X-Message-Number: 9412
From: Ettinger <>
Date: Mon, 6 Apr 1998 00:23:40 EDT
Subject: Morticians

24355 Sorrentino Court
Clinton Township MI 48035
Phone (810) 791-5961, Phone/Fax (810) 792-7062
E-Mail  or 
Web site <http://www.cryonics.org>

Can We Cooperate on Mortician Standbys?

[The following notes were written before my talk on Sunday, April 05, 1998.
This paragraph is written Sunday evening, after conclusion of the Alcor
conference. Thanks to Alcor, Fred and Linda Chamberlain, Mary-Margaret
Glennie, and the other organizers, participants (including featured speakers
James Halperin and Prof.Marvin Minsky), and attenders (not "attendees"). I
fear I was less tactful than I should have been in expressing skepticism about
the plans for BioTransport, but there is nothing mutually exclusive between BT
and a mortuary build-up. Art Quaife of Trans Time was present but has not yet
expressed an opinion, as far as I know. Brian Wowk of CryoCare expressed
guarded interest in preparing morticians at least to do washout. Individuals
in Alcor also expressed interest. We shall see. ---R.E.]
Cryonics Institute has begun to build a network of cooperating funeral
directors to assist in or perform initial phases of patient preparation, up
to--and sometimes including--washout and perfusion.

We can and will continue this by ourselves, if necessary. But the pace of
implementation, and the quality, could benefit from participation of other
organizations or/and their individual members. 

Instead of touching the bases to fill in the background, let me leave this for
an appendix. I think the appendix is important, because it relates to matters
insufficiently appreciated, especially by late comers. But it also involves
issues on which there are deep differences of opinion, unlikely to be
resolved, and I am concerned today primarily with practical matters and
questions on which we can agree.

The following brief background, then, is relatively non-controversial:

1. Many deaths of members of cryonics organizations occur at unexpected or
inconvenient times and places. This makes it difficult to have any assurance
of a well trained and well equipped traveling team on the spot when needed.
The simple logistics of travel almost guarantee many hours of delay in most
cases of sudden death.

2. If death is reasonably forewarned, traveling team standbys will usually
still involve unknown waits and sometimes false alarms. This is very costly in
time and money and sequestering of resources.

3. If the traveling teams are mostly professionals, costs will be very high.
If they are mostly volunteers serving without pay, there can be excessive
hardship on the team members and consequent lack of reliability and attrition
of teams.

4. Even if traveling teams are augmented by local volunteers, it is still very
questionable whether volunteers can be relied upon to leave their jobs and
other responsibilities at the drop of a hat, and to maintain their commitments
over extended periods of time.

5. For the foreseeable future, there will be many cases, for many reasons,
that are far suboptimal in terms of conditions and preparation at time of
death, regardless of good intentions on all sides. In many of these cases,
many of the usual "optimal" procedures will be irrelevant, money and time

6.  There are many localities where, any time in the relatively near future,
it is simply unrealistic to expect either a promptly arriving traveling team
or any local trained volunteers. This point is slightly redundant with some of
the others, but deserves mention because we are so thinly scattered, and
likely to remain so for many years. 

7. Dave Pizer for many years has tried to approach the problem with retirement
communities of cryonicists, adjacent e.g. to Alcor. This could work, but not
for the large majority of members, who simply will not relocate.

8. Mortuary personnel are widely available, usually cooperative, and usually
reasonably competent, reasonably priced, and very reliable. They have valuable
legal standing and are already trained to some extent in anatomy and surgery.
Many of them, in fact, are very sharp and capable of good judgment and

9.   CI research suggests strongly that promptness of washout and perfusion is
more important than the details of procedure. Obviously we would like to get
the best of everything--promptness and optimal procedure--but ideal
circumstances are seldom encountered. 

10 CI has already, in several cases, used local morticians to do washout and
perfusion at the geographical location of death. We do not have detailed
quantitative data to evaluate the results (one of many areas requiring
improvement), but, judging by such simple criteria as appearance of the
patients, verbal reports, some written reports, and time lines, these cases
seem to have worked out satisfactorily--much better than any available
alternative. In several states, our morticians have reached the patients much
sooner than any traveling team from out of state could have done. In Germany,
Albin's team from London was there much sooner than any team from the USA
could have been.

