678. Who Gets to Choose a “Good Death”?

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.