X-Message-Number: 2942
Date: 25 Jul 94 04:49:46 EDT
From: Mike Darwin <>
Subject: SCI.CRYONICS dehydration

Ben Best asks some further questions regarding dehydration and euthanasia for
cryonics patients.  


<Is dehydration the only form of suicide which can be used to avoid autopsy?>

That depends on how you classify "suicide."  For instance, a patient who is
terminally ill may choose (or have his medical surrogate choose) to forgoe

medical therapy which will rather immediately cause cardiac arrest.  I give here

two examples: ventilator support and oxygen administration.  I have seen several
patients die after making a decision to turn off the oxygen which they were

getting by mask.  Turning off ventilator support is usually quicker, although to
the best of my recollection I can't remember having seen this in a cryonics
setting (I've seen it many times in-hospital).  While these kinds of things are
technically euthanasia, they are *passive* euthanasia and are therefor
considered legal. *Generally.*

And there is the catch.  I expect that sooner or later in a cryonics situation
the decision to terminate oxygen or ventilator supporty will be challenged as
active euthanasia because of a disagreement over the patient's salvageability.
For instance, if you were an otherwise healthy 25-year-old with pneumonia with
good prospects for recovery I think more than a few eyebrows would be raised if
someone decided to turn your oxygen off and freeze you.  Unfortunately, as you
will soon see,  if you are reading my book chapters as they are posted, not all
situations are so clear cut.  Sometimes things are muddier.  Mud attracts
lawyers, prosecutors and the media.  A bad combination.

<Would any legal jurisdictions require autopsy for suicide by dehydration
under certain circumstances?>

I had the same question myself when I started writing the book on standby.  I
called around to nearly 30 different counties in 10 states and asked the
following question:

"If a terminally ill patient who was not imminently going to die (i.e., was
perhaps several weeks to a month or two from death and was not frankly agonal)
decided to die by dehydration in order to facilitate a good cryopreservation
would you consider this a coroner's case?"


3/4ths of the Coroners or MEs I queried said "yes."  To those who answered yes I
asked why they would consider this a Coroner's case.  Answers varied but
basically it went like this:

"The critical difference here is that the patient is not *unable* to take food
because of pain or illness, but is consciously deciding on a course of suicide
in order to undergo an (put correct word here) "fraudulent", experimental", "
unproven", procedure.  

In some cases I rephrased the question to simply state that the reason was that
the patient did not want to undergo the disease-related aspects of the dying
process.  This did not seem to affect outcome much, but I didn't keep precise
records.


So, to answer your question,  a lot depends on the nuances.  And yes, I wouldn't
be surprized to see a cryonics patient seized at some point for committing
suicide by dehydration when it was not "medically necesssary" (whatever that
means).

<What brain damage is done by dehydration?>

Good question.  Short answer: probably little or none.  The big problem is a

long period of antemortem shock and that happens pretty much routinely except in
cardiac, hypoxic or hemmorraghic death.  In other words,  many if not most
cancer patients, AIDS patients, the elderly,  and so on, actually die of
dehyration.  This did not used to be so since it was once considered a black
mark on a resident to have his patient "die out of balance" (i.e., with screwed
up electrolyes; high sodium, etc., and dehydrated).  Alas, we live in more

enlightened times and keeping *everybody* nicely hydrated right up until the end
is no longer done.  I might also note that death by dehydration is relatively

painless and there are an increasing number of articles in the literature noting
this fact and urging clinicians to allow this course to occur in their dying
patients.  Indeed, the last issue of the JAMA has a nice article about a
physician's mother who checked herself into the hospital to die by dehydration.
Steve Harris, MD also has several cites from the literature on this subject
which I would appreciate his posting (I need them as references for my chapter
on passive euthanasia).


Dehydration also causes blood hyperviscosity, hypercoagulability and makes CPR's
effectiveness problematic.  Some of these problems can be overcome by prompt
rehydration after cardiac arrest.  Others (like premortem clotting) are not so
easily overcome, but are (in my experience) rarely a serious problem.  I think
the big problem is the long period of agonal shock and questionable brain
perfusion.  However, even here the situation may not be as bleak as I've
previously thought.

<Is cryonic perfusion compromised in a dehydrated patient?>

Theoretically, this could be a problem.  I will say that I've seen or heard of
the following problems related to dehydration:

1) I have opened the femoral artery on one patient where I found a large clot
obstructing the vessel.  This is remarkable because the patient was promptly
heparinized and rehydrated *immediately* after legal death and the patient was
operated on less than 90 minutes later.  Most significant, the clot was large,
dark, and retracted and it was both Jerry's (Leaf) and my opinion that it had
formed *premortem* during the period of agonal shock and hypoperfusion.  I
understand that Alcor had another case where this occurred after I left.

 Similarly, I have seen post mortem lividity start to develop in patients
*before* they were dead.  In one (noncryonics) hospital case I saw a patient
(still barely conscious) begin to experience rigor mortis in his lower
extremeties *before* death occured (by about an hour!) due to failed peripheral
perfusion.  In this case it is worth noting that the patient's brain was still
being perfused because he asked me why he couldn't feel his legs!  His lower

extremeties were purple, he had dependent lividity (blood pooling in the skin on
the lower part of the limb) and full rigor in his toes and calves.

2) If rehydration, heparinization, etc., are delayed in dehydrated patients it

is possible that they will clot completely and be unperfusable.  Reportedly this
happened in a Trans Time case, although I have no direct knowledge here, only
second hand details.  Morticians run into this with some frequency: their
response is to just crank up the pressure and ram the fixative into the tissue
until the body plumps up pleasingly (20 psi.).  This is not an option open to
us.

<Could a patient get-away with self-infection by virulent microbes?>

Probably.  You could probably "get away" with all sorts of things.  But for how
long before you are caught?  If you mean would such a course be legal?  I doubt
it, but I do not know for sure.

It would be an ugly way to die and quite possibly a brain disrupting one.  Bugs
sometimes colonize the brain in overwhelming sepsis.  The brain doesn't look so
hot afterwards.  Consult a textbook on neuropathology and look at post mortem
septic menningitis brains.

All of these questions beg THE QUESTION and I'm not sure which version of the
question you asking:

1) Is there another legal way (other than dehydration) to commit suicide?

OR

2) Is there an illegal way which is almost foolproof to do so and not get
caught?


The answeer to question # 1 is above in the commentary I've made (as muddy as it
may be).

The answer to question #2 should probably come in the form of tract published
overseas and available much like the Hemlock books.  Cryonicists could then
choose to use or not use such advice privately and on the basis of a personal,
closely held decision which even the cryonics team should not know about.
Sorry, but I'm not the guy to help you out there and I would caution that there
are always risks no matter how foolproof the scheme.  I certainly do not think

cryonics organizations should distribute such a book, but related organizations,
perhaps like the Venturists, might.

In most cases dying can be made relatively painless (although making it less
humiliating or degrading (a quiite diffrent issue than of physical pain) is not
yet possible: somebody still has to wipe your bottom, feed you, etc.) and the
brain can be spared without recourse to illegal or questionable maneuvers.
However, the real problem here is with the patient's psychology, as I've
previously delineated.  And that is a problem which is far more difficult than
any of the others you've raised.











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