Create a questionnaire that lists 15 interview questions you would ask your patients or their family members regarding Death with Dignity and end of life/palliative care for the patient. Ask your questions to a friend or family member, and document their answers in a Word document in question/answer format.

Be sure to include this question: Do you agree with the Death with Dignity Act, why or why not?

questionnaire:

1- do you think that to die intubated is to die in an unworthy way?

2- would you allow a family member to decide about your life in case you have not previously authorized it in writing in an affidavit?

3- to what extent do you consider that intensive therapy treatment is worthy?

4- Are you willing to collaborate with organ donations to make the lives of other people continue in a dignified way?

5- would a relative of more than three months be admitted in a vegetative state?

6- Would you be hospitalized in a vegetative state for more than three months?

7- Would you allow the use of your living organism as study material or trial and error of drugs in terminal stages?

8- Would you allow to see a member of your family suffer from severe pain for more than a year?

9- Would you accompany a family member strictly during the entire intensive care hospitalization every day of your therapy so that you have more hope of improvement?

10-Could I leave it up to medical professionals to decide when it is a decent life or not?

11- What is decent health for you?

12-Until what pain threshold do you consider worthy to bear?

13-Could I endure inactive treatments for more than two years?

14- Could it withstand extreme isolation in cases of immunosuppression? if true, indicate for how long

15- Do you agree with the Death with Dignity Act, why or why not?

Explanation:

34-year-old questioned person, female, name: Catalina

 the questionnaire was answered as follows:

1- yes

2- no

3- until the day the death occurs

4- no

5- yes, if he asked me or clarified previously. Otherwise not.

6- yes

7- yes

8- no

9- yes

10- yes, but before taking into account the professional experience of the doctor

11- That it respects all the main human rights

12- up to intense stabbing pain, approximately level 7

13-yes

14- yes

15- Yes, since I consider death to be the end of our lives and we must withdraw from this world with dignity respecting human rights