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Exit Survey
 
 
Nationality
 
a) American
 
 
b) British
 
 
c) Chinese
 
 
d) European
 
 
e) Canadian
 
 
 
Gender

 
a) Male
 
 
b) Female
 
 
 
Age
 
a) Under 18
 
 
b) 18 – 24
 
 
c) 25-29
 
 
d) 30 – 40
 
 
e) 40 or above
 
 
 
Religion
 
a) Christianity
 
 
b) Hinduism
 
 
c) Islam
 
 
d) Buddhism
 
 
e) Jewish
 
 
f) Atheism
 
Other
 
 
 
 
Political Persuasion
 
a) Democratic
 
 
b) Republican
 
 
c) Independent
 
 
d) Communist
 
Other
 
 
 
 
In your opinion, which of the following best describes your definition of euthanasia?
 
a) Murder
 
 
b) Merciful death
 
 
c) Assisted suicide
 
 
d) Death with dignity
 
 
e) Right to die
 
 
 
Should you have a right to choose life or death?
 
a) Yes
 
 
b) No
 
 
c) Not sure
 
 
 
4) From the following list, choose the reason(s) why a person will choose death over life support:
 
a) Terminal illness
 
 
b) Intense pain
 
 
c) Prolonged suffering
 
 
d) Burden on family/friends
 
 
e) Wastage of financial resources
 
 
g) All of the above
 
 
f) None of the above
 
 
 
5) From the following list, select the reason(s) why you will choose to keep someone on life support:
 
a) Young age
 
 
b) Strong attachment
 
 
c) Hope
 
 
d) None of the above
 
 
e) All of the above
 
 
 
6) Which of the following would you consider as a reason(s) for euthanizing your loved one:
 
a) Terminal Illness
 
 
b) Curable illness but insufficient funds for treatment
 
 
c) Prolonged Suffering
 
 
d) Emotional burden
 
 
e) None of the above
 
 
f) All of the above