Cryonic Preservation and Physician Assisted Suicide

Recently a terminally ill teenager won the right to have her body preserved by cryonics in the hope that she might live again at some future date. Such a hope comforted her. The case was really a case of whether she had the right to determine how her body was disposed of when she died, see bbc news . Cryonic preservation is not a form of treatment at the present time, cryonic preservation is simply a form of bodily disposal tinged with hope and as a result does not presently appear to pose any major ethical problems. However, let us imagine a scenario in the future when cures become available for some diseases which are currently terminal and that those preserved by cryonics can be brought back to life. This scenario raises ethical concerns and this posting I want to examine these concerns.

At the present time cryonic preservation might be defined as the preservation by freezing of a dead body in the hope that a cure for the disease that body died from becomes available in the future and that the body can then be resuscitated and cured. The case of the teenager above was an example of this type of cryonic preservation. However, an alternative form of cryonic preservation seems possible. Let us consider someone suffering from a terminal illness who finds his present life not worth living. He might consider physician assisted suicide PAS, such an option is available in several countries and some states in the USA. On reflection he might think a better option might be open to him. He wants his body frozen whilst he is still alive and preserved in the hope that a cure for the disease he suffers from becomes available in the future in the hope that he may be resuscitated and cured. For the rest of this post cryonic preservation will be referred to by CP. These alternative types of CP will be defined as follows.

• Type 1 CP will be defined as the preservation by freezing of a dead body in the hope that a cure for the disease that body died from becomes available in the future in the hope that he may be resuscitated and cured.
• Type 2 CP will be defined as the preservation by freezing of someone’s body whilst he is alive in the hope that a cure for the disease he suffers from becomes available in the future in the hope that he may be resuscitated and cured.

Type 1 CP is extremely fanciful because not only do cures need to be found and bodies unfrozen but also dead bodies need to be brought back to life. I will deal with type 2 CP first because there is more realistic opportunity of it being realised. There seems to be some possibility that in the future it might become possible to freeze and preserve someone’s living body and unfreeze it after a substantial period of time permitting him to resume his life. Such a scenario remains fanciful but is by no means impossible. Let us assume studies have frozen and stored large living animals and that after a substantial period of time have thawed them permitting them to resume their lives. I am assuming here that studies on rats or mice might not be applicable to humans. Let us assume someone is aware of this fact and learns he is starting to suffer from Alzheimer’s disease. I have previously argued it would not be irrational or wrong for such a person to commit suicide if he so desired and moreover it would not wrong to help him do so, see alzheimers and suicide . In this scenario it might be argued by analogy it would neither be irrational nor wrong for such a person to choose type 2 CP. Indeed, it might be argued as I have suggested above it is a more rational option than suicide. I now want to examine the ethical concerns raised by type 2 CP.

If we preserve someone using type 2 CP are we doing something which is wrong? To answer this question, we must first ask what are we doing if we preserve someone using type 2 CP? The company providing the service is simply storing a living body and this seems to raise no ethical concerns. But what are the doctors who prepare the body for storage doing? It is uncertain whether a cure might be found for Alzheimers. In this scenario how we describe these doctors’ actions in preparing him for preservation raise different ethical concerns. Are they killing him now, preserving him to die in the future or helping him commit suicide? The first possibility is clearly wrong. Is the second possibility also wrong? Delaying death is an accepted part of medical practice. But would it be right to delay death if there is no conscious life between the start of the delaying process and death? Intuitively though such an action harms no one and might not be wrong it seems pointless. If we accept physician assisted suicide, then we must accept the third option isn’t wrong. In the case of the teenager what was being decided was how a body might be disposed of. Let us now consider a variation of this case. Let us assume that a relatively young person who is competent to give informed consent is suffering from terminal cancer wishes to have his body preserved by type 2 CP. He wants his body preserved whilst he is still alive. Let us also assume using type 2 CP it is possible to preserve a body for a hundred years and then resuscitate it. It seems possible that a cure, or at least an ability to manage cancer, might well come about in the next hundred years. In this case if his doctors prepare his body for type 2 CP, what are they doing? In this scenario it seems wrong to say they are killing him, delaying his death or helping commit suicide. If the techniques involved in type 2 CP are proved to be safe and a cure for cancer is a genuine possibility then I would suggest his doctors are treating his disease, they are treating him a patient and there are no ethical objections to doctors treating patients. In might be objected that doctors only treat patients so they can recover from their illnesses. In response I would point out doctors treat patients when they manage cancers they can’t cure by providing palliative care. Let us assume it is possible to preserve a body for a hundred years and then resuscitate it. In the light of the above it might be concluded that it would not to be wrong for doctors to prepare a relatively young competent person for type 2 CP provided he or those close to him could pay for the service. The above conclusion is subject to two conditions. First there must be a reasonable prospect that the condition he suffers from will become curable or manageable in the future and secondly that it has proved to be possible freeze and store large living animals and after a substantial period of time these can be unfrozen permitting them to resume their lives.

Let us accept the above conclusion that it is not wrong to provide type 2 CP to relatively young competent patients when there is a realistic possibility that their illness can be cured in the future. But would it be wrong to provide such treatment to older or even incompetent patients. I will deal with someone who is incompetent first. If someone is incompetent to give consent to treatment then a surrogate decision maker, such as the courts or his parents, acts on what is in his best interests. Intuitively it might be objected deciding to use type 2CP is not deciding about treatment. However, I have argued for a relatively young competent person type 2 CP can be seen as a form of treatment. Moreover, I would suggest treatment doesn’t become non-treatment simply because someone is unable to give competent consent. Accepting the above raises many practical problems. Should type 2 CP be carried out if someone who is incompetent resists such treatment? I would suggest it should not but will not offer any arguments here to support my suggestion. Should type 2 CP be carried out if someone who is incompetent but is prepared to accept such treatment? I would suggest it should. If we believe it shouldn’t then mustn’t we also believe the lives of the incompetent have less value than those of the competent whilst at the same time remembering that young children are incompetent. Moreover, if we accept the above aren’t we are encouraging eugenics by the backdoor? It might be concluded that it would not wrong to provide type 2 CP to relatively young incompetent patients, provided they are prepared to accept treatment and those close to them are prepared to pay for the service. This conclusion is subject to the same conditions required for the relatively young competent patients outlined above.

Is it wrong to offer type 2 CP to older persons? It seems to me in world of infinite resources it would not. Resources in this scenario are not a problem and it would appear that if someone believes it would wrong to offer type 2 CP to older persons that it should be up to him to justify his belief. It can again be concluded it would not be wrong to offer type 2 CP to older persons, subject to the same conditions outlined in the other two cases.

I now want to consider a different question. If type 2 CP could be regarded as treatment would we have a duty to provide this treatment? This question is at the moment completely hypothetical. However, if studies froze and stored large living animals and then after a substantial period of time thawed them permitting them to resume their lives, then this question would cease to be a hypothetical one. Indeed, if there was also the possibility of several new cures for previously incurable diseases an answer to this question becomes important. Usually whether someone should be offered treatment depends on the quality added life years, QUALYs, expected from the treatment in question. It might be concluded that it would not be wrong to offer type 2 CP to older persons when the number of expected QUALYs is similar to the expected QUALYs offered by other accepted treatments subject to two provisions. First, the number of expected QUALYs should not include the years spent in frozen state. Secondly it possible that the freezing process might reduce the number QUALYs and this should be taken into account.

I have argued that it would not be wrong to provide type 2 CP to people who can finance this service themselves. I have also argued that it is possible that in the future type 2 CP might be regarded as treatment. It seems that the same arguments I used regarding type 2CP can be applied to type 1 CP concerning its permissibility. However, in some circumstance type 2 CP might be seen as a form of treatment, it is difficult to see how type 1 CP might be regarded as a form of treatment. Philosophy should not only be concerned with what should be permitted but also with what helps people flourish, philosophy should make recommendations about how to live. Let us assume one or both types of CP prove to be effective. Should we recommend that someone facing terminal or life changing illness try CP? Several reasons might be advanced as to why we should not. First, a long suspension might mean they awake to an alien world making it hard for them to cope. Secondly a long suspension might mean they awaken to find their friends, spouse and even children have died. Whether someone would want to undergo CP would depend not only on their imagined future but also on their current circumstances. A single lonely person might find CP attractive whilst someone whose life centres on family might not. The young might find CP more attractive than the old because CP offers them the possibility of a longer life extension. Personally as a relatively old man I do not find the idea of CP attractive, however returning to our starting point if I was fourteen I might well do so.

Nussbaum, Transitional Anger and Unconditional Forgiveness

Charles Griswold argues that forgiveness is a kind of transaction and as a result there are certain conditions attached to the transaction which mean that one cannot truly forgive without fulfilling these conditions (1). In response it might be pointed out that conditional love is inferior to unconditional love. It might then be argued by analogy that conditional forgiveness, transactional forgiveness, is inferior to unconditional forgiveness. In this posting I will argue this doesn’t hold and that transactional forgiveness is morally more desirable than unconditional forgiveness because of the message it sends to the offender.

Martha Nussbaum rejects the idea of transactional forgiveness as suggested by Griswold and goes further by arguing that there are also problems with unconditional forgiveness. The problem with all sorts of forgiveness according to Nussbaum is that it is essentially backward looking and attached ideas of payback. She argues rather than forgiving we should engage with offenders in a spirit of active love (2). In response to such arguments Griswold suggests that for a victim just to give unconditional forgiveness means she lacks self-respect and that others will also fail to respect her. Intuitively if someone who has been wronged and the offender exhibits no remorse or indeed continues offending, holds no resentment, then the victim lacks self-respect. Intuitively it also seems morally wrong, not just hard, for someone who has been sexually assaulted to unconditionally forgive her assailant.

In this posting I don’t want to examine a lack of respect. Instead I want examine two different objections to unconditional forgiveness. First, I will argue that in some circumstances unconditional forgiveness means the victim far from having too little self-respect, means she actually has too much and is over proud. Secondly I will argue unconditional forgiveness by the victim harms the offender. Let it be accepted that all forgiveness whether unconditional or transactional means letting go of resentment. Intuitively this appears to be true for it seems impossible to believe a victim truly forgives her transgressor if she still bears resentment towards him. For the sake of argument let us assume Sue has been morally harmed by John and that she has unconditionally forgiven him. In this context because Sue’s forgiveness is unconditional it is possible that John might remain quite happy with the fact that he has morally harmed Sue and would be fully prepared to do so again.

Let us examine Sue’s motives in unconditionally forgiving John. According to Nussbaum sometimes,

“the person who purports to forgive unconditionally may assume the moral high ground in a superior and condescending way.” (3)

If we accept Nussbaum view, then it is possible that Sue’s underlying motive in unconditionally forgiving John is to feel good in a superior way. Sue’s motive displays a certain moral arrogance. Such a motive does not justify unconditional forgiveness. However, let us assume that Sue’s motive is not to feel superior but simply a desire to act in a moral manner.

Let us examine the above assumption. I now want to present two arguments why even in this context Sue’s unconditional forgiveness might be flawed. Both arguments will be based on Sue’s focus. Firstly, I will argue that by unconditionally forgiving John to satisfy her desire to act in moral manner Sue might still be exhibiting an excessive moral pride. Before proceeding I must make it clear I am not attacking limited moral pride, moreover I believe that some limited moral pride is a good thing. How then can Sue exhibit excessive moral pride by unconditionally forgiving John? It seems possible to me that Sue’s motives for forgiving John might have nothing actually to do with John. Let us assume Sue’s unconditional forgiveness is due to her focus on acting morally and isn’t a case of moral grandstanding. Her focus might be flawed if it focusses exclusively on Sue’s behaviour because her focus is too narrow. If Sue focusses exclusively on her own behaviour, focusses on herself, then she seems to be exhibiting excessive pride. Nussbaum for instance might argue such a limited focus is unhealthy because it contains a narcissistic element. It follows that if underlying Sue’s unconditional forgiveness is an excessive pride that her motive for this forgiveness is flawed, indeed it might be argued that by excessive cherishing of herself she damages herself. However, it does not automatically follow that her unconditional forgiveness of John cannot be justified by other reasons just because Sue’s motivation is flawed.

Let us assume Sue’s motive for her unconditional forgiveness is simply focussed on acting morally and has nothing to do with excessive pride. This brings us to the second of my two arguments. I want to argue that whilst Sue’s simple desire to act morally is admirable the way she enacts this desire is flawed. I will base my argument once again on Sue’s narrow focus. In order to act in a true moral way people must consider all moral agents and not just a select few, a particular morality is a partial morality. Any non-partial system of morality must include those who harm us. I would suggest that Sue’s narrow focus on unconditionally forgiving John means she fails to genuinely consider his moral needs. Sue is only considering herself morally and disregarding the moral needs of John. By withdrawing her resentment Sue is withdrawing something that might help John become a better person. Resentment at wrongdoing is not simply something the victim feels; resentment also sends a signal to the offender that he is causing moral harm. It seems to me that by unconditionally forgiving John Sue is denying John this signal which might help him become a better person. Agnes Callard makes a similar argument with respect to revenge when she argues that “revenge is how we hold one another morally responsible” (4). It follows Sue’s unconditional forgiveness of John whilst admirable in some ways is nonetheless flawed because she ignores John’s moral needs or is mistaken about what will help John become a better person.

I have argued that conditional is superior to unconditional forgiveness however it might be argued by some that my conclusion is unsound. They might point out that unconditional forgiveness seems to set an excellent example of how to love others and this reason for supporting unconditional forgiveness outweighs the reasons against I have advanced above. In response I would argue the recognition of others as moral agents is even of even more fundamental importance to morality than any possible demonstration of love. Without this basic recognition no system of morality can even get started. In my example it seems to me if Sue unconditionally forgives John then she is acting in a way she believes is best for John and by so doing she is failing to recognise him as a fully moral agent.

Does accepting that unconditional forgiveness might be harmful mean we must accept the type of transactional forgiveness favoured by Griswold? Nussbaum sets out the long list conditions necessary for Griswold’s conditions for transactional forgiveness to take place (5). She argues that going through such a process is a humiliating one smacking of payback, I am inclined to agree. Griswold’s transactional forgiveness makes sense if we accept a traditional view of anger which includes payback. However, Nussbaum argues ideas of anger involving payback doesn’t make sense. Once we see traditional anger doesn’t make sense we can transmute it into action according to Nussbaum. Traditional anger,

“quickly puts itself out of business, in that even the residual focus on punishing the offender is soon seen as part of a set of projects for improving both offenders and society.” (6)

I am again inclined to agree with Nussbaum that anger should be transmuted into something useful. I am inclined to agree because I believe like Michael Brady that emotions, including anger, act in a way analogous to alarms focussing our attention on the need to do something (7). Alarms are meant to be attended to, an unattended car alarm is annoying, unattended anger can be damaging. However, even if unattended anger is harmful this doesn’t mean anger is harmful. Unattended alarms are annoying but alarms are useful. Unattended anger may be harmful but anger is useful, anger draws attention on the need to do something. According to Nussbaum anger should “focuses on future welfare from the start. Saying ‘Something should be done about this”. (8) If we accept that anger should be attended to, be transmuted, then it seems to me Griswold’s transactional idea of forgiveness is in trouble because the transactions involve payback which seem to me to be related to un-transmuted anger.

If we forgive someone and we do not adopt Griswold’s ideas on transactional forgiveness are we forced somewhat reluctantly to conclude that our forgiveness should be unconditional? I don’t believe it does. What does it mean to forgive? If we define forgiveness as simply as relinquishing anger and its associated desire for revenge, then a commitment to transitional anger also means commitment to unconditional forgiveness. It means even if John remains quite happy with the fact that he has morally harmed Sue and remains prepared to do so again that if Sue translates her anger that she forgives him unconditionally. However, forgiving someone might mean also be defined as the normalisation of relations between the forgiver and the forgiven. Translating anger in this context doesn’t simply mean moving on. Transitional anger means looking to the future, moving on. Transitional anger also means looking back to the past, past wrongdoing cannot be ignored after all it is the reason why we must look to the future. This approach doesn’t of necessity involve a formal transactional process involving payback. It does however mean that certain minimum conditions not involving payback must be met. Relations cannot be normalised if a wrongdoer disputes the facts or wrongness of his action. In this situation victims are entitled to protect themselves by withholding trust. Trust is an essential part of normal human relations if someone is always wary of another their relationship cannot said to be a normal one. Protecting oneself doesn’t need involving payback. It follows forgiveness requires that the wrongdoer must accept responsibility for the act and acknowledge its wrongness for normal relations to be met. It further follows if someone accepts transitional anger that his acceptance does not commit her to unconditional forgiveness which might harm the wrongdoing.

1.    Charles Griswold, 2007, Forgiveness, Cambridge University Press.
2.    Martha Nussbaum, 2016, Anger and Forgiveness, Oxford University Press, Chapter 3.
3.    Nussbaum, chapter 3.

4.    Agnes Callard, 2020, On Anger, Boston Review Forum, page 15
5.    List of Griswold’s conditions as outlined by Nussbaum.
·       Acknowledge she was the responsible agent.
·       Repudiate her deed (by acknowledging it. Express regret to the injured at having caused this particular injury to her
·        Commit to becoming a better short of person who does not commit injury and show this commitment through deeds as well as words.
·       Show how she understands from the injured person’s perspective the damage done by the injury. Offer a narrative of accounting for how she came to do the wrong, how the wrongdoing does not express the totality of the person and how she became worthy of approbation.
·       Acknowledge she was the responsible agent. Repudiate her deed (by acknowledging its wrongness) and herself as the cause.
·       Express regret to the injured at having caused this particular injury to her.
·       Commit to becoming a better short of person who does not commit injury and show this commitment through deeds as well as words. 
·       Show how she understands from the injured person’s perspective the damage done by the injury. Offer a narrative of accounting for how she came to do the wrong, how the wrongdoing does not express the totality of the person and how she became worthy of approbation.
 
6.    MARTHA C. NUSSBAUM, 2015, Transitional Anger. Journal of the American Philosophical Association, page 51.
7.    Michael S. Brady, 2013, Emotional Insight; The Epistemic Role of Emotional Experience, Oxford University Press
8.    MARTHA C. NUSSBAUM, 2015, Transitional Anger. Journal of the American Philosophical Association, page 54.

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