Premedication in Cryonics Revisited

Disclaimer: Alcor cannot provide medical care for living patients and must regard the care and medication of legally living members as the sole responsibility of members and their treating physicians. To avoid conflict of interest Alcor cannot advocate premedication protocols for cryonics patients.

If there are medications, nutrients, minerals, and/ or vitamins that can mitigate the adverse effects of ischemia after circulatory arrest, it stands to reason that some of these strategies may even confer greater benefits if they are already being pursued prior to pronouncement of legal death.

Two surveys of the topic of premedication, the only such writings that I know of, were penned by Michael Darwin many years ago. The first is “Reducing Ischemic Damage in Cryonic Suspension Patients by Premedication” (Cryonics, April 1991). The second, more extensive treatment is “Premedication of the Human Cryopreservation Patient,” Chapter 7 of the 1994 cryonics manual Standby: End-Stage Care of the Human Cryopreservation Patient. One case report showing use of premedication is that of James Gallagher, 1995 (Alcor Patient A-1871).

In his contributions, Darwin covers topics such as medico-legal issues, risks and benefits, patient evaluation, drug categories, specific medications, evidence, contraindications, etc. Here I briefly review some recent stabilization medications research for its relevance to premedication protocols.

Broadly speaking, there are two categories of premedication drugs: (1) Drugs aimed at preventing certain events following circulatory arrest and (2) drugs aimed at mitigating the damage that (inevitably) follows circulatory arrest. An example of the former is prevention of blood clots and an example of the latter is ischemia-induced free radical generation.

When our lab, Advanced Neural Biosciences, conducted stabilization medications research we administered medications prior to or concurrent with circulatory arrest. This model is effective in
looking at the efficacy of drugs but in real human cryopreservation administration of medications is often delayed. An interesting feature of this model, however, is that it may tell us something about the efficacy of these medications had they been part of a premedication regime.

As reported in our research summary in the January-February, 2017 issue of Cryonics magazine, we only found consistent and beneficial effects for two medications; heparin and sodium citrate. Both agents prevent the formation of blood clots, although sodium citrate may also exhibit general neuroprotective properties as a calcium chelator.

If we reflect on these results with the two categories of drugs discussed above in mind, it is tempting to conclude that only drugs that can prevent a specific ischemia-induced effect (like blood clotting) can improve the cryopreservation of the patient. This would be premature to conclude at this stage. Not just because of our choice of animal model and sample size, but because some of the medications in Alcor’s stabilization protocol may better help to sustain biological viability after the start of cryonics procedures and/or inhibit biochemical events that degrade brain ultrastructure.

Stabilization medications research can provide data to formulate an evidence-based premedication program, but there are issues that are unique to premedication. For example, a highly effective agent like sodium citrate cannot be administered prior pronouncement of legal death because it immediately stops the heart. There are also medications that may be effective for the critically ill patient (for example, drugs aimed at preventing arrhythmias and sudden death during decline) that have no meaningful role to play in cryonics stabilization procedures.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, May-June, 2017

Medical Myopia and Brain Death

Recently someone sent me a number of papers that discussed the biophilosophical underpinnings of brain death. Medical doctors increasingly find themselves in the midst of heated debates about what constitutes death by neurological criteria. It is not hard to understand how controversies can occur in this area. Whenever a patient who satisfies the criteria for brain death shows signs of improvement or recovery, these criteria are called into question. Or, perhaps more troublesome, some people will simply not concede that a patient is dead because recovery can be envisioned. In such cases, the concept of death becomes more like a subjective “decision” than an objective property of the brain.

To someone sympathetic to cryonics these debates are mildly infuriating because it shows the reckless medical myopia with which matters of life and death are approached. When bioethicists debate what constitutes “permanent and irreversible loss of the capacity for consciousness and self-awareness” there is little recognition of the possibility that what looks hopeless and irreversible by contemporary medical technologies may be rather straightforward to repair or recover by future medical technologies. Would we abandon a patient if a cure would be available tomorrow? What about next month? Next year? 50 years?

The standard rejoinder to this position is that cryopreservation of the patient (cryonics) itself produces irreversible damage to the brain and is thus not suitable to stabilize the patient longterm until more advanced treatments are available. But how can we know what will be considered irreversible damage in the future? Should we simply pull the plug based on our guesswork about the limits of future technologies? Would it not be more prudent to let future doctors make that determination?

