[tt] [ccm-l] Alcor Conference, Phoenix 10/5/07

Mon Oct 8 19:49:26 UTC 2007

----- Forwarded message from David Crippen <crippen+ at pitt.edu> -----

From: David Crippen <crippen+ at pitt.edu>
Date: Mon, 08 Oct 2007 15:45:57 -0400
To: ccm-l at ccm-l.org
Cc: 
Subject: [ccm-l] Alcor Conference, Phoenix 10/5/07

I was asked to be part of a panel exploring the concept of death, 
it's substance and timing for the 7th annual Alcor Life Extension 
Foundation.  You can Google it. Alcor is an organization that pursues 
the goal of (essentially) preserving brain function for posterity, in 
the hopes that nanotechnology will be available at some time in the 
future to re-boot the brain, and participants (re)live again. The 
theory is interesting, and certainly not out of the question that it 
could work. Remember that what sits on my desk right now is more 
computing power that existed in the world in 1967.  Fifty years on, 
it may be possible to do a lot of things that we don't conceive of 
now.  I am not a cryonicist, but I have close friends that are and I 
understand a lot of it. There are some pretty high powered PhD types, 
and a few MDs deeply involved. I have no doubt that Darwin will 
correct any of the above if I got any of it wrong.

At any rate, cryobiology is facing a big problem, that of the timing 
of death. In order to preserve the structures they are interested in, 
it's necessary to first pronounce the patient dead. Obviously they 
cannot start any of their procedures if the patient is still alive. 
Once dead, the rules change regarding what can be done to a cadaver. 
Most of what happens thereafter comes under the Anatomical Gift Act. 
Normally, a physician pronounces the patient dead and immediately 
thereafter, the patient is (re)intubated and a mechanical CPR devise 
is attached to restore circulation while various intravenous 
preservatives are infused into the brain, preparing it for freezing.

Prior to the advent of high tech critical care, this was much 
simpler. A patient was dead when his pronouncing physician said he 
was dead. However, nowadays, it isn't that simple. Patients sometimes 
show renewed "signs of life" following resurgence of ventilation and 
circulation. Pupils constrict and sometimes spontaneous motion is 
observed, sometimes requiring the use of potent sedative drugs 
intravenously to stop it. This then forces a very interesting and 
important question. Was the patient really dead when he was 
pronounced so?  Or is it a resurrection.

Naturally, cryonicists are very concerned about this since the timing 
of what is sort of dead and stone dead directly impacts their entire 
function. The brain must have some semblance of continuing function 
in order to be resuscitated. For this reason they rely on Donation 
after Cardiac Death criteria, not brain death. There is frequently if 
not always some residual brain activity following cardiac standstill 
but the patient can be pronounced dead. They are counting on this 
flickering flame to be amenable to nurturing.

The other panelist and I spent a good bit of time explaining the 
realities of what constitutes death, following which we were opened 
up to questions from the audience.  They (cryonicists) have some 
interesting ideas about all this, which I will outline below:

1.  They are very much ethical utilitarians. If it is a good and just 
end, the route there matters little. Few of them seem to understand 
that the end is directly modified by how it's achieved. They don't 
understand why it's a big deal to insure that the route taken is as 
pristine as the end they hope to achieve. It does not enter their 
logic how frighteningly dangerous utilitarianism can be.

2.  They are deeply into "consent" as a trump card for all obstacles. 
If they are authoritative, autonomous individuals and they have a 
desire, that should trump all other issues. This is what they want 
for themselves, and that should be enough to cut through all the red 
tape. In fact, one fellow actually did get up and say: "This is what 
I want and that should be enough to cut through all the bullshit".

3. At some point in my diatribe, I mentioned that there was nothing 
inherently evil about Donation after Cardiac Death. These patients 
were going to die anyway, and so it isn't too big a stretch to use 
that fact to the advantage of others, BUT it IS a creative workaround 
of the rules which state that brain death is the only form of death 
defined by the Dead Donor regulations.  And once a workaround starts, 
you can be sure there will be more and the foot gets deeper into the 
crack between the door and the jamb, and with the current high demand 
for organs, the bottom of the slippery slope might be selling organs 
on EBAY.

At this point no less than ten, or maybe more audience members yelled 
out: "What's wrong with that?" I was stunned speechless, and that 
takes a lot for me. My jaw bounced off the floor with a loud clatter. 
I was totally at a loss for words. It took me a minute to 
reconstitute and utter something along the lines that any such 
transactions would always be at the expense of the poorest factions 
of society, most amenable to manipulation and abuse of others who 
would profit from them. And I thought that was unacceptable in a just 
society. Most didn't seem to be impressed with that argument. The 
ultimate libertarians.

So, for my part, I left them with the following advice.

If they expect to evolve and assimilate into the mainstream of 
science, they need to start doing their research in mainstream labs 
and publishing in mainstream journals. They need to get over their 
current concept of consent as a trump card. One cannot consent to be 
dead at a specified time, and consent to be dead before that time is 
euthanasia, which is illegal and people go to jail for it.  They need 
to start moving away from the concept that they are practicing 
medical interventions on cadavers. Technically, most if not all of 
their patients are still alive by brain death criteria, and DCD is 
this justification as is it still not universally accepted. They need 
to develop some kind of a mode of
"intervening in a dying process" that will be found acceptable by 
ethicists and lawyers.  Ultimately their ministrations will attract 
the attention of both if it hasn't already.

Disclaimer:  "Everything I know or ever learned about any of this was 
taught to be by Leslie Whetstine PhD"

(I have to throw this in now routinely)

-- 
David Crippen, MD, FCCM
Associate Professor
University of Pittsburgh Medical Center
Department of Critical Care Medicine
Medical Director- Neurovascular Critical Care
Presbyterian -University Hospital
644a Scaife Hall
3550 Terrace Ave
Pittsburgh, Pa 15261
Administrative Assistant: Barb Shields-  412 647 5387

"Whose motorcycle is this?
It's not a motorcycle....It's a chopper, baby.
Whose chopper is this?
It's Zed's.
Who's Zed?
Zed's dead, baby".

                   Butch

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