30. September 2016 · Comments Off on The Valley of the Shadow of Death · Categories: Cryonics, Death, Society

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.

27. September 2016 · Comments Off on Reintegration, Personalized · Categories: Cryonics, Death, Society

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.

16. September 2016 · Comments Off on The Multi-Headed Hydra · Categories: Science, Society

This article explores some of the regulatory challenges facing those who would bring rejuvenation biotechnologies, like those pursued by Dr. Aubrey de Grey and the SENS Foundation, to market. It does not presume familiarity with Dr. de Grey and his work; I’ve tried to make it informative to all alike.

The Conquest of Aging

Biomedical gerontologist Aubrey de Grey predicts that the first human being to live to 1,000 years old is alive today. Who exactly that person might be – or rather, how old they are today – is a detail that Dr. de Grey has wavered on, but he has remained firm in his commitment to that prediction, and is certainly one of the most prominent figures working towards realization of the technologies required to make his prophecy reality. In his book, Ending Aging, Dr. de Grey describes his proposed approach to the “problem” of aging, and how it differs from those presently in practice.[1]

In Dr. de Grey’s opinion, the current paradigm devotes a vast majority of resources to geriatric care, which attempts to cure or manage age-associated diseases only after they emerge as recognizable groupings of symptoms. To quote an apt metaphor from another longevity advocate:

“[T]he challenge of treating illnesses in the elderly must at times seem like Heracles’ trials of combating the multi-headed Hydra. Each time one head was severed, two more would sprout in its place. Likewise, a patient might survive a serious cardiac episode with help of antihypertensive drugs only to succumb to cancer and dementia.”[2] [emphasis in original]

Meanwhile, the (significantly smaller) remaining portion of research dollars goes towards biogerontology, which studies the upstream causes of aging, any benefit of which is probably unrealizable for several human generations. However, Dr. de Grey argues that without necessarily knowing much more about the upstream causes of aging than is currently understood, it is already possible to categorize the different forms of aging “damage,” and devise therapies that will repair the damage at a sufficient rate to achieve what he terms “longevity escape velocity.”

Dr. de Grey calls his theory “Strategies for Engineered Negligible Senescence” (SENS). There are seven strategies, each related to one of the seven major categories of aging damage thus far discovered. Those categories (and proposed therapies) are: (1) cancer-causing nuclear mutations (removal of telomere-lengthening machinery, aka OncoSENS); (2) mitochondrial mutations (allotopic expression of 13 proteins, aka MitoSENS); (3) intracellular junk (novel lysosomal hydrolases, aka LysoSENS); (4) extracellular junk (immunotherapeutic clearance, aka AmyloSENS); (5) cell loss & tissue atrophy (stem cells and tissue engineering, aka RepleniSENS); (6) cell senescence (targeted ablation, aka ApoptoSENS); and (7) extracellular crosslinks (AGE-breaking molecules and tissue engineering, aka GlycoSENS). The SENS Foundation was established in 2009, helped in part through seed funding provided by Peter Thiel, co-founder of PayPal and a managing partner of The Founders Fund. The SENS Foundation’s stated purpose is “to research, develop and promote comprehensive regenerative medicine solutions for the diseases and disabilities of aging.”[3]

Delving into the details of each of Dr. de Grey’s proposed strategies is beyond the scope of this article, but it is worth taking a closer look at one of the seven. LysoSENS aims at “junk” molecules which cannot be broken down by human lysosomal enzymes. Over time, these molecules accumulate within cells, contributing to conditions like macular degeneration, atherosclerosis, and Alzheimer’s disease (AD)[4]. Dr. de Grey’s proposition is to search for novel lysosomal enzymes (novel to humans, that is) in bacteria, molds, and other microbes that are involved in “recycling” dead animal bodies, since the “junk” inside our cells is — along with the  rest of us — food to them. SENS research being carried out at Rice University has already identified one such enzyme that, when targeted to the lysosome, decreases cytotoxicity of 7-ketocholesterol (7KC), an oxysterol associated with atherosclerosis and Alzheimer’s disease.[5] Enzyme replacement therapy is already used for the treatment of lysosomal storage diseases not associated with aging, like Gaucher’s disease. Insofar as it could be used to treat a condition (or conditions) remedially, a therapy targeting 7KC with a novel lysosomal enzyme might otherwise resemble traditional approaches to disease treatment, but it could also be used preventively. Other SENS pose even greater challenges to the traditional distinctions between cure, prevention and enhancement. The objective of MitoSENS, for instance, is to render the recipient immune to the fallout consequences of mitochondrial DNA mutations by placing backup copies of the thirteen mitochondrial genes — which naturally reside only inside the mitochondria — into the cell nuclei. Significant research progress is being made into this strategy as well.[6]

