The larva of the arctic drosophilid fly, Chymomyza costata, is probably the most complex multicellular organism that can survive submergence in liquid nitrogen (-196 °C) in a fully hydrated state. A research team in the Czech Republic headed by Vladimír Koštál examined the associations between the physiological and biochemical parameters of differently acclimated larvae and their freeze tolerance. Entering diapause, a metabolically dormant state, is an essential and sufficient prerequisite for attaining high levels of survival in liquid nitrogen (23% survival to adult stage), although cold acclimation further substantially improves this capacity (62% survival). Profiling of 61 different metabolites identified proline as a prominent compound whose concentration greatly increased (from 20 to 147 mM) during diapause transition and subsequent cold acclimation. The study provides direct evidence for the essential role of proline in high freeze tolerance. Levels of proline in the larval tissues were increased by feeding larvae proline-augmented diets. The researchers found that this simple treatment dramatically improved their freeze tolerance.

 June 30, 2011, Proceedings of the National Academy of Sciences (US)

]]> http://www.alcor.org/magazine/2012/02/24/arctic-fly-larvae-survive-liquid-nitrogen-cryopreservation/feed/ 0 http://www.alcor.org/magazine/2012/02/24/arctic-fly-larvae-survive-liquid-nitrogen-cryopreservation/ http://feedproxy.google.com/~r/CryonicsMagazine/~3/_1kyRZb1cNE/ http://www.alcor.org/magazine/2012/02/23/injectable-gel-could-repair-heart-attack-damage/#comments Thu, 23 Feb 2012 17:49:33 +0000 Editor http://www.alcor.org/magazine/?p=1390 Read more »]]> [TECH NEWS]

University of California, San Diego researchers have developed a new injectable hydrogel that could be an effective and safe treatment for tissue damage caused by heart attacks. The study by Karen Christman and colleagues appears in the Feb. 21 issue of the Journal of the American College of Cardiology. Christman is a professor in the Department of Bioengineering at the UC San Diego Jacobs School of Engineering and has co-founded a company, Ventrix, Inc., to bring the gel to clinical trials within the next year. Therapies like the hydrogel would be a welcome development, Christman explained, since there are an estimated 785,000 new heart attack cases in the United States each year, with no established treatment for repairing the resulting damage to cardiac tissue. The hydrogel is made from cardiac connective tissue that is stripped of heart muscle cells through a cleansing process, freeze-dried and milled into powder form, and then liquefied into a fluid that can be easily injected into the heart. Once it hits body temperature, the liquid turns into a semi-solid, porous gel that encourages cells to repopulate areas of damaged cardiac tissue and to preserve heart function, according to Christman.

February 21, 2012, University of California, San Diego/Newswise

The Qualcomm Tricorder X PRIZE is a $10 million global competition to stimulate innovation and integration of precision diagnostic technologies, making reliable health diagnoses available directly to “health consumers” in their homes. The dire need for improvements in health and healthcare in the U.S. has captured the attention of government, industry, and private citizens for years. But a viable solution has yet evaded one of the most technologically advanced, educated and prosperous nations on the globe. Integrated diagnostic technology, once available on a consumer mobile device that is easy to use, will allow individuals to incorporate health knowledge and decision-making into their daily lives. Advances in fields such as artificial intelligence, wireless sensing, imaging diagnostics, lab-on-a-chip, and molecular biology will enable better choices in when, where, and how individuals receive care, thus making healthcare more convenient, affordable, and accessible. The winner will be the team whose technology most accurately diagnoses a set of diseases independent of a healthcare professional or facility, and that provides the best consumer user experience with their device.

 Jan. 10, 2012, Qualcomm Tricorder X PRIZE

The smallest transistor ever built—in fact, the smallest transistor that can be built—has been created using a single phosphorous atom by an international team of researchers at the University of New South Wales, Purdue University and the University of Melbourne. The single-atom device was described Sunday (Feb. 19) in a paper in the journal Nature Nanotechnology. Michelle Simmons, group leader and director of the ARC Centre for Quantum Computation and Communication at the University of New South Wales, says the development is less about improving current technology than building future tech. “This is a beautiful demonstration of controlling matter at the atomic scale to make a real device,” Simmons says. “Fifty years ago when the first transistor was developed, no one could have predicted the role that computers would play in our society today. As we transition to atomic-scale devices, we are now entering a new paradigm where quantum mechanics promises a similar technological disruption. It is the promise of this future technology that makes this present development so exciting.”

 Feb.19, 2012, Steve Tally, Purdue University

The quest to grow meat in a lab rather than on an animal is due to reach its climax this fall, with the first-ever culture-dish hamburger served to a celebrity taster after a $330,000 development effort. Mark Post, a physiologist at the University of Maastricht in the Netherlands, said the project is being funded by an anonymous investor who is interested in “life-transforming technologies” and believes lab-grown meat could revolutionize the food industry. “It’s a reputable source of money, I can tell you,” Post said today in Vancouver, Canada, at the annual meeting of the American Association for the Advancement of Science. Post hopes the tasting will be a media event, with experimental chef Heston Blumenthal cooking the burger. The patty will be much like a regular quarter-pounder—but with one big difference: This one will be created by growing bovine stem cells in a vat, transforming them into thousands of thin layers of beef muscle cells, mincing them into tiny pieces, then combining the bits with lab-grown animal fat to form a lump of meat the size of a golf ball.

Feb. 19, 2012, MSNBC/Cosmic Log

Click on the cover image to peruse or download PDF version.

By Chana de Wolf

"Do you like living?" Max asks the attendees of TEDx Hong Kong as part of his presentation in December 2011.

