Monday, July 12, 2010

Why Do Cryonicists Wait to Be Frozen Until After They're Dead?

Per Wikipedia, the first person to be frozen for revival in a future age was James Bedford in 1967, who died from cancer. An outsider with an earnest interest in understanding cryogenics might ask two questions. The first is whether there's anybody in storage now who could be helped with any of the medical advances made in the previous 43 years; we might be the gleaming future civilization Bedford was hoping for. And it's almost certain that Bedford's cancer, whatever kind it was, is more treatable today than it was in 1967. But there's a bigger challenge than the disease that Bedford had, which is that he's dead. To put it bluntly, "he shoulda got it looked at sooner." That is, he should have gone to the cryo-doctor earlier. Why do cryonicists wait until they actually die?

I am not a cryonicist, but presumably the motivation of people who are is that they want to be revived at such time that their disease can be treated or cured, and in such a way that they, their selves, are intact, so that they can enjoy being alive again. (Otherwise, what's the point?) This being the case, waiting until you're actually dead seems to introduce unnecessary challenges to your would-be future healers. For this, we return to Professor Bedford.

Even if tomorrow someone finds a way to thaw people out without damaging them, we still couldn't help Bedford, even though we could treat less advanced forms of his cancer. Because he died. His self is gone, because his heart stopped, the oxygen that kept his brain organized as James Bedford stopped coming, and that delicate organization broke down. The information is gone. "Yes," objectors might say, "but in the future, they might be able to fix that." Even assuming that they could, it would be just like watching Rebel Without a Cause and reassembling a car from random parts you find in junkyards, and saying, "This - this specific car was the car James Dean drove in that movie." Without even getting into the philosophical debate of continuity of self, the point is if that's what you're going to do, you don't need James Dean's car, just the blueprints and pictures of it, and you don't need James Bedford's body, just the information about it. "But," the objectors might say, "we don't have a way of recording brain structure yet, so the best thing to do is keep his body." No dice. He died and his brain organization was irretrievably damaged. That was the whole problem in the first place. It's gone. Yes, there might be amazing science in the future that we have no way of imagining today, but today, there's no more reason to think that you could recover Bedford's intact brain structure than there is to think if I gave you a bag of dice, you could tell how the last thousand rolls came up.


Above: not you anymore. Not anybody. Credit Concurring Opinions.

I assume that cryonicists have heard these kinds of arguments before and remain unpersuaded that being frozen after you die renders the whole project pointless; they would seem to believe that this is just a limitation of current technology and imagination. Fine; for the sake of discussion let's move past that. But can there be any question that being frozen while you're still living would make it much easier for your future doctors to help you? Imagine that Bedford had been frozen six months before his death, with his cancer in a then-terminal state, and today someone discovers a way to thaw out tissue (frozen in the method Bedford was) without damaging it. Bedford's descendants (or whoever, no offense, cares about him at this point - more on that later) could send his records to a 2010 oncologist who would say "Oh, he just had XYZ cancer, and that's relatively easy to fix now. Thaw him out and I'll treat him." Done!

My knowledge of cryonicists' positions is very superficial, and I assume that the community has answers for these questions (though I haven't heard them.) But I'm very curious whether most cryonicists have plans to be frozen before their natural deaths, and if not, why not. If you really believe that in the future, you will be able to be awakened and treated for a disease that is now incurable, why make it harder on your future doctors? If you really believe that life will be much better then, why wait? Assuming you're fortunate enough (from the Buddhist standpoint anyway) of having a protracted and predictable decline from some progressive disease (as opposed to a massive MI that takes your right now, this minute), why not bid farewell to your family a few months before your otherwise inevitable demise?

Imagine: you have a tearful farewell party. Your family takes you to the facility and gathers around you, and the medical staff places the IVs. You get drowsy as the anesthesiologist injects the initial push of midazolam. Your thoughts relax and scatter, your eyes close, and then re-open. A strangely uniformed attendant is leaning over you speaking to someone you can't see with an odd accent: "Can you believe this guy was 'dying' from melanoma? Sheesh." The attendant says to take two pills and call her in the morning, then she compliments you: "You're smart. All these other people in your facility were frozen after they were dead. Pointless." Again, it seems that if cryonicists really believe their best bet is to be frozen to await a future cure, missing a few days or weeks with misguided non-cryonicist loved ones now in exchange for a much better chance of the future revival they want would seem to be a no-brainer - and at worst, all you're doing is a very expensive form of euthanasia. The argument has odd parallels to theists who hold forth on the virtues of the afterlife. If they're so hot to get to heaven and pick up their harp or their houris, why aren't they more eager to leave this life right now? Why wait? You might say, because euthanasia is illegal in most of the U.S., and freezing a not-yet-almost-terminal person would probably be considered murder; healthcare practitioners wouldn't touch it with a ten foot pole. That's probably true, and maybe this legal reality is the admittedly unfortunate reason for post-mortem cryopreservation.

