Medico-Legal Aspects of Human Cryopreservation Optimization

Introduction

Ongoing legal challenges and hostile interference of relatives have increased awareness among cryonicists that addressing the likelihood that one will be cryopreserved at all should take center stage among other strategies for survival. As a consequence, a number of individuals have recently taken on the task of working out the conceptual and legal challenges to minimize hostile interference (for a contribution on the ethical aspects of cryonics interference, look here).

One aspect of cryonics optimization planning that has received little attention to date is to develop legal strategies to deal with medical and legal issues surrounding one’s death, terminal illness, and the dying phase. In this memo I will outline some of the most important medical and medico-legal issues, how cryonicists could benefit from recognizing them, and suggest some legal and practical solutions. Before I get to the substance of these issues I would like to briefly identify all the stages in which proactive cryonics planning can improve our odds of personal survival.

Opportunities for cryonics optimization

The first and most obvious decision is to make cryonics arrangements. Alcor members face complicated decision making because the organization offers both whole body cryopreservation and neuro cryopreservation. From the perspective of cryonics optimization many members choose neuropreservation because it enables the organization to exclusively focus on what matters most; the brain. There is also a logistical advantage. In case transport of the whole body across state lines is delayed the isolated head can be released in advance as a tissue sample. Additionally, a number of Alcor members have recognized that it is possible to have the best of both worlds and combine neuro-vitrification and separate cryopreservation of the trunk. This allows the member to take advantage of the superior preservation of the brain that is available for neuro patients without having to forego whole body cryopreservation. This option is not widely advertised so one is encouraged to contact Alcor about revisions in funding and paperwork.

The other obvious decision is to have secure funding in place. Many members have given extensive thought about funding mechanism and wealth preservation so there is little need to discuss this here. From the perspective of cryonics optimization it is important to emphasize the importance of over-funding your cryopreservation. This not only protects you against future price increases, but also enables you to take advantage of technical upgrades that cannot be offered at the current preservation minimums. Another aspect to consider is leaving money to cryonics research. Although it is reasonable to expect that general progress in science will include general cell repair, there may be areas that will only be pursued by those who have a scientific or personal interest in resuscitation of cryonics patients. As in many areas in life, diversification is key. One should not solely depend upon Alcor or CI for successful resuscitation research or efforts.

Another important opportunity for cryonics optimization is to recognize the importance of proximity. From a technical point of view, there is simply no comparison to de-animating near the cryonics facility of your choice. This is not just a matter of reducing ischemic time. Remote standby and stabilization is a fertile ground for all kinds of logistical and legal complications. Most cryonics members do recognize the importance of reducing transport times but it is an established fact that as soon people become terminally ill they become more resistant to the idea of relocating and often prefer to die among friends at home. It is important to anticipate this scenario and to not delay relocation plans until the last minute. Another advantage of relocating at an earlier stage is that one is better protected in case of a terminal disease with rapid decline or sudden death.

As mentioned above, one issue that is getting increasing attention is how to protect oneself against hostile relatives and third parties. The take-home message is to alter cryopreservation contracts and your paperwork in such a matter that there is an incentive *not* to interfere.

Last but not least, something should be said about community building. Cryonicists can greatly benefit from becoming active in their local cryonics group. Often these meetings are open to members of all cryonics organizations. Most cryonics groups organize standby and stabilization trainings where members can familiarize themselves with the basics of the initial cryonics procedures. Such groups may not only play a part in your own future cryopreservation but are also useful to get a basic understanding about what you can do in the case a local member or a loved one needs to be cryopreserved. Another important aspect of participation in a local cryonics group is that one remains in contact with other cryonicists. When people get older their friends and family members die and the member has little communication with those who are aware of his desire to be cryopreserved. If you live in an area where there are no local cryonics groups contact your cryonics organization and/or start your own local group.

Physician-assisted dying

If there was more widespread acceptance of cryonics the harmful delay between pronouncement of legal death and the start of cryonics procedures would not exist. After a determination of terminal illness, preparations would be made to ensure a smooth transition between the terminal phase and long term care at cryogenic temperatures.

Some states have enacted legislation that allows a terminally ill patient to request the means to terminate their life.  Assisted suicide is currently legal in the following three states: Oregon, Washington, and Montana. Physician-assisted dying does not remove the current obstacle that cryonics procedures can only be started after legal pronouncement of death but it can bring the timing of death (and thus of standby) under the patient’s control. Utilizing such laws can also greatly reduce the agonal phase of dying and its associated risk of damage to the brain.

The legal requirements for utilizing physician-assisted suicide can vary among states but, as a general rule, require that a patient has been diagnosed with a terminal illness with no more than six months to live, that the patient is of sound mind, and that the request is made in written form and witnessed. The State of Oregon has a residency requirement to discourage physician-assisted dying tourism.

Since cryonics procedures are performed after legal death, there is no reason why cryonics patients are exempt from utilizing these laws. Despite rumors to the contrary, there is no evidence that utilization of these laws require mandatory autopsy. After all, the cause of death in physician-assisted dying is clear; self- administration of the lethal drug. To avoid any possible accusations that cryonics organizations encourage the use of such laws, it is recommended that no person associated with the cryonics organization should be a witness, let alone be the physician that prescribes the lethal drugs.

Sudden death and autopsy

One of the worst things that can happen to a cryonics member is sudden death. Especially when the patient is young with no prior heart conditions, an autopsy is almost guaranteed. There is little one can do to avoid sudden death aside from choosing a lifestyle that reduces cardiovascular pathologies. The only preparation for dealing with sudden death is to become a religious objector to autopsy. Some states (including California, Maryland, New Jersey, New York and Ohio) have executed laws to restrict the power of the state to demand an autopsy. Although exceptions can still be made in cases of homicide or public health there is little to lose in using such provisions. The websites of Alcor and CI have links to the relevant forms to execute. The Venturists are offering a card for their members stating that they object to autopsy. This card can be requested from Michael Perry (mike@alcor.org) at Alcor. An example of such a card is provided below.

Sudden cardiac death is not the only reason for ordering an autopsy. An autopsy is typically ordered if there are criminal suspicions (homicide) or suicide. There is also a greater risk of autopsy when a patient dies in absence of other people. Since many old cryonicists are single and spent a lot of time alone they are also at an increased risk for autopsy. This is another good argument to remain involved with local cryonics groups and in frequent contact with other cryonicists.

If autopsy cannot be avoided it is important that the cryonics organization is notified promptly. Cryonics organizations can make another attempt to persuade the authorities to abstain from an autopsy or to request a non-invasive autopsy that exempts and protects the brain. The cryonics organization can also issue instructions for how the patient should be maintained prior, during and after autopsy. It might be worthwhile to generate a template of general autopsy instructions for cryonics patients. Such a document may not be binding but it could be useful in limiting the amount of ischemia and injury.

The dying phase and Advance Directives

Most cryonics members have a basic understanding of the importance of time and temperature to protect a cryonics patient after legal pronouncement of death. Fewer people recognize the effect of the dying process itself on the outcome of a cryonics case. In best case scenarios (physician-assisted dying, withdrawal of ventilation) the dying phase is relatively rapid while in worst case scenarios extensive ischemic injury to the brain is possible. Little work has been done to outline recommendations for the terminally ill cryonics patient. One of the main objectives of this article is to recognize that cryonics members could benefit from a general template that can be used in their Advance Directives and to guide surrogate decision makers.

At this point it is useful to briefly describe how the dying phase itself can affect the outcome of cryonics procedures (for a more detailed treatment see the appendix at the end of this article). A useful distinction is that between terminal illness and the agonal period. A patient is classified as terminal when medical professionals establish that the patient cannot be treated with contemporary medical technologies. During this period the patient is usually still of sound mind and able to breathe and take fluids on his/her own. Unless the patient has suffered an insult to the brain or a brain tumor, there is no risk for ischemic injury to the brain yet. At some point, however, the body’s defense mechanisms will be overwhelmed by the patient’s disease and the patient enters the agonal phase. The agonal phase, or active dying phase, can be characterized as a form of general exhaustion. The body is still fighting but with decreasing success and efficiency. One of the biggest concerns for cryonics patients is the development of (focal) brain ischemia while the (core) body is still mounting its defense.