Following an arduous search lasting many months, Alcor was pleased to hire long-time member Max More to the CEO position in January 2011. Max comes to Alcor with an extensive background as a writer, speaker, and philosopher of futurist topics and as an activist for life extension technologies, including cryonics. Readers of Cryonics magazine may have followed his quarterly CEO Reports with interest as he has outlined his vision to support Alcor’s mission and plans to meet goals and overcome challenges in the years to come. But what of Max the man? After a year in the hot seat, it seems like a good time to learn more about Alcor’s latest leader.

Max originally hails from England, where he lived and completed his education through undergraduate studies. Max didn’t perform particularly well in school until he began studying topics that interested him – namely, economics and politics. By the end of his second year of A-Levels at Yeovil College in Somerset he had advanced from the bottom of his class to the top of the economics program, allowing him to apply to prestigious Oxford and Cambridge Universities.  After acceptance to Oxford in 1984, Max worked diligently and obtained a degree in Philosophy, Politics, and Economics in 1987.

Max first heard about cryonics in a British children’s television show called Timeslip in the 1970s. “Cryonics was part of the second story of the series in an episode called ‘The Time of the Ice Box,’ he recalls. “Remarkably, the same story also involved a longevity drug and intelligence augmentation. It was set in the remote future of 1990!” Later on, he again came across the idea in Robert A. Heinlein’s 1957 novel, The Door Into Summer.” His first real-world exposure to cryonics was Cosmic Trigger,in which Robert Anton Wilson writes about the cryopreservation of his daughter’s brain after she was murdered.

Such reading led Max to an early interest in radical life extension. By his mid- to late-teens he was committed to furthering progress in this area and cryonics seemed like a natural extension of that. “I started reading Cryonics magazine around 1984 or so,” he says. “When I read an appeal for funds by Alcor…(in late 1985), I responded by sending a little money out of my tiny student bank account from England to California. Mike Darwin wrote to me, challenging me both to sign up and to start a real cryonics organization in England. I took him up on both challenges.”

So Max joined Alcor as a member in 1986 at the age of 22. In the same year, he came to the U.S. for six weeks to visit Alcor and obtain some training and experience under Mike Darwin and Jerry Leaf. He went back to England with medications and some equipment to start Mizar, Ltd., the precursor organization to Alcor UK. As an initial foray into writing in this field, he and English cryonicists, Garrett Smyth and Michael Price, began publishing a small magazine called Biostasis.

Young Max stands proudly in front of his home in Bristol, England.

Near the end of Max’s undergraduate work, the University of Southern California began a campaign to recruit graduate students from England. Max jumped at the chance, and was able to come to the U.S. as a graduate student at the University of Southern California in 1987. In 1988, he and Tom W. Bell started publishing Extropy: The Journal of Transhumanist Thought. This brought together thinkers with interests in artificial intelligence, nanotechnology, genetic engineering, life extension, mind uploading, idea futures, robotics, space exploration, memetics, and the politics and economics of transhumanism. It was, in fact, the founding effort of transhumanist philosophy.

It didn’t take long for news about Extropy to make a splash. It was soon advertised in Factsheet 5 and highlighted in a review in Wired by Kevin Kelly. Before long, Max was bombarded by people who were surprised to find others who thought the same way about futurist topics.

Around the same time, Alcor suffered some difficult legal issues and the resulting politics and infighting deflected Max’s attention away from cryonics for a while. He turned his attention to transhumanism and the development of the Extropy Institute, founded in 1991. He did still attend cryonics events, though, and even met his future wife, Natasha Vita-More, at a cryonics event hosted by Timothy Leary at his home in Beverly Hills in 1992.

The philosophy behind Extropy Institute was “to use current scientific understanding along with critical and creative thinking to define a small set of principles or values that could help make sense of the confusing but potentially liberating and existentially enriching capabilities opening up to humanity.” The Institute published Extropy magazine, organized five conferences, and ran one of the longest-lived email lists on the net. As other organizations arose with similar aims, Extropy Institute closed in 2006.

While Max was still heavily involved with the Extropy Institute, he and Natasha decided to move from California to Austin, Texas, in 2002. There, they organized several local CryoFeasts and participated in at least one standby and stabilization training session. Then, in 2008, Alcor began actively recruiting for a new President/CEO. In 2010, Natasha suggested that Max apply for the position.

“At first I was reluctant, knowing that it would be a challenging job,” Max admits. “But then I realized that it may be my last chance to make a difference. I had seen little progress in achieving major life extension over the past 30 years, so cryonics was coming to seem ever more crucial. I wanted a new challenge, as well. So I submitted my application and went through the selection process, ultimately getting hired.”

Enjoying a favorite pastime, Max hits the slopes in December 2000.

As President and CEO of Alcor, Max wants to accomplish kaizen, the Japanese word for “improvement” or “change for the better.” In his own words, Max explains the concept as always asking, “why? Why do we do things the way we do?” “We can’t afford to be complacent,” he explains. “Our lives are at stake. We must keep improving every aspect of cryonics protocols and practices. I’d like to improve the quality of Alcor’s care, maintain standards, and keep our patients preserved.”

Beyond that, Max is interested in getting Alcor to grow. “Membership growth gives us more resources to protect ourselves, fund our research, and more. [Cryonics] is a very long-term effort, and it requires us to set examples and to give people the right kind of feedback to encourage them along the way. An important part of this is to formalize our processes, develop SOPs (standard operating procedures), etc.”

Max knows very well that there are many highly challenging aspects of cryonics. Technical progress, including improvement of standby, stabilization, transport, and cryopreservation, must be made to improve the chances that patients will be preserved in sufficiently good condition to eventually be resuscitated in good health. But financial and organizational challenges must be met first to ensure that Alcor continues functioning over a period of decades or longer. And, he adds, “another huge challenge is figuring out how to change the thinking of more people so they understand and at least seriously consider cryonics, rather than the practice being an option only for a tiny minority.”

