X-Message-Number: 7440
Date: 07 Jan 97 02:53:58 EST
From: Mike Darwin <>
Subject: Autopsy and Unfavorable Circumstances


Thomas Donaldson has requested that I back up statements about the percentage of
currently cryopreserved patients who have been autopsied or subjected to very
long delays as a result of thir circumstances of legal death:

>I'm still puzzled by the high percentage of autopsies. Would anyone explain?
>There other ways things can fall to pieces look like their statistics are
>appropriate, but in virtually all the reports of suspensions I've read 
>autopsy did not happen. So what's going on? (And I include here the reports by
>Alcor when Mike Darwin was a member and a major participant in Alcor's 
>suspension team). 20% just seems too high.

Thomas says "in virtually all the reports of suspensions I've read autopsy did
not happen." I'm afraid Thomas must have the selective memory we all suffer
from.  We tend to remember the detailed descriptions of the interesting cases,
not the short paragraphs announcing another badly cryopreserved "patient."

The following are the IDs of patients who were either autopsied or were ME's
cases with significant delays to treatment during my tenure at Alcor:

A-1171 Gunshot wounds to head. Autopsied.
A-1058 Sudden cardiac death. Multihour delay.
A-1108 Sudden cardiac death.  Multihour delay.
A-1242 Legal dispute. Autopsied
A-1268 Ruptured infrarenal aortic aneurysm with acute post surgical death. 45
minute delay till start of transport. No detectable response to CPR.
A-1196 Sudden cardiac death. Autopsied with multiday delay.
A-1057 Sudden cardiac death.  ME's case with over a day's delay.

I do not have statistics for ACS but believe the numbers are as high or higher.
The above numbers should not be taken to be some kind of attack or slur.  They
represent the reality that ALL cryonics organizations confront.


Perhaps more to the point is to consider (from the same time frame) patients who
had serious delays or suffered serious antemortem injury which interfered
materially with their cryoprotection (here I use cerebral edema or need to
terminate perfusion before the desired endpoint is reached) as the marker.

A-1142 Negligence by cryonics organization resulting in hours of warm ischemia
and no cryoprotective perfusion. (James Bedford, CSC's first patient).
A-1036 Antemortem cerebral edema due to toxoplasmosis infection of the brain.

A-1055 Antemortem cerebral hypoxic insult that resulted in persistent vegetative
state (PVS).
A-1082 Antemortem multi-infarct brain disease that resulted in PVS-like state.

A-1148 Profound pulmonary edema and antemortem hypoxia which prevented effective
restoration of circulation or gas exchange during transport resulting in hours
of warm ischemia.  
A-1169 Hours of severe antemortem ischemia/hypoxia.
A-1239 Post surgical death from cerebral edema following neurosurgery resulting
in hours of severe global normothermic ischemia.

Since I left Alcor, the number of patients who have experienced cardiac arrest
with minimal or no stabilization has remained high.  Brief CPR with
anticoagulation and packing in ice results in severely degraded ultrastructure
when followed by cryopreservation in animals.  I will just run down a list of

cases that come to mind that fit the catergory "grossly substandard or nonideal"
followed by the reason for this classification:

Jerome White: Severe antemortem brain injury from HIV encephalopathy and
toxoplasmosis gondii.  Severe antemortem hypoxia due to prolonged agonal
process.

Richard Marsh: Sudden cardiac death with hours of warm and cold ischemia.

Andrew Epstein: Unstabilized cardiac arrest while markedly hyperthermic.
Pre-existing CNS disease (glioblastoma multiforme).

Mona Dick: Sudden decompensation and cardiac arrest.  Multihour period of warm
and cold ischemia.

LS: Elderly NYC woman with Alzheimer's and multi-infarct brain disease.
Unstabilized cardiac arrest with over a day of warm and cold ischemic insult
before CPA perfusion.

Stanley Penska: Rapid decompensation with minimal cardiopulmonary support.
Developed cerebral edema during glycerolization.

