Honestly with Bari Weiss: "Should We Legalize Assisted Suicide?"

Date: December 9, 2025
Host: Bari Weiss (The Free Press)
Guests: Dr. Lydia Dugdale (Physician, Medical Ethicist, Columbia University) & David Hoffman (Healthcare Attorney, Clinical Ethicist, Professor of Bioethics, Columbia University)
Producer/Interviewer: Rafaela Siewert

Episode Overview

This episode confronts one of the most vexing medical, ethical, and societal questions of modern American life: Should physician-assisted suicide, also known as "medical aid in dying" (MAID), become the law in New York and potentially elsewhere? Eleven states and D.C. already allow some form of this practice for terminal patients. Weiss’s producer Rafaela Siewert facilitates a debate between physician and ethicist Dr. Lydia Dugdale (arguing against legalizing assisted suicide) and attorney and clinical ethicist David Hoffman (in favor), tackling issues of compassion, medical autonomy, slippery slopes, and potential for abuse.

Key Discussion Points & Insights

1. Defining Medical Aid in Dying: Terms and Distinctions

• [04:47] Dr. Lydia Dugdale:
  • MAID in the U.S. is a process where a doctor (or, in some jurisdictions, another qualified provider) prescribes a lethal dose of medication to a terminally ill patient (prognosis: 6 months or less), to be self-administered.
  • Distinction between MAID (self-administered) and euthanasia (physician-administered, e.g., lethal injection as in Belgium/Netherlands).
  • Quote: "It's just pills...You have to be able to self-ingest, you have to have a terminal diagnosis. And that is what it is in this country."
• [06:06] David Hoffman:
  • Argues terminology matters: MAID for terminally ill patients is fundamentally different from suicide due to mental despair, and it is disrespectful to conflate the two.
  • Stresses need for distinct language, and that U.S. laws are restrictive to terminal illness.
  • Quote: "People seeking medical aid in dying by definition in the United States have a terminal illness...they are looking to end their suffering because their life is going to end anyway."

2. The New York Bill: Criteria and Safeguards

• [12:59] David Hoffman:
  • NY’s proposed bill is modeled after Oregon’s 1997 law, requiring:
    • Terminal diagnosis (typically six months or less)
    • Over-18
    • Self-administration
    • Multiple requests: both oral and written, two physicians’ assessments, possibly mental health referral
  • Residency requirements in some states are under legal challenge or have been removed (OR, VT).
• [15:05] Dr. Lydia Dugdale:
  • NY bill requires: 18+, terminal diagnosis, ability to consent, and self-ingestion.
• [17:04] Dr. Lydia Dugdale:
  • Notes NY bill lacks a mandatory waiting period, allowing for potentially rapid access; most states previously required 15 days, but this has shrunk or disappeared.
• [18:14] David Hoffman & Dr. Dugdale:
  • Hoffman asserts the real-world process inherently takes several days due to procedural steps, even without a formal waiting period.
  • Dugdale worries that, absent statutory delays, efficiency pressures could erode safeguards in practice—“doctors are terrible prognosticators,” and process can become routine and mechanical.

3. Safeguards, Abuses, and Subjectivity

• [21:00] Dr. Lydia Dugdale:
  • Raises concern that safeguards depend on “highly subjective” medical judgments (e.g., estimating 6-month prognosis).
  • Physicians face systemic pressure for efficiency that could hasten decision-making.
  • Quote: "It's a practice that is being asked of physicians to make a judgment...that is highly subjective."
• [24:09] David Hoffman:
  • Argues statutory safeguards (multiple assessments, documentation, etc.) have worked effectively—“no reported cases...of patients being coerced or subject to undue influence.”
• [26:42] Dr. Lydia Dugdale & [28:34] David Hoffman:
  • Dispute over cases where patients were denied treatments but offered MAID instead, especially in Canada—Dugdale claims concerning anecdotes, Hoffman asserts U.S. law and data don’t substantiate these fears.

4. Terminal Illness: Definitions and Concerns about Scope

• [29:33] Dr. Lydia Dugdale:
  • Claims “terminal illness is relative,” e.g., stopping insulin in diabetes could technically make someone “terminal.”
• [30:08] David Hoffman:
  • Responds that, in practice, 90%+ of MAID cases center on five diagnoses: cancer, CHF, COPD, ALS, and Parkinson’s. Outliers are rare, and safeguards apply.
• [33:14] Dr. Lydia Dugdale:
  • Argues death certificates may misrepresent actual circumstances, and again asserts doctors are “bad prognosticators.”

