A bill to legalize physician-assisted suicide in Maryland failed in the Senate on Wednesday after a dramatic deadlock vote saw one state senator refuse to cast the deciding ballot.

The End-of-Life Options Act was one vote short of the 24 needed to advance out of the Senate. The vote was a tie with 23 senators in favor and 23 against. There are 47 members of the Maryland State Senate.

An earlier version of the bill, which contained fewer safeguards than the measure before the Senate, easily passed through Maryland House of Delegates earlier this month. The Senate draft contained new provisions that would have restricted who was eligible to receive lethal drugs from a doctor.