Michael Blume noticed that :or defaults can depend on the values of other keys, see https://groups.google.com/d/msg/clojure/6kOhpPOpHWM/ITjWwQFS_VQJ
Michael's Gist https://gist.github.com/MichaelBlume/4891dafdd31f0dcbc727 displays a case where an associative form involving :keys and :or compiles or not depending on the order of symbols in :keys. By tweaking that case one can arrive at expressions which always compile, but produce different values depending on :keys:
I believe that the most natural solution is to demand that :or defaults be evaluated in an enclosing scope where none of the destructuring-introduced locals are present. This approach is taken by the 0001 patch.