5. Mental Health Safeguards

• [34:54] Dr. Lydia Dugdale:
  • Asserts mental health screening in the law is inadequate—only required if a doctor perceives impairment; points to Oregon data that only 3/607 cases in 2024 were referred for psych evaluation.
• [36:56] David Hoffman:
  • Doctors must ensure decisional capacity, not just absence of depression; depression is common but not necessarily disqualifying if capacity is intact.
  • Quote: "It should not surprise anyone that an elderly patient with cancer...is going to be a little depressed. That’s not the issue. The issue is whether the patient has decisional capacity..." (36:56)

6. Role of Physicians & Professional Ethics

• [38:10] Dr. Lydia Dugdale:
  • Questions why physicians must be involved at all, given their commitment to healing—not death. Suggests problem is giving doctors a “state-sanctioned hatchet.”
• [39:10] David Hoffman:
  • Contends voluntary physician participation and strong safeguards suffice. Notes hypothetical creation of a new profession (clinical ethicist-medical prescriber) if needed.
• [41:28] David Hoffman:
  • Reframes issue as about giving suffering patients immediate relief now, rather than denying them due to abstract future concerns.

7. Expansion and the “Slippery Slope” Argument

• [41:58] Rafaela Siewert, [44:41] David Hoffman, [46:51] Dr. Lydia Dugdale:
  • Concerns raised about other countries (especially Canada, Belgium, Netherlands) where access expanded to non-terminal and mental illness cases—including minors.
  • Hoffman insists U.S. legal/medical systems work differently; any expansion would require open public debate and legislative change.
  • Dugdale counters that U.S. laws have already “incrementally expanded” (shrinking waiting periods, expanded prescriber types, deliveries by mail).
  • Quote (Dugdale): "Since legalization, [access] has expanded. And the thing that I think is most worrisome is California in 2024...put forward to expand maid access to non-terminal conditions." (46:51)

8. Social Contagion, Suicide Rates, and Cultural Fears

• [47:27] Dr. Lydia Dugdale:
  • References research (Oxford) claiming jurisdictions that legalize MAID see a parallel (not causative) rise in “conventional” suicides—a phenomenon possibly related to normalization (“Werther effect”).
• [48:56] Rafaela Siewert:
  • Raises the issue that severe, non-terminal illness or even social factors (e.g., loneliness) prompt requests for MAID; Dugdale fears this undermines efforts to improve social supports and palliative care.
• [50:17] David Hoffman:
  • Rebuts the loneliness argument: "No one in Canada has ever gotten medical aid in dying...simply because they are experiencing loneliness." (50:58)

9. Socioeconomic Disparity and Potential for Coercion

• [53:24] David Hoffman:
  • Finds no evidence of poor or disabled people being disproportionately pressured towards MAID in U.S. datasets.
• [53:53] Dr. Lydia Dugdale:
  • Warns that limited state data means real abuse may be missed; points to New Mexico’s under-reporting and risk factors.
  • Quote: "We have no data. We just don't know..."

10. Minors and Global Comparisons

• [57:44] Rafaela Siewert:
  • Raises specter of minor access (as in Belgium/Netherlands).
• [58:10] Dr. Lydia Dugdale:
  • Uses Belgium as cautionary tale: originally narrow law “keeps expanding, expanding.”
• [59:32] David Hoffman:
  • Insists U.S. debate should not be driven by foreign examples; "That will never happen in the environment we currently live in."

11. Compassion, Autonomy, and Medical Ethics

• [66:34] Rafaela Siewert (with quote from Coleman Hughes):
  • Brings in testimony about the compassion of allowing terminal patients to choose peaceful death; asks both guests to address this lived reality.
• [67:22] Dr. Lydia Dugdale:
  • Empathizes deeply but argues modern medicine can essentially treat almost all pain. Points to the "doctrine of double effect"—escalating medications to relieve pain, accepting possible hastening of death as a side effect.
• [70:18] David Hoffman:
  • For many non-cancer terminal ailments (ALS, Parkinson's, COPD), palliative options remain inadequate: for these, MAID is a legitimate, compassionate final relief. Argues "the idea is just to get the law out of the way so that doctors and patients can make these decisions for themselves."

12. Public Opinion and Legal Implications

• [79:30] Dr. Lydia Dugdale:
  • Recognizes high public support but argues opinions might shift if Americans saw consequences documented abroad.
• [80:33] David Hoffman:
  • Notes his own and other studies confirm high public support in New York and elsewhere, suggesting the government’s barrier is out of step with current needs and sentiment.

