Years ago I attended a seminar on death and dying.
This is the questionnaire that was passed out at the end of the seminar.
Needless to say, there was not a dry eye at the end of the day
and never before have I had such a personal learning experience in sensitivity to end of life issues.

IF I COULD CONTROL THE END OF MY LIFE...

Instructions: Take a few moments to think what you would want to happen at the end of your life.
Fill in the blanks with the answers that you believe are true for you.

1 - I want to die when I am _____ years old.

2 - I hope my mate/significant other dies (circle one) before/after me.

3 - I would prefer to die of (event/illness) _________________.

4 - When I die, I want to be: ____ Alone ____ With my mate/significant other
____ With my whole family ____ With a health professional

5 - It's important for me to live at least until __________________.

6 - I (circle one) do/do not want to be aware that I am going to die.

7 - I want to be (check one): ____ Awake and alert until the last moment. ____ Peacefully unconscious at the end.

IF I AM TERMINALLY ILL

You have just been told that you have a terminal illness and have only a few months to live.

1 - Who would you tell?

2 - Who would you not tell?

3 - How would you tell/disclose this information?

4 - How do you believe you would feel in this situation?

REMEMBER ME

Identify the individual who would be most likely to give the eulogy at your funeral if you were to die today.
Write the eulogy that you believe that individual would give on your behalf.

To further explore this subject: Life Before Death... http://www.wellcomecollection.org/explore/life-genes--you/video.aspx