Respecting Biostasis Revival Preferences
Under what conditions and in what form do you want to be revived and who will make the decisions?
Congratulations! You got yourself cryopreserved in good condition. You got your paperwork and funding in place and you did all you could to ensure a good quality preservation. You went further by leaving a clear statement of your revival preferences. The revival specialists of the future will not have to guess what you want.
Yet questions linger: Will the revivers pay any attention to your revival preferences? Will they be morally or legally bound to do so? Could any ethical problems arise from your specifications? Can we give informed consent to revival/rehabilitation procedures that have not been thought of yet? How much does that matter? It is okay to revive someone initially into a virtual environment with no physical presence? Is it okay to revive someone not in a biological body but as an upload? For those who were not placed in biostasis, what should be done with unaccompanied pets?
We will have a slightly easier time getting people to see the wisdom of biostasis if they have some assurances about the revival end of the procedure.
Some of us expect to need biostasis to get us to a time when aging and most causes of death have been eliminated. We want some assurance that our revival preferences will be respected when reasonably workable. We will also have a slightly easier time getting people to see the wisdom of biostasis if they have some assurances about the revival end of the procedure. It is easier to tolerate a long and uncertain journey if you have a clear image of the destination. (The topic of rehabilitation is important and fascinating but not my focus here.)
The range of revival preferences
One of the objections to cryonics is that, even if it works, you will come back alone and out of place. Speaking for myself, I would very much rather be revived alone than never be revived. But I would certainly prefer to come back with my wife and a few friends – and to be able to revive our dog when we are ready. Other people with biostasis arrangements also see the value of company at the far end of the journey. This is why the great majority of revival preference statements relate to family.
When couples make biostasis arrangements, it is common for them to specify in their documentation that they would prefer to be revived together. Couples support each other and so would naturally want to continue supporting each other in the post-revival future. In a few cases where a marriage has long been struggling, those involved might prefer an “until biostasis do us part” directive. Perhaps the best time for a fresh start! Whether a marriage is happy or unhappy, it makes sense to include your wishes in your revival preference statement.
Future decision makers might have a problem if Joe wants to come back as a couple but his wife Ann does not. In other cases, perhaps one person feels much more confident than the other. Then they might both specify that they want the more venturesome partner to be revived first. We might call this person the cryo-canary since they will be the couple’s canary in the coal mine of the future.
Apart from spouses and life partners, the most obvious subjects of revival preferences are children and parents. The most likely instructions will be to revive all family members at the same time, if feasible. It makes a lot of sense for parents to say they want to wait until their children can be revived. It makes less sense for children to specify waiting until their parents are revived. If procedures have improved over generations, the offspring might have to stay cryopreserved for longer. These defaults will not always apply. For instance, parents might want to come back with their children but the (adult) children do not want this.
Do not revive until aging has been cured. This may be what happens regardless. But some people could be revived before aging is fully conquered, especially young people whose terminal illness or injury has become fixable. What if aging has been slowed by 50% but not yet stopped? Would you want to be revived? Or wait maybe more decades to get to 75%, or 100%? You might specify something like this: “Revive me when I can be cured of whatever caused me to stop living so long as the risk of the revival procedure is low and if all conditions that would likely kill me (major diseases) have been largely eliminated. If these conditions are not met, I would prefer to wait so long as that is not likely to endanger my future revival.”
What if your chances of full, high fidelity revival will improve if you wait another 20 years?
What if your chances of full, high fidelity revival will improve if you wait another 20 years? You might provide some guidance about your risk tolerance. You want to be revived as soon as possible but also want to be revived in optimal condition. Those two preferences could end up in conflict. Most likely the “optimal condition” consideration will outweigh the delay consideration when the delay is expected to be just a few years. But it is possible that some people preserved less than optimally will require more advanced repair methods and those advanced methods might take decades more to develop. This seems fairly unlikely to me but I do not know.
You might also want to specify the apparent age or physiological age that you would like. Do you want the appearance and function of a 20 year old? 30? 40? Perhaps the appearance of a healthy 50 year old but the internal function of someone younger? Given the control over biology expected by revival time, these are choices you can probably make post-revival. I would be happy to return looking as I did at 40 but with no sign of aging in my joints and organs.
Legal personhood requirement: Currently, patients in biostasis have no legal rights. They are not recognized as persons. They are regarded legally as biological remains owned by or in the care of an organization. It would not be good to return without legal status or rights. You do not want to enter the future in legal limbo. Surely no biostasis organization would revive you under such conditions? It seems unlikely. Surely, future revivers will assume that we would want to wait for legal personhood? But we can imagine scenarios where they would. Suppose revival becomes possible and the government is about to ban biostasis. Even if patients are not recognized as persons the biostasis organization might revive you because the alternative is to let you be destroyed. You might specify:
“Do not revive me until the law recognizes me as a legal person with normal rights. Ignore this preference unless the alternative is my destruction.”
