X-Message-Number: 9412 From: Ettinger <> Date: Mon, 6 Apr 1998 00:23:40 EDT Subject: Morticians CRYONICS INSTITUTE 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 wasted. 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 initiative. 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 charge.) 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 hardship. 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 conference. 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 requirement. 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 http://www.cryonics.org Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=9412