X-Message-Number: 26011
Subject: Living Will and Beyond 
Date: Wed, 13 Apr 2005 22:17:19 US/Eastern

   In CryoMessage #25915 James Clement offered a Living Will which
might be suitable for cryonicists:


   As a result of some prodding, I have decided to share on CryoNet
what some of us in the Toronto, Canada cryonics Local Group have
developed. The Living Will creates a written testament which can
be used in a court of law, and which can also be used as guidance
to an agent who could act on behalf of the patient. In a hospital
situation, few people have time to examine a Living Will, but an 
agent is an active entity who can insist on attention.

  Therefore, a Living Will should be used in association with a 
Durable Power of Attorney for Health Care (or Power of Attorney for 
Personal Care, as it is called in Canada). 

   With some input from me, Christine Gaspar (emergency nurse) and 
Bruce Waugh (lawyer) -- cryonicists all -- drafted a Power of Attorney 
for Personal Care, which is associated with a Living Will (guidance
to the agent). The document includes references to Canadian statutes,
which would obviously be inappropriate for the United States:

old version:    http://www.cryocdn.org/attorney.html

   The emphasis in that document is on maintaining life support
until a cryonics emergency rescue team can be assembled and to
withdraw life support once the team is ready. 

   Christine advanced the position of maintaining a person on 
life support if there is no ischemic damage. I agreed with this.
If I or Christine are on life support and recovery is unlikely, 
removal of life support and cryonics are ONLY to be undertaken if
remaining on life support is likely to increase ischemic damage. The 
fact of being in a vegetative state is irrelevant. A person
in cryostorage is in a vegetative state. If being on life support does not
result in ischemic damage, then we would both prefer to remain in that
state rather than be cryopreserved. The chances of medicine discovering
a cure for the condition causing our vegetative state may be better
than the chances of medicine discovering a way to revive us from cryostorage.

  To make this point more clear I modified the document. I removed the reference
to the vegetative state and stressed the fact that life support should continue
if no ischemic damage is being done. I also added a reference to other kinds
of damage -- the most serious being to the brain or the blood vessels (damage
to the latter would damage the former, anyway). 

I placed the new version of the document on the CSC website:

new version:   http://www.cryocdn.org/attorney2.html

Christine also raised another complication, which I don't particularly
want to concern myself with unless someone can suggest an easy
solution. Namely, the definition of life-support. By her definition, life
support can include something like intubation, which assists a person
in breathing. Removal of this form of life support won't necessarily
lead to immediate deanimation -- it could take hours or days to
choke to death. It seems to me that this form of life support is
far less common than the form associated with immediate deanimation
upon removal. It is also not likely to lead to ischemic damage, and
therefore would not be relevant.

Even this leaves a few loose ends. There may be situations in which
maintenance on life-support leads to increased ischemic damage and
yet there is some (small) hope of recovery. Then the question might
be *how much* ischemic damage and *how much* chance of recovery? And
how does one assess that ischemic or septic damage is not being done?
A person in a vegetative state can easily acquire infections. 

Another more likely problem is the availability of the person who is the
Power of Attorney. Most of us are geographically mobile, so the Power
of Attorney would probably have to be making an assessment and
giving instructions by telephone. Would this be a problem? Will there
be a problem when it crosses national boundaries? The document does not
sufficiently address the problem of non-availability of the Power of
Attorney. Ideally there should be a list (in prioritized order) of people
who could take the role of Power of Attorney. Also, the authority of 
Power of Attorney ends at declaration of death. There should be some
means of maintaining a Cryonics Surrogate after declaration of legal 
death -- someone who could have the authority to deal with problems
and contingencies that might arise (NOT necessarily the next-of-kin). 

It simply is not possible to anticipate and give directions for every
possible scenario with absolute precision. There is a far greater danger
in making no arrangements at all because of intellectual paralysis
over the incompleteness of the directives. I prefer to take the risk of
incompleteness rather than the risk of doing nothing. Anyway, an
incomplete directive can be revised in the future 
(case in point: attorney2, with attorney3 in the making). 

                   -- Ben Best

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