Reintegration, Personalized

The latter half of therapeutic cryopreservation involves three “R”s: resuscitation, rehabilitation, and reintegration. Of the three, reintegration receives the least attention as to its content, so permit me to deconstruct it a bit before diving straight in. First off, it’s re-integration, so like re-resuscitation and re-habilitation, we are talking about some present state or condition that we want to return to – in this case, a state of integration, of being part of a larger whole. By identifying a need for something called reintegration, we are predicting that being awakened from a cryonic slumber, even with every memory intact and in perfect health, is not going to be the same as going to sleep one night and waking up the next morning. The world around us will have changed – possibly quite dramatically – and all that we were prior to cryopreservation may not be enough to immediately begin operating as part of the larger whole as we did before. However, none of us is integrated into all subsystems and sub-communities of the larger human social organism at the same time, and to the same degree. So when we talk about reintegrating revived cryonics patients, are we talking about bare, functional integration into the community immediately around the cryonics facility, or something more than that? And either way, how will we measure success of reintegration? According to the norms at the time of revival, or somehow relative to the individual’s first integration?

I think it is problematic to think of reintegration as a general, one-size-fits all process that will not require extensive, non-medical background knowledge of the individual patients. Reintegration is as much about how to fit resuscitated patients back into tomorrow, as it is about how they already fit into today. By leaving the reintegration problem entirely to our friends in the future, we may be allowing data about the patients which would greatly assist with reintegration slip through our fingers to be lost in the sands of time.

But there is another problem that is closely related to the reintegration problem, and that is fear of dis-integration, which is really combination of two things: fear of separation from features of one’s present integration, especially family, friends, but also wealth and possessions; and fear of not having a “place” in the future, of not having a reason to get up in the morning, or as the Japanese call it, ikigai. This problem was very well encapsulated in a recent segment on cryonics on the television show “The Doctors,” when one of the panelists was asked if she would want to be cryopreserved. After her resolute “No,” she was asked why not, so she quickly elaborated, “Well, everybody else you love is not there. Why would you want to be around without people you love?” In reply, one of the more openminded panelists suggested, “Well, freeze everyone then!” There is a certain logic to this, but social inertia being what it is, it is not a very persuasive argument to someone on the fence (or the other side of it) today.

Nor is such fear soothed by simply telling people that we (or our successors) will figure out how to tackle the reintegration problem closer to the relevant time. And by not addressing people’s fear of disintegration more effectively by making tangible efforts today to assist reintegration tomorrow, we may be hampering our own growth, potentially hindering the pace of development and thus prolonging revival for all patients – making the task of their eventual reintegration all the more difficult.

Personhood

It probably goes without saying that reintegration has legal components to it. The one which has received the most attention thus far is asset preservation, but this and most other legal aspects of reintegration rely on the threshold issue of personhood. Legal personality is quite fundamental to our current integration, as is the continuity of that legal personality over time, based on various identifying data like our names, unique appearance, date of birth, etc. Maybe some of us wouldn’t mind fresh starts, but for the sake of exploration I’m going to assume that, given the choice, most cryonicists will want to be recognized as continuations of who they are today, same as we would for any other lapse of consciousness. But for all the good of waking up feeling like we are the same person we were prior to cryopreservation, and expressing that feeling, how do we prove that is what we are? We wouldn’t expect to have much of a problem in an idealized (and impossible) revival scenario that just involved thawing the patient, waking them up with a sharp pinch, and going about curing the disease that caused their initial legal death – but clearly more is going to have to be done  for today’s patients than that. So the question is, how much deviation from that fictional ideal will the legal system of the day be able to tolerate before concluding that the resuscitated patient is not a continuation of the previous person – or maybe not a person at all! Those who are setting up trusts for their resuscitation may be able to work around the issue of continuity of legal personality by dictating that their cryonics organization and trust advisors are responsible for “recognizing”’ them, but without legal personality, the resuscitated patient may have rather a difficult time using those saved resources, not having recourse against those who might try to take them away, or even being able to enter into simple contracts.

Law is highly contextual, and particularly sensitive to place and time. We can only make predictions about what the legal result will be of certain facts tomorrow or the next day because we can predict with a reasonably high degree of certainty what the governing rules will be tomorrow or the next day. This gets a lot harder when we are talking about some decades in the future, though we can certainly try to make reasonable guesses about the larger context to which the system will have already had time to react and adapt. For example, it seems improbable that a cryonics organization would attempt an uploading method of resuscitation without it being previously established that apparently self-aware, conscious, intelligent beings can exist on substrates other than biological brains. Thus, the political and legal organs of the day should have already had opportunity to develop a rule on whether such beings are “persons,” and rules governing the effect of copying and transferring them, etc. But is it reasonable to assume that the rules arrived at will be the ones we want, when and where we want them? We can think ahead to all sorts of good arguments supporting our positions on the matter, but we can’t argue them unless and until we actually get there. It seems more practical to advocate for greater recognition and protection of cryonics patients now, through public awareness campaigns, lobbying and legal efforts.

Our Living Family

Some of the more logistical aspects of reintegration are equally ripe for present action. Practically speaking, the closest analogues to revived cryonics patients today are survivors of very long comas. However, only the longest of long comas are remotely comparable to the scale of temporal displacement cryonics patients are looking at, and survivors of such long comas are very rare. As such, good evidence for successful reintegration strategies is unfortunately lacking. However, one shared feature of several of the cases I found was extraordinary commitment of the patients’ families and/or spouses.[1] In fact, this is usually cited as the reason the patient recovered at all – and to some extent that may be true, given that long-term coma patients without such persistent advocates and caregivers might not be expected to receive the same quality of care, and thus survive long enough to reawaken. But surely reintegration, too, is facilitated by involvement of family, just as it is during our first integration in childhood. This got me thinking about whether my family (and friends) would remain connected to me and my care, if I were cryopreserved tomorrow. Would they scan the science headlines for relevant advancements? Would they check in periodically on the health of my cryonics organization? And even if they did at first, how long would their interest last? Would I have any connection to the people at my bedside upon resuscitation?

Well, maybe I would, because I am fairly integrated with the cryonics movement itself – but that is not going to be the case for everyone, and by leaving it entirely up to the patients’ families and friends to remain engaged… well, results may vary. Here, we have a real opportunity to personalize integration. What if cryonics organizations were to track their patients’ family trees, periodically reaching out to new members of the family (once they are old enough to understand) to inform them that they have a relative being cared for in cryostasis? Sadly, there are probably many cryonicists today whose immediate family are resistant or indifferent to their wishes, but perhaps the next generation will find the novelty intriguing. Ongoing family engagement could potentially benefit the patients’ cryonics organizations in the form of donations, and even new members. The real payoff, though, would be to have relatives of the patients on hand to greet them upon resuscitation, and hopefully assist with the reintegration process – maybe even hosting them with some financial assistance from the Patient Care Trust (and/or personal resuscitation trusts, where existing). Even if average human lifespan does not increase significantly in the decades ahead, the older living relatives of revived patients may not be very many generations removed from them.

Right now, the familial data collected by Alcor and CI as part of the sign-up process is significantly less than what most people can rattle off the top of their heads in the way of names of grandparents, aunts, uncles, and cousins. While a cryonics organization may have some ability to obtain this kind of information via medical records after the patient’s legal death, it would certainly be much easier to get it while they are alive. And that still only gets us part of the way. Where I live, at least, vital statistics information on births, marriages and deaths is not made publicly available for genealogical research until many decades after they occur. Part of keeping the family engaged with the patient would involve asking for their assistance in filling in our picture of the patient’s family tree as it grows new branches. This information may also be obtainable by scouring the web and social media, but the point is not to passively track the patient’s living genealogy in the most efficient manner possible – it is about the cryonics organization maintaining an active relationship with the family, keeping the connection between patient and family alive.

Arguably, this is a lot of work to identify relatives who might be tracked down with the aid of genetic data closer to the day, but I think the power of this idea is more than just the possibility of having patient relatives at bedside for resuscitation, but rather in the effort we make in keeping the family informed, and if they’re willing, engaged. It’s about what we can say we are doing, to the person who expresses to us that, in effect, their fear of being revived permanently separated from their families and loved ones is greater than their fear of death.

These are only some of multiple aspects of reintegration that I think can be constructively brainstormed and worked on today. I will be exploring more at the upcoming Symposium on Resuscitation and Reintegration of Cryonics Patients, hosted by the Institute for Evidence Based Cryonics in Portland, Oregon on May 12, 2013.

