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Questions about euthanasia and death with dignity

Request of the questionnaire



I'm doing the next questionnaire survey as the part of the graduation study. Please cooperate.


operation.

I’m a 4th year undergraduate student at the University.
I’m part of the Social Welfare Studies at school, and need to gain some primary research, I have there fore decided to create a questionnaire and be grateful if you could answer a few questions.
The main purpose of this questionnaire is to understand how people know about euthanasia and passive euthanasia death with dignity. Your feedback will help me finish my final exam in statistics and graduation research. The date was made for non-profit-making purpose, applicable only for academic purposes. I will make greater efforts than ever to protect personal information and privacy.
Appreciate your time and generosity foo participation in this questionnaire. You answers will only be used statistics and as information for my graduation research essay.

Please surround the number which applies about the following item or is closest with a circle.

問 1. Where do you live?

問 2. How long do you live this country?

問 3. Are you male or female?

male
female

問 4. What age group do you fall into?

10s
20s
30s
40s
50s
others

問 5. Do you believe in something religion?

yes
no

問 6. Does your grandparents live with you?

yes
no

問 7. If yes, how many years?

問 8. Do you know what is the different between euthanasia and death with dignity?

yes
no

問 9. Do you agree or disagree the euthanasia?

agree
disagree
not applicable(N/A)

問 10. Please let us know the reason for your choice.

問 11. Do you agree or disagree the death with dignity?

agree
disagree
N/A

問 12. Please let us know the reason for your choice.

問 13. How do you think about if your family wished for euthanasia?

agree
disagree
N/A

問 14. Please let us know the reason for your choice.

問 15. Would you like for euthanasia if you need?

will
will not
N/A

問 16. Please let us know the reason for your choice.

問 17. How do you think about if your family wished for death with dignity?

agree
disagree
N/A

問 18. Please let us know the reason for your choice.

問 19. Would you like for death with dignity if you need?

will
will not
N/A

問 20. Please let us know the reason for your choice.

問 21. Do you know about “Dignitas”?

yes
no

問 22. If you have any other comments or opinions that you can share with us, please describe in below form.