Any family member of a patient who is considering euthanasia may fill out this form.
What is your relationship to the patient?
Do you agree with the decision to euthanize the patient?
What are your reasons for agreeing or disagreeing with the decision?
Have you discussed this decision with all other family members?
Are there any other factors that you feel we should consider before making this decision?
Do you have any questions that you would like to ask us about this process?
Is there anything else that you would like to add?