This does look a lot like saying that cryonics is just an argument in favor of prudence based on ignorance. A sophisticated way of saying, “well, you never know!” Not quite. If a healthy brain without damage gives rise to consciousness and identity, it follows that if the original state of the brain can be inferred from the damaged state, the capacity to restore consciousness and identity is preserved in principle. Ice formation undeniably alters the structure of the brain but it does not make the ultrastructure “disappear.” In fact, at cryogenic temperatures nothing “disappears,” a point that is not even sufficiently recognized by many cryonics advocates. Today we can do better than freezing, though, and use vitrification agents, which solidify into a glass upon cooling to cryogenic temperatures. While these vitrification agents exhibit some toxicity, at the ultrastructural level this expresses itself at most as alteration of cell membranes, protein denaturation, etc., not wholesale destruction.

Where does this leave us on the issue of brain death? For starters, looking at a monitor and concluding that the patient is dead because of the absence of organized electrical activity will tell us little about the ultrastructure of the brain (case in point, at 15 degrees Celsius even a healthy brain will show a flat EEG). It is true that in some cases of brain death absence of electrical activity corresponds to substantial decomposition of brain tissue but it is important to recognize that in many such cases the brain has been permitted to self-destruct at body temperature as a result of trauma and ischemia. When a hospital is faced with a traumatic event of such magnitude that profound cell death can be expected, the most prudent action is to quickly cool the patient and prevent “information-theoretic death.” If the capacity for consciousness and awareness resides in the neuroanatomy of the brain, the first mandate of medicine is to preserve this.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, March, 2015

I’m Not Dead Yet!

The prevailing view among cryonics advocates is that cryonics patients are not dead. This view is reflected in the cryonics custom of calling people who are cryopreserved “patients” instead of corpses. We feel quite strongly about this, but to what extent do our organization and practices actually reflect this perspective?

Let us consider an event in which a person had a traumatic accident and is in a coma. There is no evidence of severe brain damage but it is not known if and when the patient will regain consciousness again. In a sense this patient appears better off than a cryonics patient because contemporary technologies are at least sufficient to sustain the patient in his current state. On the other hand, unlike the coma patient, the cryonics patient is not in a race against time and will be in a stable condition until advanced resuscitation technologies are made available.

We would be surprised, if not outraged, if we learned that family members and friends started calling a patient in a stable coma a corpse and started closing his bank accounts, selling his assets, and removing his internet presence. But this is what often happens to cryonics patients. While some of this behavior can be attributed to the different legal status of coma patients and cryonics patients, in many cases we simply don’t make the effort. Despite our objection that our patients are “not dead” we do not always act consistently with this view. Why is this important?

Acting consistently with our perspective that our patients are not dead is of crucial importance because the most formidable obstacle for people to make actual cryonics arrangements (instead of just endorsing the practice) is fear of losing their family, friends, and assets in an unknown future. Alcor’s response should not be to simply assure them that everything will be fine but to offer constructive solutions to these concerns that makes potential members feel safer.

Making potential members feel safer, and even positively interested in surviving and reaching the future, should start by broadening our presentation of cryonics to include topics such as re-integration and asset preservation. Currently, these topics (if discussed at all) are delegated to a dark corner on the Alcor website as if such concerns are just afterthoughts. We need to think of better ways to integrate these topics in our presentation of cryonics to the general public.

When someone decides to become an Alcor member (s)he should be issued an Alcor email address with the assurance that this email address will remain functional during cryopreservation and that Alcor will keep updating technologies to let communication options evolve with the times. Alcor can also offer a secure space on the main website where personal data and memories can be stored. After cryopreservation of the patient, authorized family members, relatives and/or Alcor should be able to update this space as well.

An even more ambitious realization of this idea is for Alcor to appoint a reintegration staff member whose sole responsibility is to help members maintain a presence during cryopreservation by assisting the member in preservation of assets and execution of trusts. This person could also function as a liaison between family members / friends and the patient during cryopreservation.

