Tag: Critical Care Medicine

The pursuit of cryonics as medicine

The biggest obstacle to the acceptance of cryonics is medical myopia; the idea that someone who has been pronounced dead by contemporary medical criteria will still be considered dead by future criteria. Advocates of human cryopreservation strongly argue against this. There are few things more discomforting than the idea that medical professionals of the future will look back in horror and wonder why we gave up on people who still possessed the neuroanatomical basis of their identities and memories.

But there is another kind of myopia in the public discussion of cryonics that warrants consideration. It is taken for granted by some critics of contemporary cryonics that cryonics has always been framed as a form of medicine. Nothing could be further from the truth. The history of cryonics is replete with debates between advocates of the medical model and those who believe that timely transport of the patient to a cryonics facility for low temperature storage should be adequate for future resuscitation by advanced nanotechnology. It is only because  cryonics advocates with medical and research backgrounds such as Mike Darwin and Jerry Leaf vigorously argued for adopting conventional medical techniques and protocols that today’s cryonics organizations can even be criticized  for falling short of these criteria.

There is a silver lining to a lot of the controversy that surrounds today’s cryonics . Critics now adopt the premise that cryonics is a form of medicine to make a case against practices they consider suboptimal.  It was not long ago that public critics of cryonics simply dismissed the whole idea as pseudo-science. This was never a sophisticated response but ongoing advances in cryobiology (such as vitrification of the central nervous system) and synthetic biology/nanotechnology have made this position even more of a showcase of ignorance. When people read the news about animals being cloned from straight frozen DNA they will be less receptive to tendentious claims that existing cryonics technologies are hopelessly inadequate to preserve the identity of a person.

The current development in which cryonics is being criticized from a clinical framework should have positive effects on how cryonics will be approached from a regulatory framework. It does not make sense to argue that cryonics is a pseudo-science and offering false hope but at the same time insist that cryonics organizations adopt high standards of medical care. The acceptance of the concept of “patient care” in cryonics would be incoherent without (implicitly) embracing the premise that cryonics patients have interests and deserve legal recognition of that fact. As more public information is disseminated about the quality of brain vitrification that is possible today, the need to recognize cryonics as an elective medical procedure will receive more attention from bioethicists and medical professionals.

There are those who believe that the acceptance of cryonics itself is being held back by amateurism. If this is the case there should be unexploited profit opportunities for cryonics providers that pursue the highest standards of medical care.

Cryonics as an elective medical procedure

The two most popular technical arguments against human cryopreservation are that cryonics causes irreversible freezing damage and that the delay between pronouncement of legal death and the start of cryonics procedures causes irreversible injury to the brain. Such arguments can be countered by pointing out that freezing damage and prolonged periods of warm ischemia do not necessarily produce information-theoretic death. The argument that cryonics procedures themselves produce additional forms of injury which cannot be treated with contemporary technologies misses the point that cryonics involves stabilization of critically ill patients so that they can be treated with future technologies. In the case of freezing damage, this argument has also lost most of its value because today’s cryonics organizations employ vitrification agents to stabilize a patient at cryogenic temperatures without ice formation.

The criticism that delays between pronouncement of legal death and start of cryonics procedures will cause irreversible injury to the brain is also unfair because it treats the current social and legal obstacles to perform better stabilization of cryonics patients as an intrinsic element of cryonics itself. But cryonics does not necessarily involve cryopreservation of persons who have been pronounced legally dead. The current Wikipedia entry on cryonics defines cryonics as follows:

Cryonics is the low-temperature preservation of humans and other animals that can no longer be sustained by contemporary medicine until resuscitation may be possible in the future.

As can be deduced from this definition, cryonics constitutes a form of medical time travel that uses cryogenic temperatures to allow a terminally ill patient to reach a time when more advanced treatments may be available. As such, it would be premature to declare a cryonics patient “dead.” In most cases, pronouncing a person dead only reflects our current inability to treat the patient and our psychological need for definitive answers to questions of life and death. The limitation that cryonics procedures can only be started after pronouncement of legal death reflects the unfortunate fact that the current medical establishment does not recognize cryonics as a credible form of advanced critical care.

