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

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

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

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

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

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

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

Robert Freitas Jr – Death is an Outrage

Ben Best – Why Life Extension?

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

26. September 2011 · Comments Off · Categories: Cryonics, Health · Tags: , , , ,

As every modern consumer knows, smartphones are today’s go-to portable technology. Everything from GPS navigation to finding a good deal on your next meal or haircut right NOW to a wide variety of games and applications may be had at the touch of a button. But developers of smartphone applications (i.e, “apps”) are only just beginning to realize the true capabilities of having so much computing power in the palm of your hand. Indeed, the possibilities for health monitoring applications in combination with GPS location bodes well for cryonicists.

Until cryonics-specific apps become available, there are several existing applications useful to cryonics members and organizations. Here are some of the most interesting from the Android Market:

ICE (In Case of Emergency):   Emergency personnel look for ICE information in patient mobile phones. This ICE app has a couple of widget options and can be accessed even when the phone is locked. My favorite feature is the ability to put any special instructions (like the protocol from your Alcor bracelet) on the main screen. The app acts primarily as an emergency contact list. Your cryonics service provider should be #1, followed by family and friends who support your cryonics arrangements. Additionally, you may enter your vital stats, medical and dental insurance information, and any known allergies, conditions, and/or medications.

For those with “dumb phones,” just create a contact called “ICE” and enter your cryonics organization’s emergency number. Additional information about placing ICE  numbers in your cell phone may be found in this article by Fred and Linda Chamberlain.

Emergency Button: Emergency Button sends a distress signal with your coordinates to a defined recipient when pressed. This has obvious utility for all matters of personal safety, and can be used to alert your cryonics organization to emergency health situations as soon as they emerge.

Google Latitude: Latitude is a GPS location tracking app. It allows for various privacy settings and can be configured to share only with specific people. A cryonics organization could, with its members’ permission, use such an app for real-time location tracking.

These are just three basic apps that are commonly available and useful to cryonicists now. I hope to be updating this list as improvements in smartphone technology continue.

Personalized Cryonics is an approach to cryonics that emphasizes the use of individual (health) information to optimize a person’s cryopreservation circumstances and outcomes.

To exchange information and empower individuals, a moderated discussion list was created by the Institute for Evidence Based Cryonics. It is a discussion list for members of existing cryonics organizations who seek to understand and change their personal circumstances to optimize their own survival and (potential) cryopreservation.

Typical topics on this list include personal genomics, personalized medicine, diet options, fitness, nutrigenetics, cryonics first-aid, custom-built stabilization equipment, advance directives and living wills, third-party interference, brain threatening diseases, and local support groups.

The recent issue of Cryonics magazine features a comprehensive update on intermediate temperature storage (ITS). This article contains an important observation:

Acoustic events consistent with fracturing were found to be universal during cooling through the cryogenic temperature range.  They occurred whether patients were frozen or vitrified.  If cryoprotection is good, they typically begin below the glass transition temperature (‑123°C for M22 vitrification solution).  If cryoprotective perfusion does not go well, then fracturing events begin at temperatures as warm as -90°C.  Higher fracturing temperatures are believed to occur when tissue freezes instead of vitrifies because freezing increases the glass transition temperature of solution between ice crystals.  The temperature at which fractures begin is therefore believed to be a surrogate measure of goodness of cryoprotection, with lower temperatures being better.

This is an important observation because one of the arguments that has been made against intermediate temperature storage is that Alcor routinely records fracturing events above the nominal glass transition temperature (Tg) of the vitrification solution. But if we recognize that such events can be (partly) attributed to ice formation due to ischemia-induced perfusion impairment it should be obvious that the recording of fracturing events above Tg as such cannot be an argument against ITS. After all, we also do not argue against the use of vitrification solutions because ice formation will still occur in ischemic patients that are perfused with vitrification solutions. Because cryonics patients almost invariably suffer some degree of ischemia prior to cryoprotective perfusion and cryopreservation, our knowledge about fracturing events in “ideal” human cases remains incomplete.

But even if ITS would only be successful in reducing fracturing events, instead of completely eliminating them, this should not be an argument against ITS. To argue that a technology should not be used because it does not completely eliminate a problem would constitute a sharp departure from the philosophy that has informed Alcor since its formation. In many areas, the evolution of Alcor’s technologies has been one of incremental evidence-based progress towards better procedures and storage conditions, not one of radical change.

