The Liberal government’s doctor-assisted dying bill has passed a final vote in the House of Commons, but it is unlikely to clear its biggest hurdle – the Senate – before the Supreme Court of Canada’s June 6 deadline.

What’s more, the bill now stands the chance of being significantly altered in the Red Chamber – setting the stage for a showdown between the elected Commons and a newly independent Senate.

Bill C-14 passed third reading on Tuesday night by a vote of 186-137, with all but four Liberal MPs supporting the legislation. Another 14 Conservatives voted in favour of the bill, while the NDP, Bloc Québécois and the Green Party’s Elizabeth May voted against it.

The bill is now in the hands of the Senate, where the Conservative and Liberal leadership say there is no way it will pass before June 6.

“It can’t. It isn’t going to happen,” Senate Liberal leader James Cowan said in an interview.

That means there would be no federal law regulating the practice of physician-assisted death in Canada. However, provincial medical bodies have put in place their own framework in the interim, and the Supreme Court’s ruling that the procedure should be available to adults with a “grievous and irremediable” medical condition who are suffering intolerably would stand.

Some constitutional experts have said no legislation is better than the government’s bill, which many deem far more restrictive than the court’s decision because it refers to a patient’s natural death as being “reasonably foreseeable” in order to qualify.

Still, Health Minister Jane Philpott said on Tuesday she is “very concerned” that there may be a legal void as of next week.

“I’m concerned about the lack of access that will be resulting from this and I’m concerned about the fact that there are not sufficient safeguards in place,” she told reporters. The Canadian Medical Association has also warned that without a law, there will be confusion in the medical profession and fewer safeguards, such as a written request and a reflection period for patients.

Ms. Philpott, along with Justice Minister Jody Wilson-Raybould, are set to appear in the Senate chamber for up to two hours each on Wednesday to try to convince senators to pass the bill – and fast.

In her final speech to the Commons on Tuesday, Ms. Wilson-Raybould called the legislation “reasonable” and warned that if the bill were opened up to anyone with a serious medical condition, it could include a soldier with post-traumatic stress disorder or someone who is haunted by memories of sexual abuse.

Senator Peter Harder, the government’s representative in the Senate, did not respond to an interview request on Tuesday.

But he told The Globe and Mail last week that he was in discussions with the other Senate leaders on how to move the bill along quickly, while still giving all senators the opportunity for “due consideration.”

Both Mr. Cowan and Conservative Senator Claude Carignan, the opposition leader in the Senate, believe the bill is unconstitutional – and they want to see it changed.

“This bill has serious constitutional issues,” Mr. Carignan said in an interview on Tuesday. “This opinion is shared by many senators.”

Both leaders predict the bill will pass the second reading phase this week, and will be considered by the Senate’s legal and constitutional affairs committee by next Monday – the Supreme Court’s deadline.

It is then expected to make its way to the Senate floor by mid-week, where senators will be allowed to propose and debate amendments.

It appears there will be many – ranging from restricting physician-assisted dying to only those with terminal illnesses, to broadening its scope to include advance requests for those with mentally degenerative disorders such as dementia.

Alberta makes public draft rules governing physician-assisted death

Alberta has made public its own draft regulations for physician-assisted death, but notes those rules will be superseded when the federal law is in place.

“The federal government has the primary responsibility for legislation in this area, and we intended for our regulations to fit within their legislative framework,” associate health minister Brandy Payne told reporters Tuesday. “In the meantime, Alberta needs to be prepared.”

The Alberta rules mandate that anyone who wants medical assistance to do so must be at least 18 years old and have a “grievous and irremediable medical condition.”

They must be mentally capable of making a decision on their own health, makes a voluntary request for the assistance and give informed consent to have it carried out.

There is no mandated period of reflection between when a patient makes the request for assisted death and the procedure is carried out.

Any doctor who is asked by a patient to assist in the death may decline on reasons of religion or conscience but must ensure that the patient has access to those at Alberta Health Services who can carry out the request. The drug used to end a patient’s life must be approved by Alberta Health Services. The issue is now being debated under a motion put forward in the legislature.

The Opposition Wildrose party said the government has not given enough time for debate. “This shortened timeline imposed by the NDP government is simply unacceptable,” Drew Barnes, shadow health critic, said in a statement.

“Less than an hour is not nearly enough time for any Member to prepare for the constructive and helpful debate that we would like to see on this motion, and that Albertans expect from their representatives.”

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