X-Message-Number: 4063
Date: 21 Mar 95 19:24:02 EST
From: Mike Darwin <>
Subject: CRYONICS What If?

The question was asked of Bob Ettinger (I paraphrase); "How will CI protect
itself from a legal assault on a patient as a result of a cryonics team member
hastening that patient's death?"  The short answer is that there are no easy

answers, but things can be done to reduce the risk.  The shortest answer is that
there is no 100% way to guard against this, or any of a number of related
failure modes.  Perhaps by considering related "failure" modes the problem can
be better defined.  The following scenarios illustrate this point:


1) What if the patient precipitates his/her death early without the knowledge of
the storage organization or any of the cryonics personnel involved with the
patient?  Over the years I have had several cryonicists tell me  with great
force of conviction that they personally planned to do this if their terminal
course met certain criteria (unrelieveable pain, risk of irrevocable brain
injury from neoplasm, etc.).  It is currently estimated in LA county that a
minimum of 1 in 10 and perhaps as high as 1 in 5 AIDS patients are practicng
active euthaniasia, often with assistance from friends, lovers, or family (or
all three!).

In the case of a severely depressed patient, suicide may be committed in a way

not immediately obvious to either the treating medical personnel or others (with

the possible exception of a close friend or relative who may later disclose this
information thus jeopardizing the patient's cryopreservation).

2) How does a cryonics storage organization deal with accusations that
contraband (drugs, cash, costly, reuseable dental/medical devices) have been
added to or removed from a patient or patients in storage either by the
organization or by one of its personnel without the knowledge of management?
Such accusations, whether very credible or not could trigger removal of all
patients from storage in such a case and their systematic examination by
dissection or other damaging means.

3) How does a cryonics storage organization protect against being involved in

litigation as the deep pocket in the event that lawsuits are brought (rightly or
wrongly) by next-of-kin or others accusing the transport team, perfusion team,
or others of malpractice or malfeasance in preparation of the patient?  (This

incidentally has almost happened in the past with the entire team of the service
provider (in this case cryovita Labs) as possible targets of the litigation.)
Or, of simply causing emotional distress, or of violating (unknown to cryonics
personnel) prior stipulations of the patient regarding disposition: in fact,
this has already happened to Alcor and Alcor had to remove one of its patients
from storage.  Variations on this theme can be imagined: what happens if a

mistake is made and a whole body patient is treated as a Neuro!  After all, even
in medicine surgeons cut off the wrong foot even when it is obviously healthy
and the other obviously gangrenous. And consider this, I have been hospitalized
4 times in my adult life.  Every single time I caught a medication error before
I was dosed: none of them would have been life threatening, but that's not the
point!

When a member or client experiences legal death the cryonics organization is
obligated both legally and morally to respond and respond quickly if they have
reasonable assurance that the patient is properly funded and has given
appropriate authorization and consent.  However, this is no guarantee of the
patient not having changed his mind *without* notifying the cryonics
organization.  Further, as in the case of Dick Jones, patients with (from the
court's standpoint) competence to make legal decisions (even though in reality
medically and morally they are not able to make such decisions, as was the case
with Dick) may be induced to sign documents voiding their cryopreservations or
overturning bequests, changing insurance funding, etc. 

This has already happened.   I know of one case (where Alcor actually went to
court, which was very good of Alcor to do) where (in my opinion) a patient who
was clearly demented was influenced to void his/her arrangements by distant
friends who then took control of the estate: the patient died and did not get
cryopreserved.

The point here is that action may be taken on an emergent basis by the cryonics
organization and the patient may be in storage before litigation commences.

4) What is the liability of the cryonics storage organization if the service
provider, perfusion team, etc., had a serious conflict of interest in being
involved in the patient's medical care BEFORE legal death and such medical care
was substandard and resulted directly or indirectly in the death of the patient
resulting in turn in blanket (joint and several) litigation which involves the

storage organization merely as the "deep pocket" or even criminal action? Again,
this kind of thing is quite common in medicine and defendants who have little,
or in some cases no rational culpability, are still penalized.  In such
situations loss of *one* patient is not the only issue: the finances of the
whole storage organization may be gutted and *all* of its patients may come out
of storage.


5) What happens if *no one has done anything wrong at all* and still accusations
are made by  malicious, misguided or zealous individuals which are then seized
on by a crusading local authority as an excuse to destroy the storage
organization or cryonics in general?


6) What if the cryonics storage organization takes on a patient who has an enemy
with a pathological desire to destroy the patient's chances at the expense of
everyone else in storage as well?  I know of one case where such threats were
actually made by (in my opinion) a mentally unbalanced relative of a potential
patient.  Once again, such actions may be taken after the patient is in storage
and without any warning or foreknowledge being available to the storage
organization.


I could go on and on. As any thinking person will soon realize there are endless
interations and permutations of these problems.

Now lets talk about possible solutions, mitigation, and hard realities where
there are neither ways to mitigate or remove the risk.

1) As long as cryonics patients are considered dead they will be at risk of
removal from storage for medico-legal reasons just as any interred corpse is at
risk of subsequent exhumation and forensic evaluation.  Nor does time eliminate
the risk.  In the case of one President of the United States his body was

recently exhumed over 100 years after his death to rule out the possibility that
he had been poisoned with arsenic.

2) Depending upon the case, patients subjected to cryopreservation wherein
perfusion occurs will be very difficult if not impossible to evaluate
forensically *unless* the drug used to "hasten" death is one which was not
theraputically used by the patient or was not a part of the cryopreservation
protocol.  For instance, overdoses of sedatives or narcotics will (depending
upon the route and time course of administration) be difficult or impossible to
document after cryoprotective perfusion has occured.  Washing of the patient's
tissues with large volumes of solution will make drug level determination
problematic at best and impossible in most situations.  This, also, is not an
academic argument: in the Dora Kent case expert witnesses pointed out that
autopsy of Ms. Kent's head would be ineffective in documenting overdosage with
theraputic drugs.  

