Belgium's upper house of parliament has approved by a wide margin (44 to 23, 2 abstentions) Friday night legislation that would allow terminally ill people to seek a doctor's help in ending their lives. If the bill is passed by the lower house in parliament, Belgium will become the only country in Europe other than the Netherlands to legalize mercy killing, or euthanasia.

The legislation lays out strict guidelines for doctors. It requires that a patient must be in a terminal medical situation or suffering from an incurable illness. The patient must also be in constant and unbearable physical or psychological pain. Finally, there can be no coercion. The decision to die must be made of the patient's own free will.

Legislative aides who worked on the measure say that in cases where a patient cannot speak, a written statement from the individual is needed. If there is nothing in writing, a family member or close associate who knows the patient's wishes may request that the patient be given doctor's assistance in dying. However, the doctor can refuse the request if he or she feels it is not justified or if there is not sufficient evidence of the patient's wishes.

Senator Philippe Mahoux, a doctor and one of the co-sponsors of the legislation, says it will allow physicians to answer their patients' calls for an end to suffering. "We saw a lot of patients who asked for death in dignity," he said. "We believe that the pain and the loss of dignity is not acceptable."

Though it passed in the senate by an almost two-to-one ratio, the legislation was the subject of intense public and media debate and took two years to make its way through the parliament's justice and social affairs committees.

The measure was passed by a coalition of liberals, socialists, and Green party members. Analysts say the bill's passage would have been much less certain if the relatively conservative Christian Democrats, who dominated Belgian politics for 40 years, had not lost power two years ago.

The measure next goes to the lower house of parliament, where legislative sources say it is likely to be approved before the end of the year. It must then be signed by the king and published in the official gazette before it officially takes effect.