It would be impossible to design an Advance Directives template that is optimal for all cryonics patients, but there are a number of general guidelines that can inform such a document:

* All health care decisions should be guided by the objective of preserving the identity of the patient throughout the terminal and dying phase.

* Measures to prolong dying should only be initiated or accepted if they result in less ischemic injury to the brain.

* Life-sustaining measures should be withheld in case of traumatic or ischemic insults to the brain.

To ensure that sensible decisions are made in situations that are not covered by these Advance Directives, a Health Care Proxy can be executed that designates a person to make those decisions. It is understandable to give such power to the person closest to you but in the case of cryonics it is recommended that this responsibility should be given to a person with a strong commitment to your desires and a detailed understanding of the medical needs of cryonics patients.

Pre-medication of cryonics patients

If a critically ill cryonics member is at risk of ischemic brain injury during the dying phase it stands to reason that some palliative treatment options are better than others. One possibility for cryonics patients is to specify such options in one’s Advance Directives. Another scenario in which pre-medication is possible is where the medical surrogate is strongly supportive of such measures. It should be noted that such a decision rests solely with the member or his/her medical representative. Cryonics organizations should not be involved in the pre-mortem treatment of the patient.

There are two important questions about pre-medication of cryonics patients:

1. Is it safe?

2. Is it beneficial?

The answer to the first question has a lot to do with the status of the pharmaceutical agents in question. For example, a supplement like melatonin is less controversial than a prescription drug like heparin. The most important thing to keep in mind is that drugs that may be beneficial after legal pronouncement of death could have adverse effects in critically ill patients. Good examples are drugs that have effects on blood rheology and clotting. One would rather forego the hypothetical benefit of a drug if there is a non-trivial change of triggering major controversies about drugs taken during the dying phase. This leaves only certain supplements as relatively safe options for pre-medication of cryonics patients.

The answer to the second question is not clear. The rationale behind pre-medication is that it can protect the brain during agonal shock and its associated ischemic events. Evidence for this belief is usually found in the peer reviewed literature on neuroprotection in ischemia. However, there is a clear difference between the administration of neuroprotective agents during the dying phase and the administration of neuroprotective agents prior to artificially-induced acute ischemia. One perspective is that such agents are beneficial but only delay the ischemic phase of the dying period. In this case supplements have little neuroprotective effect. An alternative perspective is one where such supplements do not alter the agonal course as such but provide more robust protection after circulatory arrest. Obviously, this matter is not of concern to conventional medicine so there is little evidence to make rational decisions. In light of the previous discussion, the current (tentative) verdict should be that a case can be made for pre-administration of neuroprotective agents but that these agents should be confined to “safe” supplements like melatonin, Vitamin E and curcumin. Whether such a regime would be beneficial needs to be decided on a case by case basis and is, therefore, more in the domain of the Health Care Proxy than Advance Directives.

Do Not Resuscitate Orders

Do Not Resuscitate (DNR) orders present one of the most challenging issues for cryonics optimization. On the one hand, we would like to benefit from any attempt to resuscitate us in case of sudden cardiac arrest (or any other acute events that can lead to death). On the other hand, we would not like to be subject to endless rounds of futile resuscitation attempts that can damage the brain.

One would be inclined to think that resuscitation attempts should be made in case of sudden insults or during surgery but that no resuscitation attempts should be made during terminal illness. In reality things are not that simple. For example, resuscitation may be possible after 8 minutes of cardiac arrest but the patient can suffer severe brain damage as a consequence. Such a scenario can be minimized by executing a DNR at the cost of foregoing any resuscitation attempts at all. Would this outweigh the benefits of successful resuscitation attempts? It is hard to see how an objective answer to this question can be given without taking a specific person’s views on risk and treatment into account. One way to mitigate this dilemma is to make a distinction in your Advance Directives between pre-arrest emergencies (for example, resuscitation should be permitted in the case of labored breathing but presence of heart beat) and full arrest. An in-hospital situation where resuscitation of a critically ill patient would be helpful would be where it would allow a cryonics standby team to deploy at the bedside of the patient. As can be seen from these examples, good resuscitation instructions for cryonics patients require a lot of attention to context. Because confusion could arise whether Advance Directives would include pre-hospital emergency procedures it is recommended to execute an explicit document if you want these cases to be covered – such a document could be complemented by wearing a bracelet.

Creating a general template

This article has identified a number of important medico-legal issues that need to be addressed by cryonicists to optimize their cryopreservation. It has become clear that in the case of many topics we would all benefit from uniform and effective language. The next step is to translate the concerns discussed in this document in clear legal language so that templates can be offered to all members of cryonics organizations to draft their own Living Will and Advance Directives. One potential problem of such a general template is that it may not conform to state regulations and needs additional tweaking to make it valid in the state where the person lives.

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Appendix :  Neurological damage during the dying phase

Securing viability of the brain by contemporary criteria is the most important objective of cryonics standby and stabilization. Recognition of how pathological events in the central nervous system can defeat this objective is of great importance. As a general rule, the risk for increased brain damage is higher during slow dying. For example, when the ventilator is removed from the patient who is not able to breathe on his own the time between this action and circulatory arrest can be short. Conversely, when a patient is going through a prolonged terminal and agonal phase (regional) injury to the brain can occur while the body itself is still fighting for its survival.

The human brain has little storage of excess energy. As a result, hypoxia causes the brain to deplete its oxygen reserves within 30 seconds. The energy depletion that follows cerebral hypoxia during the dying phase has a number of distinct effects: 1) excitation or depression of certain processes in the brain, 2) alteration in the maintenance of structural integrity of tissues and cells, and 3) alteration of neuromediator synthesis and release. The depletion of oxygen leads to a switch from aerobic to anaerobic energy production. As a consequence, there is an increase in the metabolic end-products of glycolysis such as lactic acid which decreases pH in the brain. After 5 minutes no useful energy sources remain in the brain, which can explain why the limit for conventional resuscitation without neurological deficits is put at 5 minutes as well. Because the dying phase leads to progressively worse hypotension and hypoxia the metabolic state of the brain after the agonal phase is worse than if there would have been sudden cardiac arrest.

Light microscopic changes have been observed in brain cells after 5 minutes of ischemia. Prolonged hypotension, as can occur in the agonal patient, can lead to the appearance of “ghost cells” and disappearance of nerve cells. Such observations provide evidence that structural changes, including cell death, can occur prior to clinical death. Another manifestation of hypoxia (or hypotension) is the progressive development of cerebral edema. The resulting narrowing of vessels and decrease of intercellular space can, in turn, aggravate energy delivery to tissues. Of particular importance for cryonics stabilization procedures is the development of no-reflow which can prevent complete restoration of perfusion to parts of the brain during cardiopulmonary support. There is no consensus as to whether no-reflow can occur as a result of prolonged hypotension (as opposed to complete cessation of blood flow), but an extended dying phase can set the stage for cerebral perfusion impairment after circulatory arrest.

The central nervous system does not shut down at once. Throughout the terminal and agonal phase alternations in the brain progress from minor changes in awareness and perception to deep coma. As a general rule, more recent and complex functions of the brain disappear earlier than the most basic functions of the brain. The uneven brain response to hypoxia may reflect different energy requirements, biochemical and structural differences, and/or the activation of protective mechanisms to preserve the “core” functions of the brain. The CA1 region of the hippocampus has been demonstrated to be uniquely vulnerable to ischemia. This presents a problem for contemporary cryonics since the objective of human cryopreservation is to preserve identity-relevant information in the brain.

This article is a slightly revised version of a paper that was submitted for the 4th Asset Preservation Meeting near Gloucester, Massachusetts.

Neural cryobiology and the legal recognition of cryonics

It has been said that if you want to persuade someone, you need to find common ground. But one of the defining characteristics of cryonics is that proponents and opponents cannot even seem to agree on the criteria that should be employed in discussing cryonics. The cryonics skeptic will argue that the idea of cryonics is dead on arrival because cryonics patients are dead. The response of the cryonics advocate is that death is not a state but a process and there is good reason to believe that a person who is considered dead today may not be considered dead by a future physician. In essence, the cryonics advocate is arguing that his skeptical opponent would agree with him if he would just embrace his conception of death….

