On death and cryonics
I was asked to be part of a panel for a meeting exploring the concept of death, it’s substance and timing for the 7th annual Alcor Life Extension Foundation. You can Google it. Alcor is an organization that pursues the goal of (essentially) preserving brain function for posterity, in the hopes that nanotechnology will be available at some time in the future to re-boot the brain, and participants (re)live again. The theory is interesting, and certainly not out of the question that it could work. Remember that what sits on my desk right now is more computing power that existed in the world in 1967. Fifty years on, it may be possible to do a lot of things that we don’t conceive of now. I am not a cryonicist, but I have close friends that are and I understand a lot of it. There are some pretty high powered PhD types, and a few MDs deeply involved. I have no doubt that Darwin will correct any of the above if I got any of it wrong.
At any rate, cryobiology is facing a big problem, that of the timing of death. In order to preserve the structures they are interested in, it’s necessary to first pronounce the patient dead. Obviously they cannot start any of their procedures if the patient is still alive. Once dead, the rules change regarding what can be done to a cadaver. Most of what happens thereafter comes under the Anatomical Gift Act. Normally, a physician pronounces the patient dead and immediately thereafter, the patient is (re)intubated and a mechanical CPR devise is attached to restore circulation while various intravenous preservatives are infused into the brain, preparing it for freezing.
Prior to the advent of high tech critical care, this was much simpler. A patient was dead when his pronouncing physician said he was dead. However, nowadays, it isn’t that simple. Patients sometimes show renewed “signs of life” following resurgence of ventilation and circulation. Pupils constrict and sometimes spontaneous motion is observed, sometimes requiring the use of potent sedative drugs intravenously to stop it. This then forces a very interesting and important question. Was the patient really dead when he was pronounced so? Or is it a resurrection.
Naturally, cryonicists are very concerned about this since the timing of what is sort of dead and stone dead directly impacts their entire function. The brain must have some semblance of continuing function in order to be resuscitated. For this reason they rely on Donation after Cardiac Death criteria, not brain death. There is frequently if not always some residual brain activity following cardiac standstill but the patient can be pronounced dead. They are counting on this flickering flame to be amenable to nurturing.
The other panelist and I spent a good bit of time explaining the realities of what constitutes death, following which we were opened up to questions from the audience. They (cryonicists) have some interesting ideas about all this, which I will outline below:
1. They are very much ethical utilitarians. If it is a good and just end, the route there matters little. Few of them seem to understand that the end is directly modified by how it’s achieved. They don’t understand why it’s a big deal to insure that the route taken is as pristine as the end they hope to achieve. It does not enter their logic how frighteningly dangerous utilitarianism can be.
2. They are deeply into “consent” as a trump card for all obstacles. If they are authoritative, autonomous individuals and they have a desire, that should trump all other issues. This is what they want for themselves, and that should be enough to cut through all the red tape. In fact, one fellow actually did get up and say: “This is what I want and that should be enough to cut through all the bullshit”.
3. At some point in my diatribe, I mentioned that there was nothing inherently evil about Donation after Cardiac Death. These patients were going to die anyway, and so it isn’t too big a stretch to use that fact to the advantage of others, BUT it IS a creative workaround of the rules which state that brain death is the only form of death defined by the Dead Donor regulations. And once a workaround starts, you can be sure there will be more and the foot gets deeper into the crack between the door and the jamb, and with the current high demand for organs, the bottom of the slippery slope might be selling organs on EBAY.
At this point no less than ten, or maybe more audience members yelled out: “What’s wrong with that?” I was stunned speechless, and that takes a lot for me. My jaw bounced off the floor with a loud clatter. I was totally at a loss for words. It took me a minute to reconstitute and utter something along the lines that any such transactions would always be at the expense of the poorest factions of society, most amenable to manipulation and abuse of others who would profit from them. And I thought that was unacceptable in a just society. Most didn’t seem to be impressed with that argument. The ultimate libertarians.
So, for my part, I left them with the following advice.
If they expect to evolve and assimilate into the mainstream of science, they need to start doing their research in mainstream labs and publishing in mainstream journals. They need to get over their current concept of consent as a trump card. One cannot consent to be dead at a specified time, and consent to be dead before that time is euthanasia, which is illegal and people go to jail for it. They need to start moving away from the concept that they are practicing medical interventions on cadavers. Technically, most if not all of their patients are still alive by brain death criteria, and DCD is this justification as is it still not universally accepted. They need to develop some kind of a mode of “intervening in a dying process” that will be found acceptable by ethicists and lawyers. Ultimately their ministrations will attract the attention of both if it hasn’t already.