As revival becomes imminent, biostasis orgs will lobby to establish a clear procedure for claiming your identity and rights.
As organs – including brains – are successfully revived from biostasis, and then small animals, and then larger, complex animals, pressure will naturally build to anticipate revival of humans and to consider the immediate consequences. Law already exists in many countries to provide a way for a person presumed dead to claim their legal identity. In the USA most states base their laws on the Uniform Probate Code. It should be simple enough to extend this to people coming out of biostasis. As revival becomes imminent, biostasis organizations will lobby to establish a clear procedure for claiming your identity and rights. You might have to take a cognitive test or show evidence of identity. Your patient records should help with this.
As reversal of biostasis becomes increasingly advanced, pressure will increase to accord legal status to preserved patients. Just as I was writing this, the news reported on a finding by Alabama’s Supreme Court that cryopreserved embryos are persons. This could provide a precedent. Of course, we can revive embryos today but not biostasis patients, but that will not always be the case. Eventually patients will probably have limited rights while preserved. These will likely be based on the condition of people in a long term coma. Coma patients are recognized as having a right to medical care, to dignity, to representation, to a Living Will and Advance Directives, the right to have medical decisions reviewed by a proxy, and the right to be free from abuse and neglect.
If you find it important to specify legal status before revival you probably should also give the trustees of your asset preservation trust the same specification.
Fixes and augmentations: We do not know who will make these decisions nor how they will make them but it may be worth specifying any improvements you would be happy to have made before revival. You might ask that your chronic spine problems be fixed, that your genetic predisposition to various problems be fixed, or you might ask for your tendency to depression or anxiety to be fixed. I would urge caution on personality changes. I would want to be revived first and then make those decisions based on a clear understanding of the options and possible tradeoffs. You could give your explicit approval for enhancements to your senses, upgrading your immune system, and various other augmentations. It may be easier to “install” these before revival.
Fidelity of preservation: Probably no one wants to be revived with massive brain damage, loss of memory, or loss of major parts of personality. (I do know of one person who would be fine with returning without any memories.) But we should not require 100% fidelity – we do not have that over the course of a day in normal life. We can have brain injuries that are frustrating and limiting while leaving us sufficiently intact that we would prefer not to be dead.
We should also acknowledge a tradeoff here between the highest fidelity revival and length of time in biostasis.
It could be difficult to give precise specifications for maximum acceptable damage. What exactly would it mean to be 99.9% intact? Or 90%? Or 70%? Any specific number would have a false precision given our lack of understanding of all details of neuroscience now and in future. We should also acknowledge a tradeoff here between the highest fidelity revival and length of time in biostasis. You could try to specify acceptable conditions in detail or you could empower future agents to make a reasonable decision for you. During a cryonics conference back in the 1990s Saul Kent related a long list of conditions that should be met before a revived him would be recognized as him and get his assets.
Experimental revivals: Someone has to go first. This seems to clash with a condition you probably want: Do not revive me if you are using me as an experiment. Put a bit differently: Do not revive me until the necessary technologies have become reliable and precise, and all damage can be specified and corrected. In practice no one will go first in any important sense. Before revival is attempted on any human, it will surely have first been successfully applied to numerous animals. There may also be immensely detailed and accurate simulations of the outcome before any physical attempt is made. Some people may be willing or even eager to be experimental subjects. You might want to state that you are not one of them!
Keep it simple: There are an endless number of other conditions you could specify as needing to be met before you are revived. You might say: Keep me in biostasis for 100 years. Or 250 years. I want to be the seventh person revived (someone actually said this in their paperwork). Don’t revive me until at least 25 other people have been successfully revived. Don’t revive me on Earth/off-Earth. Don’t revive me until the whole planet is at peace. Again, the more requirements you impose, the lower your chances of being revived (if anyone is paying attention to your wishes).
Recording your preferences
How do your convey your revival preferences to the future decision makers? Your biostasis organization will play the primary role. How it works will vary across organizations. I am most familiar with the way it is done at Alcor. All information on patients is compiled and kept in the “Red Books”. The physical version of these are kept in fire-resistant filing cabinets. An electronic copy is kept on the server and backed up to network-attached storage. The information is also stored, encrypted, in the cloud. A member’s revival preferences, if provided, are kept with this documentation.