Cryonicists have named their favorite conception of death “information-theoretic death.” In a nutshell, a person is said to be dead in the information-theoretic sense of the word if no future technologies are capable of inferring the original state of the brain that encodes the person’s memories and identity. There are a lot of good things to be said about substituting this more rigorous criterion of death for our current definitions of death. However, in this brief paper I will argue that our best response does not necessarily need to depend on skeptics embracing such alternative definitions of death and that we may be able to argue that opponents of cryonics should support legal protection for cryonics patients or risk contradicting conventional definitions of death.

In contemporary medicine, death can be pronounced using two distinct criteria; cardiorespiratory arrest or brain death. A lot of ink has been spilled over the co-existence of those criteria and its bioethical implications but I think that most people would agree that the practice of medicine requires this kind of flexibility. What is interesting for us is that clinical brain death (or brain stem death) is defined as “the stage at which all functions of the brain have permanently and irreversibly ceased.” There are a number of ways how such a diagnosis can be made, but in this context I want to focus on the absence of organized electrical activity in the brain.

We first should note the use of the word “irreversible.” After all, if a patient is cooled down to a low core temperature to permit complicated neurosurgical procedures most of us would not say that this person is “temporarily brain dead.” As a matter of fact, one could argue that cryonics is just an experimental extension of clinical hypothermic circulatory arrest in which there is a temporal separation of stabilization and treatment. Now, we could argue that what may be irreversible by today’s standards may not be irreversible by future standards but then, again, we are trying to persuade the other person to accept our view of future medicine. It would be much better, and I hope much easier, to argue that contemporary cryopreservation techniques can preserve organized electrical activity in the brain. The advantage of this approach is obvious. Instead of arguing in favor of our own criterion of death we can argue that, according to mainstream criteria for determination of death, cryonics patients are not dead. This is an interesting case in which a scientist (i.e., a cryobiologist) may be able to make a major contribution to the legal recognition and protection of cryonics patients.

So where are we standing right now? How good are our preservation techniques? If we aim for reversible whole brain cryopreservation a cryoprotective agent should have two properties: (1) elimination of ice formation, and (2) negligible toxicity. In the early days of cryonics, we were not able to satisfy both criteria at once. Using just a little bit of glycerol would not be toxic but it would still allow massive ice formation. Using a lot of a strong glass former such as DMSO would eliminate ice formation but at the price of severe toxicity. Mostly due to the groundbreaking work of cryobiologists Gregory Fahy and Brian Wowk, in the year 2000 the Alcor Life Extension Foundation introduced a vitrification agent called B2C that eliminated ice formation and had a more favorable toxicity profile. In the year 2005, the separation between the state of the art in experimental cryobiology and cryonics practice was further narrowed when Alcor introduced M22 as their new vitrification agent. M22 is the least toxic vitrification agent in the academic cryobiology literature that permits vitrification of complex mammalian organs at a realistic cooling rate.

M22 and other solutions derived from the same cryobiological principles have been validated in the brain as well. Former Cryonics Institute researcher Yuri Pichugin and collaborators used a related vitrification solution for the preservation of rat hippocampal brain slices without loss of viability after vitrification and rewarming. At a cryonics conference in 2007, 21st Century Medicine announced that the use of M22-based solutions permitted the maintenance of organized electrical activity in rabbit brain slices. So, at this stage we can argue that our existing vitrification solutions have a reasonable chance of maintaining organized electrical activity in brain slices. The next challenge is to demonstrate this property in whole brains.

Whole brain cryopreservation is not just the cryopreservation of a great number of individual brain slices. Brain slices can be cryopreserved by (step-wise) immersion in the vitrification solution. Vitrification of whole brains (even small brains such as rodent brains) requires the introduction of the vitrification solution through the circulatory system. This aspect of whole brain vitrification presents a number of technical challenges. Electron micrographs of vitrified tissue from whole brains, however, indicate that these challenges can be overcome. The current research objective is to perfect perfusion techniques and optimize vitrification solutions to maintain organized electrical activity in whole brains. We know that this objective is possible in principle because the famous surgeon Robert White demonstrated retention of electrical activity in whole isolated brains after cooling them to ~2-3°C. Isolated brain perfusion is a complicated surgical procedure, but the current writer and cryobiologist Brian Wowk have recognized that validation of whole brain activity is also feasible in situ.

Reversible cryopreservation of the whole brain without losing organized electrical activity is not a trivial research objective but it should be easier to achieve than reversible cryopreservation of the whole body and, perhaps, some other organs. If and when we accomplish this, we will no longer be dependent on “rationalist” arguments that appeal to logic and optimism about the future. We can argue that our patients should not be considered dead by the most rigorous criterion for determination of death in current medical practice. We can then even mount some smart legal challenges to seek better protection for cryonics patients. If we can make this step forward we should also aim at improved protection of existing cryonics patients, which will allow them, among other things, to own assets and bank accounts. This is how science can be employed in legal strategies for asset preservation.

This article is a slightly revised version of a paper that accompanied a recent presentation on neural cryobiology and the legal recognition of  cryonics at the 5th Asset Preservation Meeting in Benicia, California.

Paul Edwards on the fear of death

In his book God and the Philosophers, the Austrian American atheist philosopher Paul Edwards writes:

When we die we do not return to the “bosom of Nature” or the bosom of anything. After death we will have no experiences at all for ever and ever; and this is what is so terrible about death. The fear of death is no doubt instinctive, but it is also entirely rational. The usual consolation that we also did not exist for an infinite period before birth is not really to the point. The non-existence before birth was followed by life, but our present life will not be followed by another life after we die.

Whether the fear of death is rational or not, there is also a more common sense perspective available on this issue. Fear of death seems to be hardwired in human nature, only the intensity of  this fear differs among humans. Instead of trying to overcome this fear of death with logical arguments, it would be more productive to seek meaningful rejuvenation and human enhancement therapies that would substantially reduce the probability of death by tackling aging and the fragility of human life.

It is surprising that the work of Paul Edwards has not received more attention by life extension advocates. His book Heidegger and Death and his collection of articles about Immortality indicate a serious interest in the topic of personal survival.

Is a life worth starting? Some personal views

For life—the life of any sentient creature—to be worth living, there must, as Robert Ettinger has often said, be a preponderance of satisfaction over dissatisfaction. If this overall slant toward good rather than bad is maintained, it seems reasonable that one stands to gain by continued existence. I am not sure what fraction of the human (or other sentient) population achieves this positive balance and will not speculate except to note that by appearances there are many humans who do achieve it, along with other creatures, pets in particular, so at least for them, life is worth continuing. To say that life once started is worth continuing does not, as David Benatar points out, imply that it was worth starting in the first place, or should have been started. But I think that, barring certain problematic cases,  it is fair to conclude that a human life at least is worth starting, if there are responsible prospective parents who would like to start it. Here I think it is reasonable to expect that the resulting person will feel that life is overall a benefit, and additionally, that others, the parents in particular, will stand to gain from the new life that has entered their lives. I don’t accept Benatar’s arguments that by and large life is pretty terrible and people delude themselves who think otherwise.

Also I reject his “asymmetry” argument, that it is “good” if a life that would be bad does not come into existence, but merely “not good” rather than “bad” if a life that would be good does not come into existence. (It is easy to see how this asymmetry supports the argument that life should not start in the first place and Benatar refers to it often.) Benatar’s main rationale for this argument seems to be that, while we would consider someone morally at fault for deliberately bringing into existence someone who would be miserable and just want to die, we would not similarly hold someone culpable who elected not to bring into existence someone who would be happy and want to remain alive. This I think should not be the only consideration, for it is based only on the idea of when we should regard an action as bad, and not at all on when we should regard it as good and commendable. (Why this particular asymmetry?) Instead, weighing both sides of the issue as I think is justified, I would opt for the fully symmetric position that it is “not bad” if a life that would be bad does not come into existence, and similarly, “not good” if a life that would be good does not come into existence. On the other hand, I question and doubt whether a life that comes into existence would be bad in the long run, given the prospect of immortality, which I think is a possibility through science (see below).

Life does, of course, have its problems, death in particular, that might call in question whether it is worthwhile after all and thus, whether the life of any sentient being is worth starting.  For this one problem there are a number of possible answers that will be satisfying to different people, and thus can serve as ground for a feeling that life is worthwhile and was worth starting despite one’s own mortality. There is the famous Epicurean argument that death is not really a problem because before it happens it causes no harm, and after it happens there is no victim. There is the Buddhist argument that, more fundamentally, the self is an illusion anyway, so that in fact no persons exist and death never really happens, though bliss can still occur through states of enlightenment which thus are worth seeking. There are various religious traditions that promise an afterlife and a happy immortality for those who prove worthy, or, in some versions, all who are born. Then there is scientific immortalism, which holds that at least substantial life extension through science and technology is possible, so that, irrespective of any supernatural or mystical process, persons of today have more to hope for as they get older than the usual biological ruin and oblivion.