Furthermore, tolerance to opiates, barbiturates and other theraputic drugs
varies widely.  In patients dying of cancer (particularly those with bone pain
such as occurs in metastatic prostate cancer) the *safe* dose of opiates may be
astronomically high.  The same dose given to another patient would prove

immediately fatal while the cancer patient is actually able to remain ambulatory
and awake on the same amount of drug!

Clearly, an exception to this rule would be the use of either toxins or
theraputic agents which would not be expected to be found in the patient:
arsenic, mercurial compounds, and other inappropriate (i.e., nonprescribed)
theraputic agents.

Additionally, histological and biochemical changes associated with drug
overdosage would be garbled by the effects of cryoprotectant perfusion.

All of this presupposes the use of theraputic agents to induce "premature"
cardiac arrest.  Strangulation, suffocation, gunshot, sharp or blunt trauma,
injection with etiological (infectious) agents and other "invasive" ways of
"hastening" or causing death are another matter altogether.


Often stangulation and suffocation are missed as possible cause of death and the
mode of death is at first determined to be natural.  Indeed, in a routine
autopsy, particularly if the neck organs are not removed and carefully examined

it is easily possible to miss strangulation: bodies are not infrequently exhumed
to rule out strangulation and in at least one case here in Southern California
such an exhumation, prompted months after burial by a single suspicious
relative, resulted in a murder conviction of the decedent's husband for
strangling her.

In such cases it is quite probable that even after perfusion and
cryopreservation such insults would be forensically detectable by postmortem
examination (autopsy).

Needless to say, an accusation, credible or otherwise, could be lodged at any
time that such was the proximate cause of a patient's death.  Accusations of
crime need not be very credible to cause serious problems.  By way of example
one has only to look at the McMartin preschool molestation case or any of
thousands of others where individuals have been tried, sentenced and in some
cases even executed for crimes they did not commit.

In the case of civil liability cases (tort law) the abuses and outright rape of
defendants who had virtually no culpability (or, for that matter, absolutely no
culpability) has become so commonplace as to have become the rule rather than
the exception

3) Solutions to these problems can only come by broad changes to the society.
In the meantime, minimizing risks by providing insulation between the transport

team and the patient wherever possible is important.  Having both the individual

team members and the organizations adopt policies against dangerous intervention
(active euthanasia) is of course a given, and both I personally and all those
working for BPI have publically stated we do not intend to take such risks and
that we want no knowledge of, or involvement in, such risks where the patient
and/or his/her next-of-kin or primary caretaker(s) have decided upon such a
course of action.

It would be naive to suppose that cryonics patients or family of patients will
not engage in such behavior when the situation is bad enough; it is already a
commonplace enough practice in the gay community and anyone who has had any
contact with the Hemlock Society will at once realize that active euthanasia is
by no means confined to gay men dying of AIDS.  The best thing in such
situations is defensive education wherein educational materials are available
INDEPENDENT of any cryonics organization to aid cryonicists who feel compelled
to follow this path by providing them with information which allows them to
contain the risks to themselves and others.  And there is moral and legal

precedent for this: much material on "how to"  has been published by the Hemlock
Society and other groups.  The problem here is that such groups are not
concerned about autopsy or invasive or delaying forensic procedures, whereas
cryonicists would be.

Understand also (I repeat) that I do not think cryonics societies or service
providers to cryonics societies should create, publish, or distribute such

material.  But I do feel that such material will come into existence as cryonics
grows and people who are forced to grapple with this issue personally decide to
create such material.  Indeed, this is exactly what motivated Derek Humphry
(founder of Hemlock) and many others to write the protocols for active
euthanasia that they have written and which are in widespread use.  Finding a
plastic bag on a terminally ill patient's heads and a large dose of sedative in
the gut is a routine event for MEs and Coroners almost everywhere these days.  

Some may say that bringing up such an approach (by a service provider such as
me) is in itself dangerous.  The same argument is used about education programs
aimed at deterring the spread of AIDS in teenagers: by instructing children in
condom use and safer sex practices aren't you in fact indirectly condoning

premarital or extramarital sex?  This is a tough issue.  However, just as we all
know that many teenagers will not abstain from sexual activity, and that many
teenagers who do abstain will turn into adults who either do not abstain or who
have partners who are (unknown to them) infected, so too we can reasonably

expect that sometime, somewhere, a cryonicist or his/her family will probably be
involved in active euthanasia.

I might also add that some would say that even publically discussing these
issues is a danger (why give your enemies extra ammuntion?).  I tend to agree.
But since the issue has been raised it must be dealt with.  And, it might be
said, the sooner it is dealt with the better.  We cannot undo what we have done

once we have done it.  But we can certainly learn either from our errors or from
a prospective point of view by considering how NOT to make errors. In this case
an ounce of prevention is worth a ton of cure.

Finally, as I've said throughout this post, THERE IS NO REAL PROTECTION FOR

CONTEMPORARY PATIENTS against these sorts of risks.  And as has been pointed out
by others, there is unlikely to be any in the forseeable future.  That problem
can only be remedied by the continued growth and  spread of cryonics and, most
definitively, by the development of reversible techniques of brain/body
cryopreservation.  Neither task will be easy.

In the meantime we must all do what we can to minimize the risks while at the
same time realizing that some of the biggest risks may not even be appreciated
or appreciable at this point in time. 

Mike Darwin

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