Endnotes

[1] Annie Shapiro, 30 years. Jan Grzebski, 19 years. Terry Wallis, 19 years. (Wallis was actually in a minimally conscious state, but the effect is the same, for our purposes.)

First published as a regular column called In Perpetuity in Cryonics Magazine, May 2013.

Are cryonics patients….property?

Doodeward v. Spence, a 1908 case out of the High Court of Australia[1], addressed a very difficult question: could human remains be property? The facts of the case were somewhat bizarre. Some forty years prior to the appeal, a New Zealand woman had given birth to a stillborn, two-headed fetus. The fetus had been preserved in spirits by the attending physician, who kept it as a curiosity, until it was sold at auction after his death along with his other personal effects. The preserved fetus made its way into the hands of the appellant, Doodeward, who exhibited it for gain, resulting in his prosecution and arrest, and seizure of the preserved fetus. Doodeward sued for its return, on the grounds that his property was being wrongfully detained. The potential problem with his claim was that the established common-law rule was that “there can be no property in a corpse,” so the High Court of Australia had to consider whether this particular scenario warranted a principled exception of some kind. There was no question that exhibiting the preserved fetus was a misdemeanor – the issue to be decided was whether the mere possession of it was unlawful.

In a 2 to 1 split, the court held that “it does not follow from the mere fact that a human body at death is incapable of having an owner that it is forever incapable of having an owner,” and that in some cases, human remains could acquire property status. Chief Justice Curtis pointed to the many instances of possession of mummies, prepared skeletons, and other anatomical specimens. He went on to declare: “I entertain no doubt that, when a person has by lawful exercise of work or skill so dealt with a human body or part of a human body in his lawful possession that it has acquired some attributes differentiating it from a mere corpse awaiting burial, he acquires a right to retain possession of it, at least as against any person not entitled to have it delivered to him for the purpose of burial, but subject, of course, to any positive law which forbids its retention under the particular circumstances.”

While it is presently beyond debate that cryonics patients are not persons under the law, Doodeward and cases like it raise the question of whether cryonics patients might fall within the category of property, with some or all of the accompanying legal attributes. What would that mean, legally and practically? Could there be any benefits or disadvantages to acknowledging it?

Legal cross-pollination between common-law countries is a reasonably frequent occurrence, especially in novel circumstances where there may not be any relevant case law from within the jurisdiction to draw from. Since the High Court of Australia’s decision in 1908, the “work and skill” exemption to the no-property rule has been referred to and applied, and even expanded, in Australia and elsewhere. Of recent note, the England and Wales Court of Appeals referred to Doodeward coming to the decision that body parts preserved at the Royal College of Surgeons could be the subject of a theft, having “acquired different attributes by virtue of the application of skill.”[2] The Court of Appeals left the door open that human body parts might be capable of being property “even without the acquisition of different attributes, if they have a significance beyond their mere existence,” citing body parts destined for transplant, extraction of DNA, or for exhibit in a trial. The Doodeward exception has also been referred to in cases acknowledging property in cryopreserved sperm, expanding the principle to encompass not only human remains, but human biological products.[3]

In distinction to England, Canada and Australia, U.S. courts have long recognized “quasi-property” rights in human remains. However, these rights are closely tied to the executor/next-of-kin’s duty to dispose of the decedent’s human remains, coupled with some enforceability of testator instructions on the subject – but they do not empower a person to simply “gift” their remains to someone absolutely, to do with as they please. And it is important to remember that even an exception like the one embodied in Doodeward only applies to human remains that have been subjected to a lawful exercise of work or skill by a person in lawful possession of them. Alcor acquires lawful possession and the right to carry out the procedures which follow via Arizona’s enactment of the Uniform Anatomical Gift Act [“UAGA”]. Like the model statute, the Arizona UAGA doesn’t explicitly state whether bodies or parts donated under the Act acquire property status. However, it does prohibit the sale or purchase of parts for transplantation or therapy.[4] There are three relevant observations to make from this: (1) the presence of this provision implies that such transactions would be legally possible otherwise, which would require that the part was property capable of being sold; (2) the provision does not apply to parts donated for research and education purposes; and (3) the provision does not apply to whole bodies, as the definition of “parts” expressly excludes this.[5] The relevant federal law similarly applies only to organs for transplantation.[6] Thus, in Arizona it appears that whole bodies or parts donated for research or education purposes may be sold and purchased – implying that the donees have acquired proprietary interests in them.

I cannot see a reason why this would not apply to cryonics patients, though substantially more comprehensive research would be required to draw any real conclusions. It would certainly go too far to say that Alcor “owns” its patients, as any proprietary interest it has in them is limited by the terms of the anatomical gift. These terms lie collectively within the Cryopreservation Agreement, Consent for Cryopreservation, and the Last Will and Testament for Human Remains and Authorization of Anatomical Donation. The extent of Alcor’s interest in its patients is expressed as “full and complete custody and control,” and elsewhere, “sole and complete control”: fairly maximizing language, which is for the good purpose of protecting against third-party interferences. While complete rights of ownership would ordinarily include the right to freely alienate (i.e. give away, or sell) the property, Alcor does reserve the right to transfer patients to other organizations in circumstances where it is facing dissolution, or other circumstances which make continued maintenance of the patient impossible. However, the Cryopreservation Agreement is not immutable – lesser restraints on Alcor’s ability to alienate its patients could be possible.

The flip side of this coin, is that if the sale and purchase of bodies or parts donated for research or education purposes is legal, then research specimens of this description have a potentially ascertainable market value. I am not implying a cryonics organization would ever start selling off its patients – that would obviously be quite monstrous. However, the possibility that cryonics patients could have research value that is collateral to their true purpose, or rather collateral to the underlying motivation behind the patients’ decision to “donate” their bodies in this way, could have other consequences. If cryonics patients are proprietary assets of their cryonics organization, then they are assets which could become hostages in lawsuits against it. The actual danger of this would in part depend on the market value assignable to the patients as research specimens, which would depend on their relevance to other research efforts – none of which I am in a good position to estimate. One would hope that the research purpose expressed in the Authorization of Anatomical Donation, being “cryobiological and cryonics research” [emphasis mine], would be construed so as to limit the possible destinations of Alcor’s patients to other cryonics organizations, thereby avoiding the hypothetical danger I have identified. However, there may be another way to protect cryonics patients from being a liability to their own survival.

One of the reasons behind establishing the Alcor Patient Care Trust [“APCT”] was to protect assets marked for patient care from litigants coming after apparent “deep pockets.” If cryonics patients are a form of property, then it is possible that they themselves could be the subject matter of trusts. As with the APCT, legal title to Alcor’s “specimens” could be transferred to an entity other than the cryonics organization itself, to be held on trust for the revived patient, using similar trust law mechanics as used in personal revival trusts (which are beyond the scope of this article), all the while remaining in the custody and care of Alcor. When the patient is revived, if this is achieved through the repair and rejuvenation of the cryopreserved specimen itself, then we face the novel consequence of trust property becoming its own beneficiary (though this would not be the first occasion of a being which was previously classified as property acquiring personhood). If, alternatively, revival is achieved with some kind of uploading technology, then, rather fittingly, the recognized successor in identity will become entitled to what is left of their former substrate. On the other hand, formally acknowledging any proprietary status of cryonics patients by making them subjects of trusts, or otherwise handling them in ways that could only be done with property, could have the side effect of confusing outsiders even more than they already tend to be. There is much to be said for approaching what we do, as much as possible, as medicine being performed on patients (even if, on paper, it is research being performed on specimens). That said, there already exists a field of medicine that treats patients that are not persons, but property: veterinary medicine. Whether a veterinarian happens to think their patients should be recognized as something more than property is not something that would be expected to decrease the quality of care they provide; and, conversely, their role as a caregiver for patients that are presently classified as property would not, to me at least, detract from any efforts they might make to lobby for increased recognition of animals as persons.

The one thing we know for sure right now is that our cryonics patients are not recognized as legal persons. As with the example of animal patients, it should be possible to operate within a system that presently recognizes our patients as property, in such a way as maximizes their benefit, while at the same time arguing they are persons and should be recognized as such.

Endnotes

[1] (1908) 6 CLR 406.

[2] (1998) 3 All ER 741.

