CAROLINE PEAY

1379 Cherry Drive | (803)768-2309 | carolpeay@yahoo.com

April 25, 2016

Richard Kronick
Director, Agency for Healthcare Research and Quality
U.S. Federal Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Director Kronick:

My name is Caroline Peay and I attend the University of South Carolina. I am reaching out to you
regarding the federal implication of physician-assisted suicide (PAS). As you are the head for healthcare
research and quality, I thought it was most appropriate to inform you of the research I have found and
analyzed in hopes to spark interest within your office. Thus resulting in better quality healthcare options for
terminally ill patients. As of right now these terminally patients have to travel and uproot their life more so
than it already has been, to move to another state to receive specific attention from a willing physician
because in many states it is not legal to supply them the means to die with dignity. If you were to support
this federal implication of PAS, it would be beneficial and ethical, for the individuals and doctors and
society as a whole, as everyone should have this fundamental right under the Fourteenth Amendment, but
more humanely a person deserves an easy alternative to their excruciating and everlasting suffering.
Found below are some of the most prominent argumentative points I have discovered through researching
this controversial issue and I hope you will take the time to read and look through what I have found so
far.
There are numerous benefits and disadvantages surrounding the argument of federally
implementing PAS. One of the main debates is that citizens have the right to die. Under the Death With
Dignity Act there is strict implications physicians must follow when prescribing the medication for patients
wishing to die. The attending physician must, among other things, determine that the patient is mentally
competent and an Oregon [or other legislated state of PAS] resident, and confirm the patients diagnosis
and prognosis (Tucker 1602). The benefit of having the right to die for competent, terminally ill patients is
described by Ziegler and Bosshard as, a choice among a continuum of options at the end of life (297).
Under the Fourteenth Amendment these competent and terminally ill patients should have a choice and
their right to die protected because they are promised equality and ownership of their own body. The

counter argument of this benefit defends that PAS is not legal in all states and because of this the
asserted right to assistance in committing suicide is not a fundamental liberty interest protected by the
Due Process Clause (Washington v. Glucksberg 1997). Although this is arguing that PAS is not legal and
therefore people should not feel inclined to have the right to participate in suicide whether they be on the
receiving or administering side. However, PAS is legal in some states and thus allows the right to suicide.
Despite the fact that currently only five states, Oregon, Montana, Washington, Vermont, and California,
lawfully allow PAS under the Death with Dignity Act many more are soon to arise. Although countless
states will try for legalization, the reality is they will fail in their first attempts and possibly even the
attempts after that. Here is where you come in. If we were to federally implement the law instead of
waiting for approval for each separate state, the dividing of which state citizens have a right to suicide
would cease because it would be a fundamental liberty in the interest of the people.
Another predominant argument for the benefit of federally legalizing PAS is that patients who are
experiencing a grueling life ending illness would no longer have to. Patients would no longer have to
uproot their life to move to another state and go through the process of becoming a resident to seek
treatment from a willing physician. Patients would no longer have to live a life in a vegetable like state or
be dependent on life-sustaining treatment. According to B Steinbock, the [ethical] argument from
suffering asserts that it is cruel to force a dying patient whose pain cannot be controlled with medication to
continue living. It is undeniable that many terminally ill patients die in terrible pain (235). Although there
are valid cases of possible intentional or unintentional physician misconduct and patient harm from PAS,
the final and most crucial counter argument to this is that by not legalizing PAS, it condemns the patient
to live out a life he or she does not want a form of cruelty that violates the patients rights and prevents
discharge of the fiduciary obligations of the physician (Shaw 320). If federal implementation of PAS were
to occur, a physician would have a new code of conduct or oath to abide by from the government that
specifically regards the conduct of PAS. Therefore, decreasing the likelihood of abuse or misconduct.
Ultimately, there are an ample amount of benefits and disadvantages of PAS and those mentioned
above, although they are the primary debates, do not consider and include all arguments. It is noted that
overtime PAS has the potential to reduce the cost of healthcare within the United States (Battin, Emanuel,
1998). Organ donation after ones death in order to save another persons life is also seen as a beneficial
factor of PAS. More specifically, PAS may save the life of another person who does not have a life ending
illness, but only a general illness and who have a chance of surviving a considerable while longer.
Furthermore, the availability of PAS may have contributed to the improvement of end-of-life-care
(Steinbock 238). Meaning citizens who had the opportunity to request PAS were exposed to a more in
depth and effective discussion with their physicians about alternative options if they couldnt proceed with
the lethal medication. In essence, if the federal government were to legalize PAS and give citizens the
option of their right to die, it could in reality increase alternative end-of-life care instead.

Although the overall debate is relatively the same, PAS currently affects each individual differently
depending on which state they reside in. If the government were to federally implement PAS, all citizens
would be affected in the same way and each would benefit more so than before. Citizens would be given
their right to when they die, how they die and where they die in order to relieve them of excruciating pain
due to a terminal illness. Conclusively, the benefits of implementing such a legislation nationally cannot be
deemed as unethical by the United States and therefore unacceptable by both physicians and the public.
As mentioned before, this is only a selected amount of my research and would be willing to send
more or verify the use of sources with you shall you show interest in this matter. However, thank you for
your time and consideration in the first place and I strongly urge you to support legislation providing
terminally ill patients the opportunity of physician-assisted suicide.

Sincerely,

Caroline Peay