The worst argument against ITS is that mature repair technologies will be able to repair clean fractures. It is a poor argument because one could similarly argue that advanced cell repair technologies will also be able to reverse the biochemical effects of short periods of ischemia and moderate degrees of ice formation. What distinguishes Alcor from other cryonics organizations is that it aims to secure viability of the brain as far into its procedures as it practically can. In ideal cases, this currently means meeting the challenge of further reducing cryoprotectant toxicity during cryoprotectant perfusion and reducing/ eliminating fracturing.

Perhaps the biggest obstacle to offering ITS to the general Alcor membership is cost. An obvious solution would be to offer ITS in addition to conventional liquid nitrogen storage. An alternative would be to gradually phase out conventional liquid nitrogen storage by no longer offering it to new neuro members and to raise cryopreservation minimums accordingly. The (preliminary) cost estimates in the article indicate that this would bring the cost of ITS for neuros closer to that of conventional liquid nitrogen whole body cryopreservation. The article does not provide specific information on the “greater capital costs” of whole body ITS systems but the reported lower liquid nitrogen consumption per patient for whole body systems suggests that it might be possible to offer whole body ITS without putting it beyond the reach of most (new) members with adequate funding.

July 24-27 I attended the 2011 annual Society for Cryobiology conference in Corvallis, Oregon.

A number of the first presentations were concerned with means to *avoid* cryopreservation. Room temperature storage is much less expensive and troublesome, and improves ease of transport, especially in remote areas. One such technology “shrink wrapped” DNA in a glass  and another used trehalose to protect lipid membranes in a similar manner. Applied to cells, such technologies are viewed as a form of room-temperature vitrification.

Another researcher had successfully freeze-dried hematopoietic stem cells using trehalose and other additives without losing the ability of the stem cells to differentiate. Stress proteins in combination with trehalose allowed for desiccation of mammalian embryonic kidney cells without loss of viability. Late Embryogenesis Abundant (LEA) proteins also assist trehalose in dehydration tolerance.

Christoph Stoll showed that depleting red blood cell membranes of cholesterol can increase
trehalose uptake, but when I asked him in person about it, he said that the uptake was not enough to make much difference. Depleting cell membranes of cholesterol makes them more vulnerable to chilling injury, so I don’t think cholesterol depletion is a very good idea.

Masakazu Matsumoto spoke about some of the interesting anomalous properties of water.

Andrew Brooks spoke about the largest University cell and DNA repository in the world at Rutgers University.  They store DNA by plunging in liquid nitrogen.  He told me that 10 freezings and thawings does not impair DNA quality. That is encouraging for CI’s tissue/DNA storage program, because we plunge our samples into liquid nitrogen. Brooks gave data  showing that RNA is much less hardy in liquid nitrogen than DNA.

David Denlinger noted that HSP70 RNAi can block cold tolerance in insects. He also mentioned a Czech study which found that insect larva fed proline could survive liquid nitrogen. Perhaps we should be feeding proline to terminal cryonics patients.

In preparation for this conference, I had done a lot of reading on the subject of chilling injury and was hoping to question researchers on the subject. Steve Mullen showed a video of meiotic spindles dissociating at low temperature.

Spindles are a form of microtubules. Microtubules are known to dissociate at low temperature, but can spontaneously re-associate upon rewarming. But that would not be so beneficial when the microtubules are functioning as centrosomes because the reassembly would not be a reconstruction of the original structure. This is probably why cell division often  stops at low temperature.

Tiantian Zhang is one of the two candidates to become the new Society for Cryobiology President. Her field of study is cryopreservation of fish embryos and oocytes, which are especially vulnerable to chilling injury.

Fish are useful scientific models because they have a much simpler genome than mammals. 50% of endangered species are fish, but fish don’t get anywhere near the concern that pandas do. In both her lecture, and when I spoke to her in person, Dr. Zhang had apparently not learned any more than what was in her 2009 paper.

