Comments on the book YOUNIVERSE by Robert Ettinger

Robert Ettinger‘s book Youniverse: Toward a Self-Centered Philosophy of Immortalism and Cryonics is a book containing many insights and deep thoughts, yet has such an informal writing style that many readers might not take it seriously. I know of no other work of philosophy in which the author begins a sentence with “Anyway,”. Ettinger writes that the first cryonics-related organization was founded “in 1962 or 1963, I forget which”, then says “Why don’t I look it up?” and justifies himself by reference to a Woody Allen movie. This is not the kind of writing one expects from a philosophy treatise.

Ettinger may not take himself too seriously, but he is even more dismissive of most of the world’s foremost philosophers and religious figures. The writings of Aristotle are called “ramblings”. In describing William James’s statement that James was only able to understand Hegel while under the influence of nitrous oxide, Ettinger notes how appropriate it is that nitrous oxide is also called laughing gas. Ettinger wrote that “Rousseau has been extravagantly praised, and not only by himself”, but dismisses Rousseau as unoriginal, incoherent, not profound, and frequently wrong. Ettinger describes the philosopher G.E. Moore as being “definitely confused as well as confusing, abounding in contradictions and non-sequiturs, sometimes substituting assertions for arguments.” Ettinger often seems himself guilty of the last accusation. He faults Isaac Asimov for the “absurdity” that without the “saving grace of death” the rigid views of the old would prevent further progress — but leaves a critique of Asimov’s argument “as an exercise for the reader”. Ettinger writes that “Paeans of praise have poured from the pens of platoons of panting pundits” concerning Godel’s Incompleteness theorem, which he dismisses as a linguistic trick associated with the failure of physics to correspond identically with formal (mathematical) systems. By finding the quote from Wittgenstein “I don’t know why we are here, but I am pretty sure that it is not in order to enjoy ourselves”, Ettinger has massively deflated my respect for the philosopher Ludwig Wittgenstein. Ettinger describes the modern “self-styled bioethicist” as a “new type of vermin or parasite” whose major accomplishment has been to create “the illusion of looking down on people far above them.”

Ettinger wrote that “fear of God” is generally really fear of parents, neighbors, and a lifetime of conditioning. He says people too readily submit to tradition rather than use reason. To be “normal” is to have the same delusions as the neighbors. He says loyalty “is frequently a worthy habit”, but sometimes nothing more than an unjustified habit. Ettinger says faith is arrogant certainty in the absence of evidence, which ultimately “boils down to sacrificing your integrity for a bit of comfort”. To Ettinger it is obvious that non-human animals have consciousness and feelings, and that a God that disregarded the suffering of animals on the grounds that animals have no soul “would have less compassion than the average human”. Like many physicists, Ettinger seems accepting of the idea that time and the universe began with the Big Bang, but wonders where God would be before He created time and the universe. Ettinger can make no sense of an omniscient, omnipotent God creating people who need to live their lives to prove whether they deserve Heaven or Hell. Ettinger says that a benevolent God would forgive the skeptics, who should therefore have no reason to compromise their integrity and disbelief.

Ettinger’s irreverence extends to the legal system. Frequent use of appeals courts and split decisions in the Supreme Court are given as evidence that laws are unclear or that bias is pervasive. He describes juries as “ignorant, stupid and readily swayed by irrelevancies and by histrionics”. In connection with the adversarial system, Ettinger wrote “All lawyers are frightening, and specialty litigators are terrifying. Some firms are said to keep their lead litigators chained in a tower room and fed raw meat until needed.” I asked Mr. Ettinger what his beloved son (a lead litigator at a prestigious law firm) had to say about the law chapter, but I got no definitive response.

As the book title YOUNIVERSE implies, Ettinger believes that “me-first” and “feel-good” are the only possible basis for conscious motivation. He also states that a person ought to want whatever will maximize future “feel-good”, and that people do not always want what they ought to want. Ettinger believes that “figuring out what we ought to want is the primary problem of philosophy”. He says that a main aim of YOUNIVERSE is to debunk the views that values are arbitrary or externally given.

Ettinger challenges the claim of David Hume that “You can’t derive an ‘ought’ from an ‘is'”, and — like Ayn Rand with her Objectivist Ethics — he does so by reference to values being rooted in biology. Ettinger disparagingly dismisses Rand’s views as narcissism, “me generation”, and “looking out for number one” without explaining how this differs from “me-first”. Rooted in biology, Rand makes survival the basis of her ethics, rather than “feel-good”. Ironically, Ettinger writes more approvingly of Nietzsche’s self-centeredness, although Ettinger faults Nietzsche’s belief in the importance of power over other people as a core value. (Ettinger notes that Nietzsche believed Russians and Jews, rather than Germans, would be the “master races” of Europe.)