The scientific possibilities for overcoming death come in different varieties that each have their own advocates. Some of these hopefuls, particularly younger ones, focus on the prospect that aging and now-terminal illnesses will be remedied in their natural lifetime, so that they will escape clinical death and need not specially prepare for it. Others who are not so confident have made arrangements for cryopreservation after clinical death, in hopes of resuscitation and cure of aging and diseases when the requisite technology becomes available. Still others hold out for advances on a more cosmic scale that will eventually make it possible to raise the dead comprehensively. (Some possible scenarios for this using multiple, parallel time streams rather than revisiting or recovering a hidden past are considered in my book, Forever for All, and the article at http://www.universalimmortalism.org/resurrection.htm.) The three possibilities are not mutually exclusive, so that, for example, persons who have chosen cryonics may also place varying hopes in the other two. In fact, my personal viewpoint as a scientific immortalist grants some validity to all three possibilities, but I think it is imperative now to be engaged in cryonics, which is almost unique and the clear favorite as a proactive, interventive strategy against death. Passive acceptance of the dying process simply does not feel right, whatever the prospects for near-term medical progress, or on the other hand, resurrections in a more distant, technologically superior future. It goes without saying that I also think future life will be worth living—it should be possible to make it so, if future developments can provide the opportunity.

Review of 'Better Never to Have Been'

Review of  Better Never to Have Been: The Harm of Coming into Existence by David Benatar. New York: Oxford University Press, 2006

“Would that I had never been born” is a lament sometimes voiced in the depth of misfortune, a cry of despair we hope may be soon be stilled by something more positive, when the bad things, whatever they are, have run their course. Enter David Benatar, a respected professor of philosophy at the University of Cape Town, South Africa. In the volume here reviewed he offers the extreme view that in fact it would have been better, all things considered, if not one of us had ever existed, or even any sentient life whatever. Life is that bad, he says, and he bases this judgment on certain logical principles along with empirical evidence of the allegedly poor quality of life that most of us are forced to endure in this world. Among the consequences is that no more humans should be born, and the human race (and other sentient creatures) ought to become extinct.

Antinatalism—the viewpoint that birth of sentient life, human in particular, is bad and ought not to happen, is a recurring one theme history, a noted proponent being the philosopher Arthur Schopenhauer (1788-1860). It can also be founded, as Benatar proposes, on certain assumptions considered reasonable by many people today, particularly those of a scientific, materialist outlook who are not inclined to over-optimism. Among the assumptions are that anyone’s life, overall, is an exercise in futility. Death—eternal oblivion—is the eventual fate of each person, and will happen through the normal aging process if not sooner. (Thus there is no serious prospect of a religious afterlife. Though not stated in the book, it is clear also that radical life extension, whether by imminent medical breakthroughs or through an initial “holding action” such as cryonics, is discounted.) Moreover, the human species will eventually die out, as is the fate of all biological species, so the extinction advocated by Benatar must happen in the end regardless. Another important presumption, in this case justified at length, is that in most people’s lives sorrow and misery predominate heavily over joy and happiness, so that their lives are not worth living.

Benatar denies that any good is done in any act of procreation, even if the life of the offspring is predominantly happy and if that person expresses gratitude for having been given life. The very best that could happen, Benatar says, is that no harm would be done, but only if the offspring never experienced anything bad in his/her entire life, an unlikely prospect. Even then, no good would be done or moral credit accrue in bringing that person into existence—good is done only in not bringing into existence any person who, in the course of his/her life, would at least experience some amount of bad. Harm is done, and in any likely circumstance, unacceptably serious harm, in bringing anyone into the world.

Such arguments seem unpersuasive for any of a number of reasons, and many will also find them offensive. In the matter of family planning, the prospective parents will be motivated by thoughts such as a child would bring them joy even as they in turn strive to provide the child with a happy home life and a good upbringing. Overall the child can be expected to be grateful both during the period of childhood and later in life, something that seems borne out in practice, even if hardship also occurs. As tough as the going may be at times, most people do not feel their parents were morally at fault for having had them, and are not ready to end their lives over any perceived shortcomings in their present situation or future prospects.

Benatar devotes a chapter of his book to arguing, nonetheless, that actually life as most people live it is very bad, suggesting that those who disagree don’t realize just how bad it is and are suffering some kind of delusion. But this begs the question of who is to judge. Turning the argument around, is it not possible that Benatar himself is suffering from depression that clouds his judgment? Natural selection of course favors a brighter outlook: Benatar’s thinking is not conducive to reproductive fitness. Beyond that, it is hard to see that his point of view is more “logical” than a more life-affirming one, both being based, when the rhetoric has run its course, on basic gut feelings about what is pleasant or worthwhile or isn’t, in what relative amounts, and how the mix that occurs in life should be assessed.

Despite life’s alleged wretchedness, Benatar himself is not ready to commit suicide but insists that life once started, his in particular, may be worth continuing even if it should not have been started in the first place. (Sometimes this sort of argument is reasonable. A woman should not be raped, but a child born as a consequence should not be killed.) More generally Benatar’s stance is passive rather than proactive: having children should be legal, even though no one should have them, much as we might favor allowing smoking even though it is medically and socially inadvisable.

Benatar is aware that, despite these limited concessions, his stance will be unpopular and devotes much attention to defending it against various possible lines of attack. Still it is doubtful his arguments will persuade many who are not already strongly leaning his way. The rest of us, surely a robust majority of humanity, will find our varied reasons to demur. Religious people will argue that life is a gift of God, children are a blessing, hardships and sorrows happen but can and will be remedied, all will be well in the end. Secular humanists and others of scientific bent may believe with Benatar that their lives must permanently end, and even accept the eventual extinction of all earthly life, yet still remain optimistic, one of their arguments being that “since life is finite, even sometimes very short, each moment of life, handled rightly, is precious.” Scientific immortalists who are hoping for radical life extension will also discount Benatar’s pessimism, though possibly in an odd way supporting the end of the present human species—in this case, however, by replacing it with something better that includes themselves in an enhanced form.

Meanwhile, an antinatalist movement has grown up that has simple, passive annihilation of the human species as its goal, endeavoring as far as possible to discourage everyone from having more children. In addition to a claimed humanitarian purpose—eliminating suffering as Benatar proposes—there is an environmental motive some endorse, arguing that the earth’s biosphere would greatly benefit if there were no humans to befoul it, as they generally do. Potentially a conflict could erupt between antinatalists and immortalists, who hope to be in the world for a very long time. My feeling, though, is that the antinatalist movement is both unpopular and self-limiting—on both counts, natural selection so wills it. Immortalists in any case are not so much trying to populate the planet as trying to endure as individuals. So probably we should not worry too much. Instead let’s talk to these people. Some of them (Benatar included?) may be willing to rethink their position.

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About the author: David Benatar is professor of philosophy and head of the Department of Philosophy at the University of Cape Town in Cape Town, South Africa. Though best known for his advocacy of antinatalism in his book Better Never to Have Been, he is also the author of a series of widely cited papers in medical ethics. His work has appeared in such journals as Ethics, Journal of Applied Philosophy, Social Theory and Practice, American Philosophical Quarterly, QJM: An International Journal of Medicine, Journal of Law and Religion and the British Medical Journal.

Non-existence is hard to do

A review of  contemporary antinatalist writings

Originally published in Cryonics, 2nd Quarter, 2010 (PDF)

“Coming into existence is bad in part because it invariably leads to the harm of ceasing to exist.” David Benatar

If they could get a corpse to sit up on an operating table, they would jubilantly exclaim, “It’s alive!” And so would we. Who cares that human beings evolved from slimy materials? We can live with that, or most of us can.” Thomas Ligotti

The persistence of pessimism

When I sent out an email message soliciting contributions on the topic of philosophical pessimism and antinatalism one person declined with the reasonable response that such positions are only taken seriously by a handful of far-out philosophers. Humans have evolved to procreate and seek happiness. What is the point?