LW: Intercurrent surgical death, subsequent ME's case with autopsy.

NT: Iatrogenic death during pleurocentisis, ME's case with autopsy.

CC: Seizures with rapid onset encephalopathy, ME's case without autopsy but
multihour delay.

HP: Unwitnessed cardiac arrest with secondary flaccidity and failed
cryoprotective perfusion.

I could go on and on.  In fact, it would be simpler by far to list the cases
where the patient's care went on under reasonably good conditions (in that not
only was good stabilization available, but the patient responded well as
indicated by good response to both CPR and subsequent cryoprotective perfusion)
and this I will now do.  I've ranked them by "*" with **** being the best:

A-1068***
A-1133**
A-1324**
A-1165**
A-1049***
A-1312***
A-1260****
A-1367**
C-2150****

So, out of the number of people now cryopreserved the 9 listed above were
treated (and responded) about as well as you could reasonably hope for.

Steve Bridge later comments:

>One thing not mentioned here or by Charles Platt in his reply is that 
>in five states (California, New York, New Jersey, Rhode Island, and Ohio, 
>plus a weaker statute in Maryland) an autopsy may be prevented in many 
>cases by a "Religious Objection to Autopsy."  If you have signed one of 
>these forms -- and someone will make the local coroner or M.E. *aware* of 
>it -- the only reasons an autopsy can be performed is evidence of a 
>dangerous contagious disease or homicide.  Even then, the law requires the 
>coroner to make the least damaging examination necessary.

This is a worthwhile suggestion.  But it does not stop the ME from taking
custody of the person and delaying by many hours the start of even basic
conservative steps such as application of ice.  Steve also uses the word
"evidence" the correct word is "suspicion" and it extends not only to homicide
in the narrowest sense, but to manslaughter and suicide.  Gross medical
negligence constitutes (or can) manslaughter.  And, what constitutes "evidence"
and "suspicion" are highly subjective things, indeed.

Sadly, one of the reasons that many people like Thomas have such a rosy feeling
about the  circumstances of the "typical" cryopreservation patient is because
adequate case histories have not been published.  CI has presented virtually no
hard data on any cases they've treated and thus their clients are excluded from

consideration here.  Recent Alcor cases have contained no significant amounts of

hard data, however the time lines and actions taken do allow for some assessment
of the case conditions.

Many of the cases done during my tenure at Alcor were never written up because
of a decision by Alcor to withhold the data necessary for such write-ups from

the only person fully able to write up the case summaries (i.e., me).  They have
also refused all requests to release raw data (minus patient names) to the

community at large so that everyone has access to the material necessary to draw
critical conclusions which will aid in improving the state of the art.

As Jim Yount of ACS once acidly (and quite correctly) pointed out, ALL cryonics

cases turn out well because "we always did the best we could and it could always

have been worse.  They tell you what went right, not what went wrong."  To which
I might add, it also helps that the patient is never around to disagree or
provide a second opinion.

 I believe altogether too much attention has been paid to the public relations
aspects of cryonics, and far too little to the harder and far more important
problem of achieving reversible brain cryopreservation.  Even the best of
currently employed methods result in serious disruption of the structural

integrity of the brain on every level.  It is important to note, as many critics
of cryonics have done (albeit in unhelpfully general terms), that most humans
undergoing cryopreservation today are _not_ treated under ideal conditions, and

are badly damaged.  In fact, most patients are treated under very far from ideal
conditions and examination of EMs from animals cryopreseved with similar
antemortem and postmortem injury yeilds little encouraging evidence that such
patients are rescuable by any technology we can now reasonably envision.   And
yes, this includes nanotechnology, unless the completely unwarrented assumption
is made that all significant structures which are missing in EMs have (luckily)
been degraded into invisibility via strictly non-chaotic Newtonian processes
which are inferable by inspection.   But what requires Nature to break down
every complex stucture into a jigsaw puzzle, so that little or no  information

is  lost?  The idea that this generally happens is nothing but  prejudice gained
from experience with the world at human scale (i.e., with pottery and shredded
documents and so forth), and one which cannot be expected to apply in the
coarse-grained and quantum mechanical world of molecules.

