Humanist death apologetics

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

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

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

It is unfortunate to see an apparently reasonable person like Kirby arguing against the desire for immortality to make the case against religion. As the secular philosopher Herbert Marcuse once noted about this ideology of death, “It is remarkable to what extent the notion of death as not only biological but ontological necessity has permeated Western philosophy–remarkable because the overcoming and mastery of mere natural necessity has otherwise been regarded as the distinction of human existence and endeavor…”

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

HT Mark Plus

The ethics of cryonics interference

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

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

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

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

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

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

Facing death with Epicurus

James Warren is to be complimented for writing a thorough and persuasive book on Epicurean thinking about death. In Facing Death: Epicurus and his Critics, Warren offers a detailed review of Epicurus’ view that “death is nothing to us.” His treatment of Epicurus’ critics should be considered a success for the following three reasons. The author has a genuine understanding of  the Epicurean philosophy with all its nuances. Second, unlike many philosophers, Warren devotes a lot of time to presenting the arguments of Epicurus’ critics in their most charitable form, sometimes even raising novel potential objections, before refuting them. Finally, although the author allows for the possibility that the human fear of death may be hardwired, and even an evolutionary advantage, he stands out among other philosophers in not have a strong desire to refute Epicurus, a trait that negatively affects a lot of the literature on Epicurus.

Because the Epicurean view on the fear of death is often misunderstood, the author distinguishes and reviews four interpretations of the argument in the first chapter, Fears of Death:

1. The fear of being dead.
2. The fear that one will die, that one’s life is going to end.
3. The fear of premature death.
4. The fear of the process of dying.

In the following three chapters the author thoroughly reviews three different themes in the Epicurean tradition: the argument that death cannot be a harm because if we do not exist we cannot  experience the deprivation of things that life offered, the argument that since we do not consider the period before we existed as a harm we cannot claim that the period after we exist is a harm, and the argument that death cannot be premature or prevent a person from having attained a complete life. The chapter on premature death is of particular interest to life extensionists because it discusses the issue of immortality  from an Epicurean perspective, briefly contrasting Bernard Williams‘ argument against immortality with the Epicurean tradition.

Because Warren ultimately does not find Epicurus’ critics persuasive, he devotes the final chapter to the question of what living an Epicurean life would imply. An important reason for exploring this issue is to explore the argument that even if the Epicurean view on death is correct, it would lead to consequences that few are willing to accept or are highly impractical. The author singles out two issues: would it be incoherent for an Epicurean to write a will (as Epicurus himself did) and the desirability of prolonging one’s life.

Most reasons for executing a will are rejected as inconsistent with the Epicurean tradition but a notable exception is made for a line of reasoning that finds a rational reason for writing a will in the value of strengthening one’s relationship with friends during life:

…the knowledge that a friend will leave certain items in a will to another may ensure the continued assistance of this future beneficiary during the remaining period of the testator’s life. The beneficiary reciprocates in advance, as it were, for the goods which he has been pledged and will receive when the other dies.

This argument in favor of writing a will may have broader implications. If an Epicurean has reason to be positively involved with the fate of people who may be still alive after him, a related argument could be made that he could also be concerned about future generations because of the effect of overlapping generations. If such an argument is possible, the Epicurean view that we can neither experience good nor bad things  after we cease to exist can be reconciled with dispositions such as protecting the environment or contributing to causes that do not have a chance to succeed during a person’s lifetime. By doing so we are signaling our disposition to cooperate, reap the benefits of cooperation, and respect justice as mutual advantage.

If we should not fear death, why prolong life? Here Warren is at greater pains to reconcile Epicurus-style reasoning and a wish to remain alive. But as the author admits, perhaps one obstacle for such a reconciliation is the “highly debatable” Epicurean view that pleasure cannot be increased beyond the absence of pain, a view that seems to be at odds with both  personal introspection and empirical observation. It  may not be  incoherent to believe that death cannot be a harm but prolonging a life that is an (overall) positive experience is desirable.  Some variants of this argument, however, would run into the objection that comparing the value of existence and non-existence is nonsensical because the latter cannot be experienced. As a matter of fact, the obvious point that death cannot be experienced is one of the central tenets of Epicurean thinking. Does that just leave the Epicurean with the position that he “will simply continue to live with no sufficient reason  either to kill himself or to want to survive until tomorrow?” It is clear that this issue would benefit from some smart analytic thinking. Further benefit may be obtained  by seeking an answer to the question why the “intellectualist stance on the emotions” that informs Epicureanism  seems to contradict human psychology as it has evolved.

Will POLST integrate end-of-life care options?

A recent investigation (PDF) of state statutes and legislation affecting the ability to implement a nation-wide program to standardize medical orders reflecting individual patients’ end-of-life treatment preferences was made publicly available by Oregon Health & Science University.

The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm Program was developed in Oregon and strives to increase adherence to patient preferences throughout the health care system by providing immediately actionable medical orders on a “standardized, brightly colored form that provides specific treatment orders for cardiopulmonary resuscitation, medical interventions, artificial nutrition, and antibiotics” (p. 119). Ineed, the POLST form more accurately represents patients’ end-of-life preferences than traditional advance directives and DNR (do not resuscitate) orders because the patient completes it in collaboration with health care professionals and any proxy decision makers.

Many states have implemented (Oregon, Washington, West Virginia, New York, and Wisconsin), or are developing (Texas, Louisiana, Colorado, Utah, Nebraska, Missouri, Florida, Georgia, Tennessee, North Carolina, Ohio, Michigan New Hampshire, and parts of California, Minnesota, and Pennsylvania), a POLST Paradigm Program. However, in several states legislation enacted to create advance directives and DNR protocols may hinder the goal of national implementation. Hickman, et. al interviewed state emergency medical services (EMS) and long-term care (LTC) expert informants and conducted an independent legal review of each state’s (and the District of Columbia’s) law to “identify current state laws that could be potential barriers… (p. 120).”

Because the option to refuse nutrition and hydration can be particularly important for cryonics patients who wish to avoid the pathophysiology induced by a long agonal phase, it is important to note that:

Twenty-three states (45 percent) impose explicit limitations on substituted consent to forgo life-sustaining treatments via their advance directive or default surrogate laws. These limitations either focus on all life-sustaining interventions, including DNR and artificial nutrition and hydration, or only artificial nutrition and hydration.

Some states also require the patient to meet poorly-defined diagnostic preconditions such as “terminal condition,” “permanent unconsciousness,” and “end-stage condition” and/or additional medical certifications and witnessing requirements. DNR protocols in particular were found to frequently require such detailed specifications, medical preconditions, and witnessing requirements.

The POLST Program has significant potential in streamlining end-of-life treatment orders and providing maximum adherence to individual patient preferences. Such a program would be beneficial in assuring that cryonics patients receive appropriate treatment with the goal of reducing agonal pathology and ischemic injury to the brain prior to cryogenic long term care. The authors of the review recommend that:

States interested in developing a POLST Paradigm Program will need to review the compatibility of their existing laws with the POLST Program, and amend or adopt accordingly. States should strive to ensure the POLST form remains simple to use and maintains the goal of helping patients retain control over their end-of-life treatment.

A comprehensive list of potential statutory and legal barriers is provided in p. 126-139 of the report. A sample of the POLST Paradigm Form from Oregon may be found on p. 140. In addition, OHSU provides numerous resources and materials for developing a POLST Paradigm Program.