The cryonicist motto that “cryonics is the second worst thing that can happen to you” has always resonated with Max. “With or without cryonics arrangements, I would do the best I could to maintain my health and my prospects for a long, healthy life,” he reports. “The idea of floating in a tank of liquid nitrogen unable to influence what happens to me is deeply unappealing. Even so, it is vastly preferable to ceasing to exist.” His arrangements also compel him to save for the long term and motivate him to gently encourage his friends to make cryonics arrangements and join him in the adventure.

Hard at work, Max makes the most of his first visit to Alcor in 1986.

“I have always been completely open about my arrangements over the past quarter-century,” Max maintains. And though his family has no interest in it for themselves, his mother is supportive of his choices and no one argues with him about it. Most of his friends are favorable to life extension and many support cryonics or at least see it as a reasonable choice. “Of course, there are those who don’t understand it or reject it,” Max acknowledges. “I find little to gain by arguing about it with those. I’ve almost never found any of their objections to be rational in nature.”

Outside of his job at Alcor, Max likes to exercise using weights and with interval training. He spends a little time keeping up to date on the healthiest diets, exercise, and other practices. Other hobbies include shooting, hiking, and skiing, but his current priorities at Alcor leave him little time for such pleasures. Though he doesn’t watch television, he does keep up with his favorite shows by DVD or download, including Dexter, Mad Men, The Walking Dead, and South Park. He also continues to engage in the transhumanist community and keeps up with reading and discussion on related scientific, technological, and philosophical topics.

You can contact Max More by email at max@alcor.org to offer your feedback and suggestions as to how Alcor can provide better service and protection for its members.

By R. Michael Perry

[Update of an article that appeared in Cryonics, 1st Q. 2010]

INTRODUCTION

As cryonicists we want to be cryopreserved with mental faculties intact. Prospects for this are threatened if one has a brain disorder such as malignancy or Alzheimer’s disease—or simply advancing old age, with its usual risk of strokes and other brain damage. To best counter such a physical threat, one wishes to have cryopreservation performed electively, that is, undergo proactive legal death, when by reasonable biomedical criteria the time is right. But there are complications. Though cryonicists see cryopreservation as a medical procedure, legally it qualifies as “disposal of a dead body” (or other remains). With a normal medical operation, one might be anesthetized and the operation performed without much fanfare, even if success or survival of the patient is not guaranteed. With cryonics the procedure can be started only after the patient is legally dead (possibly barring a few jurisdictions, which have not been used). A cryonicist wishing immediate cryopreservation thus must induce a state of cardiac and respiratory arrest or clinical death—suicide in the eyes of the law—before the procedure can begin. Such an act would create an additional impediment to good preservation, in that cases of suicide are normally subject to mandatory autopsy which is highly damaging to the preservation process.

So what are we to do? A number of strategies are possible, ranging from simple advance planning to interventions, some of a more conventional nature, some of them untried thus far. Different jurisdictions offer different possible options, some of them especially favorable to cryonics, for example, states or countries where assisted suicide is legal, or where otherwise mandatory autopsy can be mitigated by using nondestructive scanning in place of dissection. In what follows I first consider preliminaries—what can be done in advance of any problem, then interventions to be used when physical symptoms of varying severity occur.

PRELIMINARIES

Cryonics arrangements themselves are the basic preliminary for addressing the problem of one’s clinical death, whatever might be involved. At the time arrangements are made some thought should be put into the possibility that intervention may be needed to escape damage to the brain, or that mental impairment may occur despite any efforts to avoid it. Stating one’s wishes and preferences in writing is a good starting strategy which can be worked out with one’s cryonics service provider. Among the desirable choices is for a durable power of attorney to make decisions in case one is incapacitated. Saving personal information in such forms as notes, diaries, photos, and audio or video clips is also highly advisable as a way to allow reconstructions of memory in case the brain is inadequately preserved. (It is expected that a level of future technology capable of reanimating a well-preserved brain and restoring it to a healthy, functioning state could probably also accomplish such tasks as restoring or reconstituting lost memories and other features from preserved records and reasonable deductions. Thus, for instance, it is unlikely that a resuscitated person will have disabilities such as paralysis or speech aphasia, regardless of how much damage may need to be addressed. Indeed, as noted below, there are significant options even with only a cell sample of the physical remains.) If possible, one should choose one’s associates to be sympathetic and understanding of the intentions and procedures of cryonics. A friendly, supportive community of fellow cryonicists will help ensure the best results.

Some discussion is in order about philosophical issues. Resuscitation from cryopreservation is a subject that has many divergent points of view even among those who accept the basic idea of cryonics. Most agree that with good preservation resuscitation is a worthwhile goal that might be achievable someday, if technological advances continue. The question then becomes whether the preservation will, in fact, be good enough to be worthwhile to the individual concerned, and what measures are reasonable to take in anticipation of problems that may arise.

Not everyone will agree that a certain measure is worthwhile, for example, separately storing a cell sample in case something should happen to one’s cryopreserved remains. (In this way a clone of oneself might be produced, which could then be “programmed” with memories and other personality elements captured in data files. A version of oneself could then emerge that would be very similar in thoughts and behavior to the original, and from some but not all points of view would qualify as a bona fide resurrection of that individual.) With this in mind I mention that a number of options exist for indefinitely storing both digitized or other recorded data and genomic samples. Some organizations that are strongly sympathetic to cryonics are the Society for Venturism (http://www.venturist.org), the Society for Universal Immortalism (http://www.universalimmortalism.org), and Terasem. As of this writing, the Society for Universal Immortalism would be amenable to storing both digital or other recorded information and genomic samples at room temperature (resin-embedded for example). The Society for Venturism is a “maybe” on both counts, though perhaps stronger on “digital” than “genomic.” Terasem at present is both “digital” and “genomic,” with years’ worth of practice and expertise Their CyBeRev project (http://www.cyberev.org) stores “mindfiles” and other personal data; their LifeNaut project http://www.lifenaut.com) stores cell samples at cryogenic temperatures. They hope to recreate individuals from these sources, if no other data about them survives. Genome sequencing, which would replace the physical genome with a digital file containing its information, is rapidly becoming cheaper and may cost less than $1,000 in the near future, making it affordable to many.

