Medical aid in dying (and Moral Economics) on Freakonomics Radio

 The latest episode of Freakonomics looks at the controversies and philosophies involved in the growing legalization of medical aid in dying (MAID).  Stephen Dubner interviews people with multiple perspectives, and offers a personal insight of his own.

"DUBNER: I have a sister who died last year, it was a pretty rotten death, honestly, and she wanted to hasten it. We couldn’t physically orchestrate it. And it really made me see this issue in a new way. It just seemed, you know, I don’t want to say the scales fell from my eyes, but I’d never encountered it first-hand. And it made me think that almost anyone who did encounter it first-hand might have a reckoning, might be in favor of it. But I don’t know, maybe that’s just me. Do you have any sense of how broad the support is for it generally?

ROTH: We’re an aging population, so I think not only do more people have a reason to contemplate their own death, but more people know a peer who’s died, and certainly parents have died, and relatives, you know, siblings and friends. So I would think that anyone who’s seen an agonizing death should at least give some thought to whether we should be legalizing medical aid in dying." 

You can listen or read the transcript at this link:

Who Gets to Choose a “Good Death”?
New York is the latest state to legalize medical aid in dying. Stephen Dubner speaks with the governor who signed the law, a Nobel Prize-winning economist, a death doula — and an ethicist who thinks the very idea is wrong.

 "SOURCES:
Kathy Hochul, governor of New York.
Suzanne O'Brien, death doula, founder of Doulagivers Institute.
Al Roth, economist at Stanford University.
Daniel Sulmasy, physician, philosopher, director of the Kennedy Institute of Ethics at Georgetown University.

RESOURCES:
Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work, by Al Roth (2026).
"New York Moves to Allow Terminally Ill People to Die on Their Own Terms," by Grace Ashford (New York Times, 2025).
The Good Death: A Guide for Supporting Your Loved One through the End of Life, by Suzanne O'Brien (2025).
The Future of Assisted Suicide and Euthanasia, by Neil Gorsuch (2009).
EXTRAS:
"Make Me a Match (Update)," by Freakonomics Radio (2023).
 

 

Starzl Lecture: "The Economics of Kidney Exchange," Sunday at the American Transplant Congress in Boston

 I'll be speaking Sunday at the American Transplant Congress, on kidney exchange.  It will be hard to squeeze in all the recent developments in my half hour, including current controversies.

State-of-the-Art Speakers:  Transplantation’s leading luminaries and innovative thinkers will share inspiring research and insights at ATC 2026.  
 
Alvin E. Roth, PhD: 
Thomas E. Starzl State-of-the-Art Lecture: The Economics of Kidney Exchange

Sunday, June 21: 11:00 AM ET 

 

 

 

When people rely on A.I. to avoid ethical challenges

 HBS puts the spotlight on a paper by Alex Chan.

When AI Gives Advice, Employees Rarely Ask Why   Featuring Alex Chan. By Ben Rand

"People increasingly trust AI to make decisions—but research by Alex Chan finds they avoid evaluating the algorithm's rationale if it causes moral discomfort. How can organizations encourage employees to think more critically? "

 

Here's the paper:

Preference for Explanations: Case of Explainable AI
By: Alex Chan   Harvard Business School Working Paper, No. 26-028, November 2025.


Abstract
Participants acted as loan officers deciding whether to approve real $10,000-loans issued by a private U.S. lender using an AI’s default-risk predictions. When explanations revealed that the AI penalized non-White or female borrowers, participants were more likely to override the AI’s profit-maximizing recommendation. When their bonuses depended on repayment, however, they sought predictions but avoided explanations, consistent with willful ignorance; this effect disappeared when explanations were framed as purely financial or demographics were hidden. A secondary experiment reveals a novel bias: participants failed to reason contingently and undervalued explanations even when these complemented private information and improved decision accuracy.
 