Why does reducing yolk content reduce chilling injury? Why is methanol the most non-toxic cryoprotectant for fish embryos, and so protective? If microtubule dissociation were a mechanism of chilling injury, it is indeed ironic that a 2006 Society of Cryobiology meeting presentation found that methanol causes proteolysis.

Kevin Brockbank spoke on the oxygenated hypothermic machine perfusion that he used to preserve pig livers at 4-6deg C for 12 hours. As a somewhat off-the-wall question, I asked him if he had assayed for chilling injury. This was off-the-wall because I have never heard of anyone assaying chilling injury. He responded that he had not, but that there were plans to use gene arrays to assay for chilling injury. This is like gene arrays to assay for aging — it requires deeper analysis, especially if chilling injury — like aging — is due to multiple mechanisms, the mechanisms are controversial, and no one mechanism is dominant. Northern wood frogs, arctic insects, and polar fish don’t have problems with chilling injury, although their adaptations include heat shock proteins and highly unsaturated cell membranes.

Much to my frustration, I have not had a good conversation with Peter Mazur (the uncrowned guru of cryobiology) since he got me to tell him I am a cryonicist several years ago. I have repeatedly asked him questions, and he has repeatedly been rude and dismissive. This year was different, for some reason. When I asked him about frozen water expansion contributing to mechanical damage he noted that cells could tolerate a 9% expansion without lysis even if freezing was intracellular. When I asked him how much dehydration cells could tolerate without damage, he said cells could lose all of the osmotic water (90% of cell water), and could lose more in freeze-drying with proper protectants (like trehalose). I was somewhat stunned by this answer, which takes no account of intracellular electolyte concentration increasing on dehydration. Next year I will be more optimistic about the possibility of talking with him, and I will prepare questions more carefully.

I spoke to Society for Cryobiology President John Crowe about his negative remarks concerning trehalose, in light of the fact that he is very aware of many of its benefits. John told me that a new method of manufacturing trehalose from starch is making trehalose as inexpensive as sucrose. If trehalose is used on bakery sugar, the sugar will not melt and run after a couple of days, as happens with sucrose. I mentioned to John that Robert Ettinger had just died. I had imagined that he might ask me to say a few words about the matter to the cryobiologists at their business meeting, but John treated the matter as a non-event, and I got the distinct impression that he would have preferred that I had not mentioned it.

At the business meeting it was noted that membership has dropped from close to 300 in 2008 and 2009 to just above 200 in 2011. There is concern that web access to the journal
CRYOBIOLOGY is becoming so easy that the incentives for membership have dropped. Or the global financial crisis is taking its toll on Society for Cryobiology membership. CRYOBIOLOGY journal impact factor has fallen to 1.830 from a high of 2.044 in 2002.

I appreciate being able to attend the business meetings, but one of the vehemently anti-cryonics cryobiologists gives me dirty looks. I have not been kicked-out yet, though, and decreasingly worry that I will be. A similar thought goes through my head as when I attend an Alcor meeting: “Spy in the House of Love.” But I really want the Society to prosper and grow, not be harmed, because I appreciate their good work (as with Alcor), even if they view me as a threat.

I had a brief chat with the cryonics-friendly Treasurer, who asked me when I think a cryonics patient will be reanimated. When I told him not less than 50 years, he said that a lot of surprising things can happen in 20 years. He is a more optimistic cryonicist than I am! At least as remarkable is that he is currently working with biotechnologists who are engineering scaffolds that can be used for growing organs from stem cells. That is a very cryonics-relevant project!

Every year I exchange a few words with Arthur Rowe (the cryobiologist who repeatedly compares cryonics to restoring a cow from hamburger — as he did in “Death in the Deep Freeze” – a comparison which probably originated with Peter Mazur). This year Arthur spent a lot of time hanging out with John G. Baust (the man who compared publishing cryonics science research with publishing Nazi hypothermia experiments). At the end of the conference I lost patience trying to catch Arthur alone, so I approached Arthur to say “hi”. Arthur said that he had seen on TV that Robert Ettinger had just died. He asked me about Robert’s educational credentials, and about my taking Robert’s place as CI President. Then he introduced me to John Baust. John was politely quiet, and said very little.

