The latter half of therapeutic cryopreservation involves three “R”s: resuscitation, rehabilitation, and reintegration. Of the three, reintegration receives the least attention as to its content, so permit me to deconstruct it a bit before diving straight in. First off, it’s re-integration, so like re-resuscitation and re-habilitation, we are talking about some present state or condition that we want to return to – in this case, a state of integration, of being part of a larger whole. By identifying a need for something called reintegration, we are predicting that being awakened from a cryonic slumber, even with every memory intact and in perfect health, is not going to be the same as going to sleep one night and waking up the next morning. The world around us will have changed – possibly quite dramatically – and all that we were prior to cryopreservation may not be enough to immediately begin operating as part of the larger whole as we did before. However, none of us is integrated into all subsystems and sub-communities of the larger human social organism at the same time, and to the same degree. So when we talk about reintegrating revived cryonics patients, are we talking about bare, functional integration into the community immediately around the cryonics facility, or something more than that? And either way, how will we measure success of reintegration? According to the norms at the time of revival, or somehow relative to the individual’s first integration?

I think it is problematic to think of reintegration as a general, one-size-fits all process that will not require extensive, non-medical background knowledge of the individual patients. Reintegration is as much about how to fit resuscitated patients back into tomorrow, as it is about how they already fit into today. By leaving the reintegration problem entirely to our friends in the future, we may be allowing data about the patients which would greatly assist with reintegration slip through our fingers to be lost in the sands of time.

But there is another problem that is closely related to the reintegration problem, and that is fear of dis-integration, which is really combination of two things: fear of separation from features of one’s present integration, especially family, friends, but also wealth and possessions; and fear of not having a “place” in the future, of not having a reason to get up in the morning, or as the Japanese call it, ikigai. This problem was very well encapsulated in a recent segment on cryonics on the television show “The Doctors,” when one of the panelists was asked if she would want to be cryopreserved. After her resolute “No,” she was asked why not, so she quickly elaborated, “Well, everybody else you love is not there. Why would you want to be around without people you love?” In reply, one of the more openminded panelists suggested, “Well, freeze everyone then!” There is a certain logic to this, but social inertia being what it is, it is not a very persuasive argument to someone on the fence (or the other side of it) today.

Nor is such fear soothed by simply telling people that we (or our successors) will figure out how to tackle the reintegration problem closer to the relevant time. And by not addressing people’s fear of disintegration more effectively by making tangible efforts today to assist reintegration tomorrow, we may be hampering our own growth, potentially hindering the pace of development and thus prolonging revival for all patients – making the task of their eventual reintegration all the more difficult.

Personhood

It probably goes without saying that reintegration has legal components to it. The one which has received the most attention thus far is asset preservation, but this and most other legal aspects of reintegration rely on the threshold issue of personhood. Legal personality is quite fundamental to our current integration, as is the continuity of that legal personality over time, based on various identifying data like our names, unique appearance, date of birth, etc. Maybe some of us wouldn’t mind fresh starts, but for the sake of exploration I’m going to assume that, given the choice, most cryonicists will want to be recognized as continuations of who they are today, same as we would for any other lapse of consciousness. But for all the good of waking up feeling like we are the same person we were prior to cryopreservation, and expressing that feeling, how do we prove that is what we are? We wouldn’t expect to have much of a problem in an idealized (and impossible) revival scenario that just involved thawing the patient, waking them up with a sharp pinch, and going about curing the disease that caused their initial legal death – but clearly more is going to have to be done  for today’s patients than that. So the question is, how much deviation from that fictional ideal will the legal system of the day be able to tolerate before concluding that the resuscitated patient is not a continuation of the previous person – or maybe not a person at all! Those who are setting up trusts for their resuscitation may be able to work around the issue of continuity of legal personality by dictating that their cryonics organization and trust advisors are responsible for “recognizing”’ them, but without legal personality, the resuscitated patient may have rather a difficult time using those saved resources, not having recourse against those who might try to take them away, or even being able to enter into simple contracts.