The problem of normative definitions of aging

Dowsing for fountains of youth is well and good, but won’t get us very far unless they can be tapped and piped to the marketplace, and while there are many scientific obstacles to overcome before rejuvenation biotechnologies are realized, there are also social, political and legal ones. Many of these problems are definitional. For one, what exactly distinguishes age-associated diseases and conditions from “normal” features of aging? In the words of one scholar: “[F]rom the perspective of modern biogerontology, there is little to distinguish biological ageing from a disease state…. To argue that ageing is not a disease by virtue of its universality is as misleading as it is to argue that the Basenji is not a dog because it does not bark.”[7] But to dismiss this debate as purely semantic or philosophical would be to misunderstand the true difficulty the definitional problem poses.

The U.S. Food, Drug and Cosmetic Act defines “drug” as, inter alia, “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals” and “articles (other than food) intended to affect the structure or any function of the body of man or other animals.” [8] So far so good, because even if the U.S. Food and Drug Administration (“FDA”) did not agree that a particular undesired physical state was a “disease” for the purposes of the first definition, it would be difficult to deny that a proposed therapeutic (whether a chemical entity or a biological product[9]) was not intended to affect the structure or functioning of the body, at some level. However, present regulatory approval pathways indirectly require that a drug be “indicated for the treatment, prevention, mitigation, cure, or diagnosis of a recognized disease or condition or of a manifestation of a recognized disease or condition, or for the relief of symptoms associated with a recognized disease or condition.”[10] [emphasis mine]. The phrase “recognized disease or condition” is not defined in this context[11], and the FDA is not itself the recognizer, but rather looks for consensus within the clinical and/or scientific communities regarding the existence of a particular disease or condition, and of clear criteria for clinical diagnosis thereof.[12] To quote one author: “To the extent that many problems of ageing have not been formally recognized by any of these processes, the FDA has no clear guidance on how to determine if a proposed indication would be acceptable.” [13]

For many age-associated conditions, the question of “recognition” is a valueladen debate. While some commentators will no doubt accuse longevity advocates of “disease-mongering”[14], Dr. de Grey would probably argue that that sort of reaction is a symptom of what he terms the “pro-aging trance”[15] — a terror management strategy that accepts and embraces the apparently unavoidable progressive wasting of one’s body (and mind), instead of rejecting and resisting it. But the cognitively dissonant distinction between normal, “healthy” aging on the one hand, and “diseases” of aging on the other is not impermeable. For some historical perspective, it is worth considering the example of Alzheimer’s disease. When it was first described in 1910, AD only included what is now referred to as “earlyonset Alzheimer’s disease,” i.e., when the symptoms of “senile dementia” appeared in someone under 65.[16] Due to its vastly less frequent incidence, this “presenile dementia” was assumed to be distinct from the normal variety. However this normal/ abnormal categorization broke down in 1977, due to professional recognition of their near identical symptomologies, making the early-onset subtype by far the minority of AD incidence.[17]

A present-day example of this process of recognizing “normal” features of aging as diseases or conditions of aging, is the case of sarcopenia. Sarcopenia (literally “poverty of the flesh”) describes the degeneration of skeletal muscle mass and strength that occurs with aging that contributes (in part) to disability, frailty, and morbidity in older persons.[18] Until fairly recently, sarcopenia and related conditions like sarcopenic obesity were considered “normal” aspects of aging, much like senile dementia prior to 1977. To be fair, both sarcopenia and senile dementia are normal, insofar as they are common conditions in older persons — but that does not mean they are untreatable, nor that they should be left untreated. A number of potential drug targets have been identified that may be of use in treating sarcopenia[19], but if consensus recognition of the condition is lacking there may not yet be a regulatory pathway for licensing therapeutics to treat it.[20]

Thus, as it stands, forging a regulatory pathway for treatments of a common, disabling (and in some cases indirectly lethal) feature of aging involves two distinct steps: first, persuade the scientific and clinical communities that a particular symptomology of aging can and should be treated, and second, persuade the FDA that everyone else is persuaded. But this is not insurmountable. The European Working Group on Sarcopenia in Older People published a “practical clinical definition and consensus diagnostic criteria for agerelated sarcopenia” in 2010[21], which was followed by a consensus definition from The International Working Group on Sarcopenia in 2011[22]. In the U.S., the Foundation for the National Institutes of Health, the National Institute on Aging, and the FDA held a Sarcopenia Consensus Summit on May 8-11, 2012.[23] A number of clinically meaningful end points have been proposed for assessing treatment efficacy[24], including patient-reported outcomes.[25] Under appropriate regulatory supervision, medicalization of sarcopenia would help older persons maintain or even regain functional independence and quality of life — and perhaps boost lifespan, via a reduction in comorbidity with diseases like osteoporosis.