(Incidentally--although this is not the motive--CI may benefit a bit
financially in such cases. We do not reduce our minimum suspension fee of
$28,000 if washout and perfusion are done by a local mortician, and the
mortician is paid by the member, not by CI. But we supply solutions at no

The foregoing considerations together make a compelling case, it seems to me,
for other organizations to consider using a similar approach in appropriate
circumstances, and for organizations to cooperate in such efforts. Some things
to consider:

Legalities and liabilities will be a concern of both organizations and
morticians. We believe the CI type of contract addresses the problems
adequately. Others may want to modify their paperwork.

Alcor-specific questions:  CC is already committed to the subcontracting
concept, but Alcor so far, partly for legal reasons, offers only vertically
integrated services. However, Alcor is considering cooperation with CC and
perhaps others in a new transport/preparation company. In any event, Alcor
necessarily uses funeral directors' services on occasion, even if only for the
paperwork of removal of bodies. Hiring morticians for some preparation
services should not be much of a stretch from this standpoint. As the
organization with the largest membership, Alcor's participation would be
important in any effort to broaden the mortuary option.

American Cryonics Society (ACS)  subcontracts and is also trying to develop or
improve its own emergency service capability. ACS and its members could
benefit from enlarged and improved mortuary availabililty.

Trans Time (TT) offers both vertically integrated services and subcontracting.
Whether TT would be interested in sharing an effort to broaden and improve use
of mortuary services is something I don't know.

The potential administrative burden is a serious problem. If an organization
permits--or in the case of CI, recommends--that members at a distance make
washout or/and perfusion arrangements with a local funeral director, this is
an unwelcome chore for the member and a time-consuming (expensive) one for the
organization if it assumes the burden. Do you risk losing the member, or do
you spend a lot of additional (uncompensated?) time working things out member
by member? At CI, we have done a lot (relatively) of the latter. Our contract
says our responsibility does not begin until the patient is delivered to
Clinton Township--but in practice we do our best to assist the member in
lining up local help.

What does it cost, and who pays? Using simple washout and perfusion
procedures, and supplied solutions, funeral directors have typically charged
from $2,000 to $3,000 plus air fare per suspension.  More elaborate procedures
would naturally cost more per case, and would also require additional
training, for which the mortuary staff must be compensated--although some will
undergo training without charging for their time, just because they are
interested.  There should be at least an  annual refresher and check of
supplies, and a fee paid to the mortuary for this. 

If more elaborate procedures are desired, or special equipment such as a
thumper, then costs of equipment, supplies (and re-supply), and training could
come from more than one organization and more than one member, in some cases.
The total would not be large as a percentage of the basic suspension fee of
Alcor, CC, ACS, or TT. Remember also that, if the mortuary does washout or/and
perfusion, the expense at the organization's facility, or that might have been
spent on a traveling team, is reduced.

Wealthy members are not rare, at least in Alcor, according to Dave Pizer. I
think he said there may be 50 millionaire members and a few with assets of
over a hundred million. Obviously, none of these has made what some of us
would consider a commensurate commitment; but they ought to be willing, at
minimum, to significantly improve their own chances by paying for high-level
training and equipment of nearby morticians, instead of waiting probably many
hours for a traveling team. Many other members of all organizations, while not
millionaires, do have considerable discretionary income, and in some
localities several together could invest at least a few thousand without

BioTransport Inc. (BT) is a proposed new company that will gradually take on
contractual responsibilities, first for Alcor and CC and then perhaps others,
for standbys, washout and perfusion and initial cooldown. Several pages were
devoted to it in the Feb/Mar issue of The Alcor Phoenix, and on April 4 (after
this is written) the Chamberlains will doubtless have more to say at the

From what I gather, BT is envisioned as achieving and maintaining the highest
(and constantly growing) professional competence as well as reliability, with
training and equipment supplied by Twenty First Century Medicine (21 CM) and
BioPreservation (BP). It is intended to be a for-profit company, but with the
single focus on cryonics emergency service.