The reason why I have not been inclined to so easily dismiss the recent renaissance of philosophical pessimism is because negative and tragic views about life are woven throughout human history and culture. Most dominant religions have little positive to say about the state of humanity (after the fall) and the prospects for a life devoid of suffering on earth. Despite its relative sophistication, even Buddhism presents a picture of the universe as a source of suffering. Much can be said about pessimism but not that its influence is outside the mainstream.

Even the antinatalist position that it is better never to have been and that we have a moral obligation not to procreate is not completely obscure. Who has not had the experience of talking to the grumpy old lady who wonders why anyone would want to bring children into this world? We routinely dismiss such positions as being out of touch with reality but modern culture persists in linking intellectualism to pessimism. This perhaps should not be surprising because, as a general rule, excessive thinking comes at the expense of sensual experience. One reason why many intellectuals are biased towards pessimism is because it provides them the opportunity to rescue us with their ideas. Antinatalism offers the triumph of Reason against existence itself; the ultimate triumph of the Intellectual.

Philosophical aversion to pessimism can be found among the finest thinkers in the history of philosophy. There is David Hume, the great empiricist thinker, and an amiable and optimistic person. Then there is Friedrich Nietzsche, who, despite a life of disease and isolation, recognized that pessimism is not an objective feature of the universe but the expression of a weak and oversensitive mind. The twentieth century witnessed a strong renaissance of the empiricism of David Hume in the form of logical positivism. These philosophers rightly abstained from putting forward a “philosophy of life,” but optimism about science and humanity’s potential is clear in their foundational writings. It is also interesting to note that the most recent forceful responses to pessimism have not come from professional philosophers but from libertarian economists who do not display the slightest intellectual embarrassment in claiming that life is getting better all the time.

In my opinion, the most obvious question that can be raised about philosophical pessimism is whether its supporting claims are factual descriptions of reality or just expressions of temperament. Another interesting question is whether philosophical pessimism necessarily obliges us to the antinatalist position. In seeking answers to these questions we turn to the literature of contemporary antinatalism.

Jim Crawford’s Confessions of an Antinatalist is a highly readable autobiographical exposition of antinatalism. Thomas Ligotti’s book The Conspiracy Against the Human Race is more ambitious in scope and contains a wealth of historical information on pessimism, discussions of modern science, and, not surprisingly, a review of the theme of pessimism in horror literature. David Benatar’s Better Never to Have Been: The Harm of Coming into Existence is the most rigorous exposition of antinatalism to date. This book covers a lot of ground and I will confine myself to some of its main topics only.

The harm of coming into existence

In its purest form antinatalism may not be attainable but the framework that informs this position rests on a couple of sound premises: (1) we do not impose a harm (or withhold a benefit) by not bringing someone into this world; (2) we do impose a harm by bringing someone into the world when this person’s life will be bad. Jim Crawford believes that these premises are evident and I see little reason to dispute him. The real debate about antinatalism is how to determine that a person’s life is (or will be) bad, and how much consideration the interests of parents should be given.

One of the most problematic aspects about the work of Crawford and other antinatalists is that they have little patience for the argument that life is better than they think it is. In some passages it is hard to distinguish the antinatalist from the Marxist. If people think that life is much better than Crawford makes it out to be, the standard rejoinder is that these people suffer from a form of false consciousness (pessimists frequently use words like “truly” and “really”). In some passages this attitude borders on intolerance. A prime example can be found in Crawford’s discussion of childhood. For many people growing up was a period of great happiness and discovery. Crawford’s agitated dismissal of such accounts introduces an element of illiberalism in what is otherwise a humanistic endeavor. It is in these passages that antinatalism turns into bitter ideology.

The way the term “bias” is employed is deeply problematic. It is used as if there is an objective perspective that can reached were it not for those pesky evolutionary biases coming between the person and the universe. At times the author appears to be saying that if evolution did not select in favor of those wanting to survive we would not want to survive. This is not particularly helpful. Some of these “biases” do not cover up anything but just make us happier.

Let us assume here the metaphysical premise that there is an objective, material reality that can be known through the use of reason and empirical observation. This does not mean that there is one “correct” fit between an organism and the world. A person who is manically depressed perceives the world in a different matter than a person who is not. How we are “wired” and respond to our environment is not a matter of “correct” or “incorrect.” Thinking otherwise would be hard to reconcile with an evolutionary outlook in which life is just the outcome of random interactions of organic molecules.

One argument that remains available to the pessimist would be that the probability of creating a miserable life is too high to warrant procreation. But it is at this point that the “transhumanist” can enter the debate and claim that our expected quality of life is no longer just the outcome of a “random” evolutionary process but can be brought under rational control. We should endeavor to make happy children.

In my opinion, the short response to empirical pessimism can take the following form. Pleasure and pain are both part of existence. For some sentient beings pleasure outweighs pain, for other sentient beings pain outweighs pleasure. A moral agent cannot add up, subtract, or divide these elements for life as a whole to produce an objective quality-of-existence function. The antinatalist runs into the same problems as all the utilitarians and welfare economists who have tried to define a social utility function as a guide for public policy. As Thomas Ligotti notes in his book, “…the reason for the eternal stalemate between optimists and pessimists, is that no possible formula can be established to measure proportions and types of hurt and happiness in the world. If such a formula could be established, then either pessimists or optimists would have to give in to their adversaries.” I think that the best response available to the antinatalist would be to follow David Benatar’s example and present a strictly formal argument, or simply argue that in case of doubt, we should abstain from procreation.

Escape strategies

After spending the bulk of his book persuading the reader that life is suffering, Crawford discusses what he calls “Escape Strategies.” In his treatment of Buddhism as an escape strategy he could simply have made the obvious internal critique that desire may be sufficient, but not necessary for suffering. Crawford’s treatment of Christianity is scathing, which may indicate regret because the author himself was a Christian for awhile. Why have children if there is the prospect of eternal damnation? Good question, but I think that a Christian can respond by saying that following Scripture is more important than applying human morality to God’s creation.

The last escape strategy that Crawford reviews is hope, which turns into a discussion of futurism and transhumanism. The argument that many of those pursuing life extension will not be around to benefit from it is too simplistic. Unless the brain is completely destroyed at death, the neuro-anatomical basis of identity can be preserved at cryogenic temperatures for a very long time. No delusional expectations about the future are required. People in cryostasis have time. But then the author delivers a critique that I think deserves serious treatment by transhumanists (discussions about “friendly AI” do not exhaust this topic by any means). In a nutshell, we should not expect that technological progress will necessarily produce moral progress. And even if it will, accidents happen. Technologies that can be designed to produce great joy can be used to create great suffering as well. If humanity can manufacture hell without God, the case for pessimism and antinatalism may be strengthened.

Interestingly enough, the anticipation of such dark future technologies may present a (subconscious) obstacle for many people considering cryonics. Hundreds of millions of people believe in the craziest things like astrology and psychoanalysis, but only a handful of people (around 1500) have made cryonics arrangements. This lack of interest can  hardly be attributed to ignorance, and perhaps the most persuasive answer may be hidden in Crawford’s book. Cryonics basically forces people to deal with the question whether they would like to be “born again” in a far and unknown future. As a general rule, the answer seems to be “no.” Antinatalists may find additional ammunition for their position in studying the reasons for the low sign-up rate for cryonics.

Mahayana antinatalism

Antinatalists should expect a lot of obvious questions such as “are most people not glad to be alive?” or “why not kill yourself?” I fear that Crawford’s answer to the question “why not kill yourself?” risks undermining the orthodox antinatalist project. If empathic sensibility can make an enlightened antinatalist who wants to stick around it is arguable  that antinatalists should make an effort to remain alive in an effort to reduce the amount of (future) suffering in the universe. Antinatalists then become life extensionists. To use conventional Buddhist terminology, perhaps at some point there will be a Theravada version of antinatalism (focused primarily on non-procreation) and a Mahayana version of antinatalism (concerned with the elimination of the suffering of all sentient beings).

David Benatar runs into a similar problem when he ponders the question whether bringing new people into the world could be justified to reduce the suffering of the last remaining people. It seems to me that how an antinatalist deals with such practical moral issues depends on how the ethics of antinatalism is conceived. Do we have a “right” not to come into existence or is the objective of antinatalism to juggle with small and great suffering towards the ultimate end of its complete abolition?

If antinatalism is conceived as a strictly individualistic endeavor, concerns about the suffering of all humans can be easily dismissed. But in that case antinatalism would just collapse into individualist pessimism. Who cares about suffering, as long as it is not me! This is not the kind of sentiment that is generally found in antinatalist writings. I do not think that the question whether there might be moral reasons to remain alive, and, yes, bring into being forms of life that are benevolent but ruthless towards suffering, can be easily dismissed.

At one point Crawford observes that secular and smart people are having fewer children. This does not look good for the inevitable triumph of antinatalism. Under such scenarios antinatalism produces dysgenics, and if one believes that stupidity and evil go hand in hand, increased suffering for more people.

To me it is not unlikely that, in practice, antinatalism leads to more suffering because it will only be adopted by sympathetic human beings such as Crawford. The antinatalist cannot argue that the amount of suffering in the universe cannot be increased nor decreased. The whole point of antinatalism after all is that suffering can and should be decreased. But how to go about this may be more complicated than it appears. A sober assessment of the practical implications of antinatalism may require revision of the antinatalist position itself.

Confessions of an Antinatalist is a fine and humane book, but in the end it is also a book of the converted written for the non-converted. Thomas Sowell has noted that in economics there are no solutions but only trade-offs. I would not be surprised if antinatalists will come to a similar conclusion at some point.

Suffering without meaning

Thomas Ligotti is a contemporary horror writer whose fiction work  is marked by cosmic nihilism, alienation and the fragile nature of reality. As a great admirer of the work of Ligotti I have been reluctant to comment on his non-fiction. Fortunately, unlike many other artists, Ligotti has little interest in “critical theory” or “progressive” politics. His book The Conspiracy Against the Human Race: A Contrivance of Horror is not concerned with such trivial topics but with the bleak fate of humanity in a deterministic and indifferent universe.

The book starts off with an introduction by obscurantist philosopher Ray Brassier, whose work would certainly qualify for the description that Ligotti gives to Schopenhauer’s oeuvre (“too overwrought in the proving to be anything more than another intellectual labyrinth for specialists in perplexity”).

Reading Ligotti’s account of why humans reject truly bleak views about life it would be interesting to see how antinatalists respond to the existence of orthodox Calvinism. Accepting a universe without free will that is ruled by an omnipotent God who has decreed that the majority of people will suffer in hell for His self-glorification seems a lot more terrifying to me. Nonetheless, millions of people have accepted this theological perspective. The existence of Reformed theology lays to rest the view that humans have an intrinsic desire to avoid doctrines that are too terrible too contemplate.

When Ligotti discusses the work of antinatalist Peter Wessel Zapfe once more we find the view that there is an objective predicament of mankind that is hidden by false consciousness. It is remarkable to see the similarities between those who argue that we do not want look our “oppression” straight in the face and those who argue that we avoid coming to terms with the horror of existence. What  is often lacking here is the recognition that there is also a wealth of literature about human suffering that supports the idea that we would be happier if we did look nature straight in the face. No nonsense about “moral responsibility,” “sin,” “duty,” “the greater good” etc. Marquis de Sade, Friedrich Nietzsche, and Max Stirner are representatives of this school of thought.

What is intriguing about Ligotti’s book is that it reads like a rather delicate balancing act. On one hand, we have the detached observer (my favorite) who is bemused at the show business of both the optimists and pessimists. On the other hand, it is unmistakable that Ligotti feels affinity with the philosophers of cosmic horror and pessimism. His fiction does not leave much room for any other conclusion. But The Conspiracy Against the Human Race contains more than a few (unintended) suggestions how someone who declines to take sides would present his argument.

Hard determinism and the illusion of the self

I have a hard time relating to the Ligotti’s discussion about determinism and pessimism. Hard determinism (or hard imcompatibilism) is just a part of the “scientific worldview” and it is not obvious to me why it should be a source of despair. Ligotti then discusses the existence of the “self.” I am inclined to think there is an important difference between free will and the self. Modern science can make sense of the world and human action without assuming free will. I am  not convinced that this is possible if the concept of the self is rejected. Unlike free will, the recognition of a “self” comes at a later stage in evolution. It has been argued that primitive people could not clearly distinguish the self from its surroundings and thus were not able to discover the laws of physics and manipulate it to their benefit. The philosopher Hans Reichenbach developed a pragmatic case for the existence of the external world and the self in his seminal work Experience And Prediction: An Analysis of the Foundations And the Structure of Knowledge. Ultimately, the Kantian question whether something “really” exists (or what something “really” looks like) does not seem particularly helpful in the study of reality, as the early logical positivists of Vienna understood well.

Why would anything that neuroscientists discover about the self and how it is constructed be a source of dread? If you believe that life is just the result of random meetings of organic molecules, it stands to reason that the physical basis of consciousness and the self reflects such a process. Why would accepting such ideas make one a “heroic pessimist?” Why the pessimism at all? Ligotti even agrees. “One would think that neuroscientists and geneticists would have as much reason to head for the cliffs because little by little they have been finding that much of our thought and behavior is attributable to neural wiring and heredity rather than to personal control over the individuals we are, or think we are. But they do not feel suicide to be mandatory just because their laboratory experiments are informing them that human nature may be nothing but puppet nature. Not the slightest tingle of uncanniness or horror runs up and down their spines, only the thrill of discovery. Most of them reproduce and do not believe there is anything questionable in doing so.”

Ligotti also discussed transhumanism, but not in much depth. As a transhumanism skeptic myself, I found little to object to but it seems that Ligotti’s real target is what is called Singularitarianism. This part in the book seems something of a missed opportunity because there is substantial overlap between Ligotti’s fiction and themes that are discussed by transhumanist writers: living in a computer simulation, parallel universes, alternate realities etc.

When Ligotti reviews near-death experiences and ego-death, the common-sense neurological explanations that were invoked in discussions of free will and the self are largely absent (a notable exception is his discussion of the possibility that a brain tumor can cause such an “enlightened” state). For critical-care physicians it is a given that many people suffer (regional) cerebral ischemia during the dying process. As such, it is surprising (but encouraging) that not more people claim enlightenment after they recover. These periods of  transient oxygen deprivation can produce long term damage and a “re-wiring” of the brain, which can explain the new perspectives these people adopt. From a physicalist perspective, death of the ego is (partial) death of the brain, something one may or may not want to celebrate.

In Ligotti’s book the reason for pessimism is multi-factorial. It includes the lack of meaning in an indifferent universe, the reality of hard determinism, and the illusion of the self. The works of Benatar and Crawford are more restricted in scope and mostly focus on more mundane suffering. Ligotti’s philosophical horror is much richer, but I wonder how much of it will resonate with people who embrace a scientific view of the universe. The Conspiracy against the Human Race may not have been designed as an argument against “unweaving the rainbow” (to use Richard Dawkin’s useful phrase) but it sometimes reads like one.

There is a lot in Ligotti’s fine book that I have not discussed such as the extensive treatment of pessimism in horror fiction, loads of interesting philosophical and scientific references, plus illuminating discussions of obscure authors such as Peter Wessel Zappfe and Philipp Mainlander. As such, it can also be considered as an indispensable reference for philosophical pessimism and cosmic horror.

Empiricism and non-existence

David Benatar is a rigorous philosopher. His work can be situated in the analytic tradition and he makes an honest attempt to anticipate objections to his own views. When he argues for positions using mainly logical arguments he is quite persuasive. A being that does not exist can neither be harmed nor benefited. I cannot see how this argument (or  tautology?) can be successfully refuted. But when Benatar attempts to argue that the quality of life of most people is much worse than they think it is, multiple challenges arise. I do not think this is the result of Benatar’s poor reasoning but because the fields that he relies on – evolution, social psychology, happiness research and the study of cognitive biases – are notorious for allowing competing views. It seems to me that ultimately Benatar cannot escape the charge that he pays excessive attention to theories that claim that we think we are happier than we really are. Perhaps I have spent too much time in the wrong subculture but it seems to me that the phenomenon of people claiming to be less happy than they really are should not be ignored either.

Like Crawford, Benatar cannot completely escape the charge of illiberalism. Classical liberalism takes very seriously the challenges in reaching satisfactory conclusions about the quality of other people’s lives. In practice this means that we exercise restraint in making strong cognitive and moral claims about the feelings and preferences of other people. This is a mindset that does not seem to come easily to antinatalists. Benatar is on more agreeable ground when he simply derives his antinatalism from uncertainty; “some know that their baby will be among the unfortunate. Nobody knows, however, that their baby will be one of the allegedly lucky few.”

Benatar believes that even if his empirical argument about the poor quality of our lives fails, his formal argument from asymmetry is still left standing. He thinks that even if there is one single painful pinprick in an otherwise good life, we still harm that person by bringing him into existence. I think that Benatar is “proving” too much here. We can agree that anyone who conceives a child cannot escape the prospect that this person will experience some harm. But from this it does not follow that the person is harmed in a meaningful moral sense without considering the expected overall quality of that life. Perhaps Benatar would respond that I have not understood his argument, and I will admit that I have a difficult time understanding why the possibility that a person’s pleasures are expected to outweigh the pains do not alter his argument. I think that both bringing into existence a life that is invariably good and a life that is generally good can be morally defended on the grounds that there will not be any post-natal moral objections from the person involved. Of course, we are not morally obliged to do so, because we will not deprive the unborn of such a good life if we don’t have children. But since most parents have a positive interest in having children, in practice this tips the scales in favor of some (but not all!) procreation. One problem I can see with my argument is that it might permit the creation of a life form that would experience great suffering but with an unalterable survival instinct and no cognitive possibility of moral blame or regret. Some antinatalists might even claim that this is a rather accurate description of the human race as it exists today.

As an empiricist, I generally give the benefit of doubt to empirical observations when they appear to conflict with logical reasoning. I think that this preference itself can be justified on historic and pragmatic grounds. The claim that coming into existence is always a harm is not consistent with the reports of all those who have come into existence. That seems to be a non-trivial epistemological roadblock for antinatalism.

When Benatar discusses the moral duty not to have children he runs into the obvious problem of how the interests of the parents should be weighed against the interests of the child. One does not need to be an ethical egoist to believe that the interests of the parents count for something. In this case the question returns to how bad the life of most people is and, as discussed, this is a rather vulnerable part of antinatalism. Benatar attempts to answer the obvious objection that most people who have been born do not regret this or blame their parents. But when I read his thoughts on “indoctrination” I only see further evidence of the anti-liberalism in his writings.

In fairness to Benatar (who seems to identify himself as a liberal of some sorts), he does defend the legal right to procreation because he admits that there can be reasonable disagreement about his views. I think this point is particularly important for antinatalism since reasonable objections often come from the very people whose lives Benatar characterizes as very bad. That is not to deny that society can choose to be less supportive of people who engage in reckless procreation. Such behavior can be substantially decreased by withholding benefits that encourage or reward such behavior. Benatar correctly argues that if one subscribes to a consistent interpretation of the Kantian argument that future people should not be treated as means, then all reproduction is morally dubious. But whether that highlights the virtues or defects of Kant’s ethics I leave to the reader to ponder.

Benatar highlights the importance of making a distinction between the decision to bring someone into existence and the decision to continue life. Even if we commit to the idea that it is better never to have been we can still have reasons for wanting to continue life. As a matter of fact, Benatar entertains the argument that the prospect of death itself is one of the reasons why existence is bad. Those who follow Epicurus believe that death cannot be experienced and thus cannot be a bad thing for the person. This is an extremely difficult argument to refute, but Benatar’s discussion of this topic is quite illuminating because he points out that those who hold this position may also have to commit to the view that death can never be good for a person. One only needs to imagine a person whose life is one of continuous suffering to see that this is not a plausible argument.

As an academic Benatar is less hostile to religion than Crawford and Ligotti but I do not think he can successfully escape the objection that antinatalism requires an atheist perspective. One does not have to be a scripturalist to note that Benatar is only concerned with the fate of humans and not with the interests of God. Perhaps Benatar cannot see any positive value in human suffering because his information about Creation is incomplete. Theodicies that reconcile the existence of God and the existence of Evil are not difficult to generate. As Plotinus has observed, “We are like people ignorant of painting who complain that the colours are not beautiful everywhere in the picture: but the Artist has laid on the appropriate tint to every spot.”

Antinatalists and life extensionists

One would think that cryonicists and life extensionists should be repulsed by antinatalism. I think such a view would be mistaken. All the antinatalist authors discussed here are motivated by empathy for the suffering of all sentient life. We should also welcome the analytical and physicalist perspectives that underpin their writings. Too much (Continental) philosophy is simply an insult to the intellect and a waste of time. If a case should be made for pessimism it needs be stated in a form that is amenable to reasoned debate and empirical investigation.

Of more specific interest to life extensionists is the plausible prospect that our abilities to decrease suffering will (necessarily?) be matched by our abilities to increase suffering too. This is a possibility that should be studied in great detail by advocates of molecular nanotechnology, strong AI, and Substrate Independent Minds.

It is no secret that cryonicists are underperforming in terms of reproduction. But as Howard V. Hendrix discusses in the article “Dual Immortality, No Kids: The Dink Link between Birthlessness and Deathlessness in Science Fiction,” this may not be a coincidence. If biological immortality becomes a credible option, having children as a substitute for personal survival will lose much of its appeal.

Most rewarding for cryonicists is the unique perspective that antinatalists can bring to the debate concerning why so few people have made cryonics arrangements. The hostility of many people towards cryonics cannot be explained if people categorically believe that  meaningful resuscitation (revival) is impossible. It is the prospect that cryonics may actually work that induces severe anxiety. If the antinatalists are correct in their assessment that coming into existence is always a harm, the unpopularity of cryonics might be indirect evidence for their position.

I want to close this review with one word of advice to those who engage in debates with antinatalists. Most antinatalists waste little time reminding their readers how controversial their ideas are. They think that they have uncovered the greatest taboo of all time. As an empirical matter, this is doubtful. Antinatalist ideas can be freely discussed in modern Western countries, something that cannot be said about a number of other controversial ideas. Antinatalists are also quick to point out that their pessimism should not be dismissed as an expression of weakness and depression. But then the antinatalists commit a similar error by too easily viewing optimism as a defense mechanism or a form of bias. But is it completely unreasonable to look for the neurophysiologic and genetic basis of pessimism and optimism? The uncompromising naturalism in the work of the antinatalists  supports such an inquiry.

Jim Crawford: Confessions of an Antinatalist (Nine Banded Books 2010)

Thomas Ligotti: The Conspiracy Against the Human Race: A Contrivance of Horror (Hippocampus Press 2010)

David Benatar: Better Never to Have Been: The Harm of Coming into Existence (Oxford University Press 2006)

Thanks to Dr. Michael Perry for discussing some of the topics in this review and proofreading an earlier version of this document.

Humanist death apologetics

Some contemporary atheists and secular humanists do not stop at debunking the idea of God but seem to think that making a persuasive case against religion requires them to refute all of its associated ideas as well; including the desire for immortality. Paula Kirby is not the first secular person praising our limited lifespan and glorifying death:

For atheists it is the very transience of life that helps to give it its meaning: for it prompts us to live it to the full, to try to make the most of each day, each hour, and to savour every experience along the way. It is the acceptance of the finality of death that spurs us to live our lives to the full, thereby ensuring they are as meaningful as we can possibly make them. It is also what makes it matter that for too many people life really is a vale of tears, and why it is so important to take practical steps now to alleviate their suffering wherever possible, for there is no afterlife in which all wrongs will be righted and all tears will be dried.

Kirby does not just repeat the hollow non-empirical cliché that life can only have meaning in the face of death but she also pretends to speak on behalf of all atheists. As can be expected, she cannot imagine an extremely long lifespan to be anything else than unspeakable boredom. When she writes that “Susan Ertz got it spot on with her witty remark that ‘Millions yearn for immortality who don’t know what to do with themselves on a rainy Sunday afternoon” one cannot help thinking that she is conveying more information about herself and Susan Ertz than about humans in general.

It is unfortunate to see an apparently reasonable person like Kirby arguing against the desire for immortality to make the case against religion. As the secular philosopher Herbert Marcuse once noted about this ideology of death, “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…”

When Kirby states that it is “so important to take practical steps now to alleviate …suffering wherever possible, for there is no afterlife in which all wrongs will be righted and all tears will be dried” she is exactly promoting the kind of  fanatical pursuit of “justice in our lifetime” that is a major source of ideological struggle and ill-conceived public policies. One of the major advantages of a vastly expanded lifespan is that it will reduce this desire for immediate moral gratification and stimulate a culture with more consideration for  the long-term unintended consequences of our actions. One might even go further and claim that it is exactly the prospect of being around for a long time that will foster a culture of moral responsibility and rational decision making.

