The World Federation of Right to Die Societies counts twenty-three countries as members and engages in international advocacy work to promote PAD (physician-assisted death). Faults in medical management of dying in America and international advocacy for PAD also set stage for spirited battles in the courts, voting booths, and state legislatures. The central pillar in the case for PAD is principle of personal autonomy, the idea that individuals should be able to act according to their own wishes and free of coercion from others. The principle played a central role in developing the Patient Self-Determination Act which set the standard for informed-consent regulations in all health care settings. It is important to note that case for PAD is contingent on the concept of suffering, frequently interpreted in the reductionist terms of physical pain. Advocates of PAD argue that it is the disease that is killing the person and that the lethal drug made available by physician under legal guidelines.