The problem of causally interrelated disease states

There is another definitional problem: What distinguishes one age-associated disease from another? This may seem like a facetious question, given the obvious symptomatic differences between atherosclerosis and AD. However, as mentioned above, the oxysterol 7KC has been implicated in the pathogenesis of both those disease states. If 7KC is indeed a metabolic byproduct that is causally related to both atherosclerosis and AD then, in addition to being a promising drug target itself, it could conceivably qualify as a surrogate endpoint for clinical trials of new drugs indicated for those diseases. FDA has issued a draft guidance regarding qualification of biomarkers as drug development tools[26], but surrogate endpoints may only be used in lieu of direct measures of clinical benefit under the FDA’s “Fast-Track Program,” which is only available for new drugs intended for the treatment of a serious or lifethreatening condition and that demonstrate the potential to address unmet medical needs for such a condition.[27] However, it would not be necessary to qualify 7KC reduction as a surrogate endpoint for both AD and atherosclerosis. Doing so for one or the other based on which is thought to be the more serious condition and/or the greater unmet need would allow its use in a fast-tracked New Drug Application for the one indication, and then if safety and efficacy in humans is established and the therapeutic is approved, data from (likely compulsory) post-marketing studies could be used in a new indication claim for the other condition.

Surrogate endpoints need only be “reasonably likely to predict clinical benefit”[28], and some commentators have pointed out that applying this lower standard to the screening of surrogate endpoints may result in drugs approved on the basis of evidence of an effect on a biomarker which, while related to the disease, is not actually causally related to any clinical benefit.[29] Of course, given its ambitious objective, the SENS Foundation has a strong vested interest in tying 7KC to clinical benefit, and the fact that FDA-qualified biomarkers are released into the public domain also fits within the Foundation’s public interest mandate, and could enhance perceptions of the legitimacy of its research goals. But more importantly, it could shorten clinical trials, an oft-criticized source of delay and drug costs. While its work to date has primarily been proof-of-concept research, in the future the SENS Foundation might devote some of its resources to running forms of aging damage like 7KC through the biomarker qualification process. Although publishing both the proof-of-concept and such valuable drug development tools might cut out some of the traditional patenting opportunities[30], it also offsets costs ordinarily borne by pharmaceutical companies. A little low-hanging fruit might stir up some productive competition in an industry sometimes criticized for chasing after minor therapeutic improvements and patent trolling.

Another option that is very in line with the social agenda of longevity advocates would be to promote the rebranding of multiple disease states with significantly overlapping low-level chemistry as single unified conditions that present varied symptom groupings based on exposure to particular environmental factors (including the endogenous “environment,” like certain genes or epigenetic variations, along with more traditional exogenous contributors like diet, exercise, etc). Admittedly, this would be the more difficult path, because it relies on the two-step process of disease recognition, discussed above, and considering how long it took AD and senile dementia to be folded into AD with an early-onset subtype, trying to replicate this process with diseases that present as differently as atherosclerosis and AD may be a Sisyphean task. On the other hand, academic pressure of this kind could have trickle-out effects on the public, re-situating the discourse of age-associated diseases further upstream, pressing on towards greater recognition of aging as disease.

Finally, slight augmentations to the SENS branding could be in order. Dr. de Grey gave unique names to his proposed strategies (LysoSENS, MitoSENS, etc.), but not to the categories of damage which are the targets of those strategies. Devising and promoting novel medical names for these categories of damage, like idiocytotoxicosis[31] for the “intracellular junk” targeted by LysoSENS, might prompt frame-shifting in the academic and clinical communities that could consequently (albeit indirectly, and thus probably slowly) broaden the scope of “recognized disease or condition”. Sadly for the planet, ‘junk’ doesn’t seem to be something humans take terribly seriously — idiocytotoxicosis, on the other hand, well that’s clearly a monster. Perhaps this suggestion borders on “disease-mongering” — but isn’t that term itself equally agenda-driven, given the not-so-subtle association with war-mongering? Dr. de Grey and other longevity advocates consider themselves to be on moral high ground, so these kinds of accusations are only of consequence if they provoke counter-productive public response, and reframing well-recognized diseases like AD and atherosclerosis as symptoms of underlying “metabolic pathology” can hardly be characterized as “questionable new diagnoses — like [premenstrual dysphoric dysfunction] and social anxiety disorder — which are hard to distinguish from normal life,” the likes of which give at least one critic concern. [32] And perhaps it is the very idea that “normal” is the ultimate objective — as opposed to simply “better” — that is the problem.