A chef makes the case for foie gras, and addresses the concerns regarding animal welfare

I'm no expert on the production of foie gras, but I am glad to see arguments about repugnant transactions and controversial markets that take seriously the concerns of opponents.

The Washington Post has the story.  

Why I’m proud to serve foie gras.  But first, let me take your concerns seriously.   By Bart Hutchins
Bart Hutchins is the chef and owner of Butterworth’s in Washington, D.C.

"There is now a proposed ballot initiative moving through Washington that would ban foie gras entirely. No producing it, no selling or serving it. Fines between $1,000 and $5,000 per violation. License suspension for repeat offenses

...

""I am asking you to not sign the petition. But first I want to do something the other side rarely does, which is to take their concerns seriously.

"Gavage — force-feeding through a tube inserted down a bird’s throat — looks terrible. I know because I have seen it. I understand completely why someone sees footage of it and reacts with horror. If you imagine the same thing done to human beings, it looks like violence.

"But here is what I also know, and what the activists with the megaphones do not know and do not want to know because it would complicate the argument they have decided to make.

...

' A duck’s esophagus, where the gavage tube is inserted, is desensitized, without a gag reflex, and it is capable of swallowing whole crustaceans and scaly fish in the wild. Its windpipe is separate from the esophagus, meaning the gavage process has no impact on breathing. More importantly, this overfeeding is something the bird does naturally. Before their annual migration, ducks gorge — they stuff themselves with excess food. The calories are stored as fat, not only in the liver but in the expanded esophagus. (The verb “gorge” comes from this behavior.) What foie gras farming does is amplify a natural biological process rather than invent a cruel one .

...

"The producer I buy foie gras from exemplifies the kind of care and attention good farming demands. Their ducks are raised for 15 weeks, about twice the poultry industry standard, in open barns, on a vegetarian diet. Force-feeding by hand happens three times a day for the final three weeks. Each feeding takes approximately 1½ seconds, and, from my observation, the ducks barely seem to notice it."   

#######

My previous posts about foie gras. 

  

Horsemeat, Prostitution and Kidney Sales, interview by Peter Coy

 Peter Coy interviewed me about Moral Economics for his substack Economics for Everyone.

You can find the video and the transcript at this link: 

Horsemeat, Prostitution and Kidney Sales  by Peter Coy 
"Nobel laureate Al Roth tackles them all in a fine new book. I interviewed him."

"I asked Roth if he’s a libertarian, since libertarians say people should be free to do what they want as long as it doesn’t hurt others. No, Roth told me.

“People who call themselves libertarians often don’t like market regulation of any sort, but I’m a market designer,” Roth said. “I think that good regulations help markets work well.”

 ############ 

 Peter C. interviewd me once before:

Tuesday, February 6, 2024

Kidney exchange (and other bits of market design) in the New York Times

" Peter Coy, the veteran New York Times economics columnist, writes about kidney exchange, after an interview/conversation sparked by a recent working paper of mine, Market Design and Maintenance. (He's a rare economic journalist who reads economists' papers.)

Here's his column, published yesterday afternoon:

The Economist Who Helped Patients Get New Kidneys, Feb. 5, 2024, 3:00 p.m. ET, By Peter Coy

He's also a rare interviewer: his column includes the names of more of my coauthors than I can recall in any other interview. In order of appearance: Tayfun Sonmez and Utku Unver, Frank Delmonico, Susan Saidman, Mike Rees (implicitly) when he names Mike's nonprofit Alliance for Paired Kidney Donation, and Elliott Peranson.  Market design is, after all, a team sport."

 

European Workshop on Market Design #6, 17 — 18 June 2026, in Paris

 Coming up this week.

European Workshop on Market Design #6

17 — 18 June 2026

• Home
• Outline
• Program
• Venue
• Contact

The 6th edition of the European Workshop on Market Design (2026 EWMD) holds at

Université Panthéon-Sorbonne (Paris 1)
12 Place du Panthéon
75005 Paris,

The 2026 Lecture in Memory of Nora Szech (1980-2023) will be given by Klaus Schmidt (Ludwig-Maximilians-University Munich).

