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.

In the bill, there is nothing about how this assisted suicide is going to happen, there's nothing about the oversight procedures, there's nothing about reporting: all of this is going to be delegated to the Health Minister, or to the Chief Medical Officer, or other people in the form of regulation, so it'll be made up afterwards. So Parliament in a sense is being asked to sign a blank cheque here allowing this, not knowing how the whole thing's going to be operated - and I think again that's very serious indeed.

The major role of the House of Lords is to scrutinise legislation very carefully and this bill, we feel, is like a piece of Swiss cheese: it's filled with all sorts of holes that unscrupulous people could exploit or abuse.

Heather: I just want to go back to something you said a few moments ago about it having to be six months that people have got to live - I know from when my mother-in-law had cancer that doctors never want to say how long you've got to live and when they did, they got it wrong twice. It only seems like when they've literally got a few days to live that they want to really commit to that and it's only then that they get it right. I don't know if there's a policy on those things? But how can it shift so dramatically if assisted suicide was legal that they would then suddenly be able to, for everybody, say when you've got six months to live?

Peter: I think that's a really good question and it highlights the fact that it's really difficult to say. The reason doctors don't like being drawn on life expectancy is because we are so often wrong. You say six months and they die in a few weeks and then the family will be pointing the finger at you; or if you say three months and they live for a year then they may have made their plans. So most doctors will talk in terms of weeks rather than months or months rather than years and try to treat each week as the most important one in your life and live each day one at a time. People talk in these terms and don't tend to give lengths of time precisely because it is so difficult. As a general surgeon myself who's looked after many dying patients, I would say the only time I am really confident about predicting death is within a few hours or days of death and even then you're not always right and you can be surprised one way or the other.

Heather: Yes I know my mother-in-law was dying, it was 3-10 days and she died after ten days. Just moving on to Europe quickly, I have seen in the news that in France there's pressure to change their euthanasia and assisted suicide laws. I wondered, with so many of our laws coming from Europe now, do you foresee in the future pressure coming on our Government from Europe to change our laws?

Peter: Well that's an interesting question. The European Court does give a lot of flexibility to individual national states to make their own laws, that they call the margin of appreciation. It means that you can have a European state like the Netherlands, which has legalised both assisted suicide and euthanasia and is allowed to do that and the European Court won't overturn it. On the other hand you'll have a state which will decide to keep it illegal and the European Court won't interfere with that either. I think this is a potential, but I think the British Parliament constitutes a much greater risk to us at the moment in this area than the European Parliament does, but that may change in the future.

The signals from Europe are very worrying though. There are four countries who've legalised euthanasia or assisted suicide to a greater or lesser extent; that's Netherlands, Belgium, Luxembourg and Switzerland, which is the last one, with just assisted suicide. The reports that are coming out of those countries are very disturbing indeed. We're seeing incremental extension, pushing of the envelope - we're seeing an increase in numbers every year of people having their lives ended in this way and we're seeing also a widening of the categories of people to be included.

You find it starts with the terminally ill, it's then the chronically ill; it starts with a physical illness, it's then mental illness; it starts with adults, it then spreads to children; it starts with people who are sick and then it's people who are disabled; it starts with the mentally competent and then it's people who are mentally incompetent. Even though in all of these countries initially, it was illegal to do euthanasia for children or people who are mentally incompetent or people with mental illnesses, now these things are happening, certainly in the Netherlands and Belgium.

In the Netherlands there were 45 people last year with mental illnesses who had euthanasia. A third of cases in Belgium involved people who hadn't given consent for it and are euthanised and Belgium just legalised euthanasia for children with cancer earlier this year. There's some very worrying things happening: cases of people in Switzerland who've had chronic diseases like arthritis or multiple sclerosis, some who were just bereaved or depressed after the loss of a loved one who had it.

The message that comes out is that it's uncontrollable: once you allow assisted suicide or euthanasia for any reason whatsoever, you can't control it and stop the boundaries progressing.

We would also argue that it's unnecessary. First of all because when we really look after people properly and address not just their physical needs but their social and spiritual and psychological needs as well, that requests for euthanasia or assisted suicide are very rare indeed, so our priority has got to be to give the best possible care. But it's also unnecessary to change the law because we have a law at the moment which has both a stern face and a kind heart. It's got a stern face in that the penalties it holds in reserve act as a very powerful deterrent to exploitation and abuse, so people think twice before crossing the line. But it's also got a kind heart in that it gives discretion both to prosecutors and to judges to be able to temper justice with mercy in hard cases and show compassion. The result of that sort of law is that the number of cases is very small, but also the cases that do happen, it's very unusual that someone will get prosecuted. The problem is if you change the law you change the environment completely and we've seen that with the Abortion Act. They tried to craft a law which allowed for abortion only in a limited set of circumstances - and then 40 years down the road we have got 8,000,000 abortions, 200,000 a year, one in five pregnancies leading to abortion. This proposed law is very similar in that it licenses doctors to end life and leaves it pretty much up to them and puts them in a position where they can't really be challenged or brought to account for pushing the boundaries. That's why it's best to stick with what we have now. As we say in surgery: If it ain't broke don't fix it.

Heather: I'd just like to end with one final question on something that I find sort of ironic. On the news, I heard that in San Francisco, bridge officials have approved the construction of suicide prevention nets alongside the Golden Gate Bridge. Obviously there's a lot of suicides off that bridge and there were 46 just last year in 2013. But with suicide and death, the one thing is there's not many people that come back and tell you their stories of regret because death is so final. But there was one man that did survive called Kevin and he said that as soon as he jumped off he had instant regret and so they're spending millions on this net to prevent people actually dying when they jump. Shouldn't those campaigning and looking at assisted suicide take seriously examples like this, where in America they're spending millions on this net and actually someone is saying: I had instant regret when I jumped? Because once you've swallowed the tablet, it's in your system, isn't it?

Peter: Yes and some of the most ardent campaigners against this law are disabled people who say: If this had been legal ten years ago, I would have taken it and I would have missed the best ten years of my life. And people under the Oregon law who have attempted to commit suicide and haven't been successful, because sometimes it doesn't work, none of them then go back and do it again and I think that's very interesting. As you say, why is it that we have all these suicide-prevention strategies? As you say, we put fences up on bridges, we put people on suicide watch, we make it illegal to promote suicide over the internet, we're not allowed to report suicides in the newspapers in any detail in case there'll be copycat suicides. So we make all these efforts to stop suicide contagion, or copycat suicides, or promote it on the one hand and then we're legalising it on the other and we're doing it in a way that seems to devalue elderly, sick and disabled people. The idea that if you're elderly, sick or disabled and you're feeling suicidal or you want to end it all then you should be helped to do it, whereas if you're young and not with any medical condition, or perhaps if you've got a mental condition, then we should do everything to stop you - and I don't see the two situations as different at all. I think if a person wants to end their life, then the natural human response, the proper compassionate response, is to ask: What is it that's making them want to end their life and can we do something to change that situation? If it's pain or a sense of worthlessness or meaninglessness or a broken relationship or something, that we should be attempting to fix the problem that's causing them to feel suicidal - and that we should be doing that right across the board and not giving all these mixed messages about its ok for disabled people to kill themselves but not for young people wanting to jump off bridges.