What’s the alternative?

If the perceived burden is too high, and the cost of doing nothing too great, stakeholders may look to circumvent the FDA. The SENS Foundation characterizes the assault on aging as the next space race.If the U.S. doesn’t take action to foster local development of what will assuredly be highly sought-after therapies, the movement may simply move underground (i.e. further in the vein of DIYbio), and overseas (medical tourism, and seasteads), which will only hamper the FDA’s mandate to protect Americans from harm.

Endnotes

[1]: Aubrey de Grey & Michael Rae, Ending Aging: The Rejuvenation Breakthroughs That Could Reverse Human Aging in Our Lifetime, (New York: St Martin’s Press, 2007).

[2]: David Gems, “Tragedy and delight: the ethics of decelerated aging” (2011) 366 Philosophical Transactions of the Royal Society B [Phil Trans R Soc B] 108 at 110.

[3]: SENS Foundation, SENS Foundation, online: <http://www.sens.org/about-thefoundation>.

[4]: Jacques M Mathieu et al, “7-Ketocholesterol Catabolism by Rhodococcus jostii RHA1” (2010) 76:1 Applied and Environmental Microbiology 352.

5]: Jacques M Mathieu et al, “Increased resistance to oxysterol cytotoxicity in fibroblasts transfected with a lysosomally targeted Chromobacterium oxidase” (2012) Biotechnology and Bioengineering, online:
<http://www.wileyonlinelibrary.com> DOI 10.1002/bit.24506.

[6]: SENS Foundation, Research Report 2011, online: <http://images.sens.org/reports/ SENS%20Research%20Report%202011.pdf>.

[7]: Supra note 2 at 109.

[8]: 21 USC § 321(g)(1).

[9]: 42 USC § 262(i). The phrase “analogous product” has been used to justify the extension of the FDA’s regulatory authority to human cells, tissues, and cellular and tissue-based products (HCT/Ps). See also Areta L Kupchyk, “Approval of Products for Human Use” in HB Wellons et al, Biotechnology and the Law (ABA, 2007) 591 at 617, note 41

[10]: 21 CFR § 201.57(c)(2) Specifically, this is a labeling requirement, but if a drug cannot be labeled according to the regulation, the New Drug Application cannot be approved. See also 21 CFR § 201.56.

[11]: The term disease is defined in 21 CFR §101.93(g) for the purposes of disease claims relating to dietary supplements, but that is only applicable in that context. See also 21 USC 343(r)(6).

[12]: William J Evans, “Drug discovery and development for ageing: opportunities and challenges” (2011) 366 Phil Trans R Soc B 113 at 114.

[13]: Ibid at 114.

[14]: Barbara Mintzes, “Disease Mongering in Drug Promotion: Do Governments Have a Regulatory Role?” (2006) 3:4 PLoS Medicine e198.

[15]: Aubrey de Grey, “Combating the Tihtonus Error: What Works?” (2008), 11:4 Rejuvenation Research 713.

[16]: GE Berrios, “Alzheimer’s disease: a conceptual history” (1990) 5:6 International Journal of Geriatric Psychiatry 355.

[17]: Robert Katzman et al, Alzheimer’s disease: senile dementia and related disorders (NY: Raven Press, 1978) at 595.

[18]: Eric P Brass & Kathy E Sietsema, “Considerations in the Development of Drugs to Treat Sarcopenia” (2011) 59:3 Journal of the American Geriatrics Society 530.

[19]: Ibid at 531.

[20]: Supra note 12 at 116.

[21]: Alfonso J Cruz-Jentoft et al, “Sarcopenia: European consensus on definition and diagnosis” (2010) 39:4 Age and Ageing 412 (Abstract).