I disagree with the arguments of Rand and Ettinger for deriving “ought” from biology. Biology dictates that animals value food and water, but many humans have committed suicide by refusing food and water. To assert that such people are “wrong” and did not do what they ought to have done would be attempting to externally impose values upon them. Ettinger could argue that such people were acting in such a way as to maximize their satisfaction — “me-first” and “feel-good” (he gives the examples of a woman rushing into a burning building to save her baby, or “saints” who gain personal satisfaction from ascetic service to others). But by that argument they were wanting what they ought to want. The point Ettinger seems to be making is that people should not allow others to impose their values upon them — should not be driven by guilt, social pressure, the need to conform. But if people are driven by these motives, they are nonetheless still maximizing their satisfaction. Ettinger might say that such people are acting without integrity by not being true to themselves, but why should people be blamed for valuing the opinions of others and for this being important to them? If it is “impossible to be motivated by anything other than self interest, because motivation means what is important to the self”, then the word “ought” is inappropriate. If “me-first” and “feel-good” are the only possible bases for conscious motivation, then the word “ought” is inappropriate. The only reason that people fail to want what they ought to want is because of matters of fact, not matters of value — people failing to appreciate the consequences of their actions in the context of their values.

The issue of determinism and free will is a subject about which I have thought, read, and written about considerably (see A Case for Free Will AND Determinism ), yet I found Ettinger’s chapter on this subject impressively thoughtful and informative. I mostly agree with Ettinger’s views, about which we are both very much in the minority. I won’t say much about the issues or insights I gained in the determinism chapter, but I will comment on how he applies determinism to cryonics. Ettinger notes that “determinism is very nearly equivalent to” conservation of information, which implies that any human who ever lived could be reconstructed without having been cryonically preserved — except that there may never be adequate computing power.

Although I can conceive of retaining my personal identity in the total absence of any memories that I have, I nonetheless find the idea hard to relate-to. I am even less comfortable about the idea that the essence of my personal identity is feeling. Ettinger has firmer opinions on these subjects than I do, but I sense that his emphasis on feeling as the essence of personal identity contradicts his admonishments about the use of reason against intuition, tradition, and conditioning.

Ettinger skims over the subject of ischemic damage in cryonics, and I think he is wrong to say that “cryothermic damage will in most cases be the most difficult to reverse”. Freezing damage is like broken pieces that are nonetheless intact, whereas ischemic damage is like dissolution or decomposition of structure. Nonetheless, I cannot quantify my argument in terms of “most cases”. I think Ettinger is wrong to cling to the word “immortality” as meaning “indefinitely extended life” when its literal meaning is “eternal life”. His use of the word “immortality” presents cryonics as an alternative to religion rather than an extension of medicine.

Although Ettinger acknowledges that death will mean an end to suffering, he sees a number of disadvantages, including
“…it’s hard to enjoy life when you’re dead.
…daisies are prettier when viewed from above.
…you can only vote in Chicago.
…you need extra strength deodorant.”
But mainly, “Life is better than death because it is more interesting.” (For my own views on the subject, see: Why Life Extension?)

In his lifetime of reading Ettinger has collected numerous notable quotes, and these gems are liberally sprinkled throughout YOUNIVERSE. Some of my favorites include “‘Love thy neighbor as thyself’ presupposes that you love yourself” (Miguel de Unamuno), “The greatest part of our happiness depends on our disposition, not our circumstances” (Martha Washington), and Will Rogers’s WWII suggestion for getting rid of German U-boats: “Boil the Atlantic Ocean. How do we do that? Hey, I’m just an idea man, I leave the details to the engineers.”

Ettinger also has a chapter called “Misunderstandings” which deals with his insights into a wide variety of subjects. Indicative of my “anti-intellectual” bias, is the fact that my favorite is Ettinger’s observation that torque (force X lever arm length) has identical units to work (newton-meters), despite the fact that work and torque are completely different. He offers no solution or explanation, however.

A consequence of Ettinger’s informal writing style is that there is much autobiographical material throughout YOUNIVERSE. But the last formal chapter (I am not counting the Appendix) is explicitly autobiographical. He says “I have perhaps a few thousand admirers, hardly any of whom give me much thought or attention”. Ettinger speaks of his loneliness in having experienced the loss of all his friends and family of his generation, and that there is nobody left whom he wants to impress. Indicative of Ettinger’s world-weariness is his quote of a comment made by his brother that all of life is “killing time and amusing oneself while waiting to die”.