As with the 2010 Cryobiology Conference, I felt decreasingly paranoid as the meeting proceeded, but my level of paranoia was nonetheless very high near the beginning of this meeting. Overall, the amount by which I “came out” as a cryonicist was modest this year, and my softening of the hostility of cryobiologists to cryonics was modest this year compared to the previous one. The 2012 Society for Cryobiology Conference is scheduled to be held in Argentina.

Reportedly, when James Watson and Steven Pinker had their genome sequenced, they declined to know their risk for Alzheimer’s disease. Clearly this is not an option for life extensionists and cryonicists, who are better off knowing whether they have a copy or, worse, two copies of the ApoE4 gene.

Patri Friedman, son of the libertarian economist David Friedman (who in turn is the son of the Nobel laureate Milton Friedman), recently learned that he has two copies of the ApoE4 gene when 23andMe updated their reports. Caucasian and Japanese carriers of two E4 alleles have between 10 and 30 times the risk of developing Alzheimer’s by 75 years of age, as compared to those not carrying any E4 alleles. Patri is a life extensionist, practitioner of the paleo diet, and recently made cryonics arrangements with his whole family at Alcor – and is thus far more prone to a pro-active course of action.

When he realized that there was no good central resource for people with copies of the ApoE4 gene he started a new blog called ApoE4 – The Ancestral Allele, which aims to share practical information and research for health-conscious E4 carriers. The first posts discuss some of the benefits of having the E4 gene (better episodic memory) and what kind of diet is recommended for E4 carriers. He also encourages guest posts and other co-bloggers to help run the website.

One of the most predictable features of public debates about cryonics is that those arguing in favor of cryonics are held to more rigorous standards than those seeking conventional medical treatment. Advocates of cryonics do not just have to prove that cryonics will work, they are also supposed to solve problems like overpopulation and the presumed boredom arising from expended lifespans. To some, people who make cryonics arrangements have an inflated perception of their own importance and should just forgo such selfish attempts to extend their lives. The default position seems to be that people should not exist and that life needs justification. Could you imagine such antinatalist rhetoric being employed when a person seeks conventional medical treatment to extend their life? We can’t, and such responses are quite indicative of the fact that people are not interested in serious evaluation of the cryonics argument.

The most striking case of cryonics being held to higher standards than conventional medicine concerns the requirement that “cryonics” needs to “work.” Even people who have made cryonics arrangements routinely say something like, “I estimate the probability of cryonics working as 5% but life insurance premiums are low and I have nothing to lose if it does not work.” To see how strange such a statement is, let’s look at these two terms, “cryonics” and “working.”

Cryonics is an experimental medical procedure to stabilize critically ill patients at low temperature to benefit from future advances in medicine. Such a definition can include a wide variety of cases, ranging from ice-free cryopreservation (vitrification) as an elective medical procedure in a hospital to the freezing of a person who is found days after circulatory arrest. Considering the enormous variability under which people can be cryopreserved, to claim that “cryonics” will not work without specifying under what conditions a cryopreservation is performed is akin to saying that “emergency medicine” or “chemotherapy” does not work — an absurd claim.

Usually when people argue that cryonics does not work they refer to the mistaken view that cryopreservation that is not initiated within hours, or even within minutes, after death does not make sense because the brain has “died” at that point. Such a view completely ignores the fundamental cryonics argument that lack of function of the brain does not imply that the neuroanatomical basis of identity is irreversibly destroyed.

But let us accept this position the sake of the argument. What such a critic is basically saying is that cryonics cannot work because cryonics patients are cryopreserved under conditions that do not allow it to work. To see how strange such a position is, imagine a country where law would prohibit CPR until 15 minutes of death. Would anyone be impressed if someone would argue that CPR does not work because patients suffer irreversible brain damage after 15 minutes of circulatory arrest? Of course not. We would instead insist that such obstacles should be removed so that these life-saving technologies can be employed as soon as needed. Clearly, whatever the merits of cryonics are, it is not reasonable to conflate the conditions under which cryonics is often conducted with the idea of cryonics as such.

