X-Message-Number: 24250
From: 
Date: Tue, 15 Jun 2004 13:13:51 EDT
Subject: Oreg'n, Asst'd Suic'de & Hypoth'rmia

Content-Language: en

Hello all:

A couple of weeks ago I wrote about the possibility of a dying cryonocist 

going to Oregon and using their Assisted Suicide law to end life a little early,
possibly using a blood cooling machine or a timer valve with a bathtub.  This 
posting got some published praise and many people seemed interested.

However, there are some, probably professionals concerned about their 

professional reputation, who seldom post to Cryonet because it is public -- 
Google 
searches will find it.  Two of these wrote me with agonized pleas *not* to 

pursue this.  They feared that any machine connected with cryonics and assisted

suicide would remind the public of Dr Kervorkian.  Then politicians would go mad
and both assisted suicide and cryonics would be outlawed.

I disagreed but tried to find a way acceptable to both sides.  We 

corresponded.  One critic grew angry and sarcastic and we stopped mailing, but 
the other 
was patient and restrained (as I'd like to think I was) and eventually I made 
a suggestion that was agreeable.  (My correspondent emphasizes he or she is 
*not* making this suggestion.)  The idea is presented fully below.  

Although it looks legal to me from my reading of the law, I am not a lawyer, 
not giving legal or any other advice, and we'd want to get a lawyer to check 
it out before acting in any way.  Discussion, of course, is fine.

BTW, there was *a lot* of agony here, and the outcome says a lot for patience 
in these matters.

The posting yesterday included the Oregon Law, making it too long.  I'll 
leave that off today and send it tomorrow.

Alan Mole

A Promising Method of Transition

Summary:  For a dying person, to avoid terminal agonies and deterioration of 
body and brain, and to die at a known time so cryo procedures can start 

promptly, and to die of hypothermia so brain deterioration is delayed for 45 
minutes 
or even several hours, Oregon's Assisted Suicide Law may provide a solution. 
The person would go to Oregon, meet the requirements of the law, and fill out 
a form for assisted suicide. A 15 day waiting period would pass.  The doctor 
would provide the drugs and stand by.  The patient would slip into a 

comfortable warm bath, take the drugs -- *and open the cold tap moderately*. 
Within 

three minutes he or she would lose consciousness and never notice the increasing
coldness of the water.  Within a half hour the water would be cold, and within 
an hour or two he'd die of hypothermia, perhaps with a core temperature as low 
20 C.  When his heart stopped the doctor would immediately pronounce death 
and the cryo team begin its work. There would be minimal delay from heart 

stoppage to cryonics stabilization procedures, and plenty of time to work before
brain deterioration began.

Details:

Too many cryo patients die, then lie around for hours before they are 

discovered to be dead, a doctor is summoned and pronounces them so, the rescue 
team 
arrives and work starts at last.  And since they die at normal body 

temperature, the brain deteriorates beyond recovery by conventional medical 
technology in 
as little as four minutes.  This is not promising.

Far better to die at a prearranged time and place with everyone present, and 
to die cold so brain deterioration is delayed for a long time.

Oregon allows assisted suicide.  One goes to a doctor and proves he is a 

resident of Oregon,  The doctor examines him and affirms he is within six months
of death.  A second, doctor confirms this independently. A psychiatrist may 

have to examine him and pronounce him sane.  He affirms his wish to die in front
of two witnesses.  Forms are filled out and submitted. (Maybe not submitted 

until after death; this part is not clear to me.)  A fifteen day waiting period
elapses. The doctor prescribes a lethal dose of drugs, and either provides 

them or the patient gets the prescription filled. The patient takes the drugs 
and 
becomes unconscious in about three minutes.  And dies in one to three hours, 
usually.

The above fills all requirements except cold.  For that we modify the 
scenario:  The patient gets into a bath of pleasantly hot water. (The law says 

nothing about location except that it not be a public place.)  He puts a support
under his armpits so he won't slip into the water and drown. 

He takes the drugs and turns on the cold tap. He goes to sleep while the 

water is still nice and warm, so he never feels it as the water grows colder and
colder.  The tub does not overflow because bathtubs have overflow drains near 
the top.  But gradually the water becomes colder and colder.  So does the 
patient.  His core temperature could go as low as 20C before his heart stops.  

(Recoveries from as low as 9C have been reported, but the heart had stopped at 
20C 
or above.) This takes an hour or so, while death from the drugs now used 
usually takes one to four hours. (Barbiturates are now out; there are newer, 
better ones.) 
(Actual time to die of hypothermia depends on water temperature, body shape 

(fat insulates), robustness of subject etc.  In some cases the heart might stop
before the core temperature was this low -- also because the drugs might kill 
faster. And vasodilators -- drugs that open the blood vessels beneath the 

skin and allow faster cooling -- may be used to hasten this.  Alcohol is one, 
but 
if it interacted unfavorably with other drugs, then the physician might be 
able to administer vasodilator drugs.  And the water should be as cold as 

possible -- i.e. a town with cold tap water is best.  All this could use some 
more 
research.  Though even if the core temperature were a little high, it should 
still be well below normal.)

If there is a danger that the drugs could kill him before he is very cold, 

then he could take a large but nonfatal dose so as to sleep deeply without dying
of the drugs.  This would force death to be by hypothermia, as desired. (The 
doctor can hardly be expected to see whether he takes all the drugs or just 
half of them.)

(This too should be discussed.  In case hypothermia does *not* kill the 

subject, he does not want to linger for weeks in a coma from an inadequate drug
dose .)