Ettinger’s final comments concern his plan to have a pre-mortem “jolly wake” with music, speakers, toasts, and other festivities prior to a suicide intended to improve the conditions of his cryonic preservation. Ettinger notes earlier in the book that “many people are more afraid of seeming cowardly than of facing danger”, which is why suicide with an audience of friends and family would boost his courage. The last line of the chapter reads “If I never wake up, my last experience will have been better than most — a very brief comfort, to be sure.”

Although there are some cryonicists who believe that Robert Ettinger would be the perfect cryonicist to win sympathy for voluntary self-euthanasia to improve cryopreservation, I am not one of them. How can you justify voluntary euthanasia in a non-terminal person when there is no way of knowing how many years of life that person could be expected to live? How can you justify voluntary euthanasia for ANYONE not suffering from a terminal disease, or expect the public to be sympathetic to voluntary self-euthanasia under these conditions? Even for terminal cryonics patients, I would not be to eager to see a public association of cryonics with self-euthanasia or physician-assisted suicide. Cryonicists would be accused of taking advantage of mentally-compliant sick and elderly people for monetary reasons, which would lead to even more cryonics-unfriendly legislation.

And there are practical problems, not the least of which is the danger of autopsy. Many cryonicists, myself included, cling to life tenaciously — much more tenaciously than the average person. I would find it very difficult to euthanize myself or have myself euthanized. The ideal situation is when death is nearly certain to occur within a week. But this is the condition in which standbys are typically initiated, not the condition in which standbys fail to occur. Heart attack is a common cause of death, and this is most often unexpected. Most cryonicists who receive standby are people dying of cancer, and whose slide toward death is along a more predictable path. The ability of cancer victims to euthanize themselves would make the standby process easier, but that would have no effect on reducing the number of cryonicists who deanimate without standby, despite having arranged for standby. There are no convincing arguments that simplifying self-euthanasia or physician-assisted suicide will lead to the majority of cryonics cases having greatly improved cryopreservation by significantly reducing the number of cryonicists deanimating under unfavorable conditions.

The case against cryonics

What is striking about cryonics is that those who have taken serious efforts to understand the arguments in favor of its technical feasibility generally endorse the idea. Those who have not made cryonics arrangements usually give non-technical arguments (anxiety about the future, loss of family and friends, etc), lack funding or life insurance, or are (self-identified) procrastinators. In contrast, those who reject cryonics are almost invariably uninformed. They do not understand what happens to cells when they freeze, they are not aware of vitrification (solidification without ice formation), they think that brain cells “disappear” five minutes after cardiac arrest, they demand proof of suspended animation as a condition for endorsing cryonics, etc.

This does not mean that no serious arguments could be presented. I can see two major technical arguments that could be made against cryonics:

1. Memory and identity are encoded in such a fragile and delicate manner that cerebral ischemia, ice formation or cryoprotectant toxicity irreversibly destroy it. Considering our limited understanding of the nature of consciousness, and the biochemical and molecular basis of memory, this cannot be ruled out. Cryonics advocates can respond to such a challenge by producing an argument that pairs our current understanding of the neuroanatomical basis of identity and memory to a cryobiological argument in order to argue that existing cryonics procedures are expected to preserve it. An excellent, knowledgeable, response of this kind is offered in Mike Darwin’s Does Personal Identity Survive Cryopreservation? Cryonics skeptics in turn could produce evidence that existing cryonics procedures fall short of this goal.

2. The cell repair technologies that are required for cryonics are not technically feasible. This argument should be presented with care and rigor because the general argument that cell repair technologies as such are not possible contradicts existing biology. A distinct difference from the first argument is that it is harder, if not impossible, to use existing empirical evidence to settle this issue. After all, making cryonics arrangements is a form of decision making under uncertainty and such decisions are not straightforwardly “correct” or “incorrect,” “right” or “wrong.” What can be done is to provide a detailed scientific exposition of the nature and scope of the the kind of repairs that are necessary for meaningful resuscitation and to argue that both biological and mechanical cell repair technologies are not conceivable – or are conceivable.

One thing that becomes immediately clear from this exercise is that there is no single answer to the question of whether cryonics can work because the answer to this question depends on the conditions and technologies that prevail during the cryopreservation of a patient. This introduces a set of more subtle distinctions concerning the question of what kind of cryonics should be assessed. It also produces an argument in favor of continuous improvement of cryonics technologies, and standby and stabilization services.