Now let’s look at the second term. What does it mean for cryonics to “work?” Naturally, we would like a medical procedure to cure the disease and restore the patient to the condition than he was in prior to the disease. In real life this often happens, especially in the case of minor infections and minor insults. But there are also many cases where (heroic) medical interventions are aimed at keeping the patient alive without expecting a full recovery without side effects. This is often the case in acute cardio-respiratory arrest and stroke. Would we prefer a complete recovery for such patients? Of course. But would we say that interventions that aim to save a patient’s life did not work if we fail to meet such an ideal – say, a permanent loss of movement in one arm or reduced memory function? No, our first concern would be with the patient’s survival and his perception of the quality of his “new” life.

In the case of cryonics things are not much different. We hope that advanced cell repair technologies will be successful in completely restoring the patient to good health in a rejuvenated state. For some patients complete inference of the original structure of the brain might not be possible, but advanced neural archeology and neurogenomics may restore a significant degree of the original person. We do not heap scorn on such scenarios in today’s medicine and there is no reason to hold cryonics to higher standards, especially if one also advocates the very restrictions that are responsible for such less than perfect outcomes. In fact, there is no reason to be scathing about any credible attempts to save or prolong a life, even if the attempt will not necessarily succeed. Such a perspective is a given in conventional medicine or rescue operations.

One objection to this position is to argue that cryonics cannot work even under the most favorable conditions. Such an argument would basically entail that if a critically ill patient is stabilized without ischemic delays, without ice formation, and without fracturing, it should be categorically ruled out that technologies will ever be developed to repair the original disease of the patient and any form of injury that occurs during the cryopreservation process itself. I personally would consider such a position extremely dogmatic (would anyone argue such a position of long-term technological stasis if the cryonics context were dropped?) but it raises a fundamental question about the burden of proof. Should it rest with the person who aims to prolong life or should it rest with the person who aims to prohibit such attempts? Asking the question is answering it.

On the evening of Thursday, May 19 and on Friday, May 20, I attended the 2011 (2nd annual) Teens & Twenties young cryonicists gathering which preceded the Suspended Animation, Inc. conference in Fort Lauderdale, Florida. The Teens & Twenties gathering (for young cryonicists having human cryopreservation contracts in place with some cryonics organization) is an offshoot of the cryonics Asset Preservation Group. Like the Asset Preservation Group, this event was created-by and is run-by Cairn Idun. Bill Faloon funds Teens & Twenties through a Life Extension Foundation education grant. Members of the Asset Preservation Group, such as myself, are permitted to attend despite being more than 30 years old. Of the 52 people who attended, ten were Asset Preservation Group members, and 42 were young cryonicists.

When asked who did not want to be photographed, only one person in the group raised his hand. I will refrain from mentioning any of the young cryonicists by name. Writing about this very people-oriented event without mentioning individual young cryonicists is like writing about lemonade without mentioning lemon. Some of the personalities were particularly colorful and memorable. But I know that many of the individuals do not want the publicity, and in my experience people get very emotional about what is said and not said about them. Even with explicit permission I am concerned that many of the young cryonicists might not fully appreciate the kinds of problems writing about them in connection with cryonics might cause for their future careers.

This year the demographics of the young cryonicists more closely matched what is typical of cryonicists. Last year about one third of those attending were female, and there was a high representation of people from the entertainment industry. This year, the attendees were overwhelmingly male, with most of the females being companions of males (which is not to say they were not cryonicists). Many members of this group were impressively highly educated, mostly in computer technologies, and secondarily in biotechnologies.

EXCELLENT MEALS WERE INCLUDED IN THE SCHOLARSHIPS

There were six Russians: five from KrioRus, and one from CryoFreedom. KrioRus is located near Moscow, whereas CryoFreedom is further south in Russia, closer to Ukraine. Dr. Yuri Pichugin (formerly the Cryonics Institute’s cryobiologist, is associated with CryoFreedom. CryoFreedom advertises neuropreservation for $7,500. Although it currently has no human patients, two pets are in liquid nitrogen. (I also learned that there is a man named Eugen Shumilov who is working to start a new cryonics company in St. Petersburg, Russia, but there was no representation of Shumilov’s organization at this event.

There are two overlapping goals of the Teens & Twenties event. One is the opportunity for members of the Asset Presevation Group to meet the young cryonicists. The other is the opportunity for the widely dispersed young cryonicists to become acquainted with each other, and to build lasting networks (community building). Cairn Idun has designed a number of “getting to Know You” exercises to facilitate the networking.