[22]: Roger A Fielding et al, “Sarcopenia: An Undiagnosed Condition in Older Adults. Current Consensus Definition: Prevalence, Etiology, and Consequences” (2011)12:4 Journal of the American Medical Doctors Association [JAMDA] 249 (Abstract).

[23]: See Marco Brotto, “Lessons from the FNIH-NIA-FDA sarcopenia consensus summit” (2012) 9 IBMS BoneKEy 210.

[24]: Supra note 18 at 531-533.

[25]: Ibid at 533. See also Christopher J Evans et al, “Development of a New Patient-Reported Outcome Measure in Sarcopenia” (2011) 12:3 JAMDA 226.

[26]: Center for Drug Evaluation and Research, “Guidance for Industry – Qualification Process for Drug Development Tools,” FDA (October 2010) online: <http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM230597.pdf>.

[27]: 21 USC § 356(a)(1).

[28]: 21 CFR § 314.510.

[29]: Thomas R Fleming, “Surrogate Endpoints And FDA’s Accelerated Approval Process” (2005) 24:1 Health Affairs 67. See also Thomas R Fleming and David L DeMets, “Surrogate end points in clinical trials: are we being misled?” (1996) 125:7 Annals of Internal Medicine 605.

[30]: There may be other intellectual property issues implicated in this shift of paradigm in drug development and regulation, but they are beyond the scope of this article.

[31]: Meaning “self, one’s own” + “cell” + “toxin” + “condition of increase”.

[32]: Supra note 14 at 0463.

[33]: SENS Foundation, Annual Report 2011, online: <http://www.sens.org/sites/ srf.org/files/SENS%20Foundation%20 Annual%20Report%202011.pdf>.

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

08. August 2016 · Comments Off on How Uniform Are The Uniform Anatomical Gift Acts? · Categories: Cryonics, Society

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

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

The model act continues:

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

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

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

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

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

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

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

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

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

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

Endnotes:

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

2 Ibid at 725.

3 http://www.uniformlaws.org

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

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

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

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

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

9 63 OS §2200.11A.

10 Va Code § 32.1-291.11

11 DC Code §7-1531.10.

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

13 Comfort, Texas is home to the Timeship project.

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

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

16 Va Code §54.1-2825.

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

18 Supra note 1 at 727.

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

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

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

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

23 SA 2006 c H-14.5 s 3.

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

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

06. January 2016 · Comments Off on Who speaks for the dead? · Categories: Cryonics, Society

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

06. May 2015 · Comments Off on Cryonics as a measure of rationality? · Categories: Cryonics, Society

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

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

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

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

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

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

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

This is a web-exclusive edition of the Quod incepimus conficiemus column that is published in Cryonics magazine but was omitted from the April 2015 issue.

13. February 2015 · Comments Off on Though She Isn’t Really Ill, There’s a Little Yellow Pill… · Categories: Health, Neuroscience, Society

Humans have been ingesting mindand mood-altering substances for millennia, but it has only rather recently become possible to begin to elucidate drug mechanisms of action and to use this information, along with our burgeoning knowledge of neuroscience, to design drugs intended to have a specific effect. And though most people think of pharmaceuticals as “medicine,” it has become increasingly popular to discuss the possibilities for the use of drugs in enhancement, or improvement of “human form or functioning beyond what is necessary to sustain or restore good health” (E.T. Juengst; in Parens, 1998, p 29).

Some (transhumansits) believe that enhancement may not only be possible, but that it may even be a moral duty. Others (bioconservatives) fear that enhancement may cause us to lose sight of what it means to be human altogether. It is not the intention of this article to advocate enhancement or to denounce it. Instead, let’s review some of the drugs (and/or classes of drugs) that have been identified as the most promisingly cognitive- or mood-enhancing. Many of the drugs we will cover can be read about in further depth in Botox for the brain: enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories (Jongh, R., et al., Neuroscience and Biobehavioral Reviews 32 (2008): 760-776).

Of most importance in considering potentially cognitive enhancer drugs is to keep in mind that, to date, no “magic bullets” appear to exist. That is, there are no drugs exhibiting such specificity as to have only the primary, desired effect. Indeed, a general principle of trade-offs (particularly in the form of side effects) appears to exist when it comes to drug administration for any purpose, whether treatment or enhancement. Such facts may constitute barriers to the practical use of pharmacological enhancers and should be taken into consideration when discussing the ethics of enhancement.