I think moving in this direction could go some way towards reducing the fears that people have about alienation and loss in the future. It is interesting to reflect why such efforts have not received a more important place in the history of Alcor. I think the most obvious answer is that Alcor has a hard enough time keeping the organization running and making sure members get a good cryopreservation. But I suspect there is also another reason. The people who have shaped most of Alcor’s presentation and policies are invariably “hardcore” advocates of cryonics and combine a strong desire to survive with a strong confidence in the technical feasibility of the idea. It would be a mistake to base our presentation and implementation of cryonics on such an unconventional subset of the population. We need to keep calibrating our presentation and services until it all becomes hugely attractive, instead of a source of anxiety.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, July, 2014

Killing Yourself to Live

I recently observed a heated exchange on Facebook about cryonics. One person said something to the effect that cryonics lacks evidence and that chemical preservation (“chemopreservation”) is the preservation technology backed by real evidence. Such statements bother me for a number of reasons. The most important reason, and this cannot be reiterated enough, is that while evidence can be presented that strengthens the case for cryonics (i.e. makes it more plausible), cryonics as such cannot be proven yet because this would require that we have certain knowledge about the capabilities and limits of future medical science. But the whole premise upon which cryonics rests is that future medicine may be able to fix conditions that cannot be treated today (including additional damage done by the cryopreservation process itself). Cryonics is a form of decision making under uncertainty and demanding proof in advance for its success is asking for the impossible.

The other problem, which I have covered in more detail in my extensive treatment of chemical preservation called “Chemical Brain Preservation and Human Suspended Animation” (Cryonics Magazine, January 2013), is that the evidence in favor of chemical preservation is necessarily incomplete because functional tests are excluded. All preservation technologies that involve a form of chemical fixation produce one consistent outcome. They render the (brain) tissue “dead” by contemporary viability criteria. Now, one could argue that making such an argument is akin to what opponents of cryonics do when they claim that our patients are dead. But this is a misunderstanding of the aim of human cryopreservation.

Cryonics is not just about “preserving structure” or preventing information theoretic death. Cryonics as practiced by Alcor is about keeping the patient alive. It is only when we fail to meet this objective that we are obliged to argue that lack of viability does not mean irreversibility. We can examine the brain (or the whole body) in its damaged state to infer the original state and (eventually) revive the patient. So when we use concepts such as “preservation of structure” or “information-theoretic” death it is important to remember that these are conservative fallback options when our efforts to keep the patient alive by conventional medical criteria have failed. The possibility of inferring the original state from the damaged state should never be used as an excuse to permit more damage than necessary. And this is the problem with chemical preservation of the brain. To borrow a song title from the metal band Black Sabbath, such approaches to life extension are akin to “killing yourself to live.”

Why is all of this important? If we want cryonics to gain greater recognition we should conceptualize it as something that is an extension of contemporary medicine but smarter. Cryonics breaks with the prevailing practice of abandoning people simply because they cannot be successfully treated by today’s medical technologies. What may appear irreversible now may be treatable in the future. But we do want to place these patients in cryostasis in the most viable state. Ultimately our aim is widespread recognition for placing critically ill people in suspended animation until a cure for their disease is found. Instead of saying “look how good the structure of this patient’s brain looks” we should aim for a situation in which we can say “this patient is in the same condition as when (s)he was admitted to us but now we have hundreds of years to think about a medical cure.” Evidence of good ultrastructural preservation after vitrification constitutes a strong case for cryonics, but cryonics can do better than doing good electron microscopy.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, June, 2014

The Valley of the Shadow of Death

The “uncanny valley” is a theory described in 1970 by robotics professor Masahiro Mori which posits that as a robot’s appearance becomes more human-like, observer affinity towards it will increase until the likeness reaches a certain threshold, after which affinity will drop sharply into the negative—the uncanny valley—before rebounding again towards levels exhibited toward ordinary, healthy-appearing humans.[1] The theory has received more widespread exposure since the advent of 3-D animated films, where attempted realistic depictions of human characters have sometimes resulted in quite negative viewer reactions, citing “creepiness” of the characters, despite animators’ efforts to render them as close to life (and presumably not-creepy) as possible.

