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The Senate chamber on Parliament Hill is shown in a May 28, 2013 photo.

Adrian Wyld/THE CANADIAN PRESS

The Senate has passed a markedly different version of the Liberal government's doctor-assisted dying bill, setting the stage for a legislative showdown with the House of Commons over Canadians' right to die.

In a vote of 64 to 12, with one abstention, senators from all sides on Wednesday evening passed an amended Bill C-14, most notably removing the requirement that a patient be at the end of life to qualify for medical assistance in dying – a change the Liberal government has already spoken against.

The bill will now go back to the Commons, where MPs will decide whether to accept or reject the amendments before it returns to the Senate, where it must pass to become law.

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Independent Liberal Serge Joyal, who proposed the amendment to remove the end-of-life condition, said it is the Senate's role to stand up for minority rights.

"Ask yourself, who we are, and where we come from. You've been appointed here to be independent of an electoral mandate," Mr. Joyal pleaded with the chamber on Wednesday night.

"We cannot compromise on the basis that…the majority is against it."

If the House rejects the amendments, the bill could bounce between the Commons and Senate several times. If neither side relents, it could stall or be defeated in the Red Chamber, as happened when the abortion bill failed in a tie vote in the Senate in 1991.

The government's representative in the Senate, independent senator Peter Harder, told his fellow senators the House of Commons should consider their amendments.

"The quality of our democracy will rest on how we as a chamber proceed even after today," he said.

"I will work as hard as I can to ensure that what we accomplish as a Parliament of Canada on this bill is one that Canadians can be proud of."

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But Senator James Cowan, leader of the independent Liberals, earlier said he was "discouraged" that Justice Minister Jody Wilson-Raybould has suggested the government will not support the end-of-life amendment.

"If the government is serious about the Senate fulfilling its role of legislative review, it should refrain from publicly attempting to influence or direct our work," he said.

He later added, "If the members of the House of Commons should reject our amendments, then we will have further decisions to make."

Liberal House Leader Dominic LeBlanc said on Wednesday some of the amendments adopted by the Senate "have been the result of a thoughtful and deliberate process," but he would not comment on which changes, if any, the House will accept.

"We see the Senate process as being constructive, and it doesn't mean necessarily that all the members of Parliament will agree with all of the Senate amendments, the same way that the Senate appears not to have agreed with every clause of the bill we passed," he said.

It is expected the House of Commons will begin debating the bill on Thursday, and a vote could take place early next week.

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Over several hours of debate on Wednesday, 33 senators spoke emotionally about their personal experiences, with one senator, independent Liberal Dennis Dawson, revealing through a statement that he has cancer.

But some senators appeared to waver when faced with the possibility that the House will turn down their proposal to remove the end-of life requirement – even as they feel that provision is unconstitutional and would force some Canadians to live for years in unbearable suffering.

"There is no doubt in my mind, after hearing all sides of the issue, that this is a case where the Senate had to amend the bill before it," newly appointed independent senator André Pratte told the chamber.

"The question that haunts me now is, what should we do next. ... Should we defer to the House or stand our ground? And I'm very much concerned about how Canadians will react in the case of a legislative deadlock."

Others warned of the dangers of defeating a bill passed by the elected Commons, and how it will reflect on the Red Chamber.

"We are accountable to the public in a very different way than those who are elected to govern in this country," independent Senator Murray Sinclair, who supports the government's bill, told the chamber.

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"We must therefore recognize that it is those upon whom we impose our will who are going to be held accountable for what we do in this House. And therefore we need to use that power very carefully."

Last week, senators voted to replace the original bill's requirement that a patient's natural death be "reasonably foreseeable" with the language of a February, 2015, Supreme Court of Canada decision that granted competent adults with "grievous and irremediable" medical conditions, who are suffering intolerably, the right to end their lives with a doctor's help.

"I fully believe that the original bill does not meet the test of the constitution," independent Liberal Senator Art Eggleton told the chamber on Wednesday.

In total, the bill contains seven amendments – five substantial and two minor technical ones. The other amendments passed by the Senate would require a palliative-care consultation, prevent beneficiaries from assisting in someone's death, require the health minister to establish guidelines and collect information, and for independent reviews into topics such as advance requests to be reported within two years.

But senators decided against broadening the bill further to include advance requests for patients with degenerative conditions such as dementia, arguing that making the change now would be too risky.

Conservative Senator Don Plett, who voted against the bill, nonetheless told the chamber legislation must be enacted to protect the vulnerable. He said he hopes the House passes the amendments dealing with safeguards, but not the one that would remove the end-of-life requirement.

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"I'm going to be conflicted, because I do not want us to defeat this bill. I think that would be the worst thing in the world that we could do," Mr. Plett, choking up, said in the chamber.

Conservative senator Betty Unger said she opposes assisted dying in principle.

"I do not know which is more alarming, the fact that we're on the wrong road, or the fact we do not recognize it and that so many are cheering," Ms. Unger said.

"In considering this legislation, we have dismissed so many safeguards that the innocent are certain to be killed."

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