Speaker
Daniel Sulmasy
Appearances over time
1 episodes
Episodes
1
Podcasts
Quotes & moments
Assisted dying has been legal in Switzerland since 1942, and now 12 US states plus D.C. have followed. The American movement was slow and contentious, shaped by figures like Jack Kevorkian, and is now arriving in major states like New York.
Al Roth's concept of 'repugnant transactions' — things some people want and others oppose on moral grounds, regardless of harm — puts assisted dying in the same historical bucket as same-sex marriage and interracial marriage. Social support, Roth argues, is what makes or breaks any contested market.
Kathy Hochul watched her mother deteriorate from ALS for months before dying in 2014, losing her voice, vision, and ability to communicate. That experience was the hidden force behind her decision to sign the Medical Aid in Dying Act — though she insists policy must not be driven by personal experience alone.
Death doulas are trained in medical terminology and disease progression but focus on emotional support, education, and presence — acting as the eyes and ears for hospice teams that can only visit for one hour a week. O'Brien's Doula Givers Institute has trained over 400,000 people in 39 countries.
61% of people who legally obtain end-of-life medication under MAID laws never use it. O'Brien argues this reveals the real driver: people want the option, the sense of control, not necessarily the act itself — which raises the question of whether addressing fear is a better intervention than prescribing lethal drugs.
At 90, Nobel economist Daniel Kahneman traveled to Switzerland and ended his life, citing a lifelong belief that 'the miseries and indignities of the last years of life are superfluous.' His close friend Al Roth says the decision was considered, unhurried, and consistent with who Kahneman was.
Daniel Sulmasy argues that medical aid in dying is bad medicine because the reasons people actually seek it — loss of control, fear of being a burden, loss of autonomy — are not medical diagnoses. It's also bad ethics because it breaks the foundational covenant of medicine, and bad public policy because every safeguard has historically been eroded.
Canada's MAID system now accounts for roughly 5% of all deaths, has expanded beyond terminal cases, and has debated extending eligibility to people whose sole condition is mental illness. Critics like Sulmasy see this as proof that any safeguards written into law will eventually be dismantled.
The American demand for assisted dying is rooted in a cultural obsession with control. But control, Sulmasy argues, is a philosophically bankrupt foundation: you can't control who your parents were, you can't avoid death, and you can't force someone to love you. A value system built on control excludes the three most important things in human life.
O'Brien says confronting death changed her life overnight: she went from 'I have to go to the gym' to 'I get to go to the gym.' She argues that accepting death's inevitability is not morbid but liberating, and that this awareness — once passed down generationally — can be taught and restored.
Shortly after Canada's court ruling requiring MAID legalization, health economists were already publishing papers on how much the cash-strapped Canadian healthcare system would save. Sulmasy's counter: if your healthcare system isn't giving people good end-of-life care, fix the system — don't prescribe death.
The current hospice model relies on family caregivers for 98% of hands-on end-of-life care, with nurses visiting for only about one hour per week. O'Brien traces the problem to the 1982 hospice benefit under Reagan, which broadened access but locked in a reimbursement model that leaves families overwhelmed and underprepared.
New York's MAID law, effective August 2025, requires a terminal prognosis of 6 months or less, a mandatory mental health evaluation, an in-person physician visit, a 5-day waiting period, and a video or audio recording of the patient's request. Hochul insisted on these guardrails as the price of her signature.
Jack Kevorkian built a machine to allow patients to self-administer lethal drugs, filmed their decisions, informed police, and was tried for murder multiple times before being convicted and imprisoned. His public advocacy — controversial and confrontational — planted the seed for a movement that took decades to gain legal footing.
Analysis
What they talk about
- Health & Fitness 40%
- Society & Culture 40%
- Government 20%
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