The phenomenon is not unique to humans—it has been observed in monkeys presented with photographs and 3-D rendered images of monkey faces of varying degrees of realism. Mate selection and pathogen avoidance have been suggested as possible evolutionary reasons why subtle deviation from appearance norms would evoke a stronger negative response than a more substantial deviation. However, one researcher, Roger K. Moore has come up with an explanation of the uncanny valley effect, using Bayesian models, that suggests that the effect applies to all conceptual categories (to some degree), not just human vs. non-human.[2]

According to Moore, “the uncanny valley effect is a particular manifestation of… [the] ‘perceptual magnet effect’, in which stimuli close to a category boundary are judged by observers to be more dissimilar than stimuli that are away from a category boundary”. Where membership in one category or the other is determined by reference to more than one perceptual cue, and these cues are in conflict with each other, the differential distortion that results at the class boundary will cause “a form of perceptual ‘tension’… [that] may be experienced as physical or emotional discomfort, e.g. feelings of eeriness or creepiness.”

Moore posits that the drop in affinity described by Mori is a function of (1) decreased familiarity near the class boundary between a ‘target’ perception (i.e. human) and a ‘background’ perception’ that does not overlap significantly with the target (i.e. non-human), and (2) perceptual tension arising from conflicting cues to category membership. Individual observers have varying sensitivities to perceptual conflict, so the depth of the valley will differ from observer to observer, but the feelings of creepiness/eeriness “may induce the observer to take action in such a way as to reduce its effect.” Moore suggests four possible behavioral responses: withdrawal, attack, willfully ignoring one or more conflicting cues (‘turning a blind eye’), or integrating the new information into the category schema (i.e. habituation). Which behavior results from a particular stimulus depends on the stimulus itself, and intrinsic properties of the observer. Moore’s model even accounts for the different curves Mori proposed for still human-like artifacts versus moving ones. However, Moore asserts that “the model derived here provides a more general mathematical explanation… for a range of real-world situations in which conflicting perceptual cues give rise to negative, fearful or even violent reactions.”

One piece that I believe is missing from Moore’s explanation of the uncanny valley is the role that observer category membership plays. I suspect that the sensitivity of an observer to particular perceptual tension, and the nature of the behavioral response exhibited, may depend in part on whether the target perception is a category the observer considers themself to be a member of. This would explain why the effect seems more pronounced when the target perception is ‘human’. It may be that the individual observer sensitivity Moore discusses is generally higher when the cue conflicts force introspection into why the observer themself is a member of the target category, which could result in feelings of insecurity as cues previously assumed to be sufficient for determining category membership need to be reconsidered. It may also be relevant whether the observer considers themself to be a core member of the target category, or on the fringe—or alternatively, a member of the background category.

Now, let us consider cryonics. Might the uncanny valley theory shed some light onto why cryonics has such a difficult time garnering public and mainstream scientific support? I think it can. Mike Darwin has written about the conflict between cryonicists and cryobiologists, pointing out that there was not always a “war” between them, and that “[s]everal cryobiologists who later became some of the most vocal critics of cryonics were not only not hostile, but actually demonstrated interest in and support of cryonics; particularly with an eye towards getting money to pursue cryobiological research.”[3] Several cryobiologists sat on the Science Advisory Council to the Cryonics Societies of America in those early years, and Arthur Rowe, who went on to become a prominent anti-cryonics cryobiologist, at one time even wished Robert Ettinger “continued success in [his] endeavors”, was consulted for his expertise in an early cryonics case… and obliged! Though the collapse of the Cryonics Society of California and tragic loss of the patients at Chatsworth no doubt contributed to rising anti-cryonics sentiment, it is interesting that the move to ban cryonicists from entry to the Society for Cryobiology appeared to occur in reaction to close exposure to “medicalized” cryonics in an impromptu presentation by Darwin at the Society’s meeting in 1981.

This negative reaction by cryobiologists to the arrival of cryonics as a serious scientific endeavor can be explained using the uncanny valley theory. The target category here is clear enough—cryonics aspires to be recognized as a medical procedure. But what is the background category causing perceptual tension? One option is quackery, and certainly many public comments from scientists superficially seem to support this. However, remembering back to Moore’s explanation of the uncanny valley, perceptual tension arises from conflicting cues to category membership near the boundary between categories with low overlap, whereas quackery and actual medicine share many perceptual cues in common (if they didn’t, the snake oil wouldn’t get sold). So while we might not expect scientists to provide ringing endorsements of a practice they perceived to sit near the boundary between quackery and medical procedure, we also would not expect a previously neutral (and in some instances positive) response to shift sharply into the negative as a result of that same practice transitioning towards operating on a more rigorously scientific basis.

