Critics have charged that the nation’s first physician-assisted suicide law lacks accountability and fails to provide mental health evaluations for terminally ill patients wanting to die.

But proponents contend Oregon’s Death with Dignity program works well, is accountable and has adequate safeguards for the public.

The Oregon law, which has helped more than 300 people end their lives in its first decade, is virtually identical to the initiative that Washington voters approved Tuesday.

Dr. Ken Stevens says the problems with the law are clear.

Patients don’t receive a psychiatric evaluation when necessary, doctors aren’t accountable enough, and there’s less incentive to take care of those who are dying, said Stevens, professor emeritus of radiation oncology at Oregon Health & Science University.

But Barbara Coombs Lee says Oregon’s law has proved transparent and that physicians who prescribe lethal doses are accountable under the law.

Safeguards include requiring two physicians to attest that a patient’s judgment isn’t mentally or otherwise impaired, said Coombs Lee, president of Compassion & Choices in Portland, which sponsored the Oregon law.

Opponents and proponents have dissected data from Oregon’s experience to support their conflicting points of view.

In the first decade of Oregon’s assisted suicide law, 341 people died after taking a fatal dose of medication prescribed by a physician. Many more received prescriptions than those who took the lethal dose.

Many terminally ill patients just want to have the option available, said Coombs Lee, who helped write Oregon’s law.

“They want an insurance policy,” she said. Anticipating the pain of dying, “they have in their minds a worst nightmare.”

The editorial board of The Oregonian, the state’s largest newspaper, has accused the assisted suicide program of not being transparent enough. The paper says public information is left to the discretion of a few doctors and others.

A spokesman for Oregon’s Public Health Division said it simply follows the law and compiles an annual report based on data required from physicians and pharmacists. Those reports are retained online at oregon.gov/DHS where users can search under “Death with Dignity.”

“There’s nothing more or less we do than comply with the provisions of the law,” said public information officer Patrick O’Neill.

The case of Barbara Wagner, however, illustrates problems with Oregon’s law, said Stevens, who is vice president of Physicians for Compassionate Care. His organization opposes assisted suicide.

Wagner suffered from lung cancer, had undergone chemotherapy and radiation, and was prescribed another chemotherapy drug. The Oregon Health Plan, the state’s health coverage program for low-income residents, wouldn’t pay for that medication but listed aid in dying as one of the options it would cover.

“Barbara Wagner said the message she got from Oregon was ‘We will pay for you to die, but we will not pay for you to live,’” Stevens said.

A pharmaceutical company supplied the drug for Wagner.

The 65-year-old Springfield, Ore., resident, who was featured in TV ads opposing I-1000, died last month of her illness.

Coombs Lee said Wagner’s situation was sad. But she said the state health plan wouldn’t pay for the drug, Tarceva, because it had only an 8 percent chance of extending Wagner’s life two months.

Stevens disagreed, saying the drug could have allowed Wagner to live another year. He said Wagner’s case illustrates how Oregon’s health system now has less incentive to provide terminally ill people with the health care they need.

“I went into medicine to take care of people,” Stevens said. “I did not go into medicine to write prescriptions to kill people.”

Coombs Lee and Stevens also disagree over whether the law adequately holds doctors accountable for prescribing medications for dying.

Stevens said physicians only have to act in “good-faith compliance” with the law. “That’s not a standard that we use in any other part of medicine,” he said.

Coombs Lee said an Oregon board reviews whether physicians have followed the law in prescribing a barbiturate to end the life of a patient. A physician who violated the law could be charged with a felony, although Coombs Lee said she’s not aware of such a case.

One of the most debated points under Oregon’s law is whether patients seeking assisted suicide are adequately screened for mental illness, especially depression.

None of the 49 people who ingested lethal, prescribed doses in 2007 – the most who’ve died in any year – had a psychiatric evaluation done, according to researchers at Oregon Health & Science University in Portland.

Their study reported that one in four people requesting lethal medications under Oregon’s law may be clinically depressed.

Dr. Linda Ganzini, the lead author, said the study supports that “more rigorous screening for depression should occur as part of the physician-assisted suicide process.”

Coombs Lee said the law requires a physician and a consulting physician to certify that the patient has no depression or other impairing illness.

Moreover, Ganzini didn’t find that patients’ judgment was impaired, Coombs Lee said.

When a person is dying, “it’s normal to be sad,” Coombs Lee said. “But if your judgment is unimpaired, you get to make your own end-of-life decisions.”

When asked how his neighbors in Washington might make their law better than Oregon’s, Stevens had no suggestions – other than to repeal it.

For him, there is no middle ground.

“You’ve opened the door so that doctors can write prescriptions for lethal drugs,” he said. “What used to be a crime is a medical treatment.”

Steve Maynard: 253-597-8647

ON THE NET

Compassion & Choices: www.compassionandchoices.org

Physicians for Compassionate Care: www.pccef.org