Euthanasia causes deep distress to the doctors who perform it, according to a new book about the experiences of medical practitioners in Belgium where assisted suicide has been legal since 2002.
The revelations come as a new assisted suicide bill is due to get a second reading in the House of Lords this autumn. Baroness Meacher's private member's bill got its first reading in May.
'Euthanasia: Searching for the Full Story - Experiences and Insights of Belgian Doctors and Nurses' is edited by Timothy Devos, Professor of Medicine at the Catholic University of Leuven.
Francois Trufin, a hospital emergency nurse and president of the ethics committee of a neuropsychiatric centre in Namur, wrote one of the nine chapters in the book. He describes the devastating effect that performing euthanasia is having on doctors.
"More often than not I have been a direct or indirect witness to the deep distress doctors experience when they perform euthanasia," he writes.
"Such was the experience of a qualified doctor who told me he had performed euthanasia several times in the care institution where he works.
"His eyes filled with tears as he confessed that some nights he wakes up in a sweat, seeing the faces of the very people he has euthanised in front of him."
The book also describes the devastating impact of euthanasia on the close family of people who die in this way.
In his chapter on 'The Slippery Slope Syndrome', palliative care nurse Eric Vermeer describes the "great distress" of a nurse whose husband had requested euthanasia but had instructed her not to tell him when it would be performed. She opened up to Vermeer after a lecture he gave about euthanasia.
"I took the time to listen to her and I learned that she had just experienced the euthanasia of her husband.
"This nurse was in great distress. This is what she told me: 'My husband was euthanized and I am not even certain that he met the conditions of decriminalization. He was indeed suffering, but the medication relieved his pain. For days and days, I asked myself what was the right day to make him die, but I could not even speak to him about it. Finally, together with the doctor, we agreed on a date, but since I had promised to say nothing to him, I was not able to say to him, "I love you," or "Thank you". The day of his euthanasia both of us died - he physically and I mentally."
Vermeer describes how she "melted into tears".
"[A]nd I had no words to offer but only silence," he continued.
"It seems more and more obvious that the grieving process is much more difficult when death has been given intentionally. The more natural death is, the more natural the grieving process is as well."
In his chapter, 'When Conscience Wavers - Some Reflections on the Normalization of Euthanasia in Belgium', Williams Lemmens, Professor of Modern Philosophy and Ethics at Antwerp University, argues that offering or performing the act of euthanasia is "a deeply morally charged existential transgression".
"It affects the physician inevitably as a human being and gives him or her a power which is from a juridical point of view immense," he said.
"No matter how you turn it, the depenalization of euthanasia allows a doctor to break a commandment on which in principle the entire legal order is built.
"Because of this transgressive nature, I believe that euthanasia can never be conceived of as a purely procedural act, which follows the logic of supply and demand," he writes.
In her chapter, palliative care doctor Marie Frings points out the deep experiential difference for a medical practitioner between "causing death and letting someone die naturally".
"After euthanasia, there is a chilling silence in the ward, nothing like the reflective silence following a natural death, even when it has been difficult, like the death of a young person whom we have looked after for a while.
"The atmosphere following a natural death is different from that following euthanasia. People are upset too, but it is not the same. There is not a deliberate act to cause death," she writes.
Medical practitioners in Belgium who cannot in conscience perform euthanasia can refuse requests from patients. But the book argues that "radical autonomy" in Western society, the individual's perceived right to control the circumstances of their death, is putting conscientious objectors to euthanasia under pressure.
In their joint foreword to the book, Margaret Somerville, Professor of Bioethics at Sydney's Notre Dame University and E. Wesley Ely, Professor of Medicine at Vanderbilt University in Nashville, argue that legalising euthanasia is "a radical rejection of the most fundamental value on which we base our societies, that of respect for human life".
"Respect for human life must be upheld at two levels: in society in general and for every human life without diminution of worth based on disease or any other factor," they write.