There are two self-introductions: the first lasting one minute, and the second lasting two minutes. I was the most anal-retentive of any of the participants in these exercises. I wrote-out my self-introductions, and practiced reading them to myself until I was sure I was within a few seconds of the one and two minute allocations. The one-minute self-introductions were on Thursday evening, and the two-minute self-introductions were Friday morning.

The Thursday evening self-introductions were followed by the exercise wherein participants classified themselves by “color”: (Green:Conceptual, Curious, Wise, Versatile), (Red:Adventuresome, Skillful, Competitive,Spontaneous), (Gold:Responsible, Dependable, Helpful, Sensible), and (Blue:Warm, Communicative, Compassionate, Feeling), as described in my write-up of last year’s Teens & Twenties event.

Once again, Greens were most numerous, followed by Reds. Cairn directed the participants to gather into groups by color. No directions were given for these meetings, so it was to foster socialization between “like-colored” individuals.

Last year a number of people had little to say in their second self-introductions, imagining that they had said all that could be said about themselves in their first self-introduction. I concerned myself quite a bit about how to prevent this from happening again. I made a number of suggestions in the Young Cryonicists Facebook Group, as did others. Cairn had participants list wants and “not-wants” of various kinds before the second self-introductions as a means of facilitating self-awareness. I tried to make my second self-introduction very personal in the hope that it would inspire others. There weren’t too many who were at a loss for words in the second self-introductions this year. Many of the participants passed-out business cards or other self-descriptive materials in conjunction with their second self-introduction.

There was a breakout session in which those with special interests had an opportunity to discuss their interests or how they might work together on those interests. The interest areas were entertainment, research, computer sciences, communication networking, and psychology/philosophy of self.

INTEREST GROUPS

Bill Faloon encouraged the participants to share thoughts about types of research that could lead to reanimation — with the thought that many of the young cryonicists would be in charge of large revival trust funds with income that can be used for research on reanimation technologies. I won’t attempt to summarize the thoughts of others, but I can say a few things about what I said.

Some people don’t want cryonics because they are afraid that they will not be restored in their original condition. The mother of one cryonicist is a stroke victim, and she has had a frightening first-hand experience of losing mental & movement capacity. Hollywood plays into this vision by depicting reanimated beings as zombies who are criminally insane.

Few people want to be the first of those reanimated — they would prefer that many others be reanimated first to ensure that the process works perfectly. I suggested that the first people reanimated might be brought back by next-of-kin who are overly eager to see their loved-ones as soon as possible. The idea of reviving pets first would not be popular with many pet owners. Reanimation technologies might be perfected on non-pet animals, although even today there is increasing sentiment against animal research. Animal rights activists seek legislation to protect animals from “unnecessary research”, which would likely include anything cryonics-related. Austria banned research on apes in 2006, and the number of countries with similar legislation continues to grow [SCIENCE; 332:28-31 (April 2011)]. Even if reanimation research was conducted on apes, the extrapolation of restoring ape consciousness/identity to restoring of human consciousness/identity is non-trivial.

I worry that as more wealthy cryonicists are cryopreserved, their only concern will be for reanimation research. Many of them will not appreciate that improved cryopreservation methods will advance cryonics and thereby enhance their chances of reanimation.

The next “getting to know you” exercise was what Cairn calls “speed dating”. Each participant is to spend two minutes with every other participant having a one-to-one conversation. For myself, it gave me an opportunity to talk to many people I would not have spoken with otherwise, and to have personal conversations with many individuals that I cannot imagine happening in any other way. Spontaneous socializing more often results in people talking only to those they already know. This exercise is a good ice-breaker, but it does involve some effort. It can be a strain to be starting conversations again-and-again, and again-and-again having to break them off once they become interesting — but the result was well worth the effort for me. Having a personal connection with individuals enables me to interact with them more productively, and this must also be true of the others. I rate speed-dating as the most valuable of all of the exercises, along with self-introductions.

Participants filled out a sheet indicating their interest level in cryonics — including such things as whether they planned to have a cryonics-related career, do volunteer work for a cryonics organization, or simply be a consumer.