This short examination of technical arguments that could be made against cryonics gives advocates of the practice two talking points in discussion with skeptics or hostile critics:

(a) If a critic flat-out denies that cryonics is technically feasible, it is not unreasonable to ask him/her to be specific about what (s)he means by cryonics. This simple question often will reveal a poor understanding of existing cryonics technologies and procedures.

(b) A decision made on the basis of incomplete knowledge cannot be “right” or “wrong” and should be respected as one’s best efforts to deal with uncertainty.

Case reports in cryonics

This article was originally published in Cryonics magazine, 4th Quarter, 2010.

Introduction

The most important reasons for writing case reports are:

1. To provide a transparent and detailed description of procedures and techniques for members of the cryonics organization and the general public. A cryonics organization that never writes anything about its cases and procedures should be treated with more caution than an organization that does.

2. To validate current protocol and procedures in general, and its actual implementation in particular. A case report should not only record what happened but should be used for guidance as to what should happen in the future. A detailed case report, especially when a variety of physiological data has been collected, contains a wealth of information that can be analyzed for the team members’ and patient’s benefit. Cryonics cases are relatively rare (compared with other medical procedures), so we should try to learn as much as we can from the cases we perform.

3. To serve as a medical record to assist with future attempts to revive the patient. Although advanced future medical technologies may make it possible to determine the physiological condition of the patient down to the molecular level, it is important to provide as much medical information as possible to help in efforts to revive patients. Having a detailed record of the patient’s condition prior to pronouncement, subsequent stabilization, and cryoprotection, may also help the organization in establishing the desired sequence of revival attempts.

4. To gain more scientific credibility. If we want scientists and physicians to take us seriously, we need to convince them that we attempting to cryopreserve our patients in a scientific manner.  Professional case reports can provide this kind of credibility.

This article will mainly concern itself with the general question of how a case report can help a cryonics organization in improving protocol, techniques and skills.

Protocol

To be able to assess the quality of patient care in a cryonics case, it is important to specify what the intended protocol was prior to writing about the case. Only if we know what the organization was supposed to do will we be able to assess how successful the care was. For example, if there is no mention of collecting (and analyzing) blood gases during a case this may have been because it is currently not a part of the organization’s protocol, but it may also be the result of a shortage of skilled personnel, defective equipment, or other problems or deficiencies. Unless the writer of the report specifies what should have happened, it is difficult to assess the quality of preparation and performance. If preparation for the case was poor and there was no (functional) extracorporeal perfusion equipment available, the case report should not simply state that the organization attempted to do a

case without substituting the blood with an organ preservation solution, but also why the blood washout was not attempted.

In reality there will be many deviations between the organization’s protocol and what actually happens. Human cryopreservation cases are not controlled laboratory experiments, and as many people who have extensive experience doing cases know, unique situations present themselves, including frustrating events that are beyond the control of even the most skilled medical professional. Nevertheless, the inherent unpredictability and uniqueness of cryonics cases is too often used as an excuse or justification for failing to follow established protocol, or for serious errors and omissions in the care of the patient. Documenting the prospective protocol will help us to gain a more systematic understanding of what is possible (or essential) and within our control, versus that which is not.

Detail

The importance of writing detailed descriptions of the procedures and techniques employed during a case cannot be overestimated. This not only enables the reader to gain a comprehensive understanding of the techniques used, it also allows detailed analysis of the difficulties that were encountered during a case that would not have been noticed if there is only a brief mention of it. For example, instead of simply noting that medications were administered, providing comprehensive details is essential. There are many reasons why this is the case.

Case reports should be prepared with the possibility in mind that what may seem mysterious, or inexplicable, to the writer may be crystal clear to an expert or perceptive reader when provided with sufficient detail.

Providing as much detail as possible also serves to allow for replication of the techniques used by others. This is a critical component of the scientific method. Other investigators or practitioners must be able to duplicate the procedures and obtain the same outcome. Yet another consideration is that factors not now perceived or considered to be important may become so in the future. There are many examples of this in the history of cryonics that have proved essential to improving patient care. For example (1), in the early days of cryonics bags of ice were used to facilitate external cooling. It was not until comprehensive and consistent core cooling data were collected that it became apparent that this technique required 6-8 hours to cool a patient to ~ +20°C (room temperature!) with the patient cooling at a rate of 0.064°C/min. Documentation of these appallingly slow cooling rates provided powerful incentive to develop stirred water ice baths which increased cooling rates to between 0.15°C/min  and 0.33°C /min, allowing cooling to ~15°C within 90 minutes to 2 hours after the start of cardiopulmonary support (CPS) (see graph below).

