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.