undefined
HomeAll templateseuthanasia surveyeuthanasia consent form

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.

Time to complete

1 minute

Eligibility

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

undefined

Questions for Euthanasia Consent Form

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.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Euthanasia Consent Form

1000+ Templates, 50+ Categories

Explore more
undefined
Physician Consent On Euthanasia Form
The Physician Consent on Euthanasia Form is a document that is used by a physician to give their consent to performing euthanasia on a patient.
undefined
Euthanasia Legalization Survey
The Euthanasia Legalization Survey is a survey used to gauge public opinion on the Legalization of euthanasia. The survey asks respondents whether they think euthanasia should be legalized, and if so, under what circumstances. The survey also asks respondents whether they have ever considered euthanasia for themselves or for a loved one, and if so, why.
undefined
Attitudes Of World Religions On Euthanasia Survey
The attitudes of world religions on euthanasia can be quite varied. Some religious groups may see it as a way to end suffering, while others may see it as a form of murder.
undefined
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.
undefined
Physician Thoughts On Euthanasia Survey
Physician thoughts on Euthanasia Survey is a research study that is looking at how physicians feel about euthanasia.
undefined
Euthanasia In Animal Shelters Survey
The Euthanasia in Animal Shelters Survey is a study that was conducted in order to determine the opinions of the general public on the subject of euthanasia in animal shelters.
undefined
Understanding Public Acceptance Of Euthanasia
The public's acceptance of euthanasia is an important factor in its legality and implementation. While there is no single answer to the question of whether or not the public accepts euthanasia, surveys and polls suggest that public opinion is divided on the issue. Some people believe that euthanasia should be legal in certain circumstances, while others believe that it should be illegal under all circumstances.
undefined
Animal Euthanasia Report Form
The Euthanasia Report Form is used to document the administration of euthanasia to an animal.
undefined
Family Consent On Euthanasia Form
The Family Consent on Euthanasia Form is a document that is used by families to provide their consent for a loved one to be euthanized. This form is used to ensure that all family members are in agreement with the decision to end the life of their loved one.
undefined
Public Acceptance Of Euthanasia Survey
The Public Acceptance Of Euthanasia Survey was conducted to measure public opinion on the issue of euthanasia. The survey found that a majority of respondents were in favor of euthanasia, with only a minority opposed to the practice. The results of the survey suggest that the public is largely supportive of euthanasia, and that this support is growing over time.

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE