Cryonics Case Scenarios

Distinguishing between different types of cryonics response scenarios

Introduction

The circumstances in which a cryonics patient “dies” can be divided into two broad categories: planned and non-planned.

Planned cryonics cases either entail “dying with dignity” or “voluntary stopping of eating and drinking” (VSED). Technically, in a suicide a member also controls the timing of his death, but such an unsanctioned course of action generally does not yield a timely or high-quality cryopreservation and can even produce a very poor outcome due to the risk of mandatory autopsy or delayed discovery by the cryonics organization.

While it is recognized that cases in which a member controls the timing of his death (i.e., pronouncement of *legal* death) favor optimal circumstances for cryopreservation quality, cryonics organizations should not play a part in a member’s “end-of-life decisions.” But if and when a member has made such a decision, it is possible for a cryonics organization to plan for a timely and smooth cryopreservation by deploying the right personnel and equipment to the member’s location. For example, Alcor case A-1002 entailed VSED and produced an S-MIX of 1.42 hours and is one of the rare examples of ice-free cryopreservation of the brain, as evidenced by the CT scan.

When we talk about standby, stabilization, and transport (SST) logistics, the challenges usually concern non-planned cryonics cases. When a cryonics case is not planned (or anticipated) a cryonics organization can be stretched to its limits. The challenge presented by non-planned (remote) cases is the major reason why some cryonics organizations (like Tomorrow Bio) only actively drive membership in areas where they have good response capabilities.

Non-planned cases come in all kinds of shapes but a distinction between three types of non-planned cases is useful:

1. Sudden Death. Sudden death cases present a formidable problem for a cryonics organization. By definition, in a sudden death case there is no standby team present. If the patient is young or dies under suspicious or illegal circumstances, there is a strong risk of autopsy. Unattended / sudden death cases are by no means rare (13% according the Alcor meta-analysis), and constitute a scenario that most cryonicists fear, given the fact that even in regions with good local capabilities, outcomes will still be sub-optimal due to poor initial cooling and procedural delays. The best thing a local cryonics organization can do is to seek (or obtain) rapid access to the patient and minimize ischemia. Having a person on the ground to ensure proper temperature management and proper handling of the patient is often more important than having great medical expertise.

2. Rapid decline. A rapid decline case can unfold in two different ways. It can be secondary to an unexpected medical emergency or accident, or it can entail an unexpected rapid decline of a terminal patient. In the the case of an unexpected medical emergency the difference between local and “fly and deploy” models is crucial. If, let’s say, a patient only has a few hours to live as a result of a car accident, a cryonics organization (or local response group) that can deploy locally can still produce a good outcome, whereas an organization that needs to fly in from another state may be delayed by many hours.

When a patient is terminally ill and under palliative care, a standby team often deploys to the bedside of the patient. Usually, in these types of cases the condition of the patient worsens progressively and good end-of-life planning for the cryonics organization is possible. While palliative care nurses usually have a good feel for the condition of the patient, it does sometimes happen that a patient stabilizes, or even seems to improve, followed by a rapid decline that takes both staff and the cryonics organization by surprise.

Cryonics organizations usually make a distinction between low-risk and high-risk patients but this distinction is not always evident (in retrospect). In the case of “fly and deploy” SST, misjudging the situation can have serious consequences since there is no local team to rapidly stabilize the patient. This is why it cannot be emphasized enough that relying only on staff and contractors who are located remotely from the patient is not an ideal approach for a cryonics organziation.

3 Slow Decline. Most people do not die suddenly or by accident. As a consequence, most cryonics cases have some degree of advance warning. A terminal diagnose can entail days, weeks, or sometimes years of remaining life so it is not always possible to draw a strict line between regular check-ups end and deployment. As a general rule, patients with a slow decline are candidates for both local and fly-and-deploy SST, although local response capabilities still have an edge because it allows for better staff rotation and drawing upon local resources and equipment (like a response vehicle).

There are a lot of finer sub-distinctions and points that can be made in this overview but this general framework should be helpful in guiding cryonics organizations and local groups how to think about cryonics response capabilities. As should be clear from this exposition, the question “how will you respond to a case?” is not particularly meaningful without specifying the nature and location of a case. Is it a planned death by the member? Is it a sudden death, secondary to an accident? Is the case the result of a prolonged terminal decline?

What is evident is that in all circumstances, having good local capabilities is a major plus. In fact, there have been many cases where having well-trained local volunteers quickly on-site would have yielded a better outcome than medical professionals arriving late on the scene. For example, the most potent cryonics intervention, external cooling, can be done well by educated laypeople before the professional SST times arrives. This is the rationale of what I have called “hybrid standby infrastructure” where trained (medical) staff works together with (local) volunteers and contractors to be able to respond to most common case scenarios.

Third-Party (Post-Mortem) Cases

In closing, it is important to mention one type of case that can present itself in all scenarios that we discussed. In third-party sign-up cases, a cryonics organization is contacted by a family member to quickly execute cryonics arrangements. Such cases present major logistical, financial, and sometimes legal challenges due to poor or non-existent informed consent.

These are usually also the type of cases that yield poor or sub-optimal outcomes (i.e, extensive ischemia and straight freeze) that cryonics organizations sometimes claim to be “beyond their control.” Accepting these types of cases, however, is completely within the control of cryonics organizations and should be treated with great caution. Responsible cryonics organizations usually impose a hefty financial surcharge to reflect this risk. Under no circumstances should an organization compromise its (local) capabilities, or the security of existing members, in taking on such cases.