GATHERING FOR THE GROUP PHOTO

he final event was the group photo, after which was a dinner and then reception for the Suspended Animation conference. The photographer who made the group photo was employed to make photographs only intended sor private use of Suspended Animation, Inc., but we did not learn this until later (even the photographer did not know).

All the young cryonicists had the fees, hotel expenses, and meals associated with the Suspended Animation conference paid-for. The opportunity for some of the young cryonicists who have an interest in science to directly interact with current cryonics researchers could eventually lead to large scientific dividends for cryonics research in the future.

There were reportedly many exaggerated rumors about what happened in the evening hot-tub sessions in the 2010 Teens & Twenties gathering. I brought my bathing suit this year, but did not spend a great deal of time in the hot tub. The conversation was a bit more playful than it was in other contexts, and there was more of a party-spirit in the hot tub — which some of the participants relished. I would guess that about half of the Teens & Twenties participants spent at least some time in the hot tub.

Despite all of the intensive social interaction and “getting to know you” exercises, I would have a hard time making a connection between names, faces, and biographies of at least a third of the young cryonicists. I don’t believe that I am unique in that regard. The “speed-dating” exercise was particularly helpful in strengthening and deepening the name/face/biography connections. Memories of the individuals and their personalities are likely to be more easily refreshed in the future thanks to the meetings and exercises of this gathering.

YOUNG CRYONICISTS VISIT WITH SAUL KENT

Gerald Feinberg, a Columbia university physicist who, among other things, hypothesized the existence of the muon neutrino, had a strong interest in the future of science and life extension. In 1966 he published the article “Physics and Life Prolongation” in Physics Today in which he reviews cryobiology research with the aim of realizing medical time travel. Unlike most of his scientific colleagues, Feinberg recognized that it might be possible for people dying today to benefit from future advances in science in the absence of perfected techniques:

For the living it is necessary to await successful completion of freezing research before attempting to freeze them. For the newly dead this consideration is irrelevant since the dead have nothing to lose by being frozen, even by imperfect methods…

He doubts, however, whether “the primitive freezing techniques now available” would be good enough to permit successful resuscitation in the future.  Although his article ends in endorsing cryonics as a procedure, Feinberg did not make cryopreservation arrangements himself, despite his familiarity with molecular nanotechnology and his association with the Foresight Institute.

In the June 1992 issue of Cryonics magazine, Mike Perry writes:

Only a few days ago, as I write this, Gerald Feinberg, aged 58, died of cancer.  He was not frozen.  It appears  that he didn’t lack the means to make the arrangements, nor the time. Somehow, he was just not interested enough.  Friends or acquaintances I’ve talked to could give little in the way of definite reasons for the lack of  interest, but I get the impression that, when all was said and done, the  interest he did show was mainly academic after all.  Another factor may  have been hostility from colleagues and family members.  Apparently he was well criticized for the Physics Today article on the prolongation of life, though not for something really scientifically daring, like the tachyon  theory.

Human cryopreservation procedures have changed considerably since 1992 and cryonics researcher Mike Darwin has composed an ambitious article to answer the question whether current cryopreservation techniques can preserve identity. One of the most important observations in this article is that we do not need to wait until the future to get a better understanding of how good our current procedures are in this regard.

As long as we keep in mind that the absence of ultrastructural evidence for the preservation of identity-critical information does not necessarily mean the absence of this information as such (after all, future imaging and data gathering technologies may be more powerful than today’s) it is very important for cryonics advocates to recognize that preliminary work to infer the original structure of the brain from (3D) images of ischemic and cryopreserved tissue can start right now. Even in the absence of physical technologies to restore those structures to their native state, demonstrating that we can infer the original state, and visually reconstruct it, can be another argument in favor of human cryopreservation.

Further reading: Gerald Feinberg – Physics and Life Prolongation

Introduction

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

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

Opportunities for cryonics optimization

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

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

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

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

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

Physician-assisted dying

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

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

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

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

Sudden death and autopsy

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

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

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

The dying phase and Advance Directives

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

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

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

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

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

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

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

Pre-medication of cryonics patients

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

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

1. Is it safe?

2. Is it beneficial?

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

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

Do Not Resuscitate Orders

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

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

Creating a general template

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

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Appendix :  Neurological damage during the dying phase

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

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

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

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

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