Modern WisdomDo We Have The Right To Die If We're Terminally Ill? - Diane Rehm | Modern Wisdom Podcast 288
CHAPTERS
- 0:00 – 0:48
Why Diane Rehm took on the “last taboo” of death
Diane Rehm explains that the book emerged from her documentary project and reflects a curated set of interviews from across the U.S. She frames end-of-life autonomy as a subject society avoids, but one that demands honest discussion.
- •Documentary preceded the book; the book draws from ~25 of ~50 interviews
- •Death as a culturally avoided topic and “last taboo”
- •Motivation to spark public conversation about end-of-life wishes
- 0:48 – 3:05
Personal losses that shaped her views on choosing the end
Rehm recounts multiple family experiences with suffering and self-inflicted death, grounding her advocacy in lived history rather than theory. These stories form the emotional and moral backdrop for her belief that individuals should have agency at the end of life.
- •Mother’s painful death from liver cancer and being unheard
- •Father’s death soon after, described as a “broken heart”
- •Father-in-law and mother-in-law both ended their own lives
- •Longstanding focus on personal choice about when life should end
- 3:05 – 5:29
What a “good death” looks like—and why planning matters
Rehm describes her preferred end-of-life scenario: at home, with loved ones, able to say goodbye. She argues that avoidance of death talk leads to defaults like hospital deaths with invasive interventions, rather than intentional, humane endings.
- •People avoid death talk; denial persists into adulthood
- •Planning can prevent unwanted hospital interventions and prolonged dying
- •Desired setting: home, loved ones present, ability to communicate and say goodbye
- •Core aim of the film/book: clarify what people want at the end of life
- 5:29 – 7:29
How medical aid in dying works in parts of the United States
Rehm outlines the legal framework in the states and DC where medical aid in dying is permitted. She emphasizes safeguards: prognosis requirements, second opinions, and assessments to reduce coercion, with the final act performed by the patient.
- •Legal in nine U.S. states plus Washington, DC (as described)
- •Eligibility typically requires a physician-confirmed prognosis of ~six months or less
- •Second doctor confirmation; sometimes psychiatric evaluation to ensure no pressure
- •Medication must be self-administered by the patient
- •Rehm states she intends to use this option when her time comes
- 7:29 – 10:36
When it’s not legal: the cost and inequity of “moving to die”
The conversation turns to what happens outside permitted jurisdictions, highlighting practical barriers that make access unequal. Rehm uses Brittany Maynard’s case to show how relocation, expenses, and time constraints shape who can exercise this choice.
- •Without legal access, people may need to establish residency elsewhere
- •Brittany Maynard moved from California to Oregon for legal access at the time
- •Severe symptoms (headaches, seizures, loss of function) drove her decision
- •Chose a date; after major seizures she proceeded and died peacefully
- •Relocation requires money, logistics, and job disruption—often impossible for many
- 10:36 – 11:50
Europe, Switzerland, and the line between assisted dying and euthanasia
Rehm and Williamson compare international approaches and clarify key terminology. They distinguish assisted dying (patient self-administers) from euthanasia (physician administers), noting different legal and ethical boundaries.
- •Some European countries permit forms of assisted dying (e.g., Netherlands, Belgium)
- •Switzerland discussed as allowing broader practices including euthanasia
- •Core distinction: who administers the final dose
- •In the U.S., physician administration is illegal (as discussed)
- 11:50 – 16:18
Gray areas, technicalities, and the ALS self-administration dilemma
Williamson probes ethical inconsistencies and practical quirks—especially cases where “self-administration” becomes a legal fiction. Rehm describes how jurisdictions try to reconcile autonomy with rules that prevent doctors from delivering the final dose.
- •Ethical question: what meaningfully changes if the patient vs physician triggers delivery?