[3] On the one hand, a survey of the legal treatment of cryopreserved embryos would seem superficially relevant to an exploration of the legal status of cryopreserved human remains, but cryopreserved embryos evidenced capacity for future personhood situates them in a different policy debate that I think distracts from an exploration of the legal status of cryonics patients today.

[4] ARS § 36-854.

[5] ARS § 36-841.

[6] 42 USC § 274e

First published as a regular column called In Perpetuity in Cryonics Magazine, April 2013

How Uniform Are The Uniform Anatomical Gift Acts?

“SECTION 11. PERSONS THAT MAY RECEIVE ANATOMICAL GIFT; PURPOSE OF ANATOMICAL GIFT”

Thus begins a very important section of a very important piece of legislation. Except it isn’t actually legislation at all, though it does look the part. It is the Revised Uniform Anatomical Gift Act (2006) [“UAGA”]. UAGA is model legislation, and in that form it does not have the force of law.

The model act continues:

(a) An anatomical gift may be made to the following persons named in the document of gift:

(1) a hospital; accredited medical school, dental school, college or university; organ procurement organization; or other appropriate person, for research or education;

Crucially, this section tells us under what, if any, authority we may direct that a cryonics service provider take custody of our bodies after legal death. Whether on plain meaning, or act-specific definition, cryonics service providers are not hospitals, medical or dental schools, colleges or universities. In some circumstances, Alcor and/or Suspended Animation behave like organ procurement organizations — insofar as brains are organs — but that term is defined in UAGA so as to require designation by the Secretary of the US Department of Health and Human Services. Subsection 2 (not reproduced above) is specific to organ transplantation, and subsection 3 pertains to eye banks and tissue banks, neither of which are good “homes” for a cryonics service provider.

So, for the time being we are left with “or other appropriate person, for research or education.” It isn’t much — but it’s home, and on that point at least one court agrees, namely the Court of Appeals of Iowa in Alcor Life Extension Foundation v Richardson. [1] But wait — how does a court in Iowa even begin to consider the meaning and effect of UAGA if it isn’t really law? Well, because the Iowa Legislature looked at the model uniform act, decided it liked it (mostly), and made it into state law. In fact, the Iowa Legislature made some changes to the model, but it left in the “other appropriate person” clause, and that is very good, because when Alcor sued Orville Richardson’s brother and sister for custody of Orville’s body, the Court of Appeals of Iowa agreed that Alcor was an “appropriate person for research” for the purposes of Iowa’s UAGA. [2]

Thus, we can see how important these words are. As the name implies, UAGA is an attempt to promote uniformity in an area of law which could otherwise vary considerably from state to state, making the procurement and transfer of life-saving organs and other tissues for transplant very difficult. So the Uniform Law Commission [3] came along and drafted UAGA for enactment in all states. Of course, this process is voluntary on the part of the states, and does not require wholesale adoption of the model act without modification — and that is where potential for trouble creeps in. Human cryopreservation is obviously not the intended subject of the act; even generally, gifts for research and education are only a secondary focus. In most states (Arizona being a conspicuous exception) there is no cryonics lobbyist at the table when state legislators are deliberating whether and how to enact the newest incarnation of UAGA; hence, they are not thinking about us or our unique interests when they consider whether to pass the model act with the words “or other appropriate person, for research or education” intact.

Now, section 24 of UAGA does state that “[i]n applying and construing this uniform act, consideration must be given to the need to promote uniformity of the law with respect to its subject matter among states that enact it.” But of course, the force of that section depends on whether or not it was itself legislated with the rest of the Act. However, assuming it was, this provision still cannot outweigh clear evidence of a legislature’s intent to diverge from the model by removing or materially altering particular language. That is to say, if the “other appropriate person” clause is left out of one state’s enactment of UAGA, a court has no discretion to read it in. [4] Where the uniformity provision does help is if Alcor ever has to go to court again in a state with a UAGA substantially similar to Iowa’s — then the Iowa case should carry significant persuasive force. [5] Happily, a majority of states’ UAGAs contain the “other appropriate person” clause, unaltered. [6] A few others have adopted different language that is equally or maybe even more applicable to cryonics organizations [7], and two states may even provide additional points of entry for cryonics service providers. [8] However, nine states present problematic aberrations from the mold. In Oklahoma, the State Anatomical Board gets to designate who is an “other appropriate person.” [9] Likewise, the Virginia Transplant Council is in charge of authorizing “other appropriate persons” in Virginia [10], and in the District of Columbia this is the domain of the mayor. [11] The remaining six states lack the “other appropriate person” clause entirely, and any other equivalent entry point: these are California, Florida, Maryland, New York, Texas, and Washington. [12] It is a little surprising to see some current (and in Texas’ case, future [13]) hubs of cryonics activity on this list.

At this stage, I feel I should point out that anatomical gift legislation is only one mechanism for making legal provisions for transference of custody of one’s body after legal death. The other (arguably more traditional) method is the “final disposition of human remains” method. Thus, the mere fact that a state’s anatomical gift legislation does not permit donations to cryonics organizations doesn’t rule out  legally enforceable cryonics arrangements. The nine states mentioned above all have some statutory provision for the disposition of human remains route, though Florida stands out for lack of clarity. Maryland and Oklahoma both provide the right to direct the disposition of one’s body after death. [14] Written preferences are likewise binding in California, District of Columbia, New York, Texas, and Washington, which states also provide the right to designate a person who will supersede the spouse or next of kin’s default authority to control disposition (though they would be bound by the decedent’s written instructions in any case). [15] Virginia allows for designation in writing of a person who will control disposition (over a surviving spouse or other next of kin), but the relevant statute does not expressly state that the decedent’s instructions are binding — though it could be argued that it is implied.[16] Florida’s statutes are not explicit as to who controls the disposition of human remains after death, nor whether written preferences of the deceased are legally binding, though case law has generally supported this result. [17]

However, even if the nine states whose anatomical gift statutes apparently preclude donation to cryonics organizations still provide legally enforceable final disposition rights, mightn’t a document that uses language around “anatomical donations” for this second purpose present somewhat of a red herring? For example, Alcor’s success in the Richardson case relied in part on the fact that Iowa’s UAGA takes precedence over its final disposition provisions, which would have favoured Orville’s brother and sister to control disposition. [18] But when an anatomical gift under UAGA fails for lack of a valid donee, the gift doesn’t fail, but passes instead “to the appropriate procurement organization” (which would not include the cryonics service provider).[19] Would this aspect of UAGA prevail over the cryonicist’s clear intent, just because he or she used the words “anatomical donation”? This result seems inconceivably formalistic, but illustrates the (potential) problem with blending legal categories. On the other hand, because we cannot necessarily control which anatomical gift legislation will ultimately apply to us (as it will be the law of whichever jurisdiction we die in, whenever that happens to be), a hybrid, one-size-fits-most solution has clear utility.

As a Canadian, my interest in UAGA was actually initially focused north of the border. I noticed that Cryonics Institute’s standard issue emergency necklace has “UNIFORM ANATOMICAL GIFT ACT” on the back, and I wondered what Canadian medical personnel might make of that, since we have no such named legislation. However, the intent of CI’s “Uniform Donor Form” [20] is fairly clear, and the majority of Canadian provinces have broadly empowering legislation for making “human tissue gifts.” [21] This is especially good because English-Canadian common law never developed the deferential approach taken by US judges to decedents’ preferences for final disposition — such preferences were only ever considered morally binding on executors and next of kin, and not legally so. [22] However, Alberta’s Human Tissue and Organ Donation Act only permits body donations to university medical, dental or related health programs. [23] This limitation expressly refers to “a body donated under this Act” as opposed to “any tissue, organ or body donated under this Act,” so it could be argued that Alcor neuropatients may still be transferred using the anatomical gift mechanism — but this may not reflect the intent of legislature, and as such may not be a sustainable reading. Unfortunately, this would mean that Albertans (or at minimum, Albertan whole-body patients) are hit doubly — they have no legally binding mechanism for transfer of custody of their bodies to their cryonics organization under either the anatomical gift or final disposition route.

So, more than most, Albertan cryonicists might want to reconsider the wisdom of where they live. That said, while other readers may think themselves lucky to live in a state or province I didn’t mention, laws change [24], and I have just learned all-too-personally how many fifty states are to monitor. We must each be vigilant in ensuring our various cryonics legal documents are valid for their intended purposes.