In addition to a written statement, it is probably sensible to record your preferences in a short video. Your biostasis organization can include with your records. You might also store the video on an M-disc (designed to last for a thousand years) and give a copy to the trustees of your asset preservation trust if you have one. If you have a personalized trust it could specify a future trustee’s duty to find and follow your preferences.
Who will make the decisions?
It will be decades before anyone is revived from biostasis. Maybe a few decades, maybe more than a few. So much will change by then that we cannot reliably foresee who will make revival decisions.
A dystopian future would put the decision in the hands of a politicized government agency. Bureaucrats pushed by politicians would revive those people who are more “suited” to the world as the politicians want it to be, or those with the right beliefs. Assuming we can avoid that grim future, the decision is perhaps most likely to be made by your organizations’ Revival Committee. That may include individuals external to the organization, either by practice or as a legal necessity. Unless there is a great reduction in government and the desire to make laws about everything, we can expect to see legislation that specifies decision makers and the criteria to follow.
Whoever makes the decision, they can be expected to look to several sources in making the decision:
Technical capability. Most obviously it would be foolish and pointless – and clearly wrong – to attempt to revive anyone until technical capabilities make it possible and reasonably reliable.
Medical criteria. Medical professionals would need to assess whether the individual's body is in a condition suitable for revival and whether the medical issues that necessitated cryopreservation can be effectively treated.
Stated wishes of the individual. The individual’s previously expressed wishes regarding revival, documented through advance directives or similar legal instruments, would play a crucial role. This might include specific conditions under which they would want to be revived or not.
The Cryopreservation Agreement. The terms of the agreement between the individual and the cryopreservation facility might include clauses related to the conditions and decision-making process for revival. This could involve input from next of kin, appointed guardians, or an ethical oversight committee.
Next of Kin or Legal Guardian: In the absence of clear instructions from the preserved individual, the decision might involve their next of kin or a legal guardian. However, this would depend on the legal frameworks in place at the time. It might be standard practice to appoint a patient advocate. Extension of existing law might create a role for a medical proxy or medical power of attorney.
Ethical Committees or Regulatory Bodies: Given the ethical implications, specialized committees or regulatory bodies might be involved in overseeing and approving revival decisions to ensure they align with prevailing values and ethical standards. There may be a separate non-profit organization, something like the United Network for Organ Sharing (UNOS), a non-profit organization that operates under contract with the federal government. UNOS administers the national Organ Procurement and Transplantation Network (OPTN), which oversees the organ transplant system in the country. Or something like an Institutional Review Board except that IRBs do not make treatment decisions for individual patients.
Informed consent
Depending on the nature of your specified revival wishes and the state of technology, medicine, and the legal and cultural environment there may be a tension between adhering closely to your preferences and the feasible options available in the future. No set of explicit instructions is likely to fully anticipate the choices that will have to be made. We need to provide clear preferences but should also expect responsible future people to make the choices informed by your stated wishes.
How do we allow for unknown options in the future? No matter how imaginative we are the future cannot be fully foreseen. This is not a unique situation. Doctors have to make medical decisions for unconscious patients, sometimes without any close family members for input. You really want the organization to ask you: “Given the state of the world, the condition of your preserved body or brain, and the current capabilities and developmental trajectory of relevant technologies, do you think now is a good time to revive you in this specific manner?”
Ask simulated me: One promising idea (which I recently heard from Max Marty) is to simply ask this of the patient. How are you going to do that when the patient is in biostasis? Given the current state of artificial intelligence and its increasing sophistication, it might be feasible to create an accurate model of your personality or brain function and pose the question to this simulation. I do not mean creating a conscious, complete digital replica of you. I really do mean simulation, just as today’s LLM’s simulate understanding but do not actually understand. Clearly, the more information you have left about your life and your preferences the better such a simulation is likely to do.
Virtual reality rehabilitation
When comatose patients wake up – especially those who have been comatose for years – they require therapy and rehabilitation. The same can be expected for patients being revived from biostasis. Both types of patients may need physical therapy, occupational therapy, speech and language therapy, neuropsychological rehabilitation, psychological support, and case management. Patients who were well preserved and revived effectively might need very little physical therapy or neuropsychological rehab. With the reversal of their aging the patient may wake up “better than well”. Presumably impairments from pre-biostasis or from the biostasis procedure itself will be remedied. But these revived patients will still benefit from social support and instruction in contemporary conditions.
It may be safer, cheaper, and perhaps more effective to revive you in virtual reality.