- •Rehm notes covert practices like “extra” morphine doses historically occurring
- •Only about one in five Americans live where aid-in-dying is available (as stated)
- •ALS cases complicate swallowing/self-administration; Oregon explores workarounds
- •Rehm stresses the importance of family/doctor discussions regardless of stance
- 16:18 – 21:00
Arguments against medical aid in dying—and where mistrust comes from
Rehm summarizes key opposition blocs and their reasoning, emphasizing that objections are not monolithic. She highlights religious doctrine, medical paternalism, disability-rights concerns, and historic injustice driving distrust in healthcare systems.
- •Roman Catholic Church: life is sacred; only God should decide timing of death
- •Some physicians oppose due to duty to preserve life and desire for control
- •Disability community split: fears of coercion vs concerns about exclusion from access
- •African American mistrust tied to historical abuses (e.g., unethical experiments)
- •Fairness, trust, and safeguards are central to persuasion
- 21:00 – 23:53
Withdrawing treatment vs hastening death: different paths, similar outcomes
The discussion distinguishes stopping treatment from taking medication intended to end life. Rehm shares her husband’s Parkinson’s decline and his decision to voluntarily stop eating and drinking, portraying it as a harsh alternative when legal aid isn’t available.
- •Ethical tension: “pulling the tube” vs administering a lethal medication
- •Some choose to stop treatment and die peacefully; others face institutional barriers
- •Rehm’s husband had advanced Parkinson’s and felt dignity was gone
- •He used VSED (voluntarily stopping eating and drinking); death took 10 days
- •State laws shaped options; Maryland did not allow medical aid in dying
- 23:53 – 27:10
DNR failures, 911 realities, and “death cafes” as community preparedness
A story about a Do-Not-Resuscitate order being ignored in practice illustrates how systems default toward intervention. Rehm argues that beyond legal documents, community awareness and repeated conversations help ensure wishes are respected.
- •Even with clear DNR paperwork, calling 911 triggers mandatory resuscitation attempts
- •The patient was angry after being revived against her stated wishes
- •Rehm frames calling 911 as the first step in a chain toward unwanted intervention
- •“Death cafes” help neighbors and communities discuss end-of-life preferences
- •Talking about death clarifies values and reduces chaotic, traumatic outcomes
- 27:10 – 32:03
Aid in dying vs suicide—and why control can be the real “medicine”
Rehm differentiates terminal-illness aid in dying from non-medical suicide, emphasizing intent, context, and suffering. She notes that many who obtain the medication never use it—because having the option restores peace and perceived control.
- •Distinction: terminal illness and intolerable suffering vs not wanting to live without illness
- •Story of a young mother with metastatic cancer seeking to spare her child witnessing suffering
- •Many patients obtain medication but ultimately do not take it
- •Rehm cites roughly one-third not using it; two-thirds do (as described)
- •Primary benefit for some: comfort and autonomy from having the option available
- 32:03 – 41:37
When to have the conversation—and how to actually start it with family
Williamson admits he has never discussed end-of-life wishes with his parents, prompting Rehm to insist that waiting for a crisis is too late. She offers scripts and a realistic model: multiple, gradual discussions that normalize planning without panic.
- •Crisis-driven conversations are often “too late”
- •Responsibility belongs to anyone—parents or adult children can initiate
- •Suggested phrasing: framing aging, possible illness trajectories, and personal preferences
- •Expect initial resistance; the first talk plants a seed
- •Rehm reflects on never discussing death with her own mother and regrets the silence
- 41:37 – 51:38
Why the topic matters: legal risk, personal regret, and making meaning of mortality
Rehm recounts being warned not to help her husband due to legal jeopardy, underscoring how law can constrain compassion. The episode closes with practical resources and Williamson’s broader philosophy: confronting death to live more deliberately today.
- •Physician warned Rehm she could face serious trouble if she helped her husband die
- •Rehm describes the physical decline she witnessed and the cruelty of limited options
- •Resources: PBS documentary release, book, Compassion & Choices, Death with Dignity (as mentioned)
- •Williamson connects the discussion to Stoicism (memento mori) and seeking joy today
- •Closing reflections: normalizing discomfort to improve end-of-life outcomes