Endnotes:

1 785 NW (2d) 717 (Ill Ct App 2010).

2 Ibid at 725.

3 http://www.uniformlaws.org

4 UAGA’s choice of law provision (section 19) states that a document of anatomical gift will be valid if it is executed in accordance with either (i) the law of the forum (i.e. the UAGA where the document is sought to be used), (ii) the law of the state/country where it was executed, or (iii) the law of the state/country where the person was domiciled, had a place of residence or was a national when the document was executed. However, the interpretation of the document of gift is governed by the forum law.That is to say, a document of anatomical gift to a cryonics service provider which is formally valid in the forum by merit of its validity under the laws of the state/country where it was executed, etc., may yet be ineffective under the laws of the forum.

5 The Richardson decision also included a tentative, but nonetheless authoritative finding that Orville’s payment to Alcor to preserve his body, and less-than-perfectly-altruistic motives did not move the transaction outside the legal category of “gift.”  Again, this finding and the uniformity provision should go a long way to deciding the issue if it comes up again in another state.

6 For ease of reference: Alabama, Alaska, Arkansas, Arizona, Connecticut, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, West Virginia, Wisconsin, Wyoming.

7 Minnesota replaces “other appropriate person” with “non-profit organization in medical education or research.” Minn Stat § 525A.10. Delaware, Illinois, and Pennsylvania still use language from older incarnations of the UAGA, which lack “other appropriate person” but define “any bank or storage facility” in such a way that so long as the cryonics service provider is recognized as a permissible donee in its home state, it should qualify under the Delaware/Illinois/Pennsylvania statutes. 16 Del Code § 2712, 755 ILCS § 50/5-10, 20 Pa C S § 8612.

8 Alcor’s own lobbying efforts resulted in the inclusion of the comparatively broadly defined “procurement organization” in Arizona’s ARS §36-850; Missouri has provision for “cadaver procurement organization[s]”. Mo Rev Stat § 194.255.

9 63 OS §2200.11A.

10 Va Code § 32.1-291.11

11 DC Code §7-1531.10.

12 Cal Health & Safety Code § 7150.50; Fla Stat § 765.513; Md Code, Est & T §4-509; NY PBH Law §4302; Texas Health & Safety Code § 692A.011; RCW § 68.64.100.

13 Comfort, Texas is home to the Timeship project.

14 Md Code, Health §5-509; 21 OS § 1151.

15 Cal Health & Safety Code §7100.1; DC Code §3-413; NY PBH Law §4201.2(c); Texas Health & Safety Code § 711.002; RCW § 68.50.160.

16 Va Code §54.1-2825.

17 Fla Stat § 497.005(37) sets out an apparent order of priority in a definitions section, without elsewhere stating that that priority grants any particular rights; § 732.804 uses permissive language instead of imperative. See also Leadingham v. Wallace, 691 So (2d) 1162 (Fla 5th DCA 1997).

18 Supra note 1 at 727.

19 Uniform Anatomical Gift Act (2006), § 11(c)(4).

20 http://www.cryonics.org/documents/Uniform. html

21 These are largely derived from various iterations of the Uniform Human Tissue Gift Act proposed by the Uniform Law Conference of Canada.

22 Quebec and British Columbia are the only provinces which provide statutory rights to direct disposition of one’s own human remains: art 42 CCQ and Human Tissue Gift Act, RSBC 1996 c 211 s 4.

23 SA 2006 c H-14.5 s 3.

24 For example, the 2006 revision of UAGA was introduced in the Pennsylvania Legislature this year.

First published as a regular column called In Perpetuity in Cryonics Magazine, February 2013

Advances in Cryoprotectant Toxicity Research

There is little disagreement among cryobiologists that the biggest limiting factor to reversible organ cryopreservation is cryoprotectant toxicity. It is actually not that hard to create vitrification solutions that completely inhibit ice formation at even the slowest cooling rates. The problem is that such highly concentrated vitrification solutions are too toxic to permit recovery of complex tissues. The least toxic vitrification solution for complex mammalian organs as of writing is M22. M22 is the culmination of many years of experimental and theoretical work by cryobiologist Greg Fahy and colleagues using rabbit kidney slices. Studying selected cryoprotectant mixtures on rabbit kidney slices, Fahy and colleagues came to the following conclusions:

1. High concentrations of a cryoprotective agent (or a mixture of different cryoprotective agents) can prevent ice formation during cooldown and warming.

2. The toxicity of some cryoprotectants can be neutralized by combining them with other cryoprotective agents.

3. The non-specific toxicity of a  cryoprotectant solution can be predicted by calculating a quantity (“qv*”) which is intended to measure the average hydrogen-bonding strength of the cryoprotectant polar groups with the water molecules in the solution.

4. Within limits, non-penetrating agents can reduce the exposure of cells to toxic amounts of cryoprotectants without reducing vitrification ability.

5. Synthetic “ice blockers” can be included in a vitrification mixture to reduce the concentration of toxic cryoprotective agents necessary to achieve vitrification.

While M22 is a low toxicity solution, its toxicity profile still necessitates minimizing exposure time and introduction and removal at low (subzero) temperatures. If we had a better understanding of the mechanisms of cryoprotectant toxicity, vitrification solutions with no toxicity at all could be introduced at higher temperatures and exposure times could be increased to optimize complete equilibration of the tissue with the cryoprotectant. It would also allow safer storage at intermediate temperature temperatures (around -130 degrees Celsius) because ultra-stable vitrification solutions could be used that are less prone to de-vitrification upon re-warming. This would be of particular interest for the cryopreservation of large organs or even whole organisms (with applications such as suspended animation and cryonics).

Two major reviews of cryoprotectant toxicity were published in the last 5 years; Gregory Fahy’s “Cryoprotectant Toxicity Neutralization” (Cryobiology, 2010) and Benjamin Best’s “Cryoprotective Toxicity: Facts, Issues, and Questions” (Rejuvenation Research, 2015).

Greg Fahy’s paper is a rigorous exposition of experimental results concerning the phenomenon of cryoprotectant toxicity neutralization. The paper is mostly limited to the discovery that DMSO can block the toxic effects of amides such as formamide. The combination of DMSO and formamide (or other amides such as urea and acetamide) is indeed one of the building blocks of M22 but this combination cannot be used without limit and the paper includes data that indicate the maximum molar concentrations (and ratios) that still permit full viability. In theory, if two (or more) cryoprotectants would completely neutralize each other’s toxicity they could be the sole components of a vitrification solution. But as the formulation of M22 shows, it is still necessary to add weak glass formers such as ethylene glycol, extracellular CPA’s, and “ice blockers” to supplement the toxicity neutralization obtained with formamide and DMSO. An important finding in Fahy’s paper is that n-methylation abolishes toxicity neutralization for amides and combining methylated amides also does not lead to toxicity neutralization between them. In fact, Fahy found that the presence of n-methylated compounds renders even small amounts of DMSO toxic. The remainder of the paper discusses the mechanisms of cryoprotectant toxicity and Fahy now favors protein denaturation as a plausible mechanism of (non-specific) toxicity. While other cases of toxicity neutralization have been reported in the literature, no rigorous studies have been done to produce a body of knowledge that is comparible to what we know about amide-DMSO interactions.

Benjamin Best’s paper is more general in scope but presents a lot of experimental data and also critically discusses Fahy’s work on cryoprotectant toxicity. As Ben Best points out, different (and seemingly contradictory) results do not necessarily mean that cryoprotectant toxicity is a species or cell-type dependent phenomenon. One could imagine a meta-analysis of cryobiology data in which variables such as concentration, loading- and unloading protocols, exposure temperature, exposure time, and the type of viability assay are matched to ensure methodological consistency. It is also important to compare cryoprotectants at their minimum concentration to vitrify to make meaningful toxicity comparisons. If the work at 21st Century Medicine is an indication, universal low-toxicity cryoprotective solutions should be feasible. Perhaps the most interesting part of the paper is where Best offers a critique of Grag Fahy’s “qv* hypothesis of cryoprotectant toxicity”, which aims to show that non-specfic toxicity concerns the degree to which cryoprotectants leave water available to hydrate macromolecules. This discovery allowed for the substitution of ethylene glycol for propylene glycol in Fahy’s lower toxicity vitrification solutions, despite the resulting higher CPA concentrations. Best observes, “it seems contradictory that water remains available for hydration, but not available for ice formation.” A potential rejoinder to this observation is that so called “bound water” does not participate in ice formation but can be disturbed by strong glass formers. Best also suggests a potential refinement of qv* that allows for more precise calculation of the hydrogen bonding strength of the polar groups that are used to calculate qv*. It is conceivable that such a refinement would eliminate the few remaining outliers in the data that support the qv* hypothesis. The paper also draws attention to the possibility of kosmotropic co-solvents and changes of pH and microenvironment polarity to mitigate cryoprotectant toxicity.