And of course, crude structural preservation by present and largely ignorant
criteria is by no means the only area that should be of concern to cryonicists.
While optimally applied contemporary methods of cryopreservation yield
encouraging ultrstructural results by some measures, it is also important to
point out that the significance of ultrastructure as evaluated using relatively
coarse methods (such as transmission electron microscopy) may not be sufficient
to insure survival and recovery of humans so cryopreserved.  While there is
growing understanding of the neurobiology of learning and memory, and
considerable speculation and research into the nature of personal identity, the
fact remains that the biochemistry and ultrastructure underlying these critical
elements remains unelucidated.  The foregoing is a rather complicated way of
saying what should be both obvious and taken very seriously: the only really

acceptable assurance that reversible human cryopreservation is being achieved IS
demonstrably reversible cryopreservation of the brain with acceptable
_mentation_ (i.e., function) as the endpoint.  In matters of survival, of life
or death, anything less than this is unacceptableand must be viewed as a
desperation measure of questionable merit (in terms of outcome for the
individual), at best.

In particular, cryopreservation of the terminally ill human using unperfected
and largely feeedback-free techniques is not a "no-load" proposition as many
cryonicists have frequently seemed to assume.  The procedure is financially
costly and materially affects the quality and sometimes the quantity of the
client/patient's temporal existence.  Loss of temporal financial value in terms
of dues, contributions, insurance premiums and interest on same amounts to

hundreds of thousands of dollars over the projected lifetime of the "average" 30
to 40-year old cryonicist.  Arrangements for cryopreservation also often
interfere with "alternative" or peer reviewed experimental treatments in
terminal cryonicists, and not infrequently have devastating impact on the
dynamics of family interactions during the dying process.  Cryonics is thus not
only unproven, but demonstrably a very costly proposition both financially and
psychologically for many who practice it.  

These costs must be weighed against the benefits (perhaps mostly psychological
at this point).  I believe that any careful weighing of costs versus benefits

leads to the inescapable conclusion that the best course of action is to improve
cryopreservation methods and to achieve reversible suspended animation, rather
than to focus primarily on recruitment of (using Bob Ettinger's recent words)
"numbers of patients (sic)  which could still be substantial on our scale of

business."  The difference here being that recruiting people to the unproven and
speculative "business" of post mortem cryopreservation which is virtually free

of meaningful real-time feedback, is a proposition quite removed from recruiting
people to participation and investment/contribution in a program of research
with a clear set of milestones and objectively verifiable goals, which results
in the development of a preservation procedure which people can have reasonable
confidence will actually WORK.


The absence of objective, scientific endpoints or feedback in the application of
cryonics today has led to acceptance and treatment of patients under conditions
which cannot be differentiated from that of ritual, perhaps with a veneer of
science.  The Cryonics Institute (Ettinger's organization), for instance, has
yet to publish even the most basic physical documentation of the procedure(s)
and conditions under which its human clients are prepared and cryopreserved.

Speaking of the public relations advantages of vitrification as applied to_human
patients_ using the enormously specific techniques developed for the _rabbit
kidney_, is grossly inappropriate,  at best.


Again, most patients who have been cryopreserved to date have been treated under
conditions that are at best described as dismal.  I believe this will not only
continue into the future, but will accelerate as more and more people choose
cryonics as a last minute alternative.  Leaving these last minute cases aside,
it is still wise to consider that cryonics clients/patients consist of people
who are DEAD by contemporary medical standards.  While such standards are
clearly flawed and inadequte, they are not quite so naive as many cryonicists
would like to believe.  After 25 years of delivering cryonics services in the
world beyond the rainbow I can say with deep sadness and regret that in my
considered opinion most of the people now frozen are "not only merely dead, but
really most sincerely dead," to quote the Coroner of Oz.  

Mike Darwin, President
BioPreservation, Inc.


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