HT Mark Plus

The ethics of cryonics interference

Advocates of human cryopreservation argue that death is not an event but a process. Cryonics patients are stabilized at low temperatures in anticipation of a second medical opinion in the future. This raises an important ethical issue. What is the moral status of cryonics patients? It is not possible to argue that cryonics patients will be resuscitated in the future. But it is not possible to categorically rule this out either. As a matter of fact, evidence from cryobiology, neuroscience, and synthetic biology support the technical feasibility of cryonics. As a consequence, cryonics patients are somewhere on a continuum between alive and irreversible biological death.

What does this mean when someone interferes with a person’s wish to be cryopreserved? In essence, those who successfully prevent the cryopreservation of a person have altered the probability of future revival from “possible” to “impossible.” For example, let us assume that cryonics patients can be resuscitated in the future. What does this mean for those who were not cryopreserved because of hostile interference? Have they been killed? Most people would agree that such a verdict is too strong. But do we believe that a person who knowingly changes the prospect of future revival from possible to impossible (or decreases those probabilities by causing delays) should be free from moral blame and legal consequences?

A related problem is the termination of cryonics procedures. Advocates of cryonics agree that a person who has not chosen for cryonics should never be forced to be cryopreserved. But what is the right course of action when such a person is already cryopreserved? Can we just thaw him out? Let us consider the case of a person with a Do Not Resuscitate (DNR) order who is accidentally resuscitated because paramedics were not aware of his wishes on the matter. Few people would argue that this person should be killed before he gains awareness to honor his wishes. Now let us consider a situation where it is discovered that a person was cryopreserved against his will but at a point in the future when the prospect of resuscitation becomes increasingly likely. In such a case, the issue would be similar to a resuscitated DNR patient in deep anesthesia.

This example illustrates a number of issues. There is a meaningful distinction between ignoring someone’s wishes not to be cryopreserved and terminating the cryopreservation of an existing patient. Honoring a person’s wishes not to be cryopreserved requires non-interference. Thawing out an existing cryonics patient is an act to change someone’s existing chance at revival from possible to impossible. The example also illustrates the role that probability of resuscitation plays in such considerations. Few people would argue that it does not matter at all how credible resuscitation of cryonics patients is for making decisions about the  moral status of cryonics patients, interference with cryonics procedures, and the decision to terminate somebody already in cryostasis.

We want certainty in a universe that only offers us probabilities. The ethical and legal issues surrounding cryonics are not unique to cryonics. It is not just in cryonics where issues of moral obligation are discussed in the context of uncertainty, probability and risk. It will be rewarding to review these philosophical and legal debates and see how debates about interference with cryonics can be framed from these perspectives.

In the meantime, people who have made cryonics arrangements are not completely powerless against hostile interference. They can alter their cryonics paperwork and living will to ensure that there is little incentive for greedy relatives to interfere. As a matter of fact, one could change one’s “last” wishes to ensure that interference would trigger the worst financial outcome for greedy family members and others who would stand to benefit from a person not getting cryopreserved.

The science of personal survival

There are various competing strategies how to achieve meaningful life extension or rejuvenation, including , but not limited to, genetic manipulation, periodical elimination of damage, caloric restriction,  molecular nanotechnology and mind uploading. A useful review of these strategies has been published in the book The Scientific Conquest of Death: Essays on Infinite Lifespans (2004) by the Immortality Institute. Most people will recognize that these strategies are not mutually exclusive. Some of them can be practiced right now (e.g., caloric restriction) and others ( e.g., periodical elimination of damage) could serve as a bridge to more comprehensive interventions such as a comprehensive genetic overhaul of human biology. As has often been recognized on this website, cryonics holds a special place among life extension strategies because it enables one to benefit from progress in the biomedical sciences that may not occur during one’s lifetime. We would like to think we can escape death by jumping from one successful biomedical innovation to another and that, of course, all the good things will happen in our lifetime, but reality often interferes with such optimism.

One thing that might greatly accelerate the pace of progress in the field of longevity science is the development of an integrated framework that studies the logical and empirical relationships among all these strategies. For example, a recent blog entry on the technical challenges surrounding chemopreservation of the brain triggered a meaningful private exchange about issues concerning the perfusion of ischemic tissue, empirical criteria for information-theoretic death, and the options for histological validation of cryonics technologies.  Such overlapping areas of investigation are plentiful and it would be helpful to explicate them.

Too much focus on “the big picture” can interfere with the identification of original ideas and rapid progress. Too little attention to the adverse effects of compartmentalization risks the waste of resources, which is not a trivial concern in the still poorly funded life extension community.

Reducing compartmentalization can have other sobering effects as well. For example, it is not unusual to see a group of researchers advocating a new approach to their field that is routine in other areas of investigation. For example, the idea that anti-aging research could benefit from less emphasis on illuminating the exact molecular mechanisms of aging and simply treat the observable manifestations of aging is no news to researchers in the field of cerebral ischemia. The pathophysiology of stroke is so complex that greater progress could be achieved by identifying clear targets for pharmacological intervention. But after decades of research it has become abundantly clear that such a paradigm change is no guarantee for more rapid progress. Despite this goal-oriented approach not one single neuroprotective agent has survived clinical trials.  This does not mean that such pragmatic approaches should be abandoned. It does mean, however, that research ideas should be evaluated on their empirical success and not just on their logical merits.

There are obvious examples where the claims in one field seem to make the claims in another field redundant. The most obvious example is the case of molecular nanotechnology. The projected timescales that are envisioned for this technology are not much different from the timescales that are envisioned by some anti-aging researchers to develop meaningful rejuvenation. In that case one could argue that (exclusive) preference should be given to those research programs that allow for the most comprehensive manipulation of biology. For example, a mature nanotechnology would be able to rejuvenate people, resuscitate cryonics patients, and alter the human endoskeleton to make us far less prone to fatal accidents. Such an argument would be a logical extension of the argument against devoting too much time to find treatments for specific age-related diseases instead of tackling aging itself.  Similar reasoning can be employed against anti-aging research. If accelerated change will bring the prospect of general molecular control within reach in the next few decades it makes little sense to spend vast amounts of time agonizing over specific anti-aging interventions. Why not just launch a “Manhattan Project” to pursue the much more comprehensive vision of molecular nanotechnology?

From a logical point of view, this is a persuasive argument. The limitations of such a perspective should now be obvious too.  We do not have certainty about the future of technological progress, let alone its specifics. As a matter of fact, in such matters it is not even evident how we should think about statistical or inductive probabilities.  To some people, the progress in one field is indicative of the progress we are going to observe in other fields, including fields in which there has been little progress to date. The problem with such naive inductivism is that it can just as well be used to  make the opposite case if a different reference class is chosen.

The logical empiricist philosopher Rudolf Carnap once wrote:

The acceptance or rejection of abstract linguistic forms, just as the acceptance or rejection of any other linguistic forms in any branch of science, will finally be decided by their efficiency as instruments, the ratio of the results achieved to the amount and complexity of the efforts required. To decree dogmatic prohibitions of certain linguistic forms instead of testing them by their success or failure in practical use, is worse than futile; it is positively harmful because it may obstruct scientific progress.

A related argument can be made about the science of personal survival. We should be cautious about privileging any line of research on  “logical” grounds. The fate of competing visions should be decided through empirical investigation.  This position should not be interpreted as saying that there is no place for logic in choosing research programs.  Logic has a central place in research design and interpretation of experimental observation but it cannot be solely relied upon a guide for decision making. Empirical observation disciplines thinking and ample room should be left for the unexpected. As Nassim Nicholas Taleb has pointed out:

There is a lot more randomness in biotechnology and any form of medical discovery. The role of design is overestimated. Every time we plan on trying to find a drug we don’t because it closes our mind. How are we discovering drugs? From the side-effects of other drugs.

Many experimental researchers have had the experience of engaging in research to find a solution to one problem but to discover the solution to another problem instead. Researchers who have recognized and embraced this phenomenon by becoming less fond of their own ideas and more open to run with such unexpected discoveries have reaped great benefits.