Neither of the papers discusses cryopreservation of the mammalian brain, but there is good reason to believe that in the case of this organ modification of low-toxicity vitrification solutions is required. Conventional cryoprotective agents such as PG, EG, and DMSO have poor blood brain barrier (BBB) penetration and the brain may not tolerate the CPA exposure times that other organs do. For example, while M22 can be used for cryopreservation of the brain, many of its component have poor BBB penetration and PVP and the ice blockers (X-1000 and Z-1000) are assumed not to cross the (non-ischemic) BBB at all. One potential solution is to (reversibly) open the BBB with so- called BBB modifying agents like detergents or perhaps to search for cryoprotective agents that can cross the BBB.

The most fundamental question in the design of vitrification solutions remains whether it is possible at all to introduce high concentrations of cryoprotectants without creating any kind of irreversible molecular and ultrastructural adverse effects. Understanding what specific and non-specific cryoprotectant toxicity exactly is should enable us to answer this question.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, September-October, 2016

Groundbreaking Scientific Results Prove that the Proposition of Human Medical Biostasis has Potential and Needs to be Brought into Mainstream Scientific and Medical Focus

Breaking News [Media Press Package with additional detail]

A team from 21st Century Medicine has developed a technology that has been independently verified to enable near-perfect, long-term structural preservation of a whole intact mammalian brain.

This new breakthrough just won the Brain Preservation Prize – five years after it was launched by the Brain Preservation Foundation (BPF).

“One of the, if not THE, most important scientific results in the history of medical biostasis and cryonics has been accomplished” Aschwin de Wolf, President of The Institute for Evidence-Based Cryonics

According to the BPF, 21st Century Medicine narrowly beat a team led by Dr. Shawn Mikula at the Max Planck Institute of Neurobiology (published last year in Nature Methods).

In addition to proof of this accomplishment and the full 21st Century Medicine “Aldehyde-Stabilized Cryopreservation” protocol recently being published in the journal Cryobiology, it was also independently verified by the BPF through extensive electron microscopic examination.

 

 

 

 

 

The prize was independently judged by neuroscientists Dr. Sebastian Seung, Professor at Princeton University and Dr. Kenneth Hayworth, President of the BPF.

“Imagine being able save, and at low temperatures, indefinitely preserve people who can no longer be sustained by contemporary medicine so that future medicine can both revive them and restore their health – these results provide strong support of that being possible”

Dr. JP de Magalhães, Chair of the UK Cryonics and Cryopreservation Research Network

This follows recent scientific evidence that long-term memory is not modified by the process of whole organism cryopreservation and revival in simple animal models.

As the two leading think-tanks/scientific networks in cryonics we share here a brief with both more color and our perspectives on what this important breakthrough means and – does not mean – for cryonics. 

In the words of Dr. Ken Hayworth, President of the Brain Preservation Foundation, and one of the prize judges:

“Every neuron and synapse looks beautifully preserved across the entire brain. Simply amazing given that I held in my hand this very same brain when it was a vitrified glassy solid… This is not your father’s cryonics”

Recent developments relevant to cryonics

A lot of interesting pieces related to cryonics have appeared over the last few months that I thought I would share:

Four professors conclude in MIT Technology Review that there is significant and growing body of evidence in support of human cryopreservation: “The Science Surrounding Cryonics” 

New York Times Cover story by Pulitzer Prize winning journalist on “A Dying 23 Year Young Woman’s Hope in Cryonics and a Future”

Skeptic Michael Sherman writes a piece in Scientific American called  “Can Our Minds Live Forever?”

Here are three recent important peer reviewed papers:

Dr. Greg Fahy and Robert McIntyre of 21st Century Medicine describe here a new cryobiological and neurobiological technique, aldehyde-stabilized cryopreservation (ASC), which demonstrates the relevance and utility of advanced cryopreservation science for the neurobiological research community. The ASC technology is now also competing against Dr Mikula at Max Planck in he brain preservation prize.

The Grand Challenges of Organ Banking and It’s Potential is described by large group of the worlds leading cryobiology scientists:  The first Organ Banking Summit was convened from Feb. 27 – March 1, 2015 in Palo Alto, CA, with events at Stanford University, NASA Research Park, and Lawrence Berkeley National Labs. Experts at the summit outlined the potential public health impact of organ banking, discussed the major remaining scientific challenges that need to be overcome in order to bank organs, and identified key opportunities to accelerate progress toward this goal. Many areas of public health could be revolutionized by the banking of organs and other complex tissues, including transplantation, oncofertility, tissue engineering, trauma medicine and emergency preparedness, basic biomedical research and drug discovery – and even space travel.

Persistence of Long-Term Memory in Vitrified and Revived Caenorhabditis elegans. Two scientists ask the question:  “Can memory be retained after cryopreservation?” and then demonstrate that a form of long-term memory in C. elegans is not been modified by the process of vitrification or slow freezing.

Who speaks for the dead?

Do the dead have rights, in the proper sense of the word? That is to say, when someone is obligated to do something with a dead person, like bury them, for whose benefit are they doing it? For the dead? Or for the living?

You might well ask, is this really important? In short, yes. The person to whom the obligation is owed is the person who may sue for enforcement of that right, and their identity may also determine the remedies which are available to them (be it money, compulsory performance of or abstinence from a particular act). So, the question of whose rights are engaged in dealing with the dead is fundamentally important from the cryonics patient advocate’s perspective.

An illustration: If you make a contract with someone, both of you intending that a substantial portion of what you have promised to do will only be done after (and in fact as a result of) your legal death, and vice versa that a substantial portion of what they have promised to do will likewise only be done after your legal death: who has promised what to whom?

While you remain alive, the answer seems quite obvious. But once you are dead, you are no longer a person. You, sadly, are not an entity recognized by law. You are your estate. Your estate has legal personality of a kind, but it is probably better to think of your estate as a medium. And, as such, it really isn’t about you anymore — it’s about your stuff, and who gets it. Yes, you can (and should, and hopefully do) have a will that references your cryonics arrangements, but practically speaking, the interest that your estate has in that contract you made for things to be done for you after you died, is the fact that something about that contract could result in more stuff for the estate’s beneficiaries. That’s really all the estate can care about, because the real, live person who was capable of having immaterial (or better still, “non-pecuniary”) interests in the contract is now gone.

But wait? How can the cryopreservation agreement (cat’s out of the bag — that contract was about cryonics after all) result in more stuff for the estate? Your cryonics service provider (CSP) didn’t promise to give anything, or pay anything. You, the patient promised to give something, and in fact cleverly entered into other contracts with other people to automatically transfer money to your CSP upon your legal death. So how could the cryopreservation agreement possibly represent a source of “stuff ” for the estate? Well, that’s because there were really two layers of promises — two sets of obligations in every contract. The top layer, or primary obligations, are what you actually bargained for. The secondary obligations are what the other party must do (or rather, pay) if they do not perform their primary obligations. These secondary obligations are the damages, and they are a part of the contract from the very beginning without anything being written about them.

So, the potential pecuniary ($) interest your estate has in the cryopreservation agreement, since your estate is just a medium that can only really have an interest in things and stuff, is in the failure of your CSP to do what it promised to do for you. And unfortunately for you, in cryonics there are no do-overs.

Hence why it is important to know who speaks for you when you are dead. The beneficiaries of your will, however friendly to your arrangements and well-intentioned they are, have no vested, personal, legal interest in the CSP’s performance of its primary obligations to you under the cryopreservation agreement. The executor of your will, on the other hand, has certain obligations to carry out promises made by you when you were alive, and (sometimes) to ensure that your body is dealt with as you directed by will or other instrument. The executor may even have an obligation to ensure that you remain interred as directed. But how long must they keep vigil? When they, too, are dead, does their executor now watch over the both of you? At a certain point (if not right away) this clearly becomes impossibly impractical. Alternately, if your CSP’s custody of your body was effected by a consent to body donation for research (which is the more robustly enforceable method, generally), even your executor has essentially no standing with respect to your body. And this is good, because above all else we trust that our CSPs want the same thing we want — and I have no reason to believe that is anything but true. But what if, someday down the road when your executor and next-of-kin are now in the dewar next to you, your CSP’s performance dips demonstrably below the threshold of “good faith best efforts”? Is there anyone who can claim authority to move you or to enforce performance of your CSP’s primary obligations under the cryopreservation agreement?