Some currently available cognitive enhancers include donepezil, modafinil, dopamine agonists, guanfacine, and methylphenidate. There are also efforts underway to develop memory-enhancing drugs, and we will discuss a few of the mechanisms by which they are proposed to act. Besides cognitive enhancement, the enhancement of mood and prosocial behavior in normal individuals are other types of enhancement that may be affected pharmacologically, most usually by antidepressants or oxytocin. Let’s briefly cover the evidence for the efficacy of each of these in enhancing cognition and/or mood before embarking on a more general discussion of the general principles of enhancement and ethical concerns.

One of the most widely cited cognitive enhancement drugs is donepezil (Aricept®), an acetylcholinesterase inhibitor. In 2002, Yesavage et al. reported the improved retention of training in healthy pilots tested in a flight simulator. In this study, after training in a flight simulator, half of the 18 subjects took 5 mg of donepezil for 30 days and the other half were given a placebo. The subjects returned to the lab to perform two test flights on day 30. The donepezil group was found to perform similarly to the initial test flight, while placebo group performance declined. These results were interpreted as an improvement in the ability to retain a practiced skill. Instead it seems possible that the better performance of the donepezil group could have been due to improved attention or working memory during the test flights on day 30.

Another experiment by Gron et al. (2005) looked at the effects of donepezil (5 mg/day for 30 days) on performance of healthy male subjects on a variety of neuropsychological tests probing attention, executive function, visual and verbal short-term and working memory, semantic memory, and verbal and visual episodic memory. They reported a selective enhancement of episodic memory performance, and suggested that the improved performance in Yesavage et al.’s study is not due to enhanced visual attention, but to increased episodic memory performance.

Ultimately, there is scarce evidence that donepezil improves retention of training. Better designed experiments need to be conducted before we can come to any firm conclusions regarding its efficacy as a cognitive-enhancing.

The wake-promoting agent modafinil (Provigil®) is another currently available drug that is purported to have cognitive enhancing effects. Provigil® is indicated for the treatment of excessive daytime sleepiness and is often prescribed to those with narcolepsy, obstructive sleep apnea, and shift work sleep disorder. Its mechanisms of action are unclear, but it is supposed that modafinil increases hypothalamic histamine release, thereby promoting wakefulness by indirect activation of the histaminergic system. However, some suggest that modafinil works by inhibiting GABA release in the cerebral cortex.

In normal, healthy subjects, modafinil (100-200 mg) appears to be an effective countermeasure for sleep loss. In several studies, it sustained alertness and performance of sleep-deprived subjects(up to 54.5 hours) and has also been found to improve subjective attention and alertness, spatial planning, stop signal reaction time, digit-span and visual pattern recognition memory. However, at least one study (Randall et al., 2003) reported “increased psychological anxiety and aggressive mood” and failed to find an effect on more complex forms of memory, suggesting that modafinil enhances performance only in very specific, simple tasks.

The dopamine agonists d-amphetamine, bromocriptine, and pergolide have all been shown to improve cognition in healthy volunteers, specifically working memory and executive function. Historically, amphetamines have been used by the military during World War II and the Korean War, and more recently as a treatment for ADHD (Adderall®). But usage statistics suggest that it is commonly used for enhancement by normal, healthy people—particularly college students.

Interestingly, the effect of dopaminergic augmentation appears to have an inverted U-relationship between endogenous dopamine levels and working memory performance. Several studies have provided evidence for this by demonstrating that individuals with a low workingmemory capacity benefit from greater improvements after taking a dopamine receptor agonist, while high-span subjects either do not benefit at all or show a decline in performance.

Guanfacine (Intuniv®) is an α2 adrenoceptor agonist, also indicated for treatment of ADHD symptoms in children, but by increasing norepinephrine levels in the brain. In healthy subjects, guanfacine has been shown to improve visuospatial memory (Jakala et al., 1999a, Jakala et al., 1999b), but the beneficial effects were accompanied by sedative and hypotensive effects (i.e., side effects). Other studies have failed to replicate these cognitive enhancing effects, perhaps due to differences in dosages and/or subject selection.

Methylphenidate (Ritalin®) is a well-known stimulant that works by blocking the reuptake of dopamine and norepinephrine. In healthy subjects, it has been found to enhance spatial workingmemory performance. Interestingly, as with dopamine agonists, an inverted U-relationship was seen, with subjects with lower baseline working memory capacity showing the greatest improvement after methylphenidate administration.