We may imagine the same kind of controlled physical environment for biostasis patients as we have today for coma patients. It may be safer, cheaper, and perhaps more effective to revive you in virtual reality. Your brain would be active but your senses and motor instructions would control a virtual body rather than activating your biological body. This would be a good way to check neurological functioning and to educate the patient with knowledge they need to live in the new world. Perhaps this knowledge could be implanted but active learning may still be valuable.
You might not want this. Perhaps you fear that the revivers would have too-complete control of you when you have no physical agency. Perhaps you want to get to grips with the physical world without delay. We do not know if your preferences will take precedence over medical practice of the day but, if you feel strongly about it, you might as well include your views in your revival preferences.
Cyborgs and uploading
The VR option might be acceptable or welcome to most of us, assuming the virtual world is pleasant and supportive. Other possible options are more drastic departures from our experience and raise philosophical questions that come with controversial and conflicting answers.
One the less drastic end of the scale, future practice might involve replacing some biological systems (organs, muscles, connective tissue, bones) with synthetic replacements boasting enhanced resilience and superior function. I suspect most of us will be fine with this so long as it does not change our appearance. Others may want to retain all their current biological parts.
One especially sensitive area is the brain. It could be that parts of the brain will be replaced with synthetic equivalents rather than repairing the original tissue. Are you okay with that? If you are uncomfortable with the idea, what if it is known that the replacements will have no effect on your subjective experience?
More drastically, we have the uploading option. Some people with biostasis arrangements strongly prefer to come back as digital beings or on other platforms such as quantum computing devices. Others regard these digital replicas as distinct individuals. Creating a digital person while destroying the biological original would, to them, mean the end of their existence. Another possible view is to accept uploading in principle but only if it is done in certain ways. A continuous transfer from the biological brain might provide a reassuring sense of continuity.
I have my own philosophical views on the topic but that is not the point here. If you are sure that an uploaded you would not be you, you should state that in your preferences. I think it is more likely that biological repair will be possible before uploading but no one knows for sure. If you have a milder preference, consider the possibility that uploading might not be available until later. Would you prefer to return in your biological body or wait it out?
Such a deep disagreement exists between proponents and opponents of uploading that revivers will probably respect your preferences if at all feasible. Possibly the philosophical issue will be resolved by then. The history of philosophy should caution us against assuming future resolution. Currently we cannot test the disagreement empirically. It is not even clear if such a disagreement could ever be resolved scientifically.
What if digital revivals become possible well before biological revivals?
What if digital revivals become possible well before biological revivals? You might still refuse the upload option. But you might also say you want to be revived as an upload so long as the method fully preserves the information of the original, and keep my biological body preserved (assuming non-destructive uploading).”
I know of one person with cryonics arrangements who is adamantly opposed to being revived as an upload or even in a VR environment if the latter gives others the same kind of control over your experience. If you do not understand why someone might fear other’s ability to control their uploaded self, watch the excellent but chilling Black Mirror episode “White Christmas”. If you are frightened by this scenario, your revival instructions should specify no virtual or non-physical revival. If revival becomes a common procedure we should hope and expect that ethical standards will be enforced and no abuse of uploads allowed.
This essay gives you some points to consider in developing your own statement of revival preferences. We cannot impose our desired order on the future with any guarantee of success. Even so, you might as well be responsible and give the future revivers all the input you can. A useful follow-up to this essay would be to distill the considerations down into a clear checklist accompanied by some sample revival statements. If no one else tackles this, perhaps I will.
Here’s to a future where we can embrace life anew, in the form and manner we choose.
Another excellent article by Max More outlining the revival possibilities and options, and encouraging all serious cryonicists to be explicit and direct in their revival instructions. While I think I am fine with a virtual uploading of whatever constitutes "me" I just asked my wife and she is not. I suspect that even those of us who are pretty serious about their cryonics and have cryonics trusts funded with serious assets have not been as precise and explicit as we could/should be about our revival preferences.
The next time I meet with our Cryonics Estate Planning Attorney Peggy Hoyt, I'm going to go over these provisions to see if wife/life partner Dawn and I can be crisp and clear about revival preferences. And then get these instructions to Alcor so they are part of my "Red Book Files."
Let's get serious about our planning for Cryonics, people! Thank you, Max, for this detailed article. I confess I find myself drawn to think on and work on other things...ANY thing else...because doing serious thought about revival possibilities seems so abstract and "hand-wavey" and academic. But we need to encourage each other to be precise and clear about what we want in life as well as in and after our "dewar nap" in cryostasis.
Planning is not easy or natural, but it is our superpower as hyper-evolved apes and we must use it.
Rudi Hoffman