Spain’s parliament has advanced a euthanasia and assisted suicide bill that Catholic leaders had decried as “a defeat for all” which abandons those who suffer.

The Congress of Deputies, the lower house of Spain’s legislative body, passed the bill by a Dec. 17 vote of 198 to 138, with the backing of the country’s left-wing coalition and several other parties. The conservative Popular Party and the far right Vox party voted against the bill.

Protesters had rallied against the bill outside of the parliament building in Madrid. They held a banner that said “Government of death.”

“The euthanasia law is a defeat for civilization and a victory for the culture of death, for those who believe that some lives are more worthy than others," said Santiago Abascal, leader of Vox, BBC News reports.

The legislation is expected to be passed by the Senate, though amendments may be suggested, then returned to the deputies for a final vote. It could become law as soon as spring of next year, making Spain the largest EU country to legalize euthanasia.

The law would allow public and private health professionals to help people kill themselves if they suffer “a serious and incurable disease” or a “debilitating and chronic condition” that is “unbearable.”

Only adult Spanish citizens or residents who can make rational decisions may request euthanasia. They must make the request on four different occasions. The first two requests must be in writing and the third request must come after consultation with a doctor.

A medical team must oversee the process and a regional oversight board approves requests for euthanasia.

Medical workers are allowed to refuse to participate on the grounds of belief.

Spain’s Health Minister Salvador Illa, who backed the bill, said, “we are moving towards a more humane and just society.”

“But above all, it is an important day for those people who are in a situation of serious suffering, and it is also important for their families and people close to them,” he said, according to BBC News.

The Catholic bishops of the country strongly opposed the bill, instead backing legislation for better palliative care.

On Dec. 11 they called for a day of fasting and prayer to be held Wednesday ahead of the bill’s expected approval.

“The pandemic has revealed the fragility of life and has sparked a request for care, at the same time as outrage at the exclusion of care for the elderly. The awareness has grown that ending life cannot be the solution to tackling a human problem,” they said.

“With the pope we say: ‘Euthanasia and assisted suicide are a defeat for all. The response to which we are called is never to abandon those who suffer, never to give up, but to care and love to give hope’,” they continued.

Portugal has approved legislation to legalize assisted suicide and euthanasia but the practice has not yet become law, Sky News reports. Belgium, Canada, Colombia, Luxembourg, the Netherlands, Switzerland, and the Australian state of Victoria have legalized euthanasia.