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

June 19, 2026 • 50m

Summary

⏱️ 11 min read

Overview

This Freakonomics Radio episode explores the evolving landscape of medical aid in dying (MAID) in America, examining how society views death, autonomy, and end-of-life choices. The episode features Nobel Prize-winning economist Al Roth discussing his new book on 'repugnant transactions,' New York Governor Kathy Hochul defending her state's new MAID law, Georgetown ethicist Daniel Sulmasy presenting religious and medical opposition, and death doula Suzanne O'Brien offering an alternative approach to end-of-life care. The discussion is anchored by the story of Daniel Kahneman, who chose assisted suicide in Switzerland at age 90.

Daniel Kahneman's Death and the Certainty Question

The episode opens with the story of Nobel Prize-winning psychologist Daniel Kahneman, who traveled to Switzerland at age 90 to end his life through assisted suicide. Despite being in relatively good health with a sharp mind, Kahneman made this carefully considered decision based on his lifelong belief that the miseries of late life are superfluous. His choice sparked debate among those close to him, with some feeling bereft at losing additional years with him, while others respected his autonomy and long-held convictions about avoiding a difficult death.

  • Daniel Kahneman was a celebrated psychologist who won the Nobel Prize in economics in 2002 for his work on human decision-making under uncertainty
  • At age 90, Kahneman traveled to France to celebrate his birthday with family, then to Switzerland where he ended his life through assisted suicide
  • Some close to Kahneman were angry at his decision, feeling he robbed them of one to three more years together
  • Al Roth notes these decisions are very personal, though he might have argued against it if more closely involved
" 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. "
" He wasn't being pressed by his family and friends. On the contrary, but he had himself witnessed some difficult deaths in his life, and he didn't want to experience one. "

The Economics of Repugnant Transactions

Nobel laureate Al Roth introduces his concept of 'repugnant transactions'—things some people want but others object to on moral grounds, even when they can't tell if it has occurred. Medical aid in dying fits this category, alongside historically repugnant but now-legal practices like same-sex marriage and interracial marriage. Roth traces how assisted dying has evolved from the Hippocratic Oath's explicit prohibition to growing acceptance across a dozen U.S. states and multiple countries, though the movement has been slower than activists expected decades ago.

  • A repugnant transaction is something some people want but others object to for moral or religious reasons, even if they can't tell it happened
  • Same-sex marriage and interracial marriage were once repugnant transactions that are now legal
  • The Hippocratic Oath from ancient Greece explicitly prohibited medical aid in dying
  • Twelve U.S. states plus D.C. now have some form of medical aid in dying, with New York joining in 2025
  • Jack Kevorkian went to prison for assisted suicide advocacy in the 1990s, though he was only convicted when he administered drugs himself
" A repugnant transaction is some people want it. Some people object to it, even though they can't tell if it has happened for moral or religious reasons. "

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