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Dennis Patterson, pictured in this 2013 file photo, was one of several senators who spoke out against including advance requests, saying it was too risky.

CHRIS WATTIE/REUTERS

Senators have rejected a proposal to further expand the Liberal government's doctor-assisted dying bill to include advance directives for patients with conditions such as dementia.

In a vote of 47 to 23 with two abstentions, senators on Monday night decided not to broaden Bill C-14 following their decision last week to remove end-of-life criteria from the legislation.

Several senators spoke out against including advance requests, also known as advance directives, saying it was too risky.

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"I wanted to know how one measures intolerable suffering in advance … it's a very subjective phrase," newly appointed independent Senator Murray Sinclair told the chamber.

"I'm just a little concerned about us rushing through to amend a bill when something as important as this requires a very significant degree of public input and study."

Conservative senator Dennis Patterson warned senators not to get "carried away with our exuberance."

"We should not do this lightly, honourable senators. The new Parliament has a clear majority," he said.

The advance request amendment was proposed by Senate Liberal leader James Cowan to allow capable adults to make a future request for assisted death if they are diagnosed with a grievous medical condition that will impact their capacity to make such decisions.

"Without advance directives, individuals with diseases such as Alzheimer's will be denied their right to end their life in a dignified manner," Mr. Cowan told the Chamber.

The government has committed to initiating an independent review of advance requests, along with the issues of mature minors and requests where mental illness is the sole underlying condition, within 180 days of the bill's passing. Some senators suggested on Monday there will be a proposal to fast-track that timeline.

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Two other senators proposed sub-amendments to Mr. Cowan's motion that were also rejected by their colleagues.

Independent Senator Pamela Wallin asked that all Canadians be allowed to write advance requests into their wills – a suggestion that was swiftly voted against. And independent Liberal Senator Mobina Jaffer proposed that Canada adopt advance requests two years from now. That, too, was turned down.

The Senate on Monday also narrowly rejected by a vote of 36 to 35 a proposal to remove nurse practitioners from carrying out medical assistance in dying without a doctor.

Last week, senators voted to remove the criteria that a patient's natural death be "reasonably foreseeable" in order to qualify for assisted death. Instead, senators agreed to replace it with language from the Supreme Court, which ruled that competent adults with a "grievous and irremediable" medical condition, who are suffering intolerably, should be eligible for medically assisted dying in Canada.

Meanwhile, Justice Minister Jody Wilson-Raybould says the government's proposed new law on assisted dying does not need to comply with the Supreme Court's landmark ruling on the issue.

She made the argument in a background paper sent Monday to all parliamentarians.

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Senators last week voted to delete the central pillar underpinning the bill – its requirement that only those near death would be eligible for medical help to end their lives – and replace it with the more permissive criteria set out by the Supreme Court's decision in Carter vs. Canada (Attorney-General), which struck down the blanket ban on assisted dying.

Numerous senators, along with legal and constitutional experts, have argued that the near-death proviso does not comply with Carter and, consequently, have predicted that C-14 would be struck down as unconstitutional.

But the paper contends: "The question is not whether the bill 'complies with Carter' but rather, whether it complies with the charter [of rights]." It maintains the bill's constitutionality "will not be determined by a simple comparison of the bill to the Carter decision." Rather, it will involve an assessment of the bill and the "new and distinct purposes" behind the provisions that restrict the right to an assisted death to those who are close to death.

Whereas the blanket ban on assisted dying had only one purpose – to protect the vulnerable who might be induced in moments of weakness to end their lives – the paper says the proposed new law is aimed at pursuing additional objectives: For instance, to ward against the "normalization" of suicide and to counter negative perceptions of the quality of life of the elderly, ill or disabled. Consequently, the paper maintains that limiting assisted dying to those who are near death is "fully consistent" with the Charter of Rights, even if it is much more restrictive than the eligibility criteria set out by the Supreme Court in Carter.

With a report from The Canadian Press

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