Other possibilities for information storage exist but all are presently underdeveloped and underutilized for the purpose of backing up cryopreservations or as standalone sources; feedback from interested parties is needed.

BRAIN DISORDERS: DEALING WITH SYMPTOMS

Dementias, malignant brain tumors, and other such threats to one’s personal identity are of very frequent occurrence as one ages and call for as much preparation as possible. Very often the cryonics member has advance warning. A diagnosis is made that provides a time window before serious impairment can be expected. A reasonable course would be proactive legal death before such has occurred, though again one must avoid an autopsy which often is mandatory. A simple, straightforward approach in the case of a brain malignancy might be voluntary stopping of eating and drinking (VSED) until clinical death occurs. This can be accomplished with hospitalization or hospice care, as has occurred with some Alcor cases witnessed by the author.

One public case of this sort was Arlene Fried who was cryopreserved (as a neuro or head-only, the rationale being that future technology could very likely create the missing rest of the body) at Alcor’s facility in Riverside, California in June 1990.¹ Ms. Fried, who is Linda Chamberlain’s mother, had the loving, attentive support of her daughter and her son-in-law Fred Chamberlain, two cryonics pioneers who well understood and sympathized with her views and what she was attempting. Ms. Fried, terminally ill with cancer that had metastasized to the brain, was cared for during approximately 10 days while her VSED was in progress, receiving only some moistening of her lips and mouth from time, and very limited amounts of fluid internally. She persevered and accomplished her mission of proactive legal death and cryopreservation, escaping both the ravages of the tumor in her head and the autopsy that would have followed had she chosen an easier “exit.”

In her case the escape from autopsy was facilitated by the fact that her illness was legally “terminal.” Death by starvation/dehydration was classed instead as occurring from “natural” causes not mandating postmortem dissection. In addition to eliminating the autopsy, hospital personnel were sympathetic and beneficial to the course that was followed. More generally in cases of diagnosed-as-terminal, brain-threatening illness, death by VSED may be the best available means for the cryonicist to proceed. A slower-acting but still lethal brain malady such as Alzheimer’s disease is not similarly classed as “terminal” and victims may find it much harder to avoid autopsy, though an alternative, “virtual autopsy” that uses nondestructive means now exists (see below). It should also be kept in mind that although autopsy presents one of the most harmful prospects for a cryonics patient, the effects of progressive destruction of the living brain may be worse.

The ideal alternative to VSED would be to administer general anesthetic and place the patient on heart-lung bypass to start cooling and the cryoprotective procedure (introduction of agents which minimize damage to tissues during the deep cooling that follows). Cardiac arrest would follow, which would classify the procedure as euthanasia. Such a procedure would be disallowed in the U. S., however, even in jurisdictions that permit assisted suicide. States in which assisted suicide is legal (currently Oregon, Washington, and Montana) allow that a physician can prescribe lethal medication which then must be self-administered by the patient (rather than administered by another party). At best a cryonicist could self-medicate to clinical death before cryoprotection was started. To date no cryonicist has attempted to use the assisted suicide law of any of these jurisdictions to hasten legal death. It would arguably be very risky to do so, in view of the unconventional nature of cryonics, which might invite bureaucratic interference. In terms of public relations it is important to emphasize that a cryonicist who would make use of such laws is seeking an extension of his/her life, not an end to life. Although many cryonicists may be supportive of dying-with-dignity and related causes, an overriding aim of cryonics as a movement is to get cryopreservation accepted as an elective medical procedure.

OUTSIDE THE UNITED STATES

Outside the United States a few jurisdictions have legalized assisted suicide, in particular Switzerland, where citizenship in the country is not required. Physicians are not prosecuted for assisting a suicide, so long as they are not motivated by self-interest. Organizations have been set up to provide this service, the best known being Dignitas.² Founded in 1998 by Ludwig Minelli, a Swiss lawyer, Dignitas enables those with terminal illness or severe physical or mental illness to die assisted by qualified doctors and medical staff. Under certain conditions persons with mental rather than physical ailments are assisted to die; the patient’s condition must fulfill specifications of the Federal Supreme Court of Switzerland. In fact about one fifth of those dying through Dignitas do not suffer from a terminal or progressive illness but from “weariness of life.” The method of suicide is generally ingestion (swallowing) a lethal dose of the barbiturate Nembutal, though helium gas has also been used. It appears that the majority of cases are not autopsied but there is, of course, no guarantee of this.³

Could Dignitas or a similar organization help cryonicists? Probably the answer is “yes” but there would be extra expense (maybe about $10,000 overall) for an American using the service, plus the remains immediately after pronouncement would need to be handed over to a cryonics service provider such as Suspended Animation, Inc. for perfusion and initial cooling, an additional and no doubt considerable expense. The operation would be greatly facilitated, in some important ways, if there could be a Dignitas-type organization that catered to cryonics cases only. The liberal laws of Switzerland in regard to assisted suicide would seem to offer such a possibility, though it remains speculative. Another country that has legalized assisted suicide is the Netherlands,⁴ though apparently it is available only to citizens of the country, unlike Switzerland. Also unlike Switzerland, euthanasia (active participation of physicians in causing death) is legal in the Netherlands. The following conditions (“due care” criteria) must be met before a doctor can proceed:

      1. The patient’s suffering is unbearable with no prospect of improvement.

      2. The patient’s request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs).

      3. The patient must be fully aware of his/her condition, prospects and options.

      4. There must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above.

      5. The death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present

      6. The patient must be at least 12 years old. (Patients between 12 and 16 years of age require the consent of their parents.)

