* 1. What is your gender?

* 2. What age range do you fall into?

* 3. Physician-Assisted Suicide is a death in which the physician provides the information or means and the patient performs the act.
Euthanasia is a death in which the physician plays an active role in ending the patient's life.

Do you understand the difference between the two definitions?

* 4. Do you consider both to be acceptable practices?

5. If you feel both or either practices are acceptable, under what circumstances?

6. If you reject these practices, on what do you base your reason?

* 7. Are you aware of any areas in which physician-assisted suicide is legalized?

* 8. The states that have legalized physician-assisted suicide have implemented the following guidelines:
The patient must have a terminal prognosis of 6 months or less
The patient must have a willingness to die and express this multiple times
The patient must be competent to make medical decisions
A second physician must confirm the diagnosis and prognosis

Do you feel that these conditions are adequate?

* 9. Who has the right to decide whether to end the patient's life? (select all that apply)

* 10. Putting aside your personal beliefs, do you believe physician-assisted suicide will become legal in more states?