I believe the background category causing the trouble is ritual burial practice. The tip-off is that the regulators that anti-cryonics agitators invariably prod to clamp down on “cadaver freezing” are state funeral boards—even though the supposed cause for governmental intervention is that “it won’t work,” a standard which would never be applied to beliefs associated with other burial practices. This approach is illogical: a better strategy against cryonics would be to push for its regulation within the medical establishment, and in particular any devices which fall under FDA’s authority over “medical devices.” This strategy would require cryonics to prove its efficacy, which of course, by presently accepted definitions, cannot be done. Instead, cryonics is shoved in the direction of regulators responsible for burial practices and other modes of disposition of human remains, where, of all places, it might actually have a chance of being protected on the basis of the practitioners’ beliefs. It is telling, too, how often negative responses by scientists to cryonics will ignore or distort well-established science, often from their own field. To me, this all points to the irrational/emotional nature of these responses—many of these researchers no doubt consider themselves members of the extended medical community, and are trying to put distance between themselves and something that looks like them and talks like them, but is nevertheless decidedly not them. Without necessarily realizing it, their instinctive reaction is to push cryonics back towards the background category causing the perceptual conflict.

Ritual burial practice and medical technology are far more dissimilar from each other than medicine and quackery, and thus Moore’s model would predict any cue conflict near the class boundary to cause perceptual tension. Here, cryonics is the perfect storm of conflicting cues: it is a procedure performed after the person is already declared dead, that looks at first like attempts to resuscitate, followed by surgery (possibly involving decapitation) and then preservation, with the ultimate objective of continued life in an as-yet-unknown form, on the basis of a theory that can never be absolutely disproven… so long as the person’s remains are left undisturbed. These perceptual cues are a complete and utter jumble, pointing 100% in both directions at the juncture of life and death.

And if that all weren’t confusing enough, what role might the category of ‘scientific research’ have in this? We utilize anatomical gift legislation to effect transfer of the body for the purpose of research, but then refer to our specimens as “patients” and wait for other research to produce the evidence and technology in order for this research to become a medical procedure. In my opinion, the ‘scientific research’ label is a red herring—it has obvious utility for us, but it is a loose foothold in the uncanny valley, given how candid we are about our objectives.

So, will any amount of R&D short of actually resuscitating someone increase our public approval, or will it just heighten perceptual tension and plunge us further into the valley? Moore’s model tells us that individual sensitivity to perceptual tension isn’t something we can directly control for, other than perhaps through desensitization, but that is hard to accomplish with a movement so small. Also, some of the conflicting perceptual cues are not ones we can change. If our objectives sound quasireligious to others, we can try to explain how we reject the ordinary definition(s) of death while still being rational people—but if they are not persuaded, there’s not much else we can do other than keep building up our evidence, brick by brick. However, we may be able to reduce cue conflict on other dimensions. We can accomplish this by continuing to emulate medicine in more positive ways, and also by de-emphasizing cues that pull the other direction (i.e. the trend away from the word “immortality” is a good one, at least for the public acceptance of cryonics).

The current legal definition of death is a source of perceptual conflict that we may not be able to do much about just yet, but in the interim, we can at least try to minimize its apparent importance to the procedure. Reliance on life insurance to fund cryonics arrangements seems to pull in the wrong direction, as we are opportunistically capitalizing on a definition of death we fundamentally disagree with, in order to afford an opportunity to disprove it— to our benefit. Of course, for many life insurance is the only real means of access available to them, but perhaps down the road, we could negotiate or design a new form of insurance specific to cryonics, formally triggered not by the patient’s legal death, but initiation of cryonics procedures. This is really just a rose by another name, but it would also finally put to rest that old worry that the insurers will come back for their money if the patient is resuscitated.

A feature of mainstream medicine which is conspicuously underdeveloped in cryonics are surrogate decision makers for patients post-cryopreservation. As it stands currently, cryonics organizations have complete or near-complete authority over their charges, and while this is for the good purpose of preventing interference by third parties, it does give the appearance that the patients are essentially the property of the care provider. Given the potential time frames we are looking at, recognizing something like a power of attorney for health care, in cryonics care, still might not stretch far enough, unless it contained a power to delegate the authority further, or was vested in a trusted organization instead of an individual. Due to the legal status of the patients, the cryonics organizations would have a lot of latitude in designing what exactly their obligations were to the patient’s representatives, postcryopreservation, keeping in mind the precarious and high stakes nature of the cryonics venture. However, one scenario which should be seriously considered, is under what circumstances a surrogate decision maker (or self-regulatory body, see below) could insist that the patient be moved.

