Barbara Coombs Lee, co-author of Oregon’s first-in-the-nation Death with Dignity law, as well as the national assisted-dying group Compassion & Choices, oppose parts of a state Senate bill that they say would remove key safeguards from the law.
The retired Eugene doctor spearheading SB 1003, Paul Kaplan, said he’s exploring how to tweak the bill to address the concerns raised by Coombs Lee and the group. But with the Oregon legislative session scheduled to wrap up later this month, it’s unclear if there’s time to amend the bill and still pass it.
Coombs Lee, who served as chief petitioner for the 1994 ballot measure to create the law, told The Lund Report that she and the group she long led to support assisted dying and spread it to other states, Compassion & Choices, supports the intent of the law as well as some aspects of it.
But the group is “very much opposed” to some changes the bill makes, such as eliminating the “fail-safe” of requiring a second doctor vouch for the patient’s state of mind. The group does not support the bill unless it restores needed safeguards, she said.
“I’m definitely an advocate waving a red flag,” Coombs Lee said. “A bill with changes to eligibility that are this substantial deserves a broad and deep discussion. I don't think this bill has had a broad and deep discussion, and I doubt that there would be time for that kind of a discussion.”
The bill makes the most significant changes yet to the law. It would shorten the mandatory waiting period to seven days from the current 15. It also streamlines requirements for institutions to notify patients of their Death With Dignity policies by allowing them to post notices on their websites, and permits electronic transmission of lethal prescriptions.
The bill had been stalled in the Senate Rules Committee since April before receiving a hearing on amendments on June 2. Compassion & Choices submitted testimony authored by Coombs Lee raising concerns about the bill, and Coombs Lee spoke at the public hearing. Much of the other testimony hinged on faith-based concerns.
Two days later the Rules Committee voted narrowly to send the bill to the Senate floor with a do-pass recommendation.
While many opponents of the bill also opposed the original law, the testimony of Compassion & Choices — a longtime supporter of the law — is different. Its concerns reflect the emphasis on safeguards and free will that were promised to Oregonians when the ballot measure was being promoted. Skeptics of medically assisted death feared that vulnerable elderly people, some of them cognitively challenged, could be pressured by family members or others into taking their own lives.
Among other things, the bill removes what Coombs Lee calls a “fail-safe” provision — the requirement that a second physician verify that the person seeking death is capable of making that decision. Instead, it merely requires a certification by a hospice physician that the person is within six months of death — without any reference to the patient’s state of mind or capacity to make decisions.
The change comes at a time when national attention in Congress and elsewhere — even the news show hosted by comedian John Oliver — has increasingly focused on the spread of for-profit hospices and hospice doctors that are inappropriately claiming a patient was within six months of death in order to fraudulently collect hefty reimbursements while providing little or no care.
In some cases, people have faced federal indictment for allegedly preying on people with Alzheimer’s or other cognitive conditions, convincing them they were about to die in order to enroll them in hospice care indefinitely.
Kaplan defends the provision accepting hospice certifications, saying that although he’s personally encountered certifications by hospice providers that were questionable enough for him to deny assisted-dying services, he thinks that based on his own experience, that kind of misconduct is rare.
“I've been doing this for probably six or seven years, and I would say it's happened two or three times during that time,” he said.
The concern of Compassion and Choices is different, though. It’s that under the proposed change, a second opinion will not be required to verify the patient’s state of mind, only that they are near death.
“The original law has a duty for the consulting physician to also verify the mental capability and the voluntariness of a request and the fact that they have been advised of their options,” Coombs Lee said, adding that in the current bill, “Those duties were just scratched.”
Coombs and Compassion & Choices are also concerned that the bill removes language stating that the person using the law must have an “incurable and irreversible” disease, instead substituting “terminal illness.”
The group says the choice to take one’s own life should be a last resort, not a desire to stop undergoing treatment.
“The criterion of terminality should always relate to the natural progression of disease — not a patient’s personal treatment decisions,” said the group’s testimony. “This was the intent of the authors and more important, the clear understanding of Oregonians who voted for the law … keeping the original language guards against creating a loophole that could distort the fundamental purpose of the law and essentially swallow long-established eligibility rules that have kept the practice safe for 28 years.”
Oregon is one of 11 states or jurisdictions that allow some form of physician-assisted death for terminally ill patients, and one of the few that doesn’t require patients to be residents. Some feared the end of a residency requirement would lead to a flood of non-Oregonians coming to the state to end their lives, but results for the last two years show that hasn’t happened, according to the Oregon Health Authority’s 2024 Death With Dignity Act report.
More people than ever — 607 — requested prescribed, lethal medications in Oregon last year, but 376 actually died, a slight decline from 2023.
Coombs Lee said she supports the goal of expanding access, likes some of the changes made by the bill, and would prefer the bill allow nurse practitioners and physician assistants oversee the procedure — not just physicians — as the initial bill did. That provision was dropped in the face of concerns from the Oregon Medical Association.
Kaplan said he’d reached out to Coombs Lee’s group months ago but did not hear back — he thinks because its lobbyist was out on leave. He said he’s not sure he understands its concerns, but he’s now in touch with the group to see if there’s time to make tweaks. If the bill doesn’t get approved, it means needed improvements would be delayed, he said, adding that “It’s an access issue.”