In addition to the very basic question of "why wait until you die", there are also operational problems that present themselves. Again I apologize to cryonicists that have thought them through (and would be thrilled to see your comments here!) Have you ever been to a cemetery where a lot of your ancestors are buried? There's one in the Appalachians in Western Pennsylvania that has a whole boatload of mine. And when I walk among the graves, I see my last name on a bunch of the stones and I feel vaguely guilty that here are the remains of people to whom I owe my existence, yet I have no idea what most of them even looked like. Imagine your own great-great-grandfather is on ice, and we have the technology to revive him, and finally a discovery is made that could cure his disease. There are problems, aren't there?

1) Almost no one has any idea what their ancestors died from going back more than three generations. The only time most people care at all about their ancestors' health is when we go to a new doctor and fill out those lists of conditions that run in the family (i.e. insofar as it directly affects our own current health.) Consequently, if a cryonicist expects to be revived, that means s/he also expects that somebody is going to be scouring Pubmed for the next ???? years on his/her behalf. If they expect it to be their great great grand-children, they're in for a shock. Those people are strangers.

2) If your great great grandchildren can't be bothered to check Pubmed on your behalf, then who's paying the power bill to keep you frozen? This raises further questions of the business model of these foundations. Sure, someone might set aside a massive endowment that generates enough interest to keep the freezers running. In 2200, when no one knows you existed, who's going to care enough to fight if they want to shut it down and use the funds for something else? If my family had been dutifully paying to keep my great great grandfather frozen and when my father died the responsibility passed to me, I'm sorry to say that old Jacob would have been in trouble, Civil War hero though he was. Keep in mind that the cost is indefinite! For all they know, there will never be a cure for what you had. It reminds you of the old cliche of lightbulbs guaranteed by the company to work for a century. At those time frames, considering other kinds of events become important. So who guarantees the company?

3) What the hell are you going to do in 2200 once you're healthy that anyone could conceivably want to pay you for? Many Americans are already paying to keep their aging parents in nursing homes. How about adding on top of that expense a recently thawed great great grandparent that you never even met and who you know ahead of time will require expensive cutting-edge medical treatment? Even if you were smart and put money in the bank to generate compound interest, you better hold your breath when you wake up and hope that in two centuries the government never seized it. As it is today in the U.S., bank accounts idle for seven years can be seized by the government. So now we need either your descendants who never met you managing your money (and not spending it), or special laws protecting cryonicists' bank accounts. If there are enough of them, will this not start to distort economies? (By the way, this is the best argument against vampires. Their compound interest would do exactly that. Only if all vampires are financial idiots does this argument not work.)


EVEN IF PEOPLE THINK CRYONICS IS SILLY, WHY DO THEY RESIST?

The recent NYT article largely focused on the culture surrounding cryonics and the resistance that some have shown to the whole idea. Though I'm making arguments against it here, if other people who want to do this, it's their money; let them! But it seems that the strongest reactions come from within families. There were two main objections. The first is money, which is a real concern. I could understand objections if the objecting partner doesn't want to spend hard-earned cash on something that s/he thinks is silly. If a person could somehow get funded or do it for free, there can be no debate. This leads to the more interesting, though less valid emotional argument: spouses feel that they're being abandoned or separated. This is ironic because if they think cryonics is a crock, all that's happening is the person's remains are being interred in a separate place. Putting yourself in the objector's place doesn't really shed any light on it. If your husband or wife came home one day and said they wanted to do this, why would you care that in the year 2200 s/he would wake up, visit your barely-legible eroded grave marker, and run off with a dashing Buck Rogers or Aeon Flux-type? Roughly even odds that your partner will outlive you anyway, and in your absence, I would hope that you want him/her to be happy, so if they re-marry to a good person once you're pushing up daisies, good for them, whether it's one year after you're dead, or two hundred. You understandably might not want them spending your money on silly stuff while you're still alive, but that's a different objection.