Another aspect of medical practice which cryonics can and probably should emulate sooner or later is self-regulation. Mainstream medicine is of course regulated through a mix of government and professional self-regulation, and the cryonics organizations’ proactively developing shared standards and oversight mechanisms will give the public confidence that whatever the patients’ status is in law, they are being treated with due care and respect. In the same vein, self-regulation may help ward off the risk of inappropriate government regulation down the road.

These are only a few ideas of how to keep non-research, non-technical dimensions of cryonics progressing smoothly toward recognized medical practice, mitigating as much as possible any perceptual tension with the background category of ritual burials.

If the uncanny valley theory holds true, there’s a high mountain of public acceptance on the other side waiting. The question is, have we already reached the bottom?

References

[1]: Masahiro Mori, “The Uncanny Valley”, 7 Energy 4 (1970) 33-35. Available online (English): http://spectrum.ieee. org/automaton/robotics/humanoids/ the-uncanny-valley

[2]: Shawn A Steckenfinger & Asif A Ghazanfar, “Monkey visual behavior falls into the uncanny valley” 106 PNAS 43 (2009) 18362-18366. Available online: http://www.pnas.org/ content/106/43/18362.full

[3]: Roger K Moore, “A Bayesian explanation of the ‘Uncanny Valley’ effect and related psychological phenomena”. Scientific Reports 2, Article 864. Published online, November 16, 2012: http:// www.nature.com/srep/2012/121115/ srep00864/full/srep00864.html

[4]: Mike Darwin, “Cold War: The Conflict Between Cryonicists and Cryobiologists”. Cryonics, June, July, August 1991. Available online: http://www.alcor.org/Library/ html/coldwar.html

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

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.

Cryonics and Natural Selection

“…it is not the strongest that survives; but the species that survives is the one that is able best to adapt and adjust to the changing environment in which it finds itself” so reads a quote that, in modified form, often has been mistakenly attributed to Charles Darwin but was in fact a description of Darwin’s views penned down by a Professor of Management and Marketing named Leon C. Megginson in 1963. But, surely, one reason for the popularity of this quote is that it captures the modern view of evolution quite well. In this column I would like to briefly reflect on what cryonics means in the context of evolution and natural selection.

Any cryonicist that has not kept his support of cryonics completely to himself must have found himself in a situation where even the most reasonable arguments seemed to leave someone else completely indifferent, or even hostile. Even in the case of family members or friends there comes a point where one cannot help thinking, “well, if you would rather die than think, fine, I am not going to stop you.” It appears, then, that people who make cryonics arrangements are part of an extremely small group of people that will escape the common fate of all humans (i.e. death), as a consequence of being extremely open-minded and adaptable.  But is this the “survival” that the theory of natural selection speaks of?

The modern theory of natural selection is essentially about reproduction. It is not necessarily the longest-lived species (the survivors) whose (genetic) traits will become more common in a population but the ones whose fitness leads to greater reproductive success. It can hardly be denied that cryonicists are extraordinarily capable of adapting to change (or ready to adapt to future change) but it has also been quite firmly observed that cryonicists (or life extentionists in general) are lagging the general population in terms of reproduction, either because of the higher number of single persons or because of the lower interest in having children. It is sometimes observed that whereas most people seek “immortality” by ensuring their genes will survive in future generations, cryonicists see immortality by seeking to survive themselves. In addition, even allowing for a growing interest in cryonics, the number of people making cryonics arrangements is simply too small to have a meaningful effect on the genetic and mental traits of future generations. At best, cryonicists may find themselves being perceived as independent, courageous, individuals that were simply more capable of anticipating the future of science and medicine.