The above is not an exhaustive analysis by any measure. I write it hoping only that it will illustrate how peculiarly vulnerable cryonics patients are under the laws currently applying to them. What I plan to do with this column is explore intersections of law and cryonics & life extension (and there are many), and one theme I expect to visit frequently is cryonics patient advocacy. This is the issue of “who speaks for the dead” adverted to above, though in truth it starts long before legal death, and is more about how the dead or incapacitated can speak for themselves through legally recognized documentary evidence of their intentions: wills, trusts, powers of attorney (financial and health care), advance directives, consents to body donation, etc. However, all of these need agents to carry them out, and others still may seek to tear them down, so the more complex questions deal with how to build checks and balances into your supplementary cryonics documents and otherwise incentivize compliance of possible threats.

One specific topic I plan to look at soon: Just how uniform is the Uniform Anatomical Gift Act in its implementation by the various States? Are body donation consent forms executed under the authority of the UAGA enforceable outside America?

Another, somewhat related question: If a cryonicist executes a valid will in Oregon, moves to California, and dies there without executing a new will, but the original will does not comply with the formalities of execution applying in California, is the will valid — and if so, is it valid for all purposes, or only some? This is the domain of private international law, aka “conflict of laws,” which refers to how one legal jurisdiction deals with foreign legal elements: foreign parties, parties asking for application of foreign law, or foreign judgments. This is a particularly complicated area, but one which cannot be ignored, since so many cryonicists do not live in the same legal jurisdiction as their cryonics organization.

Another theme I will be exploring in this column is access to cryonics and other forms of life extension. In the case of cryonics, impediments to access can take the very blatant form of a law directly prohibiting it, or essential procedures thereof, or else operate indirectly, like mandatory autopsy provisions. Access to cryonics is also context-specific — taking on a very different meaning for someone diagnosed with a brain-threatening disorder, for instance. As such, the availability of legal assistance in dying is a topic which might be dealt with under this heading, and whether the practical benefits accruing to those patients outweighs the risks, both individually and to cryonics generally. How the law defines death, and public policy debates over whether to move to new definitions for reasons quite separate from cryonics, also fall neatly here.

Access to life extension, more generally, is also interesting to examine from a legal perspective. Are the current models of regulation applying to drug development sufficiently flexible to accommodate the advent of SENS-type rejuvenation therapies? One could say that cryonics aspires to being ordinary health care someday, at which time we can expect that it will be subject to some form of regulation. What should it look like? And how can cryonics organizations today best self-monitor and self-regulate to ease that eventual transition?

Finally, constitutional rights instruments have immense potential as tools for securing meaningful access to cryonics and other forms of life extension. However, the content and implementation of these fundamental rights documents vary throughout the world. Cryonics has fairly deep roots in America, but are we certain there is no better soil on Earth in which it might flourish?

All of the above areas of law overlap and interact, and there are other relevant ones that I have not mentioned (insurance law, notably), and no doubt a few I am not yet even aware of. I also plan to report on live cases of interest, as they arise.

One last, but significant point: due to variations between the laws of different jurisdictions (even within a single nation) you cannot simply assume that paperwork designed to work in one jurisdiction will work as intended in yours. You need to find a cryonics-friendly advisor where you live and have them review your cryonics arrangements, and revise them if necessary to work in your home jurisdiction. You are fighting for your life — you cannot afford to wear ill-fitting armor.

First published as a regular column called In Perpetuity in Cryonics Magazine, January 2013.

Beyond Skull and Skin: Concepts of Identity and the Growth of Cryonics

Introduction

“Where does the mind stop and the rest of the world begin?” So begins a 1998 paper by Andy Clark and David J. Chalmers called “The Extended Mind.” In this much discussed article they defend the position that cognition, or the mind, does extend beyond the skull and can include objects or operations performed outside of the body, such as the use of calculators or notebooks. There are a lot of complicated and intricate issues involved here but I want to draw attention to the following passage at the end of their paper:

What, finally, of the self? Does the extended mind imply an extended self? It seems so. Most of us already accept that the self outstrips the boundaries of consciousness; my dispositional beliefs, for example, constitute in some deep sense part of who I am. If so, then these boundaries may also fall beyond the skin. The information in Otto’s notebook, for example, [Otto has Alzheimer’s disease] is a central part of his identity as a cognitive agent. What this comes to is that Otto himself is best regarded as an extended system, a coupling of biological organism and external resources. To consistently resist this conclusion, we would have to shrink the self into a mere bundle occurrent states, severely threatening its deep psychological continuity. Far better to take the broader view, and see agents themselves as spread into this world.

If we consider the idea that the self extends beyond the skull and skin, how does this affect our understanding of identity? Clearly, the self and identity are closely related and I suspect that many people would agree that a rich understanding of identity is not exhausted by considering a person’s brain and body. In this article it is not my intention to wade too deeply into semantic issues, or attempt to resolve philosophical debates, but to argue the point that the public perception of cryonics would benefit from embracing a richer concept of identity that includes a person’s social environment, life achievements, possessions, and other assets.

Reductionism in Cryonics

One might argue that cryonics is itself a form of reductionism because it approaches the brain solely as a biochemical entity. This can be admitted, but in this sense it is no more reductionist than the premise of mainstream medicine and neuroscience. In fact, in a properly conceptualized vision of cryonics one can remain agnostic about debates concerning “materialism” or “the soul.” What matters in cryonics (and in medicine in general) is whether approaching the brain from a biological perspective can produce meaningful treatments for medical conditions. I think it is rather obvious that the answer to this question is “yes.”

There is another sort of reductionism associated with cryonics that is more controversial, or perhaps I should say, less appealing to many people. The idea is that preservation of the body is identical to the preservation of a person’s identity. If we can cryopreserve the person’s body in a manner that permits future resuscitation of the person, then his identity has been preserved. In cryonics this idea has often been the starting point for further reductionism. The most notable example is the idea of neuropreservation in which only the brain (usually protected by the head) is deemed to be necessary for the preservation of identity. Neuropreservation raises a lot of complex issues which I will not address here and have covered in another publication.

The most important point I want to make here is that our concept of the self or personal identity is not exhausted by our brains and that our existing bodies mean something to us, even if faced with the argument that an “identical” or “improved” body can be made for our cryopreserved brain in the future.

This kind of reductionism does not stop here. I have even seen arguments that what “really matters” is preserving the hippocampus, presumably being the seat of our memories. For most people, however, our life history (which is closely associated with our identity) cannot be reduced to memories and cognitive operations. The brain is about a lot of other things, too.

Reductionism can also express itself through a position that only “structural” preservation matters, usually confined to the “structural” preservation of the brain. If this argument is made in defense of the cryopreservation of non-ideal cases, under the assumption that as long as the original structure can be inferred from the damaged structure, it is a commendable position. However, how much brain structure must be preserved to prevent information-theoretic death is not something that can be known with certainty and the most conservative approach is to aim for making our procedures reversible by contemporary medical criteria. We do not yet have a good enough understanding of the neuroanatomical basis of personhood to make such a sharp departure from mainstream medical validation.

Cryonicists who believe in “substrate independent minds” (i.e. mind uploading) would even argue that repair and restoration of the original structure is not necessary and perhaps even inefficient. We can “just” do a molecular scan of the (damaged) structure of the cryopreserved brain, reconstruct the original structure “in silico,” and revive the person in a computer. In this vision, identity is not just reduced to brain but to information about the brain.

We now have identified various concepts of identity. At one extreme we have a very rich concept that not only includes a person’s brain and body but also his social environment, assets, and life achievements. At the other end of the spectrum is the idea that a person’s identity can be captured by a scan of their brain ( and perhaps even just the hippocampus). In the remainder of this article I will defend the position that if we want cryonics to appeal to a wider audience we should embrace a much richer concept of identity.

