Cryonics: avant-garde Medicine or burial for eccentrics?
THE BELOW-FREEZING PRESERVATION OF THE HUMAN BODY: CRYONICS: AVANT-GARDE MEDICINE OR BURIAL FOR ECCENTRICS?
A popular theme in science fiction is to freeze people with incurable diseases to be revived in the distant future, when Medicine is advanced enough to cure them. The first part (to freeze a body) is relatively easy and is already done: the first customer has been frozen for almost four decades. The second part (to revive her or him) still belongs to the realms of fantasy.
Movies like "Sleeper" by Woody Allen, as well as cartoon series like "Futurama" and the rumor that Walt Disney himself is frozen in a capsule under EPCOT Center make it appear that the issue is well understood. As the two leading companies in this business, Alcor, in Arizona, USA, and the Cryonics Institute in Michigan, USA, already have more than 150 people in a state of cryonic preservation, with a waiting list of another 1000 customers, it seems that we are talking about high technology that is mature enough. However, there is much confusion.
The procedure consists usually in waiting until the patient's death occur, then start to cool the body as quickly as possible, still in the hospital. In a first stage a temperature close to 4 degrees Celsius is reached, with the help of every kind of drugs and equipment, in a manner similar to what is done with organs for transplants, only that the technique is applied to the whole body. Then it is transported to the headquarters of the organization. There, other chemicals that will protect cells from the cold are applied. Finally, the body is placed inside a special capsule where, using liquid nitrogen, cooling is continued to minus 196 degrees Celsius. From then on, the organization is committed to preserve the client's body for as long as necessary.
Sounds easy, but now let us go into the details.
Firstly, there is the issue of the definition of the time of death. It is usually considered to be the moment when the heart stops beating or the brain stops working. But the cells of different parts of the body can continue to live for several hours after this, and it is exactly for this reason that organ transplants are possible, where the transport can take hours. Different drugs, substances and techniques can prolong this period. On the other hand, after several hours or days the cells effectively deteriorate irreversibly.
Ideally, organizations providing cryonics service should start the procedure before damage occurs to the cells, i.e., within minutes after the patient's primary physician declares legal death. And here is when confusion begins.
For advocates of the technique, what is intended with this is to prevent complete death to occur. In this sense they are saying that the person is not dead, but is at the very, very edge of death, where Modern Medicine can no longer take care of her or him anymore.
They even say that if the human body has a soul, it will not separate yet if you act fast enough.
They avoid applying the technique to people with brain death, especially if several hours have passed.
Therefore, they would not be freezing dead people, but would be preserving really critically ill patients for the Medicine of the future. To assert this, they rely on the fact that intensive-care units' techniques have advanced dramatically in recent times, so that today people can continue living in critical condition much longer than what was possible a few decades ago. It is expected that cases that currently are irreversible will not be so with new developments in hospital intensive care, so that in the future the time of death will be delayed more and more.
But on the other hand, there is a legal time of death for the patient, which means that for all practical purposes that person can no longer be among us. Entities providing cryonics services to their customers continue to call them "patient" years after being frozen, alluding that they are still not really dead, and that the facilities where they are stored would have the status of a hospital for people in a state of unusually, severely-deteriorated health.
But the truth is that, for example, the Cryonics Institute operates with a cemetery license, and the techniques for preparation of the body, despite all its paraphernalia, are not very different in essence to what is made in funeral homes to embalm the deceased. In fact, they are typically performed with the help of professionals of the latter field. The difference would be the better embalming that is achieved at subzero temperatures, where chemical reactions occur too slowly to allow decay.
But this does not mean that tissues are preserved without damage to them. The major criticisms to cryonics come exactly for the fact that when cells are frozen liquid crystals form in them, i.e., the molecules are rearranged into a new structure different from the previous one. The tissue is destroyed.
It has been tried to reduce this damage by means of high concentrations of chemicals which retard crystal formation to much lower temperatures. But these chemicals are highly toxic, and nobody knows how to remove these large quantities from inside the cells when the time comes.
In recent years there have been great advances in the choice of the preservatives, so it is now possible to lower the temperature to minus 124 degrees Celsius without occurring crystal formation. They are now using a technique called vitrification, wherein the molecules effectively stop wandering, as in a solid, but (contrary to a solid) they stay where they are without rearranging themselves into a crystal structure, so it has the properties of glass. This is a major advance because it minimizes damage to the cells. But the substances still remain extremely poisonous.
The goal of these companies is to continue with their studies to achieve the preservation of tissues at very low temperatures without the damaging crystal formation, but this time using non-toxic chemicals, or chemicals that may be easily removed when the time comes, without leaving any residual damage. How close are we to this is impossible to know. But either way, they hope that any damage done today when preserving a "patient" can be reversed by the Medicine of a distant future. That's why they still continue preserving customers who were frozen with techniques of the decades of the 60s and 70s, although they are known to be worse off than current customers. They argue that those pioneer customers are just going to have to wait more, while customers of the decades (or centuries) to come will be preserved with more advanced techniques and will be the first candidates for the reversal of the process, if this is possible.
But today, many critics say that the process of "preservation" cause even more harm to the body than the disease that the patient initially had, so that what will define when to attempt the resuscitation of a person will depend much more on Medicine's ability to repair these cells than if the cure for cancer or AIDS is available. It may happen that the cure for the initial disease lies some decades from now, yet nothing can be done for the person because body repair after the cryonics procedure would not be available so soon, and may continue not being available for many centuries.
Be it highly experimental Medicine or be it a unique type of burial for eccentrics, cryonics is not yet Science, for the simple fact that the experiment has not yet ended: trying to revive someone, anyone, has not yet been attempted. That future Medicine can get it is a matter of faith. Like the faith of some people makes them think of life after life in the traditional way, where one is reunited with her of his loved ones in Heaven, others expect to be reunited with their loved ones in the 25th century. Both views could be valid.
The price for this last will to be honored is US$ 150,000. Many simply pay with their life insurance, designating the specialized company as their beneficiary for when their final hour arrive. You will need about US$ 1,000 more per year to replenish the liquid nitrogen that evaporates, and this money often comes from the interests paid by a special bank account opened in perpetuity, to avoid importunating relatives. In developed countries these sums are affordable to middle class people, not just for millionaires.
Death is always a very sensitive issue, and points of view about cryonics are so many that certainly in the end opinions will be very personal.
Speaking of visionary millionaires, Walt Disney was not frozen: his ashes are buried in Forest Lawn Memorial Park, Glendale, California.
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Originally published in ABC Color, on 26 November 2006. Photograph: This large Dewar flask (thermally-insulated container that does not require electricity) contains several "patients" immersed in liquid nitrogen at a temperature of 77 kelvins (minus 196 degrees Celsius). Photo credit: Courtesy of Alcor Life Extension Foundation, 15 February 2004. Reproduced with permission of the Alcor's Communications Committee. Special thanks to D'Bora Tarrant for making this arrangement possible.