Iatrogenesis and Cryonics

Wikipedia tells us that iatrogenesis is “an inadvertent adverse effect or complication resulting from medical treatment or advice…” The key word in this definition is “inadvertent.” For example, a doctor who exposes a patient to a bacterial infection by accidentally donning non-surgical gloves is an example of iatrogenesis. A doctor who deliberately administers a lethal dose of an anesthetic is not. One source of iatrogenesis is adverse effects.

A defining characteristic of contemporary human cryopreservation is that it is not possible to stabilize patients at very low temperatures without producing additional damage. Forms of injury in cryonics include ice formation, cryoprotectant toxicity, and fracturing. The relevance of the concept of iatrogenic diseases to cryonics was first recognized by Thomas Donaldson in his article “Neural Archeology” (Cryonics, February 1987). What sets cryonics apart is that cost-benefit analysis favors cryopreservation in a sense not encountered in ordinary medicine. Cryonics is the last hope to save the life of the patient and the alternative course of action is irreversible death.

One could say that the adverse effects of cryonics are a form iatrogenic injury, but since the major adverse effects of cryonics are known and recognized, cryonics cannot be brought under the rubric of iatrogenesis. But just as medical researchers and pharmaceutical companies allocate resources to developing drugs with fewer or less serious adverse effects, Alcor aims to improve procedures to eliminate these forms of injury. Examples include vitrification agents to eliminate ice formation, intermediate temperature storage to eliminate (or reduce) fracturing, rapid cooling devices to decrease ischemic injury, etc. The ultimate goal is to create a low temperature stabilization procedure that does not induce any additional injury. Such an achievement would constitute true human suspended animation. We would not be able to treat the disease of the patient yet, but could induce biostasis and reverse it without any adverse effects.

There is narrower application of the idea of iatrogenic injury to specific elements of cryonics procedures. For example, if a multiperson team is present at the bedside with a portable ice bath, ice, and a functioning chest compression device, but later analysis of the temperature data reveals negligible cooling, negligence or error may be involved. This is a rather dramatic example and most examples of non-intrinsic iatrogenic injury in cryonics have a subtler character. Cryonics is particularly vulnerable to iatrogenic injury because of the lack of clear objectives for the individual procedures and the lack of
consistent and comprehensive monitoring.

A rather disappointing excuse for permitting additional injury is the view that since cryonics patients will require advanced repair technologies in the future anyway it is not of great importance to minimize adverse effects of the cryonics procedures themselves. Such an attitude encourages recklessness, makes a mockery of the idea of human cryopreservation as medicine, and is not the kind of cryonics that is going to win over scientists, medical professionals, and the educated public. We do not know at which point injury translates into irreversible identity destruction, but we do know that the closer our procedures conform to reversible human suspended animation the less likely it is that we are wandering into that territory.

Cryonics cannot be disqualified merely because it introduces adverse effects. We know it does and we have no choice but to accept this. But an aggressive pursuit of human suspended animation will eliminate these adverse effects step-by-step so a future doctor will no longer need to worry about the effects of the cryonics procedure itself.

Originally published as a column in Cryonics magazine, February, 2013