The Failure of the Cryonics Movement

Since the 1980s cryonics organizations have not failed in keeping their patients in cryopreservation. In that sense, cryonics has made impressive progress compared to the days when patients where often moved from one location to another because of insecure funding, sometimes culminating in having to let them thaw. Where the cryonics movement has not been particularly successful is in persuading the general public, or at least a substantial number of people, to make cryonics arrangements. This lack of enthusiasm for cryonics has been discussed intensely in the cryonics community and several reasons have been put forward: scientific credibility, affordability, transparency of cryonics organizations, ignorance, irrationality, religion, a pro-mortalist culture, or fears of the future. In my personal experience, the two major reasons for not choosing cryonics are a lack of confidence in its scientific feasibility, and a fear of future alienation.

Let me be clear that I think it is extremely important to demonstrate the scientific feasibility of cryonics. Even if it doesn’t make cryonics a whole lot more popular, improving our procedures and developing credible resuscitation technologies, is of great importance to the people who have chosen cryonics. I do not think, however, that demonstrating the scientific feasibility of cryonics (i.e. human suspended animation) will produce a substantial attitude change towards cryonics.

First of all, I think it can be quite persuasively argued that the scientific case for cryonics is already quite strong. Ideally, we can cool down the patient to 0°C without compromising viability. The newer generation of vitrification agents can eliminate ice formation in the brain and preserve its fine ultrastructure. The ongoing trends towards miniaturization in manufacturing (such as 3D printing) and biology eventually will give rise to molecular repair technologies that can reverse aging and repair any damage associated with today’s cryonics procedures. One would believe that these developments are at least plausible to hundreds of thousands of people, if not millions. Instead, the number of people who have made cryonics arrangements does not exceed 2,000 (as of writing).

There is another way of looking at this. If insufficient scientific credibility is the reason for the lack of enthusiasm for cryonics how can we explain that millions of people spend hundreds of thousands of dollars on unproven cures when diagnosed with a terminal condition? How can we
explain the much greater popularity of astrology and all kinds of “esoteric” healing? A stunning number of people in the United States believe in the existence of ghosts (according to one poll, 45%!). Are we really supposed to think that the scientific arguments favoring the claims of astrology or the existence of ghosts are stronger than those favoring cryonics? The argument that scientific credibility is holding back cryonics cannot withstand close scrutiny and fails to take into account what moves most people to endorse an idea.

For example, the famous science fiction writer and science popularizer, Arthur C. Clarke, was no stranger to cryonics. He even assisted Alcor during its legal battles in the 1980s. As he states in a supportive letter, “Although no one can quantify the probability of cryonics working, I estimate it is at least 90%—and certainly nobody can say it is zero.” For a long time, Alcor’s Cryonics magazine had one subscriber in Sri Lanka, presumably Clarke who lived there. But even Clark had no personal interest in making arrangements. (He died in 2008, and was buried.) Clark is no exceptional case. There are a lot of people who believe cryonics is plausible. What concerns them is not that cryonics may not work but that it will work, thrusting them into a distant, unknown future with obsolete skills and no money, friends or family.

Most people do not associate cryonics with continuing their lives but with losing everything they care for as the price of admittance to some dystopian neverland—not a very appealing prospect. I do not know if we can completely neutralize those fears, or even make cryonics at all appealing to the great majority. But I do think some progress can be made if we embrace a richer concept of identity and let it shape our communication about cryonics and the services we offer.

Preserving the Extended Self

I will refer to this richer concept of identity as the “extended self.” It does not just refer to the brain or body of the patient but also to his friends and family, his career and achievements in life, his assets and possessions. The concept of an “extended self ” is not just a theoretical construct but has already been used to great benefit in the study of marketing and consumer behavior. If the aim of a cryonics organization is to preserve the extended self, what changes would need to be made? In the most general sense, it would require that we listen carefully to people about what makes them uncomfortable about being cryopreserved. We do not need to start from scratch here. We know what the predominant concerns are. I think that the common denominator that runs through most concerns is that people want their post-revival life to be a continuation of their existing life. There is one notable exception and that is people would want to be cured of the medical condition that caused them to be cryopreserved. In most cases this will require not just curing this disease but also reversing aging. It is important, however, to make it clear that these post-resuscitation decisions can and should be made by the person in question. This is why it is important to present a wide variety of visions of the future that will appeal to a wide range of people.

One unappreciated point about cryonics is that the delay between pronouncement of legal death and resuscitation only exists for people other than the patient. From the subjective experience of the patient resuscitation will be instantaneous. So I suspect that many of us would like a home to return to and continue our life. Unless we live in a post-scarcity economy where money has lost its utility it would also be helpful if we can continue to afford living in our homes and make purchases. Then there are also our personal belongings. If we are able to return to our homes a lot of those should be available once again as well. In short, “taking it with you” is not just a matter of setting up a personal trust but should extend to a person’s money, property, and possessions.

Of course, we cannot expect society to remain static when we are in cryopreservation and the organizations or companies entrusted with these responsibilities will need to be authorized to adapt to these changes. Does a house need to be renovated? What kind of upgrades need to be installed to keep up with technological changes in residences? Should one’s money (or a portion thereof) be exchanged to new digital currencies? Which personal belongings need to be replaced with newer items and which should be retained in their original state for personal or sentimental reasons? We cannot consult the patient in cryostasis and will need to be guided by common sense, written and verbal instructions, and practical considerations. I suspect, however, that most people would agree that an effort to maintain and upgrade our assets and possessions is much preferred to not having any at all.

When it comes to our social connections things are both easier and more difficult. Unlike managing a residence or personal belongings we would not have to make decisions about what to keep and not to keep. We would like to be reunited with our loved ones, family, and friends. Would it not be a lot easier to adapt to a new world if the people who were closest to you before you got seriously ill will be there, too? The biggest challenge here is to present a vision of cryonics where such a scenario is the logical and moral choice. Where making cryonics arrangements is the expression of social connectedness and family values, instead of being perceived as going it alone. This will not be a trivial task but I do not think we can claim, today, that we have put a lot of effort into this. I also suspect that cryonics organizations that make an effort to keep people who have been cryopreserved visible and part of our memories will have an easier time to convey the social nature of cryonics.

Reintegration

Will my skills, qualifications, degrees, and career achievements be completely irrelevant in the future? That is a frequently expressed and justified concern about cryonics. I have decided to treat this topic in this section about reintegration because I think it would not be plausible to claim that a cryonics organization (or associated organization) can successfully claim to resolve this completely.

The first point I want to make is that for many people who are revived in the future returning to their prior job may not be the most urgent matter provided their assets have been well preserved. In fact, even assuming a moderate growth rate, a patient in cryopreservation has a reasonable chance to come out rather well because no withdrawals are made for daily living expenses (aside from a modest asset management fee). Considering the fact that most people are cryopreserved at an old age, many of us will have accumulated some assets that can be preserved and invested during cryostasis.

Not everyone will be completely satisfied with this answer, or optimistic about their financial status in the future, but I think it is not realistic either to ignore this point. As far as the question
of obsolete skills is concerned, I suspect we will see a lot of variability here. People with skill sets that are known to change in the future (for example, maintenance of landline telephones) may be faced with greater challenges than people who work in “timeless” occupations such as artists
who use traditional means of expression (painting) or wine makers. It will be fair to say, however, that the vast majority of people who have been cryopreserved for a long time (more than 100 years) will need to adapt to changes in occupations.

If a person comes out of cryostasis moderately secure, I do not think this constitutes a formidable challenge. The prediction that technologies will accelerate in the future does not necessarily mean that it will become harder to adapt. Even for people who are not cryopreserved during this period a greater pace of technological change will produce a corresponding demand for means to adapt to these changes. I suspect that a lot of these changes can be broken down into several distinct components and some of them can be addressed when the person is in cryostasis. For example, if society changes from email to a different kind of online communication we would expect that a cryonics organization (or whoever administers and maintains the patient’s communications) would make sure that the patient will be able to access his correspondence in a contemporary format. One can think of things that can be done during a person’s absence that will allow her to adapt more quickly and successfully. Reintegration does not start after resuscitation but should be an ongoing concern when the patient is cryopreserved.

The aim of a credible cryonics organization should not only be to cryopreserve the patient but to assist in re-integration into society, too. It stands to reason that when a cryonics organization is reasonably confident that resuscitation is imminent, increasing thoughts will be given to the reintegration of their patients. Not all cryonics organizations may have such a strong emphasis (or set aside money for this), though, but confidence in an organization’s motivation and ability to do so could become an important criterion in choosing cryonics organizations. It is also likely that future charitable and for-profit organizations will focus their attention on reintegration of cryonics patients.

