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Euthanasia Consent Form

The Euthanasia Consent Form is a document that allows an individual to give their permission for someone else to end their life. This form is typically used when an individual is suffering from a terminal illness and they wish to have their life ended rather than continue to suffer.

1 minute to complete

Eligibility

The Euthanasia Consent Form is available to any individual who is suffering from a terminal illness.

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Questions for Euthanasia Consent Form

Questions

1.

Are you suffering from a terminal illness?

The answer should be a text input.
2.

Do you wish to have your life ended rather than continue to suffer?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
3.

Do you understand that once this form is signed, someone else will be able to end your life?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
4.

Do you give your consent for someone else to end your life?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
5.

Are you sure that you wish to sign this form?

The answer should be a text input.

Here are some FAQs and additional information
on Euthanasia Consent Form

What is euthanasia?

Euthanasia is the intentional killing of a person for the purpose of relieving them of their suffering. This can be done either by lethal injection or by removing life-sustaining treatment, such as a ventilator.

Who can consent to euthanasia?

Only the person who is experiencing the suffering can give their consent to euthanasia. In some cases, such as when the person is not competent to make decisions, their surrogate decision-maker may give consent on their behalf.

What are the requirements for consenting to euthanasia?

In order to consent to euthanasia, the person must be of sound mind and must be able to make a decision free of coercion. The person must also be informed of all of their treatment options and must understand the risks and benefits of each option.

What are the risks of euthanasia?

The risks of euthanasia include the possibility of pain during the procedure, the possibility of complications from the procedure, and the possibility that the person may not be truly suffering and may not be making a fully informed decision.

What are the benefits of euthanasia?

The benefits of euthanasia include the relief of suffering for the person who is experiencing it and the ability to die with dignity.

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