I spoke with an Oregon counselor for Compassion in Dying.  She said there is 
never an autopsy -- they are rare to begin with, and in the case of a person 
known to be dying, and attended by a physician, they are unheard of.

She also said there is no reporting requirement as to where the patient died 
-- that's private between him and his family.  If there were, one could 

honestly say "He said he wanted to die in a bath.  He slipped into a nice 
comforting 
warm tub, took the pills and slept."  There is no more need to tell the water 
temperature when he died than to tell, if he died in bed, whether the blanket 
was pink or blue.  Thus the public need never know about this choice, and if 
they somehow learned, well, most people find baths warm and fuzzy, not at all 
like Dr. Kervorkian and "those terrible suicide machines."

Note in the law below, the reports filed are NOT public.

The colder the tap water the better.  Someone could find a location getting 
water from the mountains where the water is quite cold.

Residency requirements:

I found the actual Oregon statute at 

http://www.leg.state.or.us/ors/127.html

Here is the residency requirement:

 127.860   3.10. Residency requirement. Only requests made by Oregon residents 
under ORS 127.800 to 127.897 shall be granted. Factors demonstrating Oregon 
residency include but are not limited to:

     (1) Possession of an Oregon driver license;

     (2) Registration to vote in Oregon;

     (3) Evidence that the person owns or leases property in Oregon; or

     (4) Filing of an Oregon tax return for the most recent tax year. [1995 
c.3   3.10; 1999 c.423   8]

I think if you rent an apartment or stay with a friend so you have a legal 
address, you can get a driver's license on day one. In fact the law usually 

demands it.  Length of residence to register to vote I don't know (James, could

you call and find out?) Obviously if you rent the merest apartment you'll get a
copy of a lease and be able to show it. With enough advanced warning you could 
even file a tax return, using a friend's address as "home".  But the tax 

return should not be necessary.  Note that not all the above (1, 2, and 3) could

be required and any one is probably enough.  Consider an old woman who does not
drive, is not registered to vote, and lives in her daughter's house. Neither 
1, 2,3 and probably not 4 apply to her, yet she in undeniably a resident. So 
if you did 1, maybe 2, and 3, surely you'd be OK.  Thus, although indeed the 
Oregonians do not *want* people coming from all over to use their law, I think 
residency is a paper tiger and would prove to be no obstacle.  
 
You could quite honestly say: "Here is my lease to show I live here now.  And 
I plan to live here for the rest of my life!"
 
Hypothermia:

http://www.tc.gc.ca/marinesafety\TP\Tp13822\chapter-1.htm

1. Initial immersion or cold shock ^ 

On initial immersion, there is a large inspiratory gasp followed by a 

four-fold increase in pulmonary ventilation, i.e. severe hyperventilation. This 
on 

its own can cause small muscle spasms and drowning. Along with this, there is a
massive increase in heart rate and blood pressure. These latter cardiac 

responses may cause death, particularly in older, less healthy people. These 
effects 
last for the first two to three minutes, just at the critical stage of ship 
abandonment.

2.. Short-term immersion or swimming failure (Of no interest here)

 3. Long-term immersion or hypothermia ^

After thirty minutes or more of immersion, death may occur from hypothermia. 
The reason for this is that water has a specific heat 1000 times that of air 
and a thermal conductivity of about 25 times that of air. Thus, when a body is 
immersed in water below body temperature (37  C), it will inevitably cool to 
hypothermic levels at a rate dependent on:

 Temperature differential 

 Clothing insulation 

 Rate of agitation of the water 

 Body heat production produced by shivering and exercise 

 Ratio of body mass to surface area 

 Subcutaneous fat thickness 

 State of physical fitness 

 Diet prior to immersion 

 Physical behavior and body posture in the water 

 As the deep body temperature falls, humans lapse into unconsciousness. Death 
may 
occur in two ways     drowning through incapacitation, and cardiac arrest. 
Death from drowning will occur in a lightly dressed individual even wearing a 

lifejacket, approximately one hour after immersion in water at 5  C, or two 
hours 
in water at 10  C, or in six hours or less at 15  C (Reference 19).

 If the deep body temperature continues to fall, death occurs on average from 
cardiac arrest somewhere below a body core temperature of 24  C. The lowest 

recorded survival temperature in an accidental victim is 13.7  C (Reference 13).
However, after surgical induction of hypothermia, there has been one reported 
incident of resuscitation from a body core temperature of 9  C (Reference 48). 
Survival predictions were made from experimental data and case histories from 
shipwrecks.

[But the heart stops at 20C or above.]

It appears that in 40-50 F water, survival time is around 40 minutes to an 
hour for a healthy person without a survival suit, but this is not perfectly 
clear. More research is needed.

I am reliably informed that heart fibrillation could occur at a higher 

temperature -- " But you really should do more research about this.  Sometimes 
it 
might only get to 28 degC.  See

http://perso.wanadoo.fr/dmtmcham/hypothermia.htm    "

And heart monitoring by ECG won't work -- "ECGs are a bad idea because

a) They are not a standard cryonics field item

b) They are not a standard field item because of the risk of EMD 

(electro-mechanical dissociation), which a heart physically stops beating, but 
the ECG 
merrily bleeps along for a long time showing a normal *electrical* rhythm, but 
without any pumping blood.

c) They won't work well under water.

    What you really want is probably a remote-video-monitored finger-tip 
pulse oximeter, like the one in the photo at

http://www.alcor.org/AtWork/p1field.html

Here is the central part of the long law: (Was too long; will send tomorrow. 
Here is the URL to it. The Assist'd Suic'de part is at the end so work 
backwards, it's a very long law.)  
http://www.leg.state.or.us/ors/127.html


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