As a result, cryonics is currently practiced as a form of emergency medicine in which conventional resuscitation technologies such as chest compressions and ventilations are used to avoid the kinds of injury that follow after cardiac arrest. Although there will always be a place for cryonics as a form of emergency medicine to treat cases of trauma and  sudden circulatory arrest, most patients who currently present for human cryopreservation would benefit from more hospital cooperation in choosing cryonics as an elective medical procedure.

Although current cryonics organizations such as Alcor try to make the best of a bad situation by employing standby teams that allow rapid intervention after cardiac arrest to reduce brain injury, much improved quality of care of cryonics patients would be possible if cryonics procedures would start at a point where medical professionals (with informed consent of the patient and/or family) would determine that further treatment of the patient with contemporary technologies would be futile, or even counter-productive.

When this determination is made, conventional life support for the patient would be terminated and deep hypothermia would be induced using cardiopulmonary bypass. At deep hypothermic temperatures, the patient’s blood would be substituted with an organ preservation solution to reduce blood complications associated with lower temperatures. When the patient’s core temperature approaches the freezing point of water, the organ preservation solution would be replaced by a vitrification agent to allow an ice-free descent to cryogenic temperatures for long term care. After lowering the patient’s temperature below the glass transition point (Tg), the patient is maintained at intermediate temperatures to reduce the risk of thermal stress and fracturing that would occur at lower cryogenic temperatures.

If such hospital based human cryopreservation will be available, most of the injury that is currently incurred by cryonics patients can be eliminated. No longer do cryonics patients have to suffer harmful periods of shock, cerebral ischemia, and circulatory arrest before intervention is possible. Cryonics as emergency medicine will be confined to cases that constitute unexpected life-threatening events.

As this brief, but simplified, description of hospital based (or assisted) cryonics makes clear, ischemic brain injury is something that can be eliminated from cryonics procedures if the current restriction to limit cryonics procedures to clinically dead people were lifted. Such a change will not only improve the quality of cryonics procedures, it will also make cryonics available to cardiac arrest and stroke victims who can be resuscitated with contemporary technologies but will suffer delayed brain injury (often leading to higher-brain death) if they are allowed to resume life at normothermic temperatures.

Contemporary cryonics procedures do not need to cause “irreversible” brain injury or  massive freezing damage. There is good reason to believe that in ideal cases existing cryonics procedures can be successfully reversed up to the point of cryoprotective perfusion. The major limiting factor in cryonics is not “brain death” or freezing  but cryoprotectant toxicity. But even in this area cryonics associated research  companies are setting the standard for conventional cryobiology, as demonstrated by Alcor’s implementation of the vitrification agent M22 to cryopreserve its patients.

Why is cryonics so unpopular?

In his 1998 essay “The Failure of the Cryonics Movement” (part 1, part 2), Saul Kent stresses that cryonics has remained so unpopular because nobody thinks it will work. One observable implication of this view is that we would expect to see broader acceptance of cryonics as its technical feasibility increases. Unfortunately, there is not much evidence that this is the case. During its existence a number of research and technical breakthroughs have been achieved in areas such as normothermic and hypothermic resuscitation, cryopreservation, and long term care, that should strengthen the case that cryonics will work. In particular, the change from conventional cryopreservation to vitrification should have appealed to critics who questioned whether the neurological basis of identity can survive freezing. But the transition to vitrification did not have any noticeable effects on membership growth at Alcor, or later at the Cryonics Institute. In 2007, researchers at 21st Century Medicine announced that they were able to observe long-term potentiation (LTP) in vitrified brain slices, further supporting the claim that current cryonics procedures should be able to preserve the physical basis of memory.

The view that acceptance of cryonics is being held back by the perception that it is not technically feasible is hard to reconcile with the observation that increased technical progress in cryonics does not translate into rapid membership growth. It is also hard to reconcile with the fact that millions of people hold on to views that cannot be falsified with any scientific method whatsoever. Perhaps there is a scientific tipping point beyond which people will sign up in droves for cryonics. For example, some cryonics activists argue that demonstration of reversible vitrification of a small animal will have such an effect. This may or may not be the case, but it still leaves the puzzle unresolved as to why cryonics organizations were not swamped with membership requests after publishing electron micrographs that demonstrated excellent ultrastructural preservation of brain tissue after vitrification.

