The Liberal government's controversial doctor-assisted-dying bill is one step closer to becoming a law.

But the proposed legislation does not include a key recommendation from the Senate to expand the parameters around who qualifies.

MPs voted 190 to 108 in favour of Bill C-14, sending it back to the Red Chamber for further consideration. 

Prime Minister Justin Trudeau defended his government's decision to reject the Senate's biggest recommended change to the bill. 

"We respect the Senate's perspective ... but we do not want to affect the fundamental balance that we achieved in this piece of legislation between protecting vulnerable Canadians and allowing for rights and freedoms," Trudeau said at a news conference in British Columbia.

He also acknowledged the government did accept some of the amendments, which Trudeau said actually improved the bill. 

Earlier today in Ottawa, Justice Minister Jody Wilson-Raybould announced the Liberals would be rejecting the Senate's recommendation to widen the scope on who qualifies for a doctor-assisted death, calling it "ill-advised."

Wilson-Raybould stood by the original language in the bill, telling reporters that "C-14 strikes the necessary and appropriate balance in terms of medical assistance in dying."

She added it presents "the right solution for our country now, and I'm confident in its constitutionality."

Health Minister Jane Philpott downplayed concerns the Senate could reject the legislation if the government doesn't agree to expand parameters around who qualifies for a doctor-assisted death.

"We ought to have federal legislation in place as soon as possible" Philpott said. "We know there will be access issues. We know there already are."

Late Wednesday, the Senate sent the federal government's proposed law on medically-assisted dying back to the House of Commons with seven amendments.

One of those amendments dramatically alters the bill, striking down a provision that would only allow patients who are near death, or where death is "reasonably foreseeable" to qualify for the medical option.  

Instead, the Senate proposed the law be expanded, allowing anyone with a "grievous and irremediable medical condition" to have access to a physician-assisted death "after the condition has begun to cause enduring suffering that is intolerable to the person".

The Liberals say they are not willing to accept that amendment.

Finding compromise

Wilson-Raybould said the government would accept Senate amendments on palliative care, regulations around death certificates and a requirement that issues around medically-assisted dying be reported back to Parliament within two years.

But Wilson-Raybould repeated her argument that she believes the original legislation is constitutional, saying "the question is whether the complex regulatory regime is consistent with the (Charter of Rights and Freedoms), not with whether it replicates the wording in the Supreme Court's ruling on (the Carter case)."

She added the original version of C-14 was "specifically crafted to protect vulnerable Canadians." Insisting she was not trying to be sensational, Wilson-Raybould added that expanding the qualifications could mean people with "any serious medical condition, whether it be a soldier with PTSD, a young person with a spinal cord injury, or a survivor whose memory is haunted with memories of sexual abuse" would now be eligible for a doctor-assisted death.

Wilson-Raybould says that highlights the "real risks at play."

Trudeau defends Senate's role

After his government announced it would not accept the Senate's key recommendation, Trudeau was asked by a reporter what is the point of having a Senate if the government rejects the most important amendment it proposes.

Trudeau did not directly answer the question, but he broadly defended the Red Chamber's role. 

"Over the past years of partisanship and patronage in the Senate, Canadians rightly began to lose confidence in an institution that didn't seem to be contributing in clear ways to better governance in Canada. And that's why we made the decision a number of years ago to make the Senate more independent and less partisan, and demonstrate their ability to weigh in on difficult issues, make recommendations and suggest improvements and changes to legislation."

Trudeau thanked the Senate for its hard work, but defended the original bill, saying it reached  "a balance that both protects the vulnerable and respects peoples choices and freedom to make choices."

Assisted Suicide

Senator Nancy Ruth says she is prepared to vote against C-14 if the government doesn't adopt the Senate's key recommendation on the bill. (Adrian Wyld/The Canadian Press)

At least one Senator says she is prepared to vote against C-14 if the government doesn't accept the Senate's amendment to expand the rules around qualifying for a doctor-assisted death.

Senator Nancy Ruth told CBC News "If it's not there, I'm not sure I want this law. I think at this time no law is better than a bad law."

"If they take it out, I'll probably vote against the bill," Ruth said.

Senator Frances Lankin says discussions in the Senate are already underway surrounding what happens next. 

"If I were to guess right now, I would think that the Senate would accept and respect that decision of the House of Commons, because we know this issue...will probably receive the study that it is requiring to put in place safeguards along with the other reviews the minister set out in the legislation," Lankin said on CBC News Network.

Parliamentary 'ping-pong' match over assisted dying bill?2:02

With files from the Canadian Press