OTTAWA -- The president of the Canadian Conference of Catholic Bishops has written to Prime Minister Justin Trudeau to voice "very serious concern" about proposed changes to medical assistance in dying legislation.

Archbishop Richard Gagnon says in a letter on Friday the government's attempt to expand assisted death to include advance directives, as well as extending it to situations where death is not reasonably foreseeable, is deeply troubling.

Trudeau's government is working to comply with a Superior Court of Quebec ruling that concluded it is unconstitutional to allow only Canadians who are already near death to seek medical help to end their lives.

Gagnon says his organization is disappointed and concerned that the federal government has refused to appeal the ruling and it objects to an online questionnaire recently conducted by the Department of Justice.

The questionnaire asked people to consider safeguards to prevent abuse if the foreseeable-death requirement is removed from the law, but Gagnon says it's inappropriate to use a survey to address "grave moral questions."

In his letter, Gagnon says bishops agree in principle with consulting Canadians, but a survey that was available online for only two weeks is insufficient.

In a statement late Friday night the Department of Justice said: "The recent online consultation focused on responding to the issues raised in the Truchon ruling."

It further noted that the government received nearly 300,000 responses from the public, "demonstrating just how engaged Canadians are with this deeply significant issue."

"Our Government recognizes that medical assistance in dying is a complex and deeply personal issue," the statement said. "We remain committed to protecting vulnerable individuals while protecting the Charter rights of all Canadians."

But Gagnon, who is the Archbishop of Winnipeg, says the survey also failed to give attention to the fears and concerns of elderly people and those with disabilities.

"The church's ministry of healing and accompanying the sick involves national and regional networks of parishes and health-care institutions on which vulnerable Canadians and their families rely for support and care," he says.

"We visit the elderly who are lonely, isolated, abandoned, and insufficiently supported by health care and community services. We listen to those who, gripped by a physical or psychological crisis, see no reason for going on."

All these people are endangered by assisted death and need advocacy, support and the protection afforded by the very safeguards the government is trying to overturn, he argues.

Experience has shown that patients are more likely to request help in dying when their pain is not properly managed or when they are lonely or socially marginalized, Gagnon adds.

He says palliative care has yet to become fully realized and accessible in Canada, even though it seeks to alleviate the pain, loneliness, fear and despair that can lead to the "tragic failure" of assisted death.

Gagnon urges the government to hear from parents of children with mental illness, health-care providers who do not wish to administer assisted death and elderly or disabled patients who have been abused by caregivers.

"We, as bishops of the Catholic faithful in Canada, call on the government to engage in a more rigorous, impartial and prolonged study of the problems inherent in euthanasia/assisted suicide by involving those whose experiences offer a different perspective and even present inconvenient truths."

Trudeau's government has been considering how to amend the law in a way that safeguards against abuse.

Justice Minister David Lametti has said he'd like to have a bill before the House of Commons as soon as possible.

Lametti has not ruled out requesting an extension to the March 11 deadline imposed by the court, but he's said he would first like to see what level of consensus exists in the House.

Dying with Dignity Canada has warned against applying more hurdles that could wind up unfairly depriving people of their right to an assisted death and being shot down again by the courts.

Requiring consultation with medical specialists, for instance, could create real barriers to access, especially for people living outside big cities, the organization has argued.

This report by The Canadian Press was first published Jan. 31, 2020.