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A bill that would tweak the language of Oregon’s Death with Dignity Act is reopening the contentious debate over where to draw the line between assisted suicide and euthanasia.

House Bill 2217, which was passed by the state House on Monday , would change the language of the 25-year-old statute to allow for a variety of means by which terminally ill Oregonians could take lethal medications. The measure is aimed at accommodating a small segment of patients who want to end their lives but cannot swallow.

While proponents maintain the bill only makes technical changes to the Death with Dignity statute to remove barriers for a small group of patients, critics have charged it would move the state closer to allowing euthanasia. Even some of the more ardent backers of assisted suicide have opposed the bill as an expansion beyond the original intent of the act.

The bill’s sponsor, Rep. Mitch Greenlick, D-Portland, said state lawyers have interpreted the existing measure to require patients to ingest the medication by physically swallowing it or through a feeding tube.

“There’s one word in the part of the original bill that talks about ingestion, and they’ve defined ingestion as being oral,” Greenlick said at a March hearing on the bill. The new language would specify the lethal medications would have to be “self-administered” whether orally or by other means.

“That’s all it does,” Greenlick said. “It doesn’t change anything else.”

The medications are generally provided to patients in liquid form or in capsules that can be opened and dissolved in about 4 ounces of liquid.

Sen. Elizabeth Steiner Hayward, D-Portland/Beaverton, a co-sponsor and a family physician with Oregon Health & Science University, testified that often by the time patients with cancer or amyotrophic lateral sclerosis have six months to live, as required by the Death with Dignity statute, they are no longer able to ingest the medications.

“They don’t have the hand control to be able to pick it up and swallow, or they can’t swallow,” she said. “Or they have a cancer that blocks them from swallowing easily.”

The state has interpreted the original statute to allow for the medication to be taken through a feeding tube. But Steiner Hayward said many terminally ill patients don’t want feeding tubes because they don’t want to prolong their lives through artificial nutrition.

The change in language would allow patients to inject the lethal medication with a syringe or through an IV. That could be set up in a way that patients only need to push a button, she said.

Dr. Charles Blanke, a medical oncologist and end-of-life specialist at OHSU, has seen more than 300 patients interested in Death with Dignity over the past two years. In 2018, he wrote about 15% of the prescriptions for lethal medication in Oregon.

“I’ve personally witnessed the profound impact and benefit of the Death with Dignity measure, as well as the frustrations patients experience because of the unintentionally ambiguous current wording,” he said. “Those seeking death with dignity all simply want control over their lives and disease. Some can’t achieve that goal because of the wording.”

Blanke said about 10% of the patients he’s evaluated for Death with Dignity have some sort of swallowing issue. Many are afraid they won’t be able to swallow the medications when the time comes.

“They are terrified they will only be able to force down a partial nonfatal dose, and they will then wake up or end up in a permanent coma,” he said. “Some take their life earlier than they and we would ideally want, because they’re afraid they will get to the point where they can’t swallow.”

Critics of the bill, however, warn the change in language would bring the statute much closer to euthanasia. Providing medications in a syringe or through an IV would require a health care provider to insert a needle into a patient’s arm or load a syringe, and many see that as more active participation in the death than simply writing a prescription.

“Oregon’s Death with Dignity law carves patients away from the health care delivery system when they want to commit suicide and doesn’t make us complicitly involved with this,” said Dr. Bud Pierce, a Salem oncologist. “This bill makes us actors in the death of patients. I think it’s morally wrong for physicians to kill their patients.”

Others maintain the bill represent a slippery slope, and that it would be more difficult to provide the same sort of safeguards against euthanasia as the current statute.

“The problem with this setup is that very easily, another person could administer the drugs without the patient having any knowledge of what is going on,” said Dr. Kenneth Stevens, a radiation oncologist from Sherwood.

Stevens said he questioned whether the state would have supported the measure in 1994 had it included the same language.

“This is a bait and switch,” he said. “Twenty-five years ago, Oregonians were baited into approving this because they said this is not going to be injection; this was not going to be euthanasia. Now, you’re switching it.”

Oregon Right to Life officials call the bill “a sweeping expansion” of Oregon’s assisted suicide law that would make it easier for vulnerable Oregonians to be manipulated.

“Oregon has a problem with elder abuse already,” said Lois Anderson, the group’s executive director. “House Bill 2217 places vulnerable Oregonians in even greater danger. There is already no safety net in the law ensuring lethal drugs are taken voluntarily.”

Even groups firmly behind the original measure have opposed the changes within the bill.

Officials at Compassion & Choices, whose president co-authored Oregon’s Death with Dignity Act, said the strict eligibility requirements in the original measure represent important safeguards to protect vulnerable populations. And while regulatory requirements pose barriers for those trying to make use of the act, the group warned the language in HB 2217 could narrow the ways patients could self-administer lethal doses as medical practices and technology continues to evolve.

“We do not believe this particular bill will achieve the desired goal or reduce unnecessary barriers and burdens, and instead may open the time tested and proven effective practice of medical aid in dying to unnecessary ethical and legal challenges,” said Matt Whitaker, director of integrated programs for the group.

The Death with Dignity National Center described the measure as containing “broad, undefined and risky language” regarding methods of self-administration.

“In 25 years, the Oregon Death with Dignity Act has worked as intended,” said Peg Sandeen, executive director of the Death with Dignity National Center. “It strikes an appropriate balance between creating a protocol for qualified terminally ill adult Oregonians to access medications to hasten death while at the same time making sure that no individuals are harmed in the process. Our law is intentionally the most narrow in the world.”

Sandeen said there was no public outcry from patients demanding those changes.

In 2018, 249 Oregonians received prescriptions for lethal doses of medication, a number that has risen nearly every year since the measure was implemented in 1997. As of January, state officials received reports of 168 people who died in 2018 from those medications. Nearly two thirds of those patients had cancer, while about 9% had ALS. Seventeen of those deaths occurred in the Central Oregon/Columbia Gorge region.

According to a report from the Oregon Health Authority, of the 168 people who died in 2018, three had difficulty ingesting the medications.

Dr. Lisa Lewis, medical director for Partners in Care, a Bend hospice, said that while some individuals have trouble taking the lethal medication, they find ways to overcome those barriers.

“I think there are probably unspoken workarounds that people come up with and be creative so that it’s not a hindrance,” she said. “They may have a spouse or close friend or someone help mix that up and then administer it through a feeding tube.”

The hospice requires all medications within its facility to be administered by its nurses, so patients intending to take a lethal dose must do so on their own at home.

HB 2217 moves to the Senate for consideration. The Oregon Health Authority declined to comment on the legislation, and a spokeswoman for Gov. Kate Brown declined to say whether the governor would sign the bill.

Blanke said most of the critics of the bill are opposed to the concept of assisted suicide, not the specific changes in language included in the bill.

“I just can’t believe the route was that important to the people who wrote the law and that they intended people to not be able to use it because they can’t swallow,” he said.

— Reporter: 541-633-2162, mhawryluk@bendbulletin.com