X-Message-Number: 9927 Date: Mon, 22 Jun 98 13:39:52 From: linda <> Subject: Personal Statement and Directive Below is a copy of an Alcor form which was published in Cryonic magazine after the Joe Cannon suspension. We recently had a request for this form from a non-Alcor member. Readers of CryoNet may want to put this, or a similar statement, into their own files. The affirmation may help a judge give your statement greater credibility, rather than worry that you had made a hasty decision. The frequency with which one signs these affirmations should probably be determined by (1) whether or not it is a first affirmation or repetitive, and (2) how old you are (a 20 year old may only do this every 10 years, a 90 year old may want to do it annually). ************************************************ PERSONAL STATEMENT AND DIRECTIVE I, ___________________________________________, make the following statement and directive pursuant to making arrangements to be placed into cryonic suspension, paperwork dated: ____________________________. The relationship between physical illness and suicide has been well documented [Douglas Berger, MD, "Suicide risk in the general hospital", Psychiatry and Clinical Neurosciences (1995), 49, Suppl. 1, S85-89]. As I have chosen to be frozen when I reach a state of legal and clinical death, I am therefore concerned that my own mental state could be affected by my terminal illness in such a manner that I would either become suicidal or lose my desire to live, and hence my desire to be frozen. While I am healthy and of sound mind, I wish to make the statement that should I become terminally ill and decide to cancel my cryonics arrangements, I want my medical surrogate or other decision makers to consider such a change of mind to be invalid due to the depression caused by my terminal state. While in good health and sound mind, I firmly direct others to discount any desire to terminate my cryonics arrangements. I do not want my decision to be frozen to be compromised by my own maladjusted biochemistry or diseased physiology. Signed: _____________________ Dated:______________________ Witnessed by: _______________ Dated:______________________ Witnessed by: _______________ Dated:______________________ Affirmation: On this date, (date), I, ___________________________, affirm that I have re-read the above statement and directive and that I am still totally in agreement with this Directive. Signed: _____________________ Dated:______________________ Witnessed by: ________________ Dated:______________________ Witnessed by: _______________ Dated:______________________ Linda Chamberlain () CryoTransport Manager Alcor Life Extension Foundation Non-profit cryonic suspension services since 1972. 7895 E. Acoma Dr., Suite 110, Scottsdale AZ 85260-6916 Phone (602) 922-9013 (800) 367-2228 FAX (602) 922-9027 for general requests http://www.alcor.org Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=9927