It is tempting, indeed, to think of cryonicists as a homogeneous group of people who are extraordinarily analytic and adaptable but a closer inspection of the motives of people who make cryonics arrangements suggests something different. Indeed, if we look at the early days of cryonics, we see a disproportionate number of cryonicists who where extraordinary visionaries, sometimes independently arriving at the same conclusions (think of Robert Ettinger and Ev Cooper). As cryonics received more mainstream exposure, however, we see different reasons why people endorse cryonics. A partner has cryonics arrangements and the other person is persuaded to do so, too. Subcultures in which making cryonics arrangements is strongly endorsed (like transhumanism). A strong fear of death that prompts a person to do anything to not die, regardless of a dispassionate assessment of cryonics. In more recent times, even career considerations can be a factor as more “market-based” salaries are available in the field of cryonics. Still, despite the possibility that the personality type that chooses cryonics is increasingly getting more diverse, it still makes sense to talk about the demographics of cryonics for as long as the cryonics population is substantially different from the general population.

Where does all this leave us concerning cryonics and natural selection? Since natural selection is basically about reproductive success despite death it would not be correct to characterize the small group of cryonicists that will survive (where others do not) as an example of Darwinian evolution in action, I think. It may be tempting to use Darwinian terminology to characterize our situation but upon closer scrutiny there are problems with this. What might be said, though, is that (successful) cryonicists will be in the extraordinary situation to live for such a long time that they can see human evolution further unfold and even be in a position to consciously direct it through human enhancement.

This is a web-exclusive edition of the Quod incepimus conficiemus column that is published in Cryonics magazine but was omitted from the December 2014 issue.  

Ultrastructural Signatures of Information-Theoretic Death

On October 11, 2013, the Wall Street Journal featured a cover story about the unintended consequences of Norway’s long-time insistence on “plastic graves” (“Grave Problem: Nothing is Rotting in the State of Norway”). You see, after World War II the Norwegians wrapped the dead in plastic prior to burial and now they are faced with…corpses that are not decomposing. Since cemetery real estate is scarce in Norway this creates a rather complicated and sensitive problem. One of the solutions is to poke holes in the ground and plastic to inject a lime-based solution to accelerate decomposition.

Not many people would expect the brains of these plastic-preserved Norwegian corpses to be in pristine condition at the ultrastructural level but this strange story does illustrate that decomposition is a process that is highly sensitive to variables like the presence of oxygen, water, microorganisms, and temperature. Of course, some of these variables are related. When temperatures are lower there will be reduced microbial activity. As a consequence, at cold temperatures the rate of decomposition can be even slower than what one would predict based on the decrease of the brain’s metabolism alone. Cold ischemia is not just warm ischemia slowed down (and vice versa).

My company, Advanced Neural Biosciences, Inc., is currently collaborating with Alcor to produce a series of electron micrographs of brain tissue exposed to very long times of cold ischemia (0 degrees Celsius). One of the reasons we are doing this project is to bring actual data to the decision making process concerning the question when to accept and when no longer to accept a patient who has been stored at low temperatures prior to contacting Alcor for cryonics arrangements.

Ultimately, what we are looking for is an ultrastructural signature of “information-theoretic death.” This presents a formidable problem because information-theoretic death is not an unambiguous identifiable property of an image but concerns our best guestimate about how much structure a future technology might still be able to infer from a given state of damage. For existing patients and members who want to be preserved under any conditions this is not a directly relevant question (the future will tell). But when you have to make a decision whether to accept a third-party “post-mortem” patient, arbitrary decisions have to be made because Alcor simply cannot accept every case brought to its attention.

We have now produced electron micrographs of up to 1 month of cold ischemia. When we shared these 1 month images with the Alcor Research and Development committee one member remarked that he “would not have guessed that so much structure could remain after one month.” When we presented an image from this series at a recent conference, attendees were also surprised about this level of preservation.

Of course, this is not the end of the story because a patient with such a long period of cold ischemia will still need to be cooled to cryogenic temperatures for long-term care and a “straight freeze” on top of such extensive ischemic damage could tip the balance towards informationtheoretic death. These results raise one interesting possibility, however. If the damage of a straight freeze is a lot worse than the damage from moderate times of cold ischemia, cryoprotecting the brain (or both hemispheres separately) by soaking it in cryoprotectant could be a superior protocol for a select number of Alcor cases. There is still much to be learned.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, November, 2013

Chemopreservation in the real world

It is generally not the task of scientists to consider the legal, financial, and logistical limitations when searching for biomedical breakthroughs but there are good examples where considering the real-world applications of a technology can be instructive. Research aimed at preservation of brains (or the “connectome”) is such an example. Even if chemopreservation can be demonstrated to preserve the intricate wiring of the brain, it can be safely assumed that there will not be a massive change in demand for brain preservation technologies (especially if the technology is too strongly tied to mind uploading). As a consequence, providers of chemopreservation will most likely operate in the same environment as providers of cryonics. That means that, as a general rule, there will be a delay between pronouncement of legal death and the start of procedures.