13. Predictions & Broader Consequences

• [84:57] Rafela Siewert:
  • Asks both guests to predict what would happen if MAID is widely legalized.
• [84:57] Dr. Lydia Dugdale:
  • Raises concerns about eldercare burden, budgetary pressures incentivizing MAID (citing studies about government cost savings), and the risk of “checkerboard” state-by-state policy (like abortion). Fears normalization and expanding criteria under economic pressure.
• [87:19] David Hoffman:
  • Agrees the American system presents difficult end-of-life dilemmas, but the solution is more communication and autonomy for physicians and patients, not blanket prohibition. Compares resistance to acceptance of MAID to the resistance earlier faced by hospice and palliative care movements.

Notable Quotes & Memorable Moments

• [06:06] David Hoffman
  "It's disrespectful to people who are what we consider classically or conventionally suicidal...people seeking medical aid in dying by definition in the United States have a terminal illness...they are looking to end their suffering because their life is going to end anyway."

• [20:41] Dr. Lydia Dugdale
  "If somebody wants to die, they've already kind of made up their mind and so laying out the alternative options. I mean, that's a nice, it's a nice gesture..."

• [36:46] Dr. Lydia Dugdale
  "The difference is that depression is often treatable, more often than not. And so maybe they wouldn't want to die."

• [39:10] David Hoffman
  "There are more than enough physicians who, who are willing to engage in this kind of an evaluation and treatment of patients at the end of life..."

• [46:51] Dr. Lydia Dugdale
  "It is true that since legalization, [access] has expanded...the thing that I think is most worrisome is California in 2024...put forward to expand maid access to non terminal conditions."

• [50:58] David Hoffman
  "No one in Canada has ever gotten medical aid in dying...simply because they are experiencing loneliness."

• [63:54] Dr. Lydia Dugdale
  "What do you think the governor of Washington state and Oregon should do about the fact that conventional suicide is rising parallel to the increase in maid?"

• [66:34] Rafaela Siewert (quoting Coleman Hughes)
  "She faced two choices. To die painlessly on the day of her choosing, surrounded by family, or to experience extreme and escalating pain for the next few weeks and then die at a random time, possibly alone."

• [74:08] Dr. Lydia Dugdale
  "The rights and responsibilities of medicine has always been to restore people to health. We are not executioners, we are not agents of death..."

• [87:19] David Hoffman
  "What we have to do is acknowledge that doing more isn't always in the best interest of the patient. And we need to be able to have that discussion. Part of the irony...is that some people...object to availability of [MAID] because that would discourage people from taking advantage of palliative care and hospice. Guess what? That's the exact same argument that the oncologists made about palliative care in hospice. If we offer palliative care and we offer hospice, people will lose hope in the cures that oncology can provide. And that would be a shame. Well, it hasn't turned out that way."

Timestamps for Key Segments

• [04:09–12:00] — History and Definitions: What is MAID? What’s the difference from euthanasia?
• [12:46–18:14] — The New York Bill: Specifics, criteria, and the controversy over waiting periods
• [20:41–24:39] — Safeguards: Are protocols followed? Are six-month prognoses reliable?
• [28:34–34:54] — Reports of Abuses and International Examples, especially Canada
• [34:54–38:14] — Mental health screening and the risk of treating undiagnosed depression
• [48:56–55:27] — Scope expansion, slippery slope, socioeconomics, and concerns about vulnerable populations
• [57:44–62:00] — Minors and global comparisons: Could U.S. laws creep toward models like Belgium/Netherlands?
• [66:34–74:08] — Personal testimonials, the compassion argument, and the doctrine of double effect
• [79:30–84:37] — Public Opinion, Legal Duties, and Potential for Watertight Legislating
• [84:57–89:40] — Predictions: What does nationwide legalization mean for U.S. society and medicine?

Takeaways

• David Hoffman: MAID for terminal patients is a humane, voluntary, and tightly regulated option with strong safeguards, a track record of safety, and broad public support in line with patient autonomy. U.S. law is robustly distinct from international outliers. Expansion fears are overblown, and reforms are deliberate and debated.
• Dr. Lydia Dugdale: Despite empathetic cases, MAID’s legalization risks eroding the medical profession’s healing ethos, opens the door to unsafe or unethical practices, and may—based on foreign precedents—expand dangerously. Robust societal investment in palliative care and social support are a superior alternative. Safeguards are subjective, and "airtight" law is impossible.

End of Summary