The doctor must then report the cause of death to the local municipal coroner. A regional review committee assesses whether the due care criteria were met, and if so, the case is closed. It appears that autopsy in approved cases of euthanasia is generally not mandatory, though this needs further investigation.

People diagnosed with Alzheimer’s disease (not considered “terminal” in the U. S., thus off-limits for assisted suicide) are eligible to request euthanasia provided they are of sound mind and experiencing unbearable suffering.⁵ Exactly what constitutes “unbearable suffering” will vary from patient to patient, and could involve a perception that one is about to lose one’s mental faculties rather than severe pain. In many cases, the protocol involves assistance with lethal self-medication, not active euthanasia. Between 1998 and 2009 only 25 people made use of this option (about two or three cases per year), all with early stages of dementia (not limited to Alzheimer’s disease). More recently the numbers have increased (12 cases in 2009, 21 in 2010) due to more publicity for this option. Doctors refer to a “window of opportunity,” in which a patient diagnosed with untreatable dementia is still capable of understanding the disease, its progress, and the effects on the quality of life. A written euthanasia request is not required and a doctor is obliged to record verbal requests in the patient’s record. In principle it is legally permissible to act upon a written request during later stages of the disease when the patient is no longer competent, but in reality most doctors are reluctant to proceed at that stage. Recent advances in early diagnosis of Alzheimer’s disease through analysis of fluid samples and PET scans should enlarge the “window of opportunity” for euthanasia and thus may increase the use of this option in countries where it is permitted.

In 2010 a citizen’s initiative called Out of Free Will demanded that all Dutch citizens over 70 who feel tired of life should have the right to end it with professional help. Thus it would no longer be essential to claim unbearable suffering, something that could work in cryonicists’ favor, at least for those old enough. A number of prominent Dutch citizens supported this initiative, including former ministers, artists, legal scholars, and physicians.

Cryonicists should be wary that assisted suicide far from a cryonics facility, especially overseas, would result in a greatly inferior cryopreservation to what can be achieved if legal death occurs near Alcor in Scottsdale, Arizona.  This should be considered carefully in comparing assisted suicide to VSED if VSED is an option.

MORE ABOUT VSED⁶

In jurisdictions where physician-assisted euthanasia is not an option, as is generally the case today, other approaches must be used. In such cases, voluntary stopping of eating and drinking is possibly the best of currently available means to hasten one’s legal deathwithout inviting autopsy or legal recriminations, provided one has a recognized, terminal illness. Otherwise an autopsy could still be mandated after VSED (as a friend of mine who wishes to remain anonymous confirmed by consulting with medical examiners in Arizona in 2009).

If water intake is stopped completely rather than tapered off, VSED takes about two weeks to cause death by dehydration; death is almost certain within 16 days. The discomfort involved is generally mild but will vary with individuals. Hunger usually disappears after a couple of days, and after a week of fasting, metabolic by-products generally cause a sense of well-being, even elation. Electrolyte imbalance (especially potassium loss) eventually causes cardiac arrest during sleep.

The bowels should be cleansed at the start of VSED to avoid gastric distress later on. The most important comfort measure is adequate mouth care. The mouth can be kept moist with small amounts of ice chips, sugar-free popsicles or gum, or saliva substitutes. VSED itself generally does not require pain medication but the patient’s other health problems may require it for palliative care. Benzodiazepines such as Valium may be prescribed for anxiety if needed.

VIRTUAL AUTOPSY AS AN ALTERNATIVE TO POSTMORTEM DISSECTION⁷

If autopsy is mandated it still might be possible to use noninvasive, “virtual” procedures, particularly those based on computerized scanning techniques (CT, MRI scans) to nondestructively section parts of the body and satisfy the requirements of autopsy. (Here it should be noted that the delay and lack of patient support prior to the procedure could still be highly damaging; further discussion below.) Another possibility is to use a combination of invasive and noninvasive techniques, with the latter reserved for the head so that traumatic damage to the brain is still avoided. Virtual autopsy or “virtopsy” came about because, in the examination of crime victims, certain needs could not be met otherwise. For example, a close comparison between a skull indentation and a possible murder weapon might be needed. Using a combination of techniques including such 3D imaging technologies as CT and  MRI scanning, a geometrically accurate representation of the body, both inside and out, could be projected on a screen and reversibly manipulated without having to disturb or touch the actual body, beyond the initial scanning. The scanning information itself would remain in a computer database where it could be accessed indefinitely for further study and analysis.

Virtopsy offers many advantages over physical dissection in postmortem examinations, including the possibility of turning back layers of muscle or other tissue like pages of a book to examine bullet tracks or other trauma, all in completely reversible fashion which can be redone according to different algorithmic strategies and goals. In some cases such as for embedded gas bubbles information will be preserved that would be irretrievably lost through dissection. At the same time there is much information that only dissection can adequately reveal, such as colors of tissue (important in assessing inflammation), what kind of tumor is present, and chemical data. A system for doing virtopsy is expensive, costing in the neighborhood of $2 million or more. Virtopsy thus is unlikely to entirely replace the dissection of autopsy anytime soon (if ever), but clearly offers forensic advantages when it is additionally available.