Future targets for enhancing cognition are generally focused on enhancing plasticity by targeting glutamate receptors (responsible for the induction of long-term potentiation) or by increasing CREB (known to strengthen synapses). Drugs targeting AMPA receptors, NMDA receptors, or the expression of CREB have all shown some promise in cognitive enhancement in animal studies, but little to no experiments have been carried out to determine effectiveness in normal, healthy humans.

Beyond cognitive enhancement, there is also the potentialfor enhancement of mood and pro-social behavior. Antidepressants are the first drugs that come to mind when discussing the pharmacological manipulation of mood, including selective serotonin reuptake inhibitors (SSRIs). Used for the treatment of mood disorders such as depression, SSRIs are not indicated for normal people of stable mood. However, some studies have shown that administration of SSRIs to healthy volunteers resulted in a general decrease of negative affect (such as sadness and anxiety) and an increase in social affiliation in a cooperative task. Such decreases in negative affect also appeared to induce a positive bias in information processing, resulting in decreased perception of fear and anger from facial expression cues.

Another potential use for pharmacological agents in otherwise healthy humans would be to blunt unwanted memories by preventing their consolidation.Thismay be accomplished by post-training disruption of noradrenergic transmission (as with β-adrenergic receptor antagonist propranolol). Propranolol has been shown to impair the long-term memory of emotionally arousing stories (but not emotionally neutral stories) by blocking the enhancing effect of arousal on memory (Cahill et al., 1994). In a particularly interesting study making use of patients admitted to the emergency department, post-trauma administration of propranolol reduced physiologic responses during mental imagery of the event 3 months later (Pitman et al., 2002). Further investigations have supported the memory blunting effects of propranolol, possibly by blocking the reconsolidation of traumatic memories.

GENERAL PRINCIPLES

Reviewing these drugs and their effects leads us to some general principles of cognitive and mood enhancement. The first is that many drugs have an inverted U-shaped dose-response curve, where low doses improve and high doses impair performance.This is potentially problematic for the practical use of cognition enhancers in healthy individuals, especially when doses that are most effective in facilitating one behavior simultaneously exert null or detrimental effects on other behaviors.

Second, a drug’s effect can be “baseline dependent,” where low-performing individuals experience greater benefit from the drug while higher-performing individuals do not see such benefits (which might simply reflect a ceiling effect), or may, in fact, see a deterioration in performance (which points to an inverted U-model). In the case of an inverted U-model, low performing individuals are found on the up slope of the inverted U and thus benefit from the drug, while high-performing individuals are located near the peak of the inverted U already and, in effect, experience an “overdose” of neurotransmitter that leads to a decline in performance.

Trade-offs exist in the realm of cognitive enhancing drugs as well. As mentioned, unwanted “side effects” are often experienced with drug administration, ranging from mild physiological symptoms such as sweating to more concerning issues like increased agitation, anxiety, and/or depression.

More specific trade-offs may come in the form of impairment of one cognitive ability at the expense of improving another. Some examples of this include the enhancement of long-term memory but deterioration of working memory with the use of drugs that activate the cAMP/protein kinase A (PKA) signaling pathway. Another tradeoff could occur between the stability versus the flexibility of long-term memory, as in the case of certain cannabinoid receptor antagonists which appear to lead to more robust long-term memories, but which also disrupt the ability of new information to modify those memories. Similarly, a trade-off may exist between stability and flexibility of working memory. Obviously, pharmacological manipulations that increase cognitive stability at the cost of a decreased capacity to flexibly alter behavior are potentially problematic in that one generally does not wish to have difficulty in responding appropriately to change.

Lastly, there is a trade-off involving the relationship between cognition and mood. Many mood-enhancing drugs, such as alcohol and even antidepressants, impair cognitive functioning to varying degrees. Cognition-enhancing drugs may also impair emotional functions. Because cognition and emotion are intricately regulated through interconnected brain pathways, inducing change in one area may have effects in the other. Much more research remains to be performed to elucidate these interactions before we can come to any firm conclusions.

ETHICAL CONCERNS

Again, though it is not the place of this article to advocate or denounce the use of drugs for human enhancement, obviously there are considerable ethical concerns when discussing the administration of drugs to otherwise healthy human beings. First and foremost, safety is of paramount importance. The risks and side-effects, including physical and psychological dependence, as well as long-term effects of drug use should be considered and weighed heavily against any potential benefits.