Comparison of Cooling Methods: Above are actual cooling curves for three adult human cryopreservation patients on Thumper support, using ice bags, the Portable Ice Bath (PIB), and the PIB augmented by SCCD (squid) cooling. Patient A-1133 weighed 56.8 kg, patient A-1169 weighed 57.3 kg, and patient A-1049 weighed 36.4 kg. As this data indicates PIB cooling is approximately twice as efficient as ice bag cooling. The SCCD appears to increase the rate of cooling by an additional 50% over that of the PIB (roughly adjusting for the difference in the patients’ body mass).

This example is even more instructive because continued diligent and comprehensive monitoring of cooling in multiple patients made clear other factors that were critically important to good outcome or, conversely, prohibited it. A large-framed obese male with heavy fat cover and a large amount of thermal inertia will not cool at anywhere near the rate that an emaciated, petite woman will. Evaluating the patient for fat cover and body mass index before deanimation allows reasonably accurate prediction of the cooling rate and may suggest the need for the addition of other cooling modalities such as peritoneal lavage with chilled fluid. Favorable results from application of peritoneal cooling in turn will suggest that even greater rates of cooling are possible for all patients and lead to the addition of the modality as a standard part of the protocol.

Failure to gather and promptly analyze data as basic as cooling rate precludes realization that problems exist as well as any possibility of solving them.

It is important to note that an incomplete case report doesn’t necessarily indicate failure on the part of a cryonics organization. In a case where the number of team members is limited, all resources may have to be devoted to doing the case, instead of collecting data, or assigning an essential person to the job of taking notes. In the case of limited personnel it is better to do a good case without documentation than to document a bad case. To some degree this conflict between tasks can be avoided by having some of the team members (the team leader, paramedic, etc.) use a voice recorder with a clip-on microphone. But if the number of team members is insufficient, and data collection is not possible, this should be reported in the case report and recommendations should be made and implemented to prevent this situation from occurring again in the future. Good data acquisition and scribe work are essential for a good case report and, if feasible, should be a full-time job during a case.

Analysis

Specifying the protocol and describing the case in great detail is necessary but is not sufficient. A critical review of the information and data culminating in a list of desired changes and specific plans to address them should complement this. Ideally every discrepancy between protocol and reality that has been observed during the case should be discussed. Even in a case where stabilization started promptly after pronouncement, and the protocol was followed to the letter, there is still a lot of (physiological) data that, once analyzed, may require a change in the protocol in future cases.

To assess skills, identify critical failures, formulate solutions, and compare cases in a meaningful and valid way, a consistent and systematic format of reporting cases is essential. A typical case report should be divided into sections describing protocol, patient assessment, preparation and deployment of standby assets, the details of the case (divided in sections such as  airway management, cardiopulmonary support, external and other cooling methods, blood washout, cryoprotective perfusion, and cooling to storage temperature), analysis, recommendations, and a variety of (public or non-public) appendices. Such appendices should include time-lines and graphic presentation of data, medications, cryoprotectants, and statistical analysis and comparisons to other cases.

Each case report should not only present solutions, or suggest tests and experiments to identify solutions, but provide a plan of action as to how these things can be accomplished. One approach to ensure that research and tests to validate solutions are implemented, and appropriate remedial action is taken, is to appoint an officer in the organization who is responsible for quality assurance and quality control. This individual’s job will be to ensure that case reports are written in a manner consistent with the guidelines as outlined by the organization, as well as to ensure implementation of required changes.

Another critical role of case reports is to educate the organization’s staff as well as consultants and, where appropriate, the patients’ physicians and other health care providers about protocol, procedures and techniques. Although case reports are not and should not be a substitute for comprehensive written protocols, standard operating procedures (SOPs), and thorough training of personnel, sometimes solutions to problems can only be found in case reports where a team member was presented with an unusual problem. Consistent and systematic organization of case reports will greatly enhance the utility of case reports for this purpose. For example, if a reader wants to know about surgical techniques, and problems encountered in gaining access to the circulatory system for blood washout, consulting a case report will be far easier if they’re organized in a consistent and predictable manner.

Answering Objections

One objection to writing up a case report is that it is not a controlled experiment and at best provides only anecdotal evidence. This is not the case for the following reasons.

Not all the mistakes and issues identified are of a hypothesis testing nature. For example, if a patient presents the human cryopreservation team members with a problem that could not be managed with the equipment at hand, the cryonics organization doesn’t necessarily need a larger number of cases to decide to make a change to their equipment, and to start teaching employees the necessary skills.

Similarly, what may be perceived as anecdotal evidence for the cryonics organization may be a consistent finding in nearly identical settings in mainstream medicine. For example, some issues during a human cryopreservation case may be well known in hemodynamic management of potential organ donors in hospitals, or, for example, a medication in the protocol that is undergoing trial as a stroke therapy may demonstrate the same adverse effects observed during transport of a cryonics patient.

Of course, such lessons are impossible to learn without both broad and deep knowledge of medicine and the relevant research literature. Considering the ever growing number of publications and hyper-specialization, case reports may increasingly become collaborations between numbers of people with expertise in diverse areas. The individuals with the most valuable input do not necessarily have to be the ones who did the case. A physician dealing with similar issues in a neuro-intensive care unit may identify problems and propose solutions not obvious to those delivering cryonics care to the patient.

Monitoring

We don’t know how our patient is going to fare in the future but we can know a lot about how our patient fared up to the point of long term low temperature care if we monitor his condition continuously. This starts from collecting detailed pre-mortem medical data to monitoring fracturing events during cooldown.

It is tempting to say that a case went very well if all the steps of the protocol were followed in a timely manner. This is not unreasonable because one would expect a strong correlation between an evidence based protocol and optimal care. But it is important to keep in mind that the goal of stabilization and cryopreservation is to treat the patient and not the book (as a saying in emergency medicine goes).

Without comprehensive monitoring of the patient through all parts of the procedures a case report will only document a predictable series of mechanical steps and some crude visual indicators of (relative) success at best. The things we are really interested in, like (quantitative) end-tidal CO2 measurements, cardiac output, pH, and cerebral oxygenation, cannot be observed without sophisticated equipment.

Not only do we want to know how the patient is doing after the fact, we would also like to be able to intervene during a case if we observe a trend that suggests (alternative) treatment. Only in-depth reporting and analysis combined with a sound understanding of the physiopathology and available treatments will enable us to do so.

Presentation

A comprehensive list of dos and don’ts in writing case reports is not something that can be explored in this article, but some things are worth mentioning. Stylistically, a human cryopreservation report should resemble a medical or research report rather than a sensationalized adventure for the patient or the standby team. This should apply to the organization of the material as well as the choosing of words. As a general rule mainstream medical terminology should be used instead of cryonics jargon. Editorializing should be limited, and if perceived necessary, be moved to the proper section of the report. For example, jumping from a technical description of procedures to quarrelling among relatives or complaining about government regulation doesn’t look very professional.

Protocol, procedures and techniques should be the subject of the report, not people. Cryonics preparation and procedures are very demanding and exhausting for all people involved and mistakes are made and will be made. Errors should be presented as dispassionately as possible to avoid a culture of blame and personal conflict. Experience also teaches that (potential) participants are more open to transparent reporting if a case report will not single out individuals in describing procedures.

No matter how competent the writer of the report is, each report should be proofread by most or all individuals who were involved in the case and, if possible, a variety of outsiders with appropriate technical and medical knowledge, before it is released to the general public.

Patient Care

Writing case reports as presented in this article may be more demanding and time-consuming than generally has been done in human cryopreservation, but the results may improve patient care to a degree not previously seen.  Ultimately, the most ambitious use of case reports will be one in which the case reports are analyzed as a series, measurements are compared, and patterns are established. Reading (and evaluating) a series of case reports in a systematic manner  will even enable us to answer some very fundamental questions as to whether, or the degree to which, protocol, procedures and techniques  have improved over the years.

Providing the best patient care possible for current and future patients is the reason why cryonics organizations exist, and considering how powerful a tool a good case report can be, a responsible cryonics organization should devote considerable resources and time to writing them.

As our members and resources increase, and human cryopreservation gradually becomes a part of mainstream medicine, the successful transition from basic algorithm, volunteer driven case to evidence-based cryonics will be an important mandate.

Case reports and increasing caseload

One of the biggest challenges facing a growing cryonics organization is that the organization will be faced with a growing number of cases per year. This challenge is further amplified if all these cases need to be documented. As a consequence, a cryonics organization will find itself allocating an increasing amount of time to writing case reports and falling behind publication schedule. One of the most unfortunate responses to such a development would be to make an attempt to keep writing case reports in the old style but to lower standards and take short cuts.

An alternative approach is to develop a new format for case reports that allows for a shorter report but still captures the essential objectives of case reporting. One approach is to eliminate all the narrative that is not essential for following the mechanics of the case and evaluating the quality of care. In the past there have been a number of case reports with excessive narrative but little technical reporting or analysis. For a cryonics organization with a growing caseload the opposite approach should be followed. Another approach is to eliminate detail about procedures that were performed without deviations from past protocol and expectations, provided that this is made explicit in the report. As a result, case reports will increasingly read as a description and commentary on events that diverged from protocol or new observations about existing procedures.

To establish a template for such case reports the following approach can be followed. First, it is established what kind of information is essential for doing a meta-analysis of all cryonics cases. Then these parameters are reverse-engineered to create a template for writing case reports that reconcile the need for economy of expression and documenting all the relevant aspects of a case.  One important advantage of producing such case reports is they permit easier consultation of the technical details of the case and still meet the fundamental objectives of writing case reports.

The history of case report writing in cryonics shows an erratic potpourri of approaches and styles. One of the most unfortunate victims has been the objective of using case reports to improve the practice of human cryopreservation and to formulate meaningful research questions for the sciences that inform cryonics. But if systematic thought is given to the objectives of case reporting outlined in this document, steps can be taken to leave this unsatisfactory situation behind while meeting the needs of a growing cryonics organization.

Notes

(1) I am grateful to Mike Darwin for this example and for reviewing earlier drafts of this article.

The RhinoChill: A New Way to Cool the Brain Quickly

We scientists are difficult, cranky, and above all, maddeningly frustrating people. Want to turn lead into gold? No problem, we can tell you how to do that, and in fact have even done it already: the only catch is that the cost of such ‘nuclear transmutation’ is many times that of even the most expensive mined gold. You say you want to travel to the moon? Done! That will be ~$80 billion (in 2005 US dollars). Want to increase average life expectancy from ~45 to ~80 years? Your wish is our command, but be mindful, you will, on average, spend the last few of those years as a fleshpot in the sunroom garden of an extended care facility.

And so it has been with an effective treatment for cerebral ischemia-reperfusion injury following cardiac arrest. Thirty years ago, laboratory scientists found a way to ameliorate most (and in many cases all) of the damage that would result from ~15 minutes of cardiac arrest, and what’s more, it was simple! All that is required is that the brain be cooled just 3oC within 15 minutes of the restoration of circulation. The catch? Well, this is surprisingly difficult thing to do because the brain is connected to the body and requires its support in order to survive. And the body, as it turns out, represents an enormous heat sink from which it is very difficult to remove the necessary amount of heat in such short time. Thus, the solution exists and has been proven in the laboratory, but it has been impossible to implement clinically.  This may be about to change as a variety of different cooling technologies, such as cold intravenous saline and external cooling of the head begin to be applied in concert with each other. Separately, they cannot achieve the required 3oC of cooling, but when added together they may allow for such cooling in a way that is both effective and practical to apply in the field.  A newly developed modality that cools the brain via the nasal cavity may provide the technological edge required to achieve the -3oC philosopher’s stone of cerebroprotection.

Read the complete article in PDF here.

Imagine there's no sleep

Imagine that human culture has never experienced sleep, but suddenly must experience it to survive. Would they be apprehensive about experiencing it for the first time?

Of course!

Just picture… this total suspension of consciousness, experienced for the very first time in human history. The notion would totally blow our minds. It would be completely shocking. We might even make up stories about dying and being replaced by an identical clone being, or trying to console ourselves that at least we will have a successor on the following day to carry out our desires.

Contrary to popular belief, there is no particular reason to assume that humans who “survive” events like freezing or vitrification would be any different from humans that “survive” sleep or anesthesia. The definition of consciousness we care about is the lifelong continuity of experiences created by memories. We might not like donating 8 hours out of every 24 to a form of comatose oblivion, but we are able to tolerate it. We would die without it — and who wants to die?

Suppose we were to meet an alien culture that undergoes 8 hour periods of liquid nitrogen immersion every night instead of sleeping. We wouldn’t find it a significant barrier to relating to them as fellow sentient beings. We wouldn’t find it socially necessary to mourn their deaths every night or become reacquainted with their newly generated “progeny” every morning. We would just think their suspension habits are an interesting facet of their biological existence, much like they might regard our sleeping habits.

Some people seem to have the idea that cryonics patients can only be “dead” by definition — that the cessation of metabolic activity somehow makes survival via cryonics an absurdity. It is true that current cryonics patients are legally and clinically dead, but that is a matter that will probably change as scientific and social progress is made. In the mean time, there needs to be a clear distinction between destruction and deanimation — which unlike “death” are not social, legal, or philosophical terms but empirical events, much like sleep.

Alcor update from CEO Max More

The Kurzweil Accelerating Intelligence blog features a short interview with new Alcor CEO Max More:

Q: Where do you see cryonics in the future?