For a cryonicist, any autopsy, even a virtual autopsy, is a disaster if there is an intrinsic delay of many hours in absence of even basic stabilization medications, cardiopulmony support, or cooling. Such an insult would degrade brain structure and jeopardize later cryoprotective perfusion, causing even more damage from freezing. Such delays are all-but unavoidable with dissections and may also be hard to circumvent with virtopsies. The hope is that, nevertheless, if an autopsy in some form is needed, a virtopsy will be sufficient. A virtopsy, in addition to being nondestructive, has the advantage of taking less time (as little as 30 minutes versus 2 hours or more). A long delay in arranging for the procedure in the first place can still occur, however, as happened in a recent Alcor case involving partial virtopsy, with nondestructive sectioning of the head [not a proactive legal death]⁸). In the case of proactive legal death, the virtopsy could even be done in advance of legal death, and other details worked out with officials to ensure that no question persists as to the cause of death so that dissection would be waived and further delay avoided. In this manner, then, cryopreservation could begin immediately after death is pronounced, as currently happens in the best of cases when clinical death occurs through natural causes.

SUMMARY AND AFTERTHOUGHTS

In confronting the possibility of brain-threatening illness and mental impairment, cryonicists have two sorts of options, (1) preparation in advance, (2) intervention when symptoms appear, possibly leading to proactive legal death. Preparing in advance includes choosing someone to act as representative and decision maker if one is incapacitated, and also, storing information to be used in restoring damaged memory or other brain functions. Interventive strategies when symptoms of intractable brain illness appear include legal ways to hasten one’s legal deathso cryopreservation can halt the destructive process. At present the safest such strategy, if one has a diagnosed terminal illness, appears to be voluntary stopping of eating and drinking. Clinical death is hastened in a way that is considered “natural” and does not require autopsy, so that cryoprotective procedures can begin without interference.

Otherwise the problem is more difficult, and overall the situation is far from ideal. An improvement might result if a service such as Dignitas in Switzerland could be used. Legal death might proceed faster with fewer medical complications, particularly if a company would limit its services to cryonicists only. Better still would be to have cryopreservation treated as a medical procedure which could be freely chosen and started at any reasonable time. This appears to be a long way off, unless progress is made in a country such as the Netherlands where voluntary euthanasia under limited conditions is presently legal and public sentiment seems to favor its extension. Meanwhile cryonicists must work together to increase whatever options are feasible. The use of virtopsy, which could be done premortem or relatively quickly postmortem, is a possibility for obviating damaging dissection but, as in so many other areas, must be researched further and efforts made for useful implementations to occur.

Bibliography: Boudewijn Chabot, A Hastened Death by Self-Denial of Food and Drink, Amsterdam, 2008, 64 pages; available from the Hemlock Society, email to fayegirsh@msn.com

References and Notes.

1. Linda Chamberlain, “Her Blue Eyes Will Sparkle,” Cryonics, Dec. 1990, 16, http://www.alcor.org/cryonics/cryonics9012.txt (accessed 18 Dec. 2011).

2. “Dignitas (assisted dying organisation),” Wikipedia, the Free Encyclopedia, http://en.wikipedia.org/wiki/Dignitas_%28euthanasia_group%29 (accessed 18 Dec. 2011).

3. Silvan Luley, Dignitas, private communication 27 Dec. 2010.

4. Except as noted, the portion on the Netherlands is summarized from “Euthanasia in the Netherlands,” Wikipedia, the Free Encyclopedia, http://en.wikipedia.org/wiki/Euthanasia_in_the_Netherlands (accessed 18 Dec. 2011).

5. This paragraph, on euthanasia for cases of Alzheimer’s disease and other dementias, is based on “Euthanasie bij Alzheimer” (in Dutch), http://www.alzheimercentrum.nl/professionals/aanmelden-van-patienten/ (accessed 18 Dec. 2011).

6. The final two paragraphs of this section are based on http://www.choicesarizona.org/files/Newsletter-2009-1.pdf, 7 (accessed 18 Dec. 2011). This is a review by David Brandt-Erichsen of the book A Hastened Death by Self-Denial of Food and Drink, by Boudewijn Chabot, MD, PhD.⁶ The author, who in the book refers to the method as STopping Eating and Drinking (STED), studied 110 cases of VSED in the Netherlands. His book is a practical guide to VSED for both patients and health care givers.

7. Summarized from http://news.wikinut.com/Virtopsy-and-the-Traditional-Autopsy/uh4ay8../, accessed 18 Dec. 2011.

8. http://www.alcor.org/Library/pdfs/casereportA1712DavidHayes.pdf, accessed 18 Dec. 2011.

My thanks to Cairn Idun, Hugh Hixon, and David Brandt-Erichsen for assistance in preparing an earlier version of this article, and to Aschwin de Wolf and Brian Wowk for assistance with the present version. —RMP

By Aschwin de Wolf

Introduction

Many people who have made cryonics arrangements tend to think of it as a “back-up plan” in case hoped-for breakthroughs in rejuvenation will be too late to help them or as protection against lethal accidents. Their confident hope is that, if other workarounds don’t pan out, they will die from an age-related disease or accident and be cryopreserved in great fixable shape, ready for an easy resuscitation when appropriate techniques are developed. We need to recognize that not all cryonics members are likely to be that “lucky.”

In this article I want to discuss one of the most dreadful scenarios of all: the occurrence of an incurable brain-threatening disorder. I will distinguish among four scenarios:

1. A member suffers an insult that produces acute damage to the brain.
2. A member has a genetic mutation that produces an early-onset brain threatening disorder.
3. A member is at higher genetic risk for a late-onset brain-threatening disorder.
4. A member is diagnosed with a brain threatening disorder.

 Insults and accidents

Absent not being cryopreserved at all, one of the worst things that can happen to a person with cryonics arrangements is to suffer an unexpected cerebral insult which produces instant brain damage and progressive neural death while the patient remains alive. Such insults could be caused by sudden cardiac arrest, severe strokes, or traumatic brain injury. In many circumstances, the patient is not aware of the insult and its consequences and is completely dependent on the paperwork he executed before the event and/or the judgment of legal representatives and medical professionals.