Speakers:

Nageeb Ali, Penn State University

Mira Frick, Princeton University

Guillaume Haeringer, Baruch College

Ilan Kremer, University of Warwick

Philippos Louis, University of Cyprus

Justus Preusser, Bocconi University

Agathe Pernoud, Chicago Booth

Cyril Rouault, GRANEM, University of Angers and Centre for Economics at Paris-Saclay

Anna Sanktjohanser, Toulouse School of Economics

Klaus Schmidt, Ludwig-Maximilians-University Munich

Nikhil Vellodi, Paris School of Economics

Maren Vairo, University of Pennsylvania

Organizing Committee

Nina Bobkova, Rice University

Olivier Bos, ENS Paris-Saclay, Centre for Economics at Paris-Saclay

Nicolas Fugger, University of Cologne & ZEW Mannheim

Daniil Larionov, University of Munster

Marion Ott, ZEW Mannheim

Xiangyu Qu, Unviersity Paris 1 Panthéon-Sorbonne

 

Organ Allocation and Transplantation, by Ashlagi and Roth, forthcoming in Annual Review of Economics 2026

 Here's a  forthcoming review paper on organ allocation and transplantation that focuses on the allocation of deceased-donor organs, particularly kidneys, and goes through the whole supply chain, from donor registration and family consent after death, to patient prioritization, and organ allocation. We also discuss the regulatory and political practices and ethical concerns that keep the availability of transplants far short of their need.

Organ Allocation and Transplantation
by Itai Ashlagi and Alvin E. Roth, Annual Review of Economics   
Vol. 18 https://doi.org/10.1146/annurev-economics-092425-123425
Review in Advance first posted online on June 08, 2026. (Changes may still occur before final publication.)
 
Abstract: There is a large shortage of solid organs for transplants. This survey reviews the allocation of organs (particularly kidneys), with an emphasis on how deceased donor organs are obtained and allocated in the United States but with pointers to related issues involving living donors and transplantation around the world. We review some of the key institutional details and theoretical and empirical studies and describe some open questions that we hope will continue to attract attention from researchers interested in the economic and operational aspects of organ allocation. 

 

The paper ends with a set of open questions and research directions, followed by these concluding paragraphs about the future:

 "THE DAY AFTER TOMORROW

"Efforts to quickly improve the availability of transplants include recovering more transplantable organs from deceased donors, successfully transplanting more of those recovered organs, and facilitating more living donor organ transplants of kidneys and livers. In the longer term, efforts are under way to reduce the need for human organ transplants by reducing the need for re-transplantation (after graft failure) and by preventing organ failure or curing it by other means. 

"It is common to hear that xenotransplantation is tomorrow’s cure for organ failure, and always will be. However, recent developments in transplanting organs from genetically modified pigs into primates and humans suggest that the future possibilities are real, even though (as of this writing) no pig organ transplant to a human has yet survived for as much as a year (although there have now been some pig kidney and heart transplants that worked for months; Tector 2025). Another somewhat related approach involves trying to bioengineer an artificial kidney by removing from a pig kidney the pig cells that would be attacked by the human immune system, leaving a scaffold that could be populated with human kidney cells (Lo et al. 2024). Less developed so far is the hope of regrowing kidneys through some kind of stem cell manipulation, although some kidney cell growth in mice has been achieved (Araoka et al. 2025).
 

"Each of these lines of research offers the possibility of reducing or ending the need for, and hence the scarcity of, human organs for transplantation. That scarcity would also be reduced by medical progress in reducing the incidence and progression of kidney disease and its precursors and of other kinds of organ failure that now require transplantation.  Yet it remains likely that almost everyone whose life could be extended by a human organ transplant today will die without one, and so our attention to the shortage of transplants is still needed."