Death and Dying Survey

* What is your age?

Younger than 18
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85 or older

Do you identify with any of the following religions? (Please select all that apply)

How important is religion (or spirituality) to you in your daily life?

Do you believe in any of the following concepts?

How concerned are you with the question of what happens (to one's consciousness, soul, etc.) after death?

Do you ever think about how you would prefer to die?

Yes, I Often Think About That	I Think About That Sometimes	I Might Have Thought About That a Little Bit	I'd Prefer Not To Think About That	No, I Never Think About That

Do you ever experience anxiety over the manner in which you will die?

Yes, Often	Yes, Sometimes	Rarely, If Ever	No, Never

If you do experience any anxiety over the manner of your own death, does
a fear of having others make important decisions for you without your
consent factor into that anxiety?

Yes, The Thought Terrifies Me	Yes, That Is A Matter of Some Concern	That Might Have Something to Do With It	I Don't Think That Has Much To Do With It	No, That's Not Something I'm Anxious About	N/A

Have you ever discussed your own wishes regarding how you would like to die with friends or family?

Yes

No

I can't recall

Which of the following statements do you agree with? (Please select all that apply)

Science trumps Religion

Religion trumps Science

[Some or All] Religious/Spiritual phenomena can ultimately be reduced to Scientific explanations

Genuine Religious/Spiritual experiences are ultimately beyond the scope of Scientific inquiry

Rational Fundamentalism in the Scientific community can be just as dogmatic as its Religious counterparts; I adhere to neither.