daniel Sulmasy use this figure to argue that guardrails erode over time, pointing to Canada's ongoing debate about expanding eligibility to people whose sole condition is mental illness as evidence of a predictable slippery slope.
- ✓Covert MAID is already widespread: Al Roth notes that high-dose pain medications routinely shorten life, and private physician surveys — including one Australian study — confirm significant undocumented assisted dying in jurisdictions where it remains illegal. This suggests official counts substantially understate how frequently medically assisted death already occurs across the healthcare system.
- ✓Death doula model as an alternative pathway: Suzanne O'Brien's Doula Givers Institute has trained over 400,000 people across 39 countries in 16 years at no cost. Notably, 61 percent of patients who legally obtain end-of-life medication never use it, suggesting that informed support, symptom education, and presence — not the medication itself — resolves much of the underlying fear driving requests.
- ✓Repugnance as a market signal: Economist Al Roth frames assisted dying within his "repugnant transactions" framework — practices some people want while others oppose on moral grounds regardless of direct harm. Same-sex marriage and interracial marriage followed this same arc from banned to normalized, suggesting that current opposition to MAID may reflect a transitional social moment rather than a stable endpoint.
What It Covers
Freakonomics Radio examines medical aid in dying through four perspectives: Nobel economist Al Roth, New York Governor Kathy Hochul, Georgetown ethicist Daniel Sulmasy, and death doula Suzanne O'Brien. The episode uses Daniel Kahneman's deliberate death at 90 in Switzerland as a framework for exploring who controls end-of-life decisions.
Key Questions Answered
- •Legal landscape and momentum: Twelve U.S. states plus Washington D.C. now permit some form of assisted dying, with Oregon first in 1997. New York's 2025 law requires a mental health evaluation, an in-person physician visit, a five-day waiting period, and a patient-recorded audio or video request — among the most restrictive frameworks enacted anywhere in the country.
- •Canada as a policy warning: Roughly one in twenty Canadian deaths — five percent — now runs through the government-assisted dying program. Critics like Georgetown's Daniel Sulmasy use this figure to argue that guardrails erode over time, pointing to Canada's ongoing debate about expanding eligibility to people whose sole condition is mental illness as evidence of a predictable slippery slope.
- •Covert MAID is already widespread: Al Roth notes that high-dose pain medications routinely shorten life, and private physician surveys — including one Australian study — confirm significant undocumented assisted dying in jurisdictions where it remains illegal. This suggests official counts substantially understate how frequently medically assisted death already occurs across the healthcare system.
- •Death doula model as an alternative pathway: Suzanne O'Brien's Doula Givers Institute has trained over 400,000 people across 39 countries in 16 years at no cost. Notably, 61 percent of patients who legally obtain end-of-life medication never use it, suggesting that informed support, symptom education, and presence — not the medication itself — resolves much of the underlying fear driving requests.
- •Repugnance as a market signal: Economist Al Roth frames assisted dying within his "repugnant transactions" framework — practices some people want while others oppose on moral grounds regardless of direct harm. Same-sex marriage and interracial marriage followed this same arc from banned to normalized, suggesting that current opposition to MAID may reflect a transitional social moment rather than a stable endpoint.
Notable Moment
Daniel Kahneman — whose entire career centered on rational decision-making under uncertainty — chose to end his life in Switzerland at 90 while in good mental and physical health. Close colleagues described feeling anger and grief, arguing he deprived them of potentially two or three more years together.
Episode Transcript
Freakonomics Radio sponsored by Pacific Life Insurance. From Pinky Swears to I Do, you make promises throughout your life. For nearly a hundred sixty years, Pacific Life has been helping you keep them by protecting those who matter most. Pacific Life, the power of a promise. Ask a financial professional how Pacific Life can help you create a more confident financial future. Pacific Life Insurance Company, Omaha, Nebraska. And in New York, Pacific Life and Annuity, Phoenix, Arizona. Freakonomics Radio is sponsored by LinkedIn ads. Ever invested in something that didn't live up to the hype? Marketers know that feeling. They optimize for the numbers that look great like impressions, but then they don't see revenue. LinkedIn has a word for that, bull spend. Instead, you can get the highest ROAS of major ad networks with LinkedIn. Cut the bull spend, advertise on LinkedIn. Spend $250 and get a $250 credit. Go to linkedin.com/freakonomics. Terms apply. Freakonomics Radio is sponsored by Mint Mobile. Unlimited talk, text, and data, and fast reliable coverage on the nation's largest five g network. No catch. To get your new wireless plan for just fifteen bucks a month, go to mintmobile.com/freak. That's it. There's no catch. $45 upfront payment required, equivalent to $15 a month. New customers on first three month plan only speeds slower above 40 gigabytes on unlimited plan. Additional taxes, fees, and restrictions apply. See Mint Mobile for details. Daniel Kahneman was a celebrated and influential scholar trained in psychology, but with a seemingly limitless way of thinking about the world. In 2002, he won a Nobel Prize in Economics. In 2011, he published a popular book called Thinking Fast and Slow. His primary topic was human decision making, especially how we make decisions under uncertainty. His work has influenced people in government and policy making, and medicine and finance, in the military, the criminal justice system, and more. And why were Kahneman's insights so valuable? Maybe because uncertainty is a feature, not a bug of human existence. Whatever you do in your professional or personal life, you have to deal with uncertainty. As for certainties, well, there just aren't that many of them. Perhaps the most reliable certainty in life is death. A couple years ago, as Kahneman approached his ninetieth birthday, that certainty must have felt particularly salient. He was still in relatively good health, and his mind was sharp, but he decided that his time had come. He traveled to France where he'd grown up, barely surviving the Nazis. He gathered with his family in Paris to celebrate his ninetieth birthday, meals, museum visits, nice walks. From there, Kahneman traveled on to Switzerland where the laws on assisted suicide are more permissive than most other places, and he ended his life. In an email to friends, he wrote, I have believed since I was a teenager that the miseries and indignities of the last years of life are superfluous, and I am acting on that belief. Danny Kahneman made …
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“Suzanne O'Brien's Doula Givers Institute has trained over 400,000 people across 39 countries in 16 years at no cost.”
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