Societal pressure to take cognitive enhancing drugs is another ethical concern, especially in light of the fact that many may not actually produce benefits to the degree desired or expected. In the same vein, the use of enhancers may give some a competitive advantage, thus leading to concerns regarding fairness and equality (as we already see in the case of physical performance-enhancing drugs such as steroids). Additionally, it may be necessary, but very difficult, to make a distinction between enhancement and therapy in order to define the proper goals of medicine, to determine health-care cost reimbursement, and to “discriminate between morally right and morally problematic or suspicious interventions” (Parens, 1998). Of particular importance will be determining how to deal with drugs that are already used off-label for enhancement. Should they be provided by physicians under certain conditions? Or should they be regulated in the private commercial domain?

There is an interesting argument that using enhancers might change one’s authentic identity—that enhancing mood or behavior will lead to a personality that is not really one’s own (i.e., inauthenticity), or even dehumanization—while others argue that such drugs can help users to “become who the really are,” thereby strengthening their identity and authenticity. Lastly, according to the President’s Council on Bioethics, enhancement may “threaten our sense of human dignity and what is naturally human” (The President’s Council, 2003). According to the Council, “the use of memory blunters is morally problematic because it might cause a loss of empathy if we would habitually ‘erase’ our negative experiences, and because it would violate a duty to remember and to bear witness of crimes and atrocities.” On the other hand, many people believe that we are morally bound to transcend humans’ basic biological limits and to control the human condition. But even they must ask: what is the meaning of trust and relationships if we are able to manipulate them?

These are all questions without easy answers. It may be some time yet before the ethical considerations of human cognitive and mood enhancement really come to a head, given the apparently limited benefits of currently available drugs. But we should not avoid dealing with these issues in the meantime; for there will come a day when significant enhancement, whether via drugs or technological means, will be possible and available. And though various factions may disagree about the morality of enhancement, one thing is for sure: we have a moral obligation to be prepared to handle the consequences of enhancement, both positive and negative.

Originally published as an article (in the Cooler Minds Prevail series) in Cryonics magazine, December, 2013

20. January 2015 · Comments Off on Alcor vs Disintegration · Categories: Cryonics, Society

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

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

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

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

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

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

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

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

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

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

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

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

20. January 2015 · Comments Off on Cryonics and Natural Selection · Categories: Cryonics, Death, Society

“…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.  

08. September 2014 · Comments Off on Social Benefits of Rejuvenation Bioechnologies · Categories: Health, Society

When advocates of radical life extension discuss the social benefits of humans having much longer lifespans, it is often just a footnote to a personal desire to prolong life. As a consequence, cynicism from critics is often encountered. It hard to counter such skepticism effectively because people may believe you are just trying to make an essentially selfish desire look socially desirable.

There is an alternative. We can approach the topic from the other direction if we ask what kind of lifespans would be desirable if we want to increase social welfare and reduce human suffering. Let’s look at a number of issues.

There is a large literature about coping with the death of loved ones, relatives, and friends. While many people find support from such self-help books, most people would agree that no amount of anticipation or coping can eliminate the suffering and devastation that follows the death of a loved one. Is there an upside? I am not aware of any serious writer pontificating about the positive aspects about a person dear to you dying or suffering from aging-related disabilities. A society in which humans have control over the aging process would be desirable because it would eliminate the dominant cause of death (age-associated diseases) and the suffering it brings to survivors.

It is not uncommon to hear people being accused of not caring about the effects of their actions on future generations. This complaint is particularly prominent in discussions about the environment and the use of natural resources. If humans were not born to die on a predictable schedule this whole dynamic would change because the distinction between current and future generations would cease to exist. If consideration of the long-term consequences of our actions requires a prominent place in human life, we should not want humans to replace each other but generations to coexist in time and space.

Age discrimination involves discrimination of individuals on the basis of their age. In most instances, however, this discrimination concerns biological age and its effects on appearance, physical health, and mental skills. Biological age is not hard to observe and can usually be inferred from chronological age. If we prefer that people are not treated differently because of their date of birth we should want to live in a society where rejuvenation biotechnologies sever the link between chronological age and biological age.

What about economic welfare? Ageless people would be able to remain productive and generous, medical costs associated with the debilitating health and mental effects of biological aging would be substantially reduced, and highly talented people would not cease to exist.

Reasoning backwards from what morality and welfare would “dictate” about human lifespans is not just a talking point in discussions about the bioethics of life extension. One can imagine the rise of a social movement that seeks to educate the general public about the social benefits of biological control over the aging process. Such a social movement would not be in the business of making excuses for eccentric individual desires but would recommend that the reduction of suffering, sustainable growth, and more virtuous conduct would require that humans do not have a fixed expiration date.

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