There is now more than 40 years of mainstream biomedical research demonstrating that even short interruptions of circulation (under normothermic conditions) can produce perfusion impairment in the brain. As has been demonstrated by cryonics researcher Mike Darwin and my own lab, Advanced Neural Biosciences, this “no-reflow” can produce poor distribution of cryoprotectants (including vitrification agents) and associated freezing. One serious concern that cryonics researchers have about chemopreservation-in-the-real-world is that poorly chemically fixed brains will be prone to autolysis during long-term storage. This limitation of chemopreservation applies to both “conventional” biological resuscitation scenarios as to whole brain emulation. One can only recover (or “upload”) what is preserved – or can be inferred. And as far as we understand things today, the advantage of temperature as a long-term preservation method is that it does not depend on a healthy, non-ischemic circulatory system. Cryopreservation of an ischemic brain can produce ice formation, but as soon as it is placed in liquid nitrogen, cold will “fix” whatever there is without further degradation. The same thing cannot be said about chemopreservation under poor conditions.

There is an understandable tendency to compare brain preservation protocols under ideal conditions and favor the method that produces the best preservation. But support for either technology cannot be solely based on results produces under controlled lab conditions. Personal survival technologies should be evaluated under conditions that are most likely to be encountered by organizations that will offer them. Demonstrating that chemical fixation (and plastination) can preserve the connectome is a laudable goal but the case for chemopreservation as a clinical experimental preservation method requires a persuasive response to the objection that delays in fixation can frustrate the aims of chemopreservation in the most fundamental manner.

One interesting aspect of the cryonics vs chemopreservation debate, though, is that it appears that some people simply feel more comfortable with one of the approaches. People who have shown the slightest interest in human cryopreservation can get really excited about the idea of chemical brain preservation. This indicates that if both approaches would be pursued actively, the growth of chemopreservation would not necessarily be at the expense of cryonics but there would be a growth in the total number of people making bio-preservation arrangements aimed at personal survival. But as Mike Darwin has recently pointed out, chemopreservation is not at the stage where it can be responsibly offered. The growth of this field requires a committed group of individuals who will research, develop, and implement this program. Chemopreservation does not need to be perfected before being offered (neither was cryonics) but so far most advocacy has been mostly at the conceptual level.

Steve Jobs’ morbid glorification of death

According to Steve Jobs, death is such a great benefit to mankind that it would have to be invented if it did not exist:

No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

As the baby boomers age, we can be sure to hear a lot more of what the cryonicist Mark Plus has called, ‘Humanist Death Apologetics.’ Never mind the horror, the destruction, and the suffering that comes with death, because, “it clears out the old to make way for the new.” Fortunately, a more enlightening perspective on death has been offered by the philosopher Herbert Marcuse:

It is remarkable to what extent the notion of death as not only biological but ontological necessity has permeated Western philosophy–remarkable because the overcoming and mastery of mere natural necessity has otherwise been regarded as the distinction of human existence and endeavor…

A brute biological fact, permeated with pain, horror, and despair, is transformed into an existential privilege. From the beginning to the end, philosophy has exhibited this strange masochism–and sadism, for the exaltation of one’s own death involved the exaltation of the death of others…

Modern market economies demonstrate on a daily basis that death is not necessary for the old to make way for the new. Neither do people have to be faced with death to have a meaningful life. Steve Jobs invites us not to be “trapped by dogma” but, unfortunately, he embraced the biggest dogma of all; the idea that human mortality is a good thing and gives meaning to life.

The reader is encouraged to explore some alternative views about death and aging:

Robert Freitas Jr – Death is an Outrage

Ben Best – Why Life Extension?

Aubrey de Grey – Old People Are People Too: Why It Is Our Duty to Fight Aging to the Death