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.

1 minute to complete


Any family member of a patient who is considering euthanasia may fill out this form.


Questions for Family Consent On Euthanasia Form



What is your relationship to the patient?

The answer should be a text input.

Do you agree with the decision to euthanize the patient?

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

What are your reasons for agreeing or disagreeing with the decision?

The answer should be a text input.

Have you discussed this decision with all other family members?

The answer should be a text input.

Are there any other factors that you feel we should consider before making this decision?

The answer should be a text input.

Do you have any questions that you would like to ask us about this process?

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

Is there anything else that you would like to add?

The answer should be a text input.

Ideas Similar to Family Consent On Euthanasia Form

  • Advanced directive
  • Do Not Resuscitate (DNR) order
  • Living will

Here are some FAQs and additional information
Family Consent On Euthanasia Form

What is euthanasia?

Euthanasia is the act of deliberately ending a person's life in order to relieve them of suffering. This can be done either by administering a lethal substance or by withholding life-sustaining treatment.

What is the difference between active and passive euthanasia?

Active euthanasia involves directly causing a person's death, usually through the administration of a lethal substance. Passive euthanasia, on the other hand, involves withholding life-sustaining treatment, such as food and water, which ultimately results in the person's death.

Why do people want euthanasia?

There are a number of reasons why people may want to end their lives. Some people may be suffering from a terminal illness and want to avoid a prolonged and painful death. Others may simply feel that their quality of life is so poor that death is preferable.

Is euthanasia legal in the United States?

Euthanasia is not currently legal in any form in the United States. However, there are a number of states that have introduced legislation that would allow for some form of assisted suicide, which is a closely related concept.

How would a family consent to euthanasia?

If a family member is considering euthanasia, they would first need to discuss it with their doctor. The doctor would then assess the person's mental state and whether they are competent to make the decision. If the doctor believes the person is competent, they would then need to obtain written consent from the family member.

Want to use this template?

Loved by people at home
and at work

“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
“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
Editor's choice
BlockSurvey social proof
4.9 Star Rating

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

1000+ Templates, 50+ Categories

Want to create secure online forms and surveys?

Join BlockSurvey.