Perhaps most relevant to my future career as a physician, I may eventually be confronted with individuals who ask me about cryopreservation. My thoughts on the matter are in this blog post, and I would tell them the same thing: that I thought they were wasting their money on an elaborate form of euthanasia, and that they shouldn't make medical decisions based on what might eventually be true. But the decision is theirs. Unless technology and law that affect these objections change dramatically over the 25-30 years of my career, I wouldn't participate in cryogenics-related procedures, although I would give patients a referral if they asked.


WHY I WON'T BE CRYOGENICALLY PRESERVED

My main concern with such a decision for myself is that it would financially burden the people I love based on a long bet. I also don't want to sacrifice a single moment of experience of my loved ones and this world for a bet that magic doctors can wake me up in the future, so doing it before I die is out too.

As for the chance that it might work - others have objected (and this occurs to me too) that the world in which you're awakened might very well be an unpleasant one, that it might even be so bad that remaining dead is preferable. I would be very surprised if the world I awakened in centuries hence was not very unpleasant to me in some ways, if only because it's so different that it's hard to get used to. Robin Hanson has discounted this as an irrational fear of a future dystopia, but there's a distinction to be made. While I like the world I live in currently, and it's not dystopian to me and many (most?) of the people living in it, it would certainly be confusing and unpleasant to many people from earlier times. If you don't grow up in an environment, adapting to it at an old age is difficult.

For example: people seem perfectly happy in the Netherlands, and it's okay to visit, but I've lived in California for the past 11 years, and if I woke up on a planet where the whole world was the Netherlands (densely urbanized, rotten weather) I'd be drowning myself in a canal after about two weeks. Is the Netherlands an Orwellian nightmare? Not by any stretch! The difference is in the people, not in the place. What's the difference between me and Dutch people? They grew up there! If you think your grandmother has trouble with the internet, try your great great grandfather. He might have trouble just getting past slavery having been outlawed and women voting, never mind driving a car. So if people who have been continuously participating in society since the 1930s have trouble adapting to 2010, try waking up in 2200. Even if you're surrounded by sympathetic well-intentioned people, or their future equivalents, and even if you agree that the culture of 2200 is some kind of sensible straight-line improvement from ours today, things will be hard for you. Don't overestimate your ability to adapt. I argued previously that just because a social arrangement seems strange and creepy to us now, to other generations growing up in the future it might not - this was in regard to corporate individuals. Because I personally can't imagine this is no reason that I should forbid it for future generations who might find personal corporatization useful and palatable. That's why even if I had a chance at free cryopreservation, I would still say no.

Reading back over this long post, I hate sounding like a naysayer. Every one of us should be all for ways to increase quality of life and the ability of those lives to contribute to each other. Cryonicists believe that that they have found one way to do just that. If you're a cryonicist, to the extent that you're neither breaking my leg nor picking my pocket, yours is a choice for you to make and I truly wish you well. If you're brushing the digital dust off this post centuries from now laughing at my narrow-mindedness, good for you.

7 comments:

Luke said...

Some brief comments. First off, you have done the topic a good deal more justice than most critics. (It is a topic that tends to provoke reaction rather than deep thought.) Second off, you really need to study "death" in more detail, and in particular ischemia. Most of the damage that causes disorganization in the brain occurs some time *after* the initial ischemic insult.

Even then, it is *very* hard to say based on current science how far the brain can go and still be recovered by future technology. We do know it is probably long before it is a soupy mess (or even visibly distorted on a macroscopic scale). The ultrastructure is critical. Many of the brain's memories are redundantly stored, or are generic in nature, and can be replaced without harming the identity. The general consensus is that cryonicists must be prepared to deal with at least some memory loss, but it should not be quite as utter as a completely mind-blank biological clone would experience.

You also seem to somewhat underestimate the political complexity of "euthanasia" or "assisted suicide" as applies to cryonics in the US. Cryonicists who face brain damaging illnesses do have a motive to have the preservation done at a time before the condition kills them. Read up on the Thomas Donaldson case, where he attempted to preemptively sue the state for the right for premortem cryonics (legally the same as suicide given that cryonics patients do not meet currently recognized criteria for "alive" after the procedure). He lost that battle, but survived for some time as his cancer went into remission. Now he is presumably dead of cancer and cryopreserved (having benefited from substantial improvements in techniques, judging by the case description). See: http://en.wikipedia.org/wiki/Thomas_K._Donaldson

Obviously present-day cryonicists have something in common with assisted suicide supporters on a practical level, in that they would prefer being able to "terminate" by existing medical standards. Philosophically they differ, not seeing death as something to be accepted willfully. Most cryonicists are tolerant of euthanasia in others, but have no desire for a permanent "final exit" for themselves, at least not in this lifetime.

