* 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?