[LINK] The Cryopreservation of Kim Suozzi

by [anonymous]1 min read1st Feb 201333 comments

16

Personal Blog

http://www.alcor.org/blog/?p=2716

With the inevitable end in sight – and with the cancer continuing to spread throughout her brain – Kim made the brave choice to refuse food and fluids. Even so, it took around 11 days before her body stopped functioning. Around 6:00 am on Thursday January 17, 2013, Alcor was alerted that Kim had stopped breathing. Because Kim’s steadfast boyfriend and family had located Kim just a few minutes away from Alcor, Medical Response Director Aaron Drake arrived almost immediately, followed minutes later by Max More, then two well-trained Alcor volunteers. As soon as a hospice nurse had pronounced clinical death, we began our standard procedures. Stabilization, transport, surgery, and perfusion all went smoothly. A full case report will be forthcoming.

Previously on LW: Aug 18, Aug 25, Aug 27, Jan 22.

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On another note:

Kim made the brave choice to refuse food and fluids.

It's despicable that this was necessary.

I'm only surprised there wasn't a law mandating the hospital staff force-feed her. It probably helped a lot that Kim's family and friends were united in her support.

That would constitute assault. Mind you, I suspect the hospital staff co-operated willingly (more because of the 'terminal' part than the 'cryonics').

It's criminal that this was necessary.

No it isn't. It's despicable.

You are using 'criminal' as a way to label something negatively, relying on the implicit premise "if something is criminal then it is bad". But you are arguing against a criminal law. To the extent that your argument has weight you are validating the very law you would deprecate.

You're right, sorry.

Edited.

In Oregon and Washington there are laws defining acceptable conditions to hasten death with lethal medication. The Montana Supreme Court has ruled that it is not illegal for a doctor to give medication to hasten death to a terminal patient. Given cryonics lifesaving intent, it ought to be possible to establish that inducing cryopreservation in a non-clinically-dead person is separate from medical hastening of death, assisted suicide, or murder, and to establish protections for providers and patients in this situation.

I would also argue that vitrification[*] deserves (and could be proven in court by competent lawyers to be) a separate matter from straight-freezing as well as normal death. There are two reasons for this.

The first is that the scientific community has not actually rejected vitrification as a form of life-preservation, and credible expert testimony claiming that a vitrified brain equals a dead human being is relatively unlikely to surface. Public statements by scientists opposing cryonics consistently refer to straight freezing, not vitrification, as being irreparable even by advanced future technologies.

Secondly, on a practical level, vitrification is very hard to do and not likely to be achieved by a murderer. Therefore, permitting vitrification of living individuals is unlikely to make it hard to prove an actual murder, whereas permitting straight-freezing of the legally and clinically alive could in theory lead to murderers putting their victims severed heads in freezers and thus being let off on lesser charges.

[*] Achieved by replacement of water with high molality of vitrificants. Cryobiologists distinguish between this "equilibrium" vitrification (E-VT) and "kinetic" vitrification (K-VT) which is achieved by extremely rapid cooling and thus is limited to small cell samples. Due to toxicity of current vitrificants at warm temperatures, and practical limits of diffusion, cellular death is generally observed upon thawing for a large organ preserved by E-VT, but good structural preservation is observed, and this is the method by which a rabbit kidney was successfully preserved and revived in 2004.

The first is that the scientific community has not actually rejected vitrification as a form of life-preservation, and credible expert testimony claiming that a vitrified brain equals a dead human being is relatively unlikely to surface.

That is reversal of burden of proof, as in "you can't prove there is no God". You'd have to find credible expert testimony claiming that vitrification preserves enough information to reconstruct the self.

Anyway, as far as I'm concerned, people should be free to do whatever their bodies, including suicide. However, it's unsettling to me that people might want to sacrifice the last of their lifespan for a most likely misplaced hope in cryonics.

  1. This is expected evidence. Cryobiologists opposed to the practice have consistently labeled cryonics as flawed on grounds of dealing with frozen bodies, not due to cryoprotectant toxicity. They have failed to attack the strongest version of the argument, indicating that they either do not understand it (e.g. PZ Myers conflating E-VT with K-VT) or do not have sufficient doubt about vitrification to stake their reputation on it.

  2. In a criminal case, the burden of proof is on the accuser, not the accused. Assisted suicide is quite illegal (and even considered a form of murder) in many jurisdictions. Therefore the question of whether someone in such a jurisdiction is guilty by legal standards should rest on whether the patient can be proven dead beyond a reasonable shadow of a doubt. I think this can easily be established for a straight-frozen person (due to severe structural damage to the cells), but not for a vitrified person.

You are free to support suicide / assisted dying, but this is a very different matter. The goal of cryonics is not to kill the patient or put an indefinite end to suffering, but to prolong life. That means that certain legal arguments against assisted suicide ("we do not want to make it okay to kill people on purpose") simply do not apply. Jurisdictions basing their laws against assisted suicide on those arguments may not be consistently opposed to cryonics.

beyond a reasonable shadow of a doubt

This seems to be a blend of two common expressions: "beyond a reasonable doubt" (which is used as an evidence standard in criminal law) and "a shadow of a doubt" (which is not).

Could you clarify what you mean here?

This is expected evidence. Cryobiologists opposed to the practice have consistently labeled cryonics as flawed on grounds of dealing with frozen bodies, not due to cryoprotectant toxicity.

And what do they think of cryoprotectant toxicity? And cryoprotectant diffusion? And ischemia?

(e.g. PZ Myers conflating E-VT with K-VT)

I don't think he did. I think he claimed that you need kinetic vitrification in order to preserve the relevant structure.

Therefore the question of whether someone in such a jurisdiction is guilty by legal standards should rest on whether the patient can be proven dead beyond a reasonable shadow of a doubt. I think this can easily be established for a straight-frozen person (due to severe structural damage to the cells), but not for a vitrified person.

I'm no lawyer, but I'm pretty sure that any court would consider a vitrified body dead beyond reasonable doubt unless you provided some good evidence that it isn't. They aren't going to buy a "You can't prove it's dead".

You are free to support suicide / assisted dying, but this is a very different matter.

Ah, sure, cryopreserved people are not dead, and vitrifying yourself while still alive is not suicide. And Heaven's Gate people didn't kill themselves, they boarded the alien spaceship following comet Hale-Bopp.

You are entitled to believe whatever you like, but as long as you don't provide good evidence that there is a non-negligible chance that the human popsicles are going to be resurrected, sane people will keep considering them dead.

To clarify, I am claiming that there is reasonable evidence that vitrification (including E-VT) does not constitute death in the information-theoretic sense. In fact, I think a stronger claim than that is justifiable because information-theoretic death criteria permits situations where inference of absent structure is needed whereas vitrification provides excellent morphological preservation and thus inference of structure is arguably not necessary (i.e. is not necessary if the connectome hypothesis is true). We could term this stronger claim "survival by inference-free information-theoretic death criteria". This is importantly distinct because it is hard to estimate how reliable or feasible such inference would be (e.g. you probably can't infer the structure of a snowflake once it has melted).

A stronger claim yet that I do not make is that E-VT currently leads to the preservation of biologically viable cells (upon thawing without the technology for e.g. first replacing cryoprotectant and deactivating autolysis mechanisms that have been triggered by chilling and toxicity). However I do think that E-VT has the potential to accomplish this (for a heavily preconditioned patient) with a few decades of research. Another claim that I do not make is that the patient can survive independently, something that can only be established (on brain that meets neuroviability criteria) when advanced organ printing and/or other cybernetic enhancement technologies permit a brain to survive without its original natural body.

Interestingly, printed/scaffold-grown organs can be preconditioned and gene-tweaked in ways that should make them more susceptible to K-VT and E-VT, for example expressing Trehalose synthesis as response to chilling, or being threaded with thermally conductive.wires during the printing process. It might thus be a short step from whole-brain revivability with lab-grown organs to more routine reversibility of whole-body cryopreservation.

Legally, vitrification is embalming. :(

I find it doubtful that the distinction is so clear-cut. Low-temperature surgery (which involves perfusion with cold saline to lower body temperature and stop the heart) is not considered embalming.

Is there any form of embalming which takes place while people are still legally alive?

Hah, I was hoping no one would think to point that practice out. It's not clear that the monk should be considered embalmed while still alive, and most of them fail, but it's pretty close.

Embalming is done for aesthetic, emotional, or possibly religious reasons. Autopsy is done to gather empirical data about the patient (for example, establishing cause of death). Surgery is done for the purpose of keeping the patient alive.

Of these three, at least given intent as the main consideration, a cryonics procedure designed to induce vitrification of the brain (or, failing that, a lesser cryoprotected state) falls more under the category of surgery than either of the others. Probable outcome can be thought of separately, but all it takes is a successful argument in court to establish legally that the patient will probably, or at least with some reasonable and relevant level of plausibility, recover from vitrification.

Intent itself does carry legal weight (in my understanding at least -- culpability for damages, degrees of homicide, etc), so the mere fact that cryopreservation implies strong intent of keeping the patient alive could easily count for something, even in the absence of an explicit judgement regarding likelihood of success. (Nonetheless I would not consider the argument having a snowball's chance of succeeding in court without a decent case for plausibility, hence my emphasis on vitrification.)

In the event that a court decides to recognize this difference in intent (and/or probable outcome) as significant, there could be profound consequences. Premortem cryonics could be effectively legalized by judicial fiat, and yet providers might still fear to do it on legally living patients despite the legality (and extreme medical advisability) due to the chance of malpractice suit from a grieving or vengeful family.

Specially crafted laws are probably needed to make sure that this can be done without undue burden on providers or undue risk to patients, clearly delineating responsibilities and liabilities. Other issues like life insurance payments (an important source of cryonics funding at this time), dissolution of debts and contracts, inheritance, and various other events that normally happen at death, should also be accounted for in a good piece of non-death-presuming cryonics legislation.

Despite the lack of such laws (even seriously proposed, as far as I know), a ruling that makes vitrification something utterly different from embalming is not especially far-fetched. It's literally just a matter of some judge listening to an argument about information-theoretic death, comparing that to what's known about vitrification, and coming to the conclusion that cryonicists are neither completely crazy nor religiously motivated, but actually doing something rational with the intent to save lives.

Yeah, this is going to be a mess. Esp. with regards to inheritance and insurance. Worried about cutting off funding for anybody but the very rich.

It's unclear how long before clinical death she began this. Why exactly was it necessary? Was this actually to induce earlier clinical death and reduce the cancer's damage to the brain? That is... grisly, and brave, indeed.

Doesn't the link say she did that 11 days before death?

The more relevant question is how long she would have lived if she had not done this.

I was thinking that the estimates I've seen were that thirst kills you in around a week depending on your ambient conditions and physical exertion; being in a hospital and doing little would seem to extend the expected duration before thirst kills you. Unless Kim were some sort of super-girl who could set world records for surviving weeks without any water, that strongly suggests that the food/water deprivation was what actually killed her.

Normally in a hospital, if a patient doesn't drink enough for any reason, they're hydrated via IV drip. When I was being treated for cancer, whenever I came in to be hospitalized I was connected to an IV drip - even if I wasn't medicated right away; that was standard policy for all hospitalized patients.

It seems bizarre that a hospitalized patient could suicide by not drinking without the staff being complicit. That's why I thought at first that something else must have killed her; perhaps she was already very weak from the cancer or from chemotherapy, and not eating for 11 days made her weak enough to die.

It seems bizarre that a hospitalized patient could suicide by not drinking without the staff being complicit.

I'm sure they are, but I don't think the situation is that bizarre. I mean, isn't that exactly how Terry Schiavo's body died? The husband had food & water withdrawn, and the hospital staff was complicit in letting it die.

Reading http://en.wikipedia.org/wiki/Terminal_dehydration#Voluntary the legal basis is actually a little weird. Apparently putting in the IV drip without consent would constitute assault! And this right to refuse treatment has been upheld at the Supreme Court. I am also surprised to read this:

One survey of hospice nurses in Oregon (where physician-assisted suicide is legal) found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide.[13] They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide.[14] There can be a fine line between terminal sedation that results in death by dehydration and euthanasia.[15] Studies have shown that for terminally ill patients who choose to die, deaths by terminal dehydration are generally peaceful, and not associated with suffering, when supplemented with adequate pain medication.[16][17][18][19][20][21]

I had thought dehydration was a terrible way to die. I guess not.

Of course that last sentence says, "when supplemented with adequate pain medication." I still suspect that dehydration is a terrible way to die otherwise.

And guess what's the preferred way to administrate some of the most intensive pain medications? IV drip!

Whoops, something made me inflate the only slight ambiguity in the grammar.

It's very interesting, and it feels very "normalizing" to read the case histories of each Alcor patient. I think this was a good idea on Alcor's part, especially to include all the details, both negative and positive, to make the process feel non-mysterious. I feel like this is something I could send my dad so he might consider it.

Nevertheless, why is there no write-up for patient 111?

So when do we start the Kimectome Project to try to revive Kim and other cryonauts from whatever remains of their cryopreserved connectomes?

So when do we start the Kimectome Project (...)?

Hopefully Next Month, once the current problems are fixed with an SDK update. (Valve Time)

I read that as "Kinectome" and thought something else entirely.

Surprisingly late, the New York Times is publishing a 7.2k-word front-page article on Kim Suozzi: "A Dying Young Woman’s Hope in Cryonics and a Future: Cancer claimed Kim Suozzi at age 23, but she chose to have her brain preserved with the dream that neuroscience might one day revive her mind." (NYT explainer; HN & OB comments).

It focuses on her life from diagnosis to cryopreservation, with a parallel thread describing Hayworth's research & his Brain Preservation Foundation and a good deal of material on plastination but not so much on cryonics (eg it mentions two of the new papers on much better plastination protocols but not the C. elegans paper or the new vitrification protocol it included). I would say it is overall positive, and very good PR for BPF, which is good news on its own.