If cryonics were available as an elective medical procedure such cases would not present a major medical challenge. The patient could be stabilized at cryogenic temperatures in anticipation of more advanced treatment options, before delayed neuronal death could run its course. Currently, such an option is not available and there is great risk that a patient who has suffered a major cerebral insult will lose most of his identity-critical information in the days following the accident.

Forward-looking cryonicists can take measures to deal with such scenarios by executing paperwork that forbids medical professionals from instituting artificial life support after such events. Such paperwork can be complemented with a ‘Do Not Resuscitate’ order. To complicate matters, DNRs are a doubled edged sword for cryonicists because resuscitation can literally be a life-saver when a person suffers a brief period of cardio-respiratory arrest without comorbidities (for example, during surgery), but can also substantially increase brain damage if resuscitation is attempted when progressive damage is likely to occur afterward (for example, after prolonged cardiac arrest or severe head trauma). The challenge is to design a legally valid DNR order that distinguishes between “good” and “bad” resuscitations.

Since such accidents are hard to predict, there is little proactive planning that a cryonics organization member can do except to optimize his legal paperwork and ensure that those who will make decisions have a strong interest in avoiding destruction of identity-critical information while the member is alive. On a more abstract level, it can still be argued that there is an element of prevention involved here, too. For example, unhealthy eating habits and dangerous recreational activities can be avoided to reduce the probability of such events.

Genetics

In medicine it is common to distinguish between genes that increase or decrease the probability of a patient developing a certain condition and single-gene mutations that invariably produce a certain condition. A good example of the latter is early-onset Alzheimer’s disease, which often runs in a family. Symptoms can start between the ages of 30 and 60. As with Alzheimer’s more generally, there are no known cures and treatment usually consists of assisting the victim and family members reactively as the disease progresses.

Prior to the availability of gene-testing, the existence of early-onset Alzheimer’s (or any kind of debilitating heritable disease) could produce severe anxiety and uncertainty in affected families, such as excessive sensitivity to normal memory lapses. Gene-testing can eliminate this uncertainty by determining whether the particular gene has been inherited from one of the parents. Not all people prefer to know if they will get an incurable disease. Cryonicists, however, are in a different situation because they can use this knowledge to take steps aimed at preventing destruction of personhood by expediting clinical death through voluntary abstention from food and drink or, in some countries like the Netherlands, to utilize assisted-suicide laws during the early stages of the disease.

Early-onset Alzheimer’s is not the only single-gene mutation heritable disease. Cryonics members with a family history of early-onset dementia, Parkinson’s, cardio-vascular problems, or accelerated aging would be well advised to have themselves genotyped or should request gene-specific tests to determine whether they are at risk too.

Susceptibility

The spectacular decrease in the cost of genome sequencing will bring whole genome sequencing within the reach of most cryonicists within 5 years. As we write, it is already possible to have yourself genotyped (though not fully sequenced) at a company like 23andMe for around $200. Customers will not only be able to learn about common health risks and traits but such services can also be used for genetic genealogy and finding relatives. Since our ability to interpret all the results lags the amount of data that can be produced, even the most informed consumer is faced with a bewildering confusion of possibilities for certain diseases and traits.

Interestingly, a gene that is associated with susceptibility to late-onset Alzheimer’s disease is one of the most robust findings in biomedical science. In short, there are three variants (alleles) of the apolipoprotein E (APOE) gene: APOE2, APOE3, and APOE4. The APOE3 gene is the most common variant among humans, followed in order by APOE4 and APOE2. Of the three alleles, APOE4 is associated with an increased risk of Alzheimer’s disease and APOE2 is associated with a decreased risk. Since all people inherit one copy of the APOE gene from their father and one from their mother, the range of possibilities vary from E2/E2 to E4/E4 (nine combinations in all), with carriers of the former having the lowest risk and carriers of the latter having the highest risk. As a matter of fact, one recent review of Alzheimer’s disease claims that there are no known cases of elderly autopsied E4/E4 humans without physical correlates of the disease, whereas these markers are virtually absent in people with E2/E2.

This does not mean that all people with high susceptibility will actually get the disease as they age. Medical examiners and researchers often find amyloid-beta plaques and tau protein (common indicators of Alzheimer’s) in autopsied patients who did not show evidence of impaired brain function during life. Presumably, the neurophysiological requirements for the development of Alzheimer’s disease need to reach a certain threshold or can be inhibited by such features as structural organization, neuron count, the presence of “good” genes, etc. Nevertheless, the APOE gene has been found to be a reasonably good predictor for the susceptibility to late-onset Alzheimer’s disease and cryonicists will benefit from knowing their status.

Diagnosis

As old as diagnosing disease is the propensity of humans to procrastinate in going to the doctor to obtain a formal verdict. In the case of brain-threatening disorders such procrastination could be equivalent to a death sentence for a cryonicist. Although a 100% accurate diagnosis of Alzheimer’s disease can only be made upon autopsy, a combination of gene tests, mental tests, blood and fluid samples, and PET scans can now be used to render a positive Alzheimer’s diagnosis in many cases. Such tests can also differentiate different kinds of (age-related) dementia. For people with a single-gene mutation, or APOE4 homozygotes, with a strong family history of Alzheimer’s disease, it is prudent to have periodic mental and physical testing to detect very early manifestations of the disease.

Similarly, people who have a strong genetic and/or family history of traits and diseases that produce (acute) brain-threatening disorders can benefit from frequent testing.

Window of opportunity

From a cryonics perspective, the progressive nature of neurodegenerative diseases presents a “window of opportunity” to prevent (further) destruction of the brain. In reality such vigilance is rare. Most people who have stated that they would never allow themselves to be consumed by Alzheimer’s disease ultimately succumb to it and end life in a vegetative state. For obvious reasons, cryonicists would strongly like to avoid such a fate.