Law is highly contextual, and particularly sensitive to place and time. We can only make predictions about what the legal result will be of certain facts tomorrow or the next day because we can predict with a reasonably high degree of certainty what the governing rules will be tomorrow or the next day. This gets a lot harder when we are talking about some decades in the future, though we can certainly try to make reasonable guesses about the larger context to which the system will have already had time to react and adapt. For example, it seems improbable that a cryonics organization would attempt an uploading method of resuscitation without it being previously established that apparently self-aware, conscious, intelligent beings can exist on substrates other than biological brains. Thus, the political and legal organs of the day should have already had opportunity to develop a rule on whether such beings are “persons,” and rules governing the effect of copying and transferring them, etc. But is it reasonable to assume that the rules arrived at will be the ones we want, when and where we want them? We can think ahead to all sorts of good arguments supporting our positions on the matter, but we can’t argue them unless and until we actually get there. It seems more practical to advocate for greater recognition and protection of cryonics patients now, through public awareness campaigns, lobbying and legal efforts.

Our Living Family

Some of the more logistical aspects of reintegration are equally ripe for present action. Practically speaking, the closest analogues to revived cryonics patients today are survivors of very long comas. However, only the longest of long comas are remotely comparable to the scale of temporal displacement cryonics patients are looking at, and survivors of such long comas are very rare. As such, good evidence for successful reintegration strategies is unfortunately lacking. However, one shared feature of several of the cases I found was extraordinary commitment of the patients’ families and/or spouses.[1] In fact, this is usually cited as the reason the patient recovered at all – and to some extent that may be true, given that long-term coma patients without such persistent advocates and caregivers might not be expected to receive the same quality of care, and thus survive long enough to reawaken. But surely reintegration, too, is facilitated by involvement of family, just as it is during our first integration in childhood. This got me thinking about whether my family (and friends) would remain connected to me and my care, if I were cryopreserved tomorrow. Would they scan the science headlines for relevant advancements? Would they check in periodically on the health of my cryonics organization? And even if they did at first, how long would their interest last? Would I have any connection to the people at my bedside upon resuscitation?

Well, maybe I would, because I am fairly integrated with the cryonics movement itself – but that is not going to be the case for everyone, and by leaving it entirely up to the patients’ families and friends to remain engaged… well, results may vary. Here, we have a real opportunity to personalize integration. What if cryonics organizations were to track their patients’ family trees, periodically reaching out to new members of the family (once they are old enough to understand) to inform them that they have a relative being cared for in cryostasis? Sadly, there are probably many cryonicists today whose immediate family are resistant or indifferent to their wishes, but perhaps the next generation will find the novelty intriguing. Ongoing family engagement could potentially benefit the patients’ cryonics organizations in the form of donations, and even new members. The real payoff, though, would be to have relatives of the patients on hand to greet them upon resuscitation, and hopefully assist with the reintegration process – maybe even hosting them with some financial assistance from the Patient Care Trust (and/or personal resuscitation trusts, where existing). Even if average human lifespan does not increase significantly in the decades ahead, the older living relatives of revived patients may not be very many generations removed from them.

Right now, the familial data collected by Alcor and CI as part of the sign-up process is significantly less than what most people can rattle off the top of their heads in the way of names of grandparents, aunts, uncles, and cousins. While a cryonics organization may have some ability to obtain this kind of information via medical records after the patient’s legal death, it would certainly be much easier to get it while they are alive. And that still only gets us part of the way. Where I live, at least, vital statistics information on births, marriages and deaths is not made publicly available for genealogical research until many decades after they occur. Part of keeping the family engaged with the patient would involve asking for their assistance in filling in our picture of the patient’s family tree as it grows new branches. This information may also be obtainable by scouring the web and social media, but the point is not to passively track the patient’s living genealogy in the most efficient manner possible – it is about the cryonics organization maintaining an active relationship with the family, keeping the connection between patient and family alive.

Arguably, this is a lot of work to identify relatives who might be tracked down with the aid of genetic data closer to the day, but I think the power of this idea is more than just the possibility of having patient relatives at bedside for resuscitation, but rather in the effort we make in keeping the family informed, and if they’re willing, engaged. It’s about what we can say we are doing, to the person who expresses to us that, in effect, their fear of being revived permanently separated from their families and loved ones is greater than their fear of death.

These are only some of multiple aspects of reintegration that I think can be constructively brainstormed and worked on today. I will be exploring more at the upcoming Symposium on Resuscitation and Reintegration of Cryonics Patients, hosted by the Institute for Evidence Based Cryonics in Portland, Oregon on May 12, 2013.

Endnotes

[1] Annie Shapiro, 30 years. Jan Grzebski, 19 years. Terry Wallis, 19 years. (Wallis was actually in a minimally conscious state, but the effect is the same, for our purposes.)

First published as a regular column called In Perpetuity in Cryonics Magazine, May 2013.