In closing, there is another aspect of reintegration that needs to be pointed out. People often tend to think of a revived cryonics patient as an “intruder” in a new society. Is that a reasonable assumption? Why not consider the idea that such people will be approached with a mix of curiosity and admiration? Why assume that revived cryonics patients only have things to learn and nothing to offer? Occasionally, advocates of cryonics are accused of being too “utopian” but it cannot be denied that a lot of skeptics have distinct dystopian views of the future. Which brings me to my last point. Cryonics organizations and their members should make an effort to present realistic but desirable visions of the future. The emphasis here is on visions. Instead of imagining the future as something scary, or at least as something presenting a series of challenges, it would be nice to be offered a panoply of good reasons to want to live longer.

Conclusion

Cryonics, no doubt, will always be associated with cryopreservation of the body or brain. That is the core activity of a cryonics organization. But if we want more people to make cryonics arrangements, we need to embrace a much richer concept of identity that gives people the impression that our ultimate goal is to ensure that their lives will be continued after resuscitation
instead of being dumped in a foreign and incomprehensible world. I am not arguing that cryonics organizations should feel exclusively responsible for this but I do think we can do a lot better than we are doing today and hope that more people will be motivated to further strengthening their cryonics organizations along those lines.

Cryonics as a measure of rationality?

Most cryonics advocates are often frustrated by the amount irrationality, ignorance, and hostility when other people encounter the idea of human cryopreservation. It should not be surprising then that some of us have simply concluded that most people “just don’t get it.” Which raises an important question. Is making cryonics arrangements a strong measure of rationality? After all, a close examination of Alcor members indicates that most of them are highly educated, a disproportionate number of them have PhDs, and their backgrounds are often in fields where strong analytic skills are required; computer science, neuroscience, biochemistry, etc. Another indicator is that cryonics is relatively popular in communities with a high proportion of “nerds.” In fact, a number of “leaders” in the “rationality” community (Robin Hanson, Eliezer Yudkowsky) have cryonics arrangements and have made public arguments in favor of cryonics. In short, someone who has made cryonics arrangements is not prone to short term gratification and minimizes cognitive biases, one could argue.

The problem with this characterization of cryonics as a measure of rationality is that it does not explain why the overwhelming number of people who can be considered highly analytical or rational have not made cryonics arrangements. Many cryonicists are smart but most smart people are not cryonicists. To explain this we will have to look elsewhere.

The 18th century skeptic and analytical philosopher David Hume once wrote that “reason is a slave to the passions.” In the case of cryonics, no matter how smart a person is, if the person does not have a passion for life (and an aversion to death and aging) that person will not be primed for an enthusiastic personal endorsement of cryonics. Closely related to having a desire to live and to pursue life extension is a an optimistic temperament. A cryonicist is not necessarily “wildly” optimistic, but (s)he should at least think that life is worth living and not be prone to thinking about the future in dystopian terms. I am also inclined to think that such a person is prone to think “like an economist” (to use Bryan Caplan’s phrase). With this I mean that a person can think in a probabilistic manner, does not see the world as a “zero-sum game,” and sees developments like automation, computerisation and biotechnologies in a positive light.

Do these combined traits produce a favorable attitude towards cryonics? This still cannot be the complete story because the traits discussed so far are shared by many millions of people in the world and support for cryonics is extremely small. I want to single out two additional traits that are usually required to prime someone for cryonics. The person also needs to be a non-conformist of some kind. When cryonics is as small as it is, strongly endorsing cryonics makes someone stand out (to put it mildly). And this “standing out” is not comparable to just having a bizarre hobby or a strange sense of style. It can sometimes produce confusion or hostility in other people, which can turn even our most life-affirming friends and family into apologetic pro-mortalists.

The most important trait, in my opinion, and the one that really distinguishes the cryonicist from the non-cryonicist, is the ability to deal with vulnerability, uncertainty and the unknown — in some cases, to even welcome it. People who have been around in cryonics for awhile know that ultimately (that is, when you dig a little deeper) skeptics are really afraid to be resuscitated in a distant and unknown future. This should not be easily dismissed. Personal identity is not identical to the brain or the body (as a simplistic version of cryonics would have it) but extends to all the things and people that have become part of a person’s life. To many people, the cryonics proposal means  survival at the cost of losing everything that gives meaning to their lives.

If we look at the limited acceptance of cryonics from this perspective, does this inspire optimism in persuading more people? An immediate response would be negative because fundamental character traits are hard to change. Another approach, however, is to change the conceptualization and delivery of cryonics so that these fears are not triggered. In particular, it might serve a cryonics organization well to transition from an organization that just “stores” a human body or brain without specific resuscitation and reintegration scenarios to an organization that offers more comprehensive means of identity preservation. Such an organization puts a strong emphasis on the cryopreservation of families and friends. It will offer means of asset preservation and personal belongings. It develops specific resuscitation protocols which are updated and calibrated as our knowledge and technologies improve. And it makes serious efforts to provide a reintegration program which seeks to minimize adjustment to the time in which an individual is resuscitated.

Is endorsement of cryonics a measure of rationality? Yes, but without a desire to live, a reasonably optimistic attitude, an independent mindset, and, most of all, confidence in a cryonics organization to preserve all that is important to a person, being smart by itself is not going to do it.

This is a web-exclusive edition of the Cryonics magazine column that was omitted from the April 2015 issue.

Alcor vs Disintegration

This article was previously published in Cryonics Magazine, May, 2013

In this short article I will discuss two distinct developments in contemporary cryonics that are setting the stage of how cryonics is going to be practiced in the foreseeable future.

First, there is the recognition that the most formidable obstacle for people to make cryonics arrangements is not scientific or technological, but psychological. We know this because people tell us so. It is a form of anxiety about the future and social alienation that is even a concern for people who have made cryonics arrangements. Ignoring this and/or telling people to “toughen up” is simply not an effective response.

Second, there is an increasing interest in long-term wealth preservation among people who have made cryonics arrangements and this interest is no longer confined to wealthy Alcor members. In addition, there is also a growing interest in preserving biographical information, ranging from personal memories to tangible objects. This development can reflect a desire to prevent “disintegration” (see Keegan Macintosh’s excellent article in this magazine) during cryostasis or may be motivated by the use of such information for damage repair or validation of resuscitation attempts.

It seems clear to me that these two developments are closely associated and that Alcor can address the desire of their members to preserve biographical information, remain “connected” and make cryonics a less anxiety-inducing choice at the same time.

In the April 2013 issue of Cryonics magazine Mike Anzis contributed a useful review of very long-term storage alternatives for personal information and materials and all these options have their pro’s and con’s. I suspect that many people not only have reservations about the long-term survival of many of the organizations and companies reviewed, but also have concerns about privacy and the alignment of the goals of these entities and the objective of personal survival.

While it is unrealistic to expect that Alcor can be involved in all matters concerning personal data storage and reintegration (there is an argument for diversification and redundancy, too) it seems rather obvious that Alcor has a more substantial role to play than it does today. It needs to play a substantial role if we want Alcor to be perceived as an organization that does not just see reversible cryopreservation and rejuvenation as a technical problem to be solved, but one that will also do its best to give its patients a face, maintain the social integration of its patients, and facilitate means to protect personal assets and personal information.

I cannot do justice to the practical aspects of this objective in this short article but let me conclude with a number of specific suggestions.

We do not know whether email in its current format will still exist in the future but we do know that Alcor owns a domain name and can issue email addresses to their cryopreservation members and provide secure storage of email messages.

We do not need to speculate as much about the nature and compatibility of very long-term data storage technologies if Alcor starts offering such services and will ensure to upgrade them as times change. In addition, Alcor can allow its members to securely edit their personal information and medical records to allow for a better response in time of need.

Alcor can hardly compete with social networking platforms such as Facebook and Google+ but we can make an effort to offer individual members the opportunity to create a private or public online profile that will be retained after cryopreservation of the member, and that can perhaps even be updated by Alcor, family, and friends.

The benefits of such changes are greater than just offering Alcor members more opportunities to retain personal information, prevent disintegration, and more strongly identify with their cryonics organization. By giving our members a visible place and the tools to remain relevant we will also communicate to the rest of the world that we are serious and that we will not let our members slide into oblivion – even during cryostasis.