Survey: Please respond anonymously to keep information confidential and private
Hello, my name is Stephanie. I am currently conducting a research on public opinions about the legalization of voluntary euthanasia. Voluntary euthanasia is the practice in which a doctor or physician induces death with a lethal injection to a consenting patient. I hope you will be able to spare 5 to 10 minutes completing this short survey. Please note that all information will be kept confidential, and it is used only for the purpose of this research study. Thank you in advance for your time!
Age:
Gender:
Occupation:
Field of Interest:
1. Do you believe that doctors should be legally given the right to end the life of a patient at their request?
Yes □ No □ Not Sure □
2. In your opinion, which age group should be eligible for voluntary euthanasia? You may check more than one box.
0-5 □ 6-10 □ 11-20 □ 21-30 □ 31-40□ 41-50□ 51-60□ 61+ □
3. Do you think that a patient’s request for euthanasia might be caused by clinical depression which could be treated by therapy and support?
Yes □ No □ Not Sure □
4. A young girl was born quadriplegic, and was bedridden since the beginning of her life. She has several seizures a day, and is operated on several times as a child. Prior to another operation, her father kills her, claiming his actions were motivated by his love for her. Was it right for him to end his daughter’s life? Feel free to express your opinions below.
(a) Was it right for him to end his daughter’s life? Yes □ No □ Not Sure □
(b) Did you consider the option that his claim might be an excuse for other motivations? Yes □ No □ Not Sure □
5. Further Comments (Optional):
Thank you for completing this survey!
Age:
Gender:
Occupation:
Field of Interest:
1. Do you believe that doctors should be legally given the right to end the life of a patient at their request?
Yes □ No □ Not Sure □
2. In your opinion, which age group should be eligible for voluntary euthanasia? You may check more than one box.
0-5 □ 6-10 □ 11-20 □ 21-30 □ 31-40□ 41-50□ 51-60□ 61+ □
3. Do you think that a patient’s request for euthanasia might be caused by clinical depression which could be treated by therapy and support?
Yes □ No □ Not Sure □
4. A young girl was born quadriplegic, and was bedridden since the beginning of her life. She has several seizures a day, and is operated on several times as a child. Prior to another operation, her father kills her, claiming his actions were motivated by his love for her. Was it right for him to end his daughter’s life? Feel free to express your opinions below.
(a) Was it right for him to end his daughter’s life? Yes □ No □ Not Sure □
(b) Did you consider the option that his claim might be an excuse for other motivations? Yes □ No □ Not Sure □
5. Further Comments (Optional):
Thank you for completing this survey!