We’ll look back on this 50 to 100 years from now — we’ll shake our heads and say, “What were people thinking? They took these people who were very nearly viable, just barely dysfunctional, and they put them in an oven or buried them under the ground, when there were people who could have put them into cryopreservation. I think we’ll look at this just as we look today at slavery, beating women, and human sacrifice, and we’ll say, “this was insane — a huge tragedy.”

More here.

Suspended Animation Conference 2011

The cryonics company Suspended Animation “will sponsor the conference, “Suspended Animation – The Company and The Goal,” which will be held in Fort Lauderdale in May, 2011. The conference will feature speakers on the latest strategies and advances toward perfecting reversible human suspended animation. During the conference, SA will also host tours and demonstrations at its facility in Boynton Beach.”

More information about the program, registration, and the free live webcast can be found on the Suspended Animation 2011 conference page.

From the conference brochure:

“The Whole-Body Vitrification Project – Greg Fahy, PhD — 21st Century Medicine, Inc. Major new findings from Phase I of a revolutionary longterm project to achieve reversible whole-body solid state suspended animation in humans. This project, conducted at 21st Century Medicine, is the only whole body vitrification research being conducted in mammals and was funded entirely by a $5.6 million dollar grant from the Life Extension Foundation. Cryobiologist Greg Fahy will discuss how well whole animals can be cryopreserved right now, the possibility of using a single advanced vitrification solution to cryopreserve entire animals and, eventually, humans, and a unique, newly-invented technology to produce large, cryopreserved tissue slices for scanning and transmission electron microscopy. A proposal and budget for Phase II of the Whole-Body Vitrification Project will also be presented.”

Support real progress in life extension

As we start the new year, it is helpful to draw attention to the sobering fact that no credible human rejuvenation therapies are available today, and it is doubtful that such therapies will see the light of day in the short term. Greg Fahy’s recent monumental collection of  interventive gerontology articles, The Future of Aging: Pathways to Human Life Extension (review forthcoming in Cryonics magazine), leaves little doubt about this predicament. It should also be emphasized that, with the possible exception of Robert Freitas’s comprehensive nanomedical overhaul of human biology, none of the envisioned strategies for life extension and rejuvenation (including SENS) confer increased protection to the brain in the case of severe traumatic insults or accidents. This fact alone highlights the fundamental importance of cryonics as  the core element in life extension. The idea that rejuvenation will make cryonics redundant has been one of the main obstacles for young people to engage in cryonics activism.

There is a broad consensus in the life extension community that more resources need to be allocated to combating aging as such, as opposed to increasingly futile efforts to extend life by treating aging-associated diseases. Unfortunately, the objective to launch a serious rejuvenation research program has limited mass appeal so far. As a consequence, we will have to get involved ourselves. Hopefully we can shift the focus from extensive hypothetical discussion about the consequences of human enhancement technologies to supporting and engaging in real experimental research to make these technologies facts of life.

In line with the foregoing observations, we suggest to consider the following areas for your support.

1. Cryonics. The first sensible step is making cryonics arrangements. Without cryonics arrangements you may not be able reap the benefits of anti-aging and rejuvenation treatments. Without cryonics arrangements you will remain vulnerable to a large number of personality-destroying diseases and accidents. In addition to making cryonics arrangements, support the major cryonics organizations and their research efforts.

2. Chemical Brain Preservation. Chemical brain preservation is an envisioned alternative (or complement) for human cryopreservation. At this point, there are no organizations offering chemopreservation of the brain but there is a new organization that aims to research the technical feasibility of the procedure.

3. Rejuvenation Research. The emphasis of interventive gerontology should be on rejuvenation as opposed to extending the maximum human lifespan by halting or slowing aging. Interventions aimed at rejuvenation have the distinct advantage that short-term empirical validation of their efficacy is possible. Rejuvenation therapies may include genetic manipulation, regenerative medicine, organ replacement and reversal of accumulated damage. A this stage of our knowledge, no privileged position should be claimed for any approach absent hard empirical breakthroughs in rejuvenation.

4. Nanomedicine Research. The logical evolution of medicine is to intervene at a progressively smaller scales. From “crudely” cutting into tissue, to pharmacology, to manipulating bio-molecules at the molecular level, nanomedical control of morbidity and aging is a prerequisite for resuscitation of cryonics patients and comprehensive rejuvenation. Biological and mechanical pathways to nanomedicine have been outlined. Whatever your position is on the relative technical merits and projected timelines  of such alternative approaches, the evolution of medicine into nanomedicine should be supported and accelerated.

Is a life worth starting? Some personal views

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

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

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

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

Review of 'Better Never to Have Been'

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

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

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

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

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

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

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

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

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

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