2007-10-14

7th Alcor Conference, October 5-7, 2007 Part II

Sunday

First up was a panel discussion and question-and-answer on cryonics and critical care with David Crippen, M.D., a prominent critical care physician, Leslie Whetstine, Ph.D., a bioethicist, and Tanya Jones, of Alcor, moderated by Alcor's Aschwin de Wolf.

The first two panelists did not seem much familiar with cryonics, and they and the audience had some heated discussion, but out of it all came some interesting information and at least the recognition of the emotional difficulty of these issues.

David noted that because physicians can keep brains alive for a long time, it is often not clear when a person is "dead". Hospitals can maintain the heartbeat, breathing, body warmth, and most metabolic functions of a patient indefinitely. Brain death is decided by fulfillment of a checklist of objective criteria, but brain death is more of a process than event; it may not be something that happens all at once.

Normally, brain death is required for organ donation, but if cardiac function has ceased, if there is no request to resuscitate, and progression to death is inevitable, organ donation may proceed. Since cryopreservation is ideally begun on patients who are NOT brain dead, but only dead by cardiac criteria, as with organ donation, there may be serious controversy about whether the patient in this case ought to be considered dead.

David reminded the audience that surgeons scoffed at hand-washing before surgery, until it became REALLY obvious that it would save countless lives. Medical professionals tend to be very conservative, reluctant to change, and they tend to be convinced only by the "gold standard" of peer-reviewed, published medical research. If cryonicists can produce some of this, they may change minds over time. Right now, cryonics operates "under the wire" and the courts have not yet become involved.

Eventually, we may be sure, the courts will become involved, when there is a significant legal challenge.

The legal status quo, reflecting a long-standing social objection to suicide and euthanasia, is that "a person cannot agree to be dead at a particular time." Consent of the patient is irrelevant. This notion ruffled the feathers of many of the strong-willed, freethinking members of the audience, but it is an honest assessment of present legal and social opinion.

Nevertheless, Hugh Hixon captured the applause of the audience when he noted, in regard to the panelists' concern about a 'slippery slope', that if public policy completely ignored the wishes of the patient, they were already AT the bottom of a slippery slope.

Cryonicists, I would say, are caught in a difficult position. They theoretically admit and support the notion that when the patient's brain is 'alive', the patient is alive or at least possibly alive (able in theory to be resuscitated or reconstituted). But they want cryopreservation to be able to be conducted on these 'live' persons, at least when they are 'legally dead'. So cryonicists must support, in practice, the cardiac criteria they do not accept, in theory. Legal, ethical, and medical technology are developing in ways that are driving cryonics toward a confrontation with the rest of society, a demand for a demonstration of their fundamental claim: that their patients ARE potentially alive, both before AND after cryopreservation.

Tanya Jones noted that Alcor makes sure hospital staff are told of the anatomical donation arrangements of the standby patients. The staff are asked NOT to wait for brain death. Alcor has never had a patient declared brain dead. Cannulae can be placed before death pronouncement, even some medicines may be supplied.

Eventually there will be a transition when the brain is considered viable through cryopreservation, so that cryopreservation will have to become a medical procedure, not performed by Alcor, and not in the context of anatomical donation. Tanya said she would like to see Alcor take a more active approach in framing the legal debate of the future rather than waiting passively for legal challenges of others to frame the debate.

Leslie Whetstine maintained her doctoral dissertation's point that "cardiac arrest is a prognosis not a diagnosis, of death. All real death is brain death." The heart can beat in a brain dead body.

Leslie admitted to being confused by cryonicists' position. Cryonicists admit patients aren't really dead, yet they want the legal definition of death applied, transferring the patients' legal rights. On the other hand, where was the ethical controversy? Whole human embryos can be cryopreserved alive legally, so why can whole adults not be?

She argued that whole brain death need not be considered a necessary criterion for brain death. Rather, she said, loss of consciousness, or personhood, should be considered sufficient. Persistent vegetative state would qualify in this sense.

Aschwin wondered whether cryonics might someday be incorporated into long-term critical care medicine.

Next up was Steve Harris, M.D., of Critical Care Medicine, discussing liquid ventilation, the new method ensuring the fastest cooling of patients. The heart-lung machine is faster, but it requires more time to set up, thus making it practically slower. Liquid ventilation can cool 5 degrees in 5 minutes in dog experiments, once the airway ventilation is set up.

There are 300,000 cardiac arrests per year in the U.S., and up to 50% will have moderate or severe brain damage. There is a 67% survival rate after 5.5 minutes down, and it takes paramedics about 5-10 minutes at least to get to the patient. Damage after 10 minutes is enough to reduce non-vegetative survival to essentially zero. Most of the good effects of cooling (clinically induced post-resuscitation mild hypothermia) disappear after 15 minutes.

Liquid ventilation with perfluorocarbons was discovered in 1965, but recent FDA trials were disappointing. (Steve and Mike Darwin from the audience disagreed over the reasons why the trials failed, so I, for one, don't know what to conclude.) The volume, pressure, and other factors must be carefully controlled to prevent damage to the lungs (which can be lethal).

The next speaker was Calvin Mercer, Ph.D., a religious studies professor at East Carolina University. It was refreshing to see a discussion of religious, and specifically Christian, concerns about cryonics, since it is likely that religious people, an overwhelming majority of the U.S. (and world) population, will be decisively influential in how or whether cryonics will be studied, funded, researched, or implemented.

Already, there have been signs of the conservative objections to this new-fangled and unsettling idea, muted only (I would suppose) because of the widespread perception of its infeasibility. But even more disturbing is the rejection by the liberal, 'progressive' religious.