There are a number of obstacles that prevent people from taking advantage of this window of opportunity. The biggest problem is lack of a formal diagnosis. This is not necessarily the result of fearing to see a doctor. In many cases, the disease has progressed enough to numb the level of analytical thinking and determination needed to seek a diagnosis. This is especially a risk for people who live alone. In a way, one could say that neurodegenerative diseases manifest themselves as the inability to clearly recognize the situation. For many patients this is not necessarily a bad thing because it still enables them to continue a meaningful life. For a cryonicist, such a scenario is a source of great fear as the outcome may annihilate the prospect of meaningful resuscitation of the original individual after cryopreservation (if cryopreservation is even attempted).

The personality changes that accompany brain threatening disorders can also be abused by family members and third parties who stand to gain from a person not being cryopreserved. For this reason, it is strongly recommended to ensure that relatives and third parties will not benefit if a person is not cryopreserved, irrespective of the condition of the patient or the quality of the cryopreservation. It should be obvious that for people with hostile partners and family members, brain threatening disorders can present an even a greater challenge.

Another obstacle to recognizing the window of opportunity is wishful thinking about treatments. One could easily imagine a life extensionist falling victim to a dangerous overoptimism. A person is diagnosed with Alzheimer’s disease but steadfastly believes that, for example, new stem cell treatments and pharmacological therapies will be able to halt or reverse the disease at a faster pace than the disease will progress. Undoubtedly, at some point in the future this will be the case, but is it prudent to believe it will happen to you?

Perhaps the hardest and most subtle problem is the tendency to delay action until the disease has progressed enough to seriously impair the quality of life but not enough to prevent self-awareness of the disease, its consequences, and the need to take action. This is often not a deliberate process but generally will manifest itself as a conjunction of the instinct to survive and day-to-day rationalizations. In reality, such attempts to let the disease progress and settle for the perfect time for cryopreservation will often fail. One reason for this is that the commitment to the idea of cryonics progressively weakens as mental faculties fail.

Conclusion

The aim of cryonics is to preserve the identity-encoding information in the brain (and any other organs) when contemporary medicine is not able to maintain the patient in good health. The prospect of clinical death is not encouraging, but the biggest threat to a cryonics member, absent not being cryopreserved at all, it is to succumb to a brain threatening disease while still alive.

One of the biggest challenges a cryonicist can face is to have an acute brain-threatening insult without being able to respond to it. Such a scenario can be somewhat decreased by making sensible lifestyle decisions (no extreme sports or dangerous errands in the home) and diet decisions. Executing smart advance directives and appointing the right medical surrogate can make a world of difference.

Having a single-gene mutation that virtually guarantees getting a brain-threatening disorder such as Alzheimer’s disease has one “good” aspect: certainty about one’s fate (absent near-term cures). This allows for (long-term) planning and execution of the right paperwork. Cryonicists who have a documented family history of such diseases will benefit from medical testing, even if they have decided to let nature take its course and just execute the right paperwork to ensure that the disease will not lead to cancellation of their cryonics arrangements.

The most complicated predicament is having a higher susceptibility to one or more brain-threatening disorders. In the case of Alzheimer’s and Parkinson’s it is now possible to get yourself genotyped to quantify such risks. What distinguishes susceptibility genes from “deterministic” genes is the role played by such things as lifestyle, diet, gender, ethnicity, exercise, stress, exposure to toxins, etc. There is no scientific consensus on the most appropriate diet or supplements to avoid dementia-inducing diseases, but this is an area where progress is conceivable. Elderly cryonicists who have a much higher susceptibility to brain-threatening disorders can benefit from routine testing.

Being diagnosed with a brain threatening disorder presents a concrete and actionable challenge. Not all cryonicists prefer to take heroic measures to ensure a timely cryopreservation, but for those who do, recognizing the existence of a window of opportunity and the dangers of procrastination is of great importance.

I conclude this article with four specific recommendations:

1. Consult Rebecca Lively’s article, “How to Protect your Cryonics Arrangements from Interference by Third Parties,” and make sure that you have executed the right paperwork.
2. Use genetic testing, genotyping, or whole genome sequencing to determine whether you have a single-gene mutation associated with a brain-threatening disease or increased susceptibility for late-onset brain-threatening disorders.
3. Familiarize yourself with the nature and progression of the major brain threatening insults and disorders and how they affect decision making and personhood.
4. Consult Mike Perry’s “Options for Elective Cryopreservation” (published in this issue) for your options in case of a brain-threatening disorder.

I am grateful for the suggestions and edits made my Mike Perry and Chana de Wolf.

Warning Signs of Alzheimer’s Disease

1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, at work or at leisure
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

More detailed information on the website of the Alzheimer’s Association.

Neuroscientists at Case Western Reserve University School of Medicine have made a dramatic breakthrough in their efforts to find a cure for Alzheimer’s disease. The researchers’ findings, published in the journal Science, show that use of a drug in mice appears to quickly reverse the pathological, cognitive and memory deficits caused by the onset of Alzheimer’s. The results point to the significant potential that the medication, bexarotene, has to help the roughly 5.4 million Americans suffering from the progressive brain disease. Bexarotene has been approved for the treatment of cancer by the U.S. Food and Drug Administration for more than a decade. These experiments explored whether the medication might also be used to help patients with Alzheimer’s disease, and the results were more than promising. Alzheimer’s disease arises in large part from the body’s inability to clear naturally-occurring amyloid beta from the brain. In 2008 Case Western Reserve researcher Gary Landreth, PhD, professor of neurosciences, discovered that the main cholesterol carrier in the brain, Apolipoprotein E (ApoE), facilitated the clearance of the amyloid beta proteins. Landreth is the senior author of this study as well.

Feb. 9, 2012, Eurekalert / Case Western Reserve University