With all due respect to those involved, this seems to me totally
unrealistic--even given that it may take several years to develop. Perhaps
information available on April 4 will change the picture materially, but that
would surprise me. Who will put up the money? How will Alcor and CC (and
others) pay for the services? How can the market, within just a few years,
possibly support a full-time team of top-flight, hair-trigger professionals? 

From the published information, BT is envisioned as eventually serving (at
least) all CC and Alcor members--but this scarcely seems possible, just on
cost considerations alone. Maybe Alcor and CC have some rabbits in their hats,
but at present--and at best--a full-fledged BT is only a possibility in early
planning stages.

Meanwhile, members and would-be members are dying. And in any event, even
given all of everyone's druthers, we are still faced with the adamantine facts
of logistics: far away is too far away for prompt attention. An ambulance in
Los Angeles cannot serve a patient in Peoria.

IMPLEMENTATION of Mortuary Expansion and Upgrades: If leaders of other
organizations are willing to consider adding this arrow to their quivers, they
need first to set initial targets for training and equipment. These should not
be unrealistically high, but must be such as clearly to improve the patient's
chances, compared to waiting for a traveling team.  We can then consult on
practical approaches, cost sharing among organizations and members, initial
target locales, and so on.

In Sum: I have made the suggestion that some or all of the cryonics service
organizations, and some of their members individually, cooperate in training
and equipping funeral directors to offer emergency cryonics services, up to
and including washout and perfusion. If and when leaders of those
organizations express interest, and offer estimates of desired levels of
training and equipment, Cryonics Institute will work with them to implement
the program.


APPENDIX--Some Background Reminders

The most sophisticated of current cryonic suspension procedures are already
too expensive for the average person. Future improvements seem likely to raise
costs significantly further.

The most sophisticated procedures presumably improve the patient's
chances--but no one knows by how much. It is entirely possible that a full-
fledged nanotechnology, or equivalent, will be both necessary and sufficient
to rescue any of today's patients. See the CI web site for background in both
cryobiology and probability theory. http://www.cryonics.org

Technical evaluation of the relative merits of various current procedures is
somewhat controversial, but CI will provide technical details, including
copies of light and electron photomicrograms, and professional reports, to
those who want them.  CI policy is to improve our methods as evidence suggests
and as we are able--but with emphasis on verification of results in our own
lab as well as the labs of independent professionals. Our methods have
eliminated the cracking problems previously reported.

Any individual member of (almost) any organization (including CI) is free to
choose a more expensive preparation procedure in the open market, if he
prefers it to the standard procedure of his own organization. The CI minimum
suspension fee of $28,000 for whole-body means that, even if CI is used for
storage only, the total is still less than with other choices.

To have any reasonable or relatively good chance of rescue, you must be frozen
at death. To allow the "best" to be the enemy of the "good" can be suicidal. 

Rescue also requires that, once you are frozen (in cryostasis), you stay
frozen. If your organization folds, it will not matter how sophisticated your
preparation was. Prospective stability of your storage organization is a prime

CryoCare envisions possible transfer of patients if the initial subcontractor
fails, and individuals can make backup arrangements of various kinds, but
these are expensive options. 

On the other hand, some have made other organizations first choice, with CI as
prepaid storage backup. This is relatively cheap--for whole-body it only adds
around 25%  or less to the total cost.

In Michigan, and probably in other states, only a licensed mortician can
legally cut or inject a dead person (with obvious exceptions for pathologists
and medical schools). 

Bringing morticians into the act is a step toward using the establishment,
rather than fighting it. We need allies, and will need them more when we grow
and enemies no longer find us too small a target.

Many medications advocated by some organizations require prescriptions, and
use in cryonics could mean legal exposure. CI uses only substances legally
obtainable without prescription. (In some cases, the equivalent of a medicine
is freely available as a chemical.)

To have any chance, you must make a decision before you lose the capability. A
commitment can always be changed, usually at relatively minor expense, but a
failure to commit can mean oblivion.

Robert Ettinger
Cryonics Institute
Immortalist Society

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