A terminally ill patient who opted for assisted death has undergone cryonic preservation at the Alcor Life Extension Foundation. This preservation—the first of its kind—signifies an important milestone for cryonics advocates, who argue that the right to death, paradoxically, is a potential pathway to an eternal life.
On October 30, 2018, Alcor performed its 164th cryopreservation. It was an otherwise unremarkable moment for the nonprofit organisation, save for the way Norman Hardy of Mountain View, California met his demise. Hardy was diagnosed with terminal metastatic prostate cancer, and it had spread to his bones and lungs. As noted in Alcor’s case summary, his “pain had been poorly managed,” so he opted for assisted death, which was legalised in California in 2016 through the End of Life Options Act (EOLOA).
For Alcor, the case was the first time EULOA was used to “reduce the potential ischemic damage that can result from a prolonged dying process,” as the life extension foundation noted in its official case report. Indeed, the quicker a patient can be put into cryonic suspension following death the better, as the sudden shortage of oxygen starts to destroy tissues.
For Alcor, time is trauma. In this case, Hardy’s choice of when to die allowed his neural tissues to be rapidly preserved following his death, or at least, preserved as well as modern cryonic technologies allow.
As it stands, no one who has opted for cryonics has ever been brought back to life, and it’s not likely to happen any time soon. Despite the limitations and tremendous uncertainties, Alcor’s customers, of which there are currently over 1,200, have been willing to pay upwards of $289,220 for a whole-body preservation and $115,688 for a head-only preservation, the latter of which was Hardy’s choice.
To offset these tremendous costs, many of Alcor’s customers take out a second life insurance policy in which Alcor is named the beneficiary.
The procedure to prepare Hardy’s head for long-term suspension in a vat of liquid nitrogen was “relatively successful,” noted Alcor in its case report. CT scans following preservation showed some ice formation in the cerebellum and frontal lobes, which isn’t ideal. That said, the quick turnaround from the declaration of death to placement in one of Alcor’s stainless steel dewars meant that decompositional damage to Hardy’s brain was minimised.
In a best case scenario, Alcor’s response team begins the cryopreservation process within seconds after death is declared. But that doesn’t always happen. In some previous cases, Alcor wasn’t notified of a member’s death until days afterwards.
Cryopreservation works by slowing down the metabolisms of organs, cells, and tissues to the point when no further biochemical reactions can occur—including decomposition. As to whether or not irrevocable damage occurs in the brain during the seconds and minutes following death, or as the brain is brought down to temperatures reaching -196 degrees Celsius is another question entirely; a notorious issue facing cryonics is the degree to which “ice crystal formation, osmotic shock, and membrane damage during freezing and thawing will cause cell death,” as noted in a 2017 Integrative Medicine Research study.
To try to avoid these potential problems, Alcor uses a vitrification solution to minimise ice crystal formation. Ideally, “vitrification avoids ice formation completely so that the entire tissue mass becomes an undisturbed block of glass,” wrote Alcor in a 2003 article about the process.
In a summary published earlier this year, Alcor said Hardy’s case was an “important milestone for Alcor and for cryonics,” and for good reason.
As I’ve argued before, the right to assisted death is important in the context of cryonics. Death is, for the time being, unavoidable, but cryonics offers a possible work-around. In the future, technologies may exist to reanimate people who have undergone cryopreservation. The general idea is that, while a person may be considered legally dead, they may not have attained information theoretic death, whereby integral brain structures have been irrevocably destroyed.
In accordance with this thinking, a person should only be considered dead when critical information in their brains—the stuff that makes a person a person—cannot be salvaged. Cryonicists would therefore argue that a person who has undergone a successful cryopreservation, while legally dead, is not theoretically dead. The key, however, is to ensure a “successful” cryopreservation, which is why it’s so important to perform the procedure as soon as possible after legal death has been declared.
In this particular case, Hardy gave Alcor two days notice that he was going to end his life, which created a “logistical problem” for Alcor, as per the case report:
It would be the first time an Alcor member used EOLOA in conjunction with their arrangements for cryopreservation. It was imperative that Alcor make sure the laws were followed exactly and two days was not enough time to do that proficiently. The member agreed to postpone taking his AID [aid-in-dying] medications but only for a few days. Additional time would have given Alcor more confidence that no legal requirements had been overlooked.
The added time allowed Alcor to get its legal paperwork in order, but it also allowed a response team from Suspended Animation to wait by Hardy’s bedside until legal death was declared, and then place his body in cold storage for transportation via helicopter to Alcor’s facility in Scottsdale, Arizona.
“With Norman Hardy we have moved one step closer to making cryonics a viable reality, since choosing the time of one’s death allows cryonicists to perform an optimal preservation instead of trying to preserve a brain that has been dead for hours,” James Hughes, a bioethicist and the executive director of the Institute for Ethics and Emerging Technologies, told Gizmodo. “This also moves us towards a future in which we get to determine whether, when, and how we die.”
The quick turnaround in the Hardy case was ideal, and the Death With Dignity legislation had a lot to do with it. But there’s more to this issue than rapid response.
Some cryonicists who are terminally ill are at risk of suffering extreme brain damage as a result of their illness, such as with brain cancer. In these cases, so-called information theoretic brain death—a term coined by cryoncist and futurist Ralph Merkle in 1994—will have been achieved if the cancer, for example, destroys critical brain functions that future technologies, no matter how advanced, will not be able to recover and restore. Neurons that encode for memories and personality are good examples. With right-to-die provisions, however, a terminally ill cryonicist could choose to die before irrevocable brain damage happens.
As an important aside, patients who choose to end their own life in places where assisted death is illegal would not be eligible for cryopreservation, as suicides typically require mandated autopsies, making a pristine and timely cryopreservation all but impossible.
“As someone who is signed up for cryonic suspension, I think legal access to doctor-assisted death is important,” Anders Sandberg, a researcher at the Uehiro Center for Practical Ethics at the University of Oxford, told Gizmodo by email. “Cryonics is a gamble, but one can certainly improve the chances of a good suspension by dying at the right time so that the suspension team can be in place and deteriorating health doesn’t destroy more of the brain than necessary. Avoiding terminal pain is also a plus.”
Back in 2017, Sandberg, along with Ghent University bioethicist Francesca Minerva, coined the term “cryothanasia” to describe the prospect of assisted dying as a means to improve the integrity of cryonic preservations. The primary takeaway of their accompanying paper was that many of the ethics arguments against euthanasia are arguments in favour of cryothanasia. “After all, it is done in order to extend life rather than to end it,” Sandberg told Gizmodo.
Shannon Vyff, the director of the Society for Venturism, a cryonics advocacy group, is also signed up for cryonic suspension, and she’s had a long interest in Death With Dignity as it pertains to cryonics.
“I’d like the ability to choose my own death if I was diagnosed with a terminal illness and felt the time was right due to failure of pain management,” Vyff told Gizmodo in an email. “Currently, Death With Dignity is not legal in all U.S. states, but over the years I’ve seen six adopt it and think that will continue to grow over the years.”
The notion that some terminally ill cryonicists might hasten their death isn’t something that concerns Vyff.
“I don’t think the percentage of cryonicists who choose Death With Dignity would be different than the general population,” Vyff told Gizmodo. Most advocates “feel life is good and they hope to have more of it through cryonics,” she said, pointing to a 2017 survey of cryonicist attitudes. Cryonicists can already “choose to forgo food and water to hasten death while helping to get optimal brain preservation,” she said, adding that “having the painless option of Death With Dignity medications would not change the decision of ending one’s life yet would help take away physical pain and suffering that difficult decision brings.”
Robin Hanson, a economist at George Mason University and an Alcor member currently signed up for cryopreservation, said it’s true that some patients who face the tradeoff of going into cryonic suspension earlier for better preservation could choose to die too early should they overestimate the chance of cryonics success.
“But just as easily people can go too late or not at all due to underestimating the chance of success,” explained Hanson in an email to Gizmodo. “Especially given that cryonics looks weird, and so many face strong conformity pressures to avoid it. Overall I’d rather give people this option, even if some of them make mistakes with it.”
Norman Hardy’s mind may never be reanimated, but we can’t know that for sure. For now, he’ll go down in history as the first person to both choose assisted death and bet on the improbable opportunity to possibly live again.
Disclosure: I am chair of the board at the Institute for Ethics and Emerging Technologies, where James Hughes is executive director.