There are many myths about cryonics, but in light of the fact that the costs of researching these issues pales in comparison with the expected rewards of finding a treatment to a terminal illness (some cryonics advocates even propose that cryonics will enable humans to become immortal), it is hard to understand why these myths persist and the total number of cryonics members and patients is currently less than 2000.

Although it can be argued that existing cryonics organizations do not do a very good job of explaining the technical feasibility of cryonics, this seems to be unlikely. If making cryonics arrangements is so appealing there would be no shortage of other people repacking the message and relaying it to others. It is also well known that there are a considerable number of people who find the technical feasibility of cryonics persuasive, have the financial resources, and even support it as a form of medical care, but have not made cryonics arrangements for themselves or their families. It is clear that something else is holding such people back from making cryonics arrangements.

Another explanation that has been offered is that people do not want to reflect on their own mortality. There seems to be some truth to this as far as casual observations of raising the issue of death is concerned. When people are young they generally do not think about death in personal terms in such a way as to induce them to make cryonics arrangements, and when they are old they may no longer be in a state to do so, or lack the financial resources. But we know that people do routinely reflect on their own mortality and make arrangements for their family in the form of life insurance and executing a living will.

One solution to the “death” issue is to present cryonics as a form of long term critical care medicine. Instead of presenting cryonics as the science of freezing “dead” people in the hope of future revival, cryonics can be presented as a branch of medicine that employs metabolic arrest to allow critically ill patients to reach a time when effective treatment is available to treat their disease. Presenting cryonics as a form of critical care medicine does not only stress the fact that human cryopreservation is a logical extension of conventional medicine, it should also minimize religious objections concerning “raising the dead,” “immortality,” and “playing God.” Just like mainstream religion has embraced modern medicine, so it can embrace cryonics as a novel but logical extension of it.

We know that terminally ill people are often willing to go to great lengths, and accept considerable uncertainty of outcome (even risks), to find a cure for their disease or to extend their life. In this sense, the lack of complete certainty of resuscitation of cryonics patients should not present a formidable obstacle to the acceptance of human cryopreservation. Perhaps the more fundamental difference between conventional medicine and cryonics is the duration of care. Although mainstream medicine already utilizes the benefits of cold temperatures to safely induce circulatory arrest in patients who need to undergo complex heart or brain surgery, these periods of unconscious depressed metabolism routinely take minutes, not hundreds of years. In this sense, contemporary cryonics is intrinsically linked to a far and unknown future.

Perhaps the biggest obstacle for people in making cryonics arrangements is that they realize that cryonics implies the potential loss of everything that gives meaning to their existing lives. They may be resuscitated in an unknown world without their family, friends, home, personal belongings, and savings. Sterling Blake mentions the writer Ray Bradbury who expressed interest in any chance to see the future. But “thinking about cryonics made him realize that he would be torn away from everything he loved. What would the future be worth without his wife, his children, his friends?” (Sterling Blake, “A Roll of the Ice: Cryonics as a Gamble” in Immortal Engines: Life Extension and Immortality in Science Fiction and Fantasy). And we know what happened with Arthur C. Clark, who strongly believed in the technical feasibility of cryonics.

Of course, this is more likely in a world where cryonics is not very popular, but it reveals a serious problem within the fabric of cryonics marketing. An important condition for most people to accept cryonics is that they will be restored to good health with everything they know and care for. But such a scenario is most likely to occur if a substantial number of people already have made cryonics arrangements and created an infrastructure to minimize loss and alienation.

There is no magic bullet to “selling” cryonics, but presenting cryonics as a form of medicine, encouraging community building, facilitating legal instruments to retain financial assets during long term care, and assisting families in making cryonics decisions may lessen the psychological barrier to choose cryonics. One sense in which the technical feasibility of cryonics and its acceptance are related is that advances in the science of cryopreservation and development of advanced cell repair technologies will reduce the time between start of long term care and resuscitation. If the duration of care presents a formidable obstacle to signing up for cryonics, supporting progress in the science of cryonics may lead to broader acceptance of the idea after all.