Heather Bellamy spoke with Dr Peter Saunders about Lord Falconer's Assisted Dying Bill, euthanasia and assisted suicide across Europe and exactly what it might look like should assisted suicide be legalised in England.

Peter: I think that public opinion hasn't really changed. In fact, public opinion polls: if you go right back to the 1980s and 90s you'll find that the majority of people (70-80%) favour decriminalising euthanasia and assisted suicide and that's the reflex gut reaction of the general population, which is based pretty much on looking at the kind of hard cases we see on the media; but the institutions - particularly the medical profession, legal profession, disability rights groups and Parliament - always block the change out of concerns for public safety. I think that the composition of the House of Lords has changed quite significantly, that since 2010 we have seen more people coming in with more socially progressive or liberal views if you like and I think we saw the evidence of that around the debates on same-sex marriage, another issue just last year. So I think the House of Lords is more liberal on social issues and therefore might be more open to this and it could well be closer than it was last time. But this is still an issue which strongly divides people and I suspect the House of Commons is still, on balance, opposed to this kind of change in the law.

Heather: Can I just clarify something? Did you say that polls showed that about 70% of the public were in favour?

Peter: Yes: 70-80% of the public have always been in favour of a change in the law to allow assisted suicide or euthanasia.

Heather: Wow, I'd never heard that before!

Peter: That hasn't changed in the last 20 or 30 years. It's just like most of the general public are also in favour of bringing back the death penalty - you know, it doesn't mean that we should do it. But the public do tend to have strong views and I'd say that even though it sounds like a big percentage, it's not strongly informed public opinion and it's not the kind of committed public opinion that would lead people to vote in a general election on that issue. I think it's more of a feeling or a sympathy that people have than a strong conviction where they want to see change in public policy or in the law.

Heather: We hear in the news numerous stories of mistakes, hiding errors, neglect of patients in hospitals and terrible stories coming from care homes, so would there be a concern that care could possibly get worse if assisted suicide was legal?

Peter: Yes, definitely. We do see very sadly in some areas of the health service this culture of neglect or lack of care and you've highlighted some of the stories: Winterbourne View care home was a classic example; the Staffordshire NHS trust enquiry, where there were cases of neglect or abuse happening sadly in our hospitals or in care homes. If that's happening in a situation where it's not legal to carry out assisted suicide or euthanasia then, if the law did change, it might be even more difficult to stop cases of exploitation and abuse.

I think one of the things that's fuelling this is the fact that we're living in times of economic recession and also family breakdown and so there's less support available for people. The health service and families are under more pressure financially and in that kind of situation a law allowing assisted suicide or euthanasia could very easily put pressure upon vulnerable people to end their lives out of fear of being a financial or emotional burden, or a care burden to loved ones, or to a stretched health service, or to a society that's short of resources; there is that very real worry. The other thing of course is that assisted suicide is very cheap: it only costs £5 for a glass of barbiturate to kill yourself whereas the alternative, good palliative care which addresses symptoms properly, might be in a hospital £1000 or more a week. Chemotherapy or radiotherapy treatment or surgery might be many times more than that. So if we get into a situation where the health service is costing different forms of therapeutic options and one of those options is killing people, then we're going to be able to fund a lot of more of those than anything else. So there will be a temptation both for families and for health ministers and those in charge of the health service to favour that option if it was ever legalised. I think that would be very dangerous indeed.

Heather: So how would it work? Would doctors, if it was legalised, be able to raise assisted suicide as an option at the end of life, or would it have to be the patient that brings it up?

Peter: GPs are taught that when they deal with any problem, they have to present all the available options to the patient in order that they can make an informed choice. So if assisted suicide were made legal for terminally ill patients, I think that would leave doctors with an obligation to raise it as an option for them, as a treatment or therapeutic option, even though it's not a therapy. I don't see how that could be avoided and I think that will add to the pressure that will be placed upon people.

Heather: I imagine a whole host of conscience cases would come up for doctors who wouldn't feel able to do that?

Peter: In Falconer's bill there is a conscience clause that says that doctors don't have to be involved, as there is in the Abortion Act, so you don't have to be - but that doesn't stop a lot of coercive pressure being brought on people to be involved in abortion. I think the same thing would happen with this. But one of the main concerns we have about this bill is that the so-called eligibility criteria for it are very loose and subjective. So we talk about terminal illness first of all, six months or less to live. We know that doctors - and I speak as a doctor here - are just unable to prognosticate, to look ahead with that degree of precision to know how long people are going to live: you so often get it wrong one way or the other. There are cases in other jurisdictions where people have lived: been given the prescription, decided not to take it and have lived for many years. We all love stories where people who were thought to have a short life expectancy have gone on and lived a long time. So that's the first thing, the six-month life expectancy.

The second thing is mental competence. It's actually quite hard to assess that, particularly in a patient you've not seen before - and Sheila Hollins, who's the past President at the Royal College of Psychiatrists, has said that only 6% of psychiatrists would feel confident in one meeting to assess mental competence with a patient in this situation - and they're the ones who are meant to know about it, so if they don't feel confident, where does that leave your common GP? And then the question of: Is there a settled wish to end their lives? Well there are all sorts of complex dynamics that go on within families and if you're seeing someone as a doctor, you've no idea of being able to assess what kind of pressures are being brought to bear and whether what the person is saying they want is what they really want.

Then if you get doctors who ideologically are committed to assisted suicide then they're going to push the boundaries. We know with the Abortion Act, which is a very similar bill to this, where doctors are licensed to end life, that they will push the boundaries, push the envelope, take liberties, say things that aren't true, falsify forms and just stretch the law - and I think inevitably that will happen and it will be very difficult to hold them to account.