I hope as a doctor you will reconsider your stance on assisting with cryonics cases. In order to maximize its chances of success -- such as they are -- the involvement of the medical community is crucial. The hands-off approach taken by doctors thus far has likely resulted in many inferior preservations, and less interest in the practice overall. It's not just about people laughing at you personally from beyond the grave, but fewer total people from today even making it there.

TGP said...

Why not get into the freezer with somebody else? i.e. When your wife get's ice-cubed, go with her.

Also, assuming the reheating process works, why not do it as a completely healthy person who just wants to travel to the future. Put a "Thaw By" date on your burrito wrapper. That way, you can just skip getting cancer altogether and catch future flu with your woefully inadequate ancient antibodies.

ciphergoth said...

I'm kind of flabbergasted that you would go to the trouble of writing at such length on the topic when by your own admission you haven't gone to the effort to learn about it. At the very least, look up the difference between legal death and information theoretic death.

Michael Caton said...

Luke: as I see it, the two main obstacles to cryonics are the legal one (which means docs won't do it) and the technical one. Whether or not it's *impossible* to recover "self", after what we legally and technically call death (cardiac arrest) it becomes progressively harder. The legal end of it of course is not a moral argument, but an unfortunately pragmatic one for the careers of those involved. As time goes on I think this discussion will become more viable and interesting largely because the science will get better. I think there will therefore be more people interested in such a project, even if I am not.

TGP: if living people are willing to jump into the freezer too, then by all means spouses can go in together, but see legal obstacles above (for at least one of them it would be considered assisted suicide). And your suggestion to undergo the procedure in a completely healthy state is the logical endpoint - if you believe that The Future will be much better, go in as a healthy 40 year old who will seem barely out ofr adolescence (or at least feel much better) in the year 3000. Doing it at an old age or after death would imply that the cryonicist thinks there's a large risk of never being revived.

ciphergoth: so what IS the difference between legal and information theoretic death?

Luke said...

We have to be careful to distinguish from cryonics in general (as currently practiced) which happens after legal death and premortem cryopreservation, which is an act of causing legal death. I can see why doctors won't do that (in jurisdictions where it is not permitted) but not why they would not assist in the former. I suspect it is out of a desire to disassociate with the mortuary profession, i.e. it might be seen as bad for a doctor's image to perform operations for pay on a legally and socially dead person.

Now, I happen to live in Oregon where not only is Medical Marijuana legal, so is Assisted Suicide. (Actually according to the law itself, it is not called Assisted Suicide, but Death With Dignity.) It would be feasible -- though probably not without political incident -- for someone to make use of a "lethal" dose of propofol to put me into cryosuspension, provided I was terminal and followed legal guidelines. (I would have to put it in writing two months in advance, and I would need to be the one to press the button for the medication, etc.) This is also a legally recognized right in Washington and Montana.

Barring that, some cryonicists have put thought into denial of food and water as a mechanism of inducing legal death in order to be cryopreserved. Charles Platt has one character in his book The Silicon Man use this method. The important thing in a suicide mechanism (apart from not irreversibly damaging one's brain of course) is not to get autopsied -- something difficult to be assured of in a world where the law is not optimized for cryonics.

Michael Caton said...

That's good news that there are more states with death with dignity laws. Was it while the governor of OR was an MD that the law was passed? (I find that interesting.) The reality is that in other states, there are deaths-with-dignity going on all the time using high-dose opiates to induce respiratory depression. So that would be one avenue that you could free the doc from prosecution and still be healthier than a person who died directly from their disease. But even apart from the very real legal and professional obstacles, it seems that most cryogenics people must not be that certain of their eventual revival if they're not willing to undergo the preservation procedure (and to our current thinking, suicide) even at an otherwise healthy 70. (Or alternatively, many are and we just don't hear about this.)

Anonymous said...

If it seems to you that cryonicists are not certain of their eventual revival then you are right. The prospect of revival depends on the brain working in the way we think it does, technological progress continuing and achieving neccessary levels and the survival of cryonics organizations until it happens. Due to complexity of involved issues it is hard to say exactly what is the probability of cryonics working but no one sane claims it is anywhere near 100%.

So if you have a reasonable chance of living for several more years (like when you are a healthy 70 year old) it isn't obvious that pre-mortem cryopreservation would be good for you. Even if you have only a few years left it is still possible that advances in preservation technology will be made during that time, leading to a higher chance of being revived.