Calvin noted that complete scientific support of cryonics (even if cryonics got it!) wouldn't help if the general public doesn't give cryonics a place in the cultural arena of religion. Religious opinions on cryonics should be important to cryonicists because they will affect membership, legislative support, funding, and legal climate. He said his speech would focus on American Christians since they predominate in the area where cryonics is unfolding.

Calvin noted that SYMBOLS are very important to religious people; they are how religious people construct their identity in the world. Conservative Christians have historically been closed-minded to new science, but religion can, and has, evolved with culture over time. He believes that in the future, when it becomes clear that life extension is inevitable, both 'bioconservatives' and life extension enthusiasts will be found among both religious conservatives and religious liberals.

Religious liberals tend to be anthropocentric, this-wordly, pragmatic, and revisionist. That makes them friendly to science. But they are worried about fairness and access to new technologies for less privileged people. Their support for cryonics will depend on how the issue of justice is addressed by cryonics. How will cryonics affect "the least of these"? The poorest, the least educated?

This is certainly a concern I, for one, share.

Conservative Christians may be evangelicals or fundamentalists (the latter defined as "evangelicals who are angry about something"). They tend to be theocentric; they have a very low view of humans as sinful and weak. Their otherworldly emphasis is on supernatural realms and beings. They value religious understanding handed down from previous generations, unchanging. They hold dogmatic beliefs not open to debate.

Conservatives' longstanding suspicion of science will play some part in their attitudes towards cryonics. But Calvin believes some significant segment of conservative Christians may embrace life extension. They may, for example, think of life extension as a way of avoiding Hell and preparing to be sure they will go to Heaven. They may also be strongly convinced by the notion that cryonics preserves life (note their general pro-life stance). Resuscitation is not raising the really dead, only the apparently dead, they might argue. Resuscitation does not result in spiritual transformation, the way resurrection would. The soul might not 'leave the body' unless the person is really dead.

Christine Petersen of the Foresight Institute gave a quick review of everyday life extension practices such as diet, exercise, adequate quality sleep, and stress-avoidance, and humor. She wisely noted that one should not take just any supplement that MIGHT help since substances in the body may interact in undesirable ways. Authorities disagree on the number and type of supplements that would be advisable (from most conservative to most liberal: doctors, the FDA, RealAge.com, Kronos, Ray Sahelian, Ray Kurzweil, and the Life Extension Foundation). People should rearrange their lives if necessary to avoid "toxic" stress from bosses, commutes, coworkers, spouses, etc. Males benefit from greater quantity of sex, while females benefit from greater quality of sex. Most of her recommendations were of the sort, obviously, that the audience was not quick to object to!

Next up was Chris Heward, Ph.D., president of Kronos Science Laboratory, which has conducted many large population studies on aging. All the while not having any clear definition of what aging IS. Apparently, it may be many different, but interacting, biochemical processes. There are no yet accepted biomarkers for 'aging'. Kronos pays close attention to signs of oxidative stress, but there is significant (huge) variation across time in single individuals.

Life expectancy has increased in recent times, but mainly only due to decreases in infant mortality. Life expectancy increases after 65 years have not been impressive. The 'downward' slope of aging begins around 20 years old. Premature aging of one element of the body is usually responsible for premature death. The top 3 killers in the U.S. are cardiovascular disease, cancer, and cerebrovascular disease.

Alzheimer's disease is increasing, and not entirely because of increasing diagnosis. Five percent of people aged 65-74 will be affected. By age 85, the risk will rise to near 50%. Such figures are obviously disturbing to those of us who wish to extend our natural lifespans, while at the same time preserving our personal identity. Alzheimer's disease, and all forms of age-related dementia, amount to a terrible conflict in our plans. Should we try to live longer, and run greater risk of dementia? Or should we lean wholly on cryonics, a completely unproven technology? One can be sure there are no easy answers.

2 comments:

V.R.Manoj said...

Greg,
Is it entirely possible from your reflections that humans are heading to a "species state" which will be able to hibernate indefinitely without loss of consciousness upon waking up ? Were there any speakers on cryonics for long distance space travel such as seen in movies like Aliens ?

you mention in your blog entry :
"She argued that whole brain death need not be considered a necessary criterion for brain death. Rather, she said, loss of consciousness, or personhood, should be considered sufficient. Persistent vegetative state would qualify in this sense."

I had an interesting discussion with a bioethics professor a few years back on this issue. I had the view that we do not yet have the proper instruments which are sensitive enough to detect consciousness in a vegetative person. I also hinted that they may be existing in another type of consciousness ! In India, these notions could be understood easily from a religious point of view as Yoga often hints at such states.

Regards,
V.R.Manoj
http://cyborgfantasy.blogspot.com

Arcturus Gregory said...

Manoj,
There is a company working toward reversible suspended animation. But there are a lot of challenges to be overcome. If/when it is possible, it will surely have some applications for space travel. Although I would prefer to see faster-than-light-speed propulsion systems or transportation wormholes :)

And you're right, we don't really yet have the instruments to measure consciousness; we don't even really have a detailed understanding of the physical basis of mind. So that speaker was just asserting her own opinion. I think it might be possible for a person who is "brain dead" to be potentially alive, in the sense that the brain's ability to "play" this person is still in existence, maybe like a CD which has a scratch on it that prevents it from being played, but which could (in theory) be fixed.

I accept Ralph Merkle's 'information-theoretic criteria' for death. Only if the 'information' supporting identity in the brain (however it is stored) is irretrievable, only then is a person really 'dead'.

I don't know about the possibilities of different types of consciousness, but as scientists learn more about the brain, they are starting to formulate theories of what people who are "minimally conscious" are experiencing, and it is really strange. "Minimally conscious" people are brain-damaged but not in a "persistent vegetative state". They can sometimes recover a bit. But if there is no consciousness whatsoever, it seems the brain begins to atrophy.