By Kristina Smith and Andria Bianchi

Case: Sasha is a 60-year-old neurologist and researcher who is interested in concepts of life, death, and consciousness. Sasha is aware of the ethical complexities that can arise in relation to death determinations, the most common of which is that some people may not recognize brain death as a legitimate type of death (as noted in a previous column). In his recent readings about death and consciousness, Sasha discovered a practice that is referred to as cryonics; this is when a person is declared legally dead, yet their body is preserved by cooling it to a liquid nitrogen temperature so that any further decay is halted. The goal of cryonics is to enable cooled bodies to regain consciousness in the future as a result of anticipated scientific advances.

After much contemplation, Sasha decides that he wants to undergo cryopreservation once he is declared dead. He registers with a cryopreservation lab so that they can support his body’s preservation. In order to ensure that this autonomous wish is respected, Sasha develops an advance care plan which states that: (1) if he has a heart attack then he wants all measures to be taken to keep his body alive until cryonics staff arrive and can transfer his body to their laboratory and/or (2) if he is declared dead then he wants his body to be immediately cooled so that there is still a potential for cryopreservation.

As mentioned above, the goal of cryonics is to preserve a person’s body after they are declared dead with the goal of reviving it through future scientific advances. Robert C. Ettinger originally introduced the idea of cryonics in his 1962 book The Prospect of Immortality. In his book, Ettinger says that most human beings “have a chance for personal, physical immortality” since, at very low temperatures, biologically dead bodies (namely, corpses) can be preserved with minimal deterioration (p.1). And if corpses can be preserved, then irreversible death may be preventable if science learns to revive these bodies and to cure them from diseases that may have previously influenced their death. Ettinger uses the term “suspended death” to refer to a dead body that has been frozen and preserved.

The purpose of Ettinger’s book is to argue for the potential to achieve immortality. At the start of his book, he says that his goal is to show that: (1) immortality is attainable; (2) immortality is practical and does not raise any overwhelming new problems (since a revived person will resume life as per usual) and; (3) immortality is desirable.

Regardless of whether new obstacles arise, however, it seems inevitable that some significant ethical questions and issues will occur when it comes to practicing cryonics. For instance, if a person has been pronounced dead and their body is being preserved (and if the person may become conscious in the future), then will they continue to maintain rights (e.g., the rights that are associated with being a citizen)? Relatedly, is the deceased (cryonics) body considered to be a person? Some theorists suggest that persons have certain traits and characteristics, such as being able to think or communicate in a particular kind of way. So, depending on one’s conception of personhood, then it seems as though a corpse may or may not be considered a person and their rights will differ depending on how they are classified. Furthermore, how should a revived person’s family treat them and what would their obligations be? For instance, would a family member be financially responsible for the revived person?

Another concern that influences all of society is that of resource allocation. Given the scarcity of resources that currently exist in our medical system, it is worth asking how many and what kinds of resources should be allocated to a dead body. Is it ethically defensible to contribute medical, social, and other resources to a person declared dead? Relatedly, if a person is revived, then should they be allocated as many healthcare (and, perhaps, other) resources as individuals who have contributed to society in recent years? In regard to the above case, one might ask whether it would be fair to provide Sasha with scarce healthcare resources in order to maintain his life post-cryopreservation? Some people may argue that Sasha has already had his fair share of resources allocated to him; no more resources ought to be provided to cryopreserved bodies post-revival. These resource allocation questions are classified under the category of distributive justice, which considers what fairness means when it comes to distributing resources.

Another ethically relevant concern is the rights and, perhaps, the dignity of the healthcare team. If a healthcare team member does not agree with the practice of cryopreservation because they think that it is immoral, then should they be involved in caring for someone like Sasha? Should they be allowed to exercise their right to refuse to provide treatment to Sasha on moral grounds (in other words, conscientiously object)? The dignity of the person is also an ethical concern. For example, if Sasha were successfully revived 50 years into the future, would he have family and/or friends to care for him? If not, then would he be able to live a quality of life that is meaningful and promotes happiness? Finally, it is important to consider the principle of non-maleficence (that is, to do no harm) when considering the family members of a cryopreserved person. By preserving their loved one and maintaining hope that they may be successfully revived, a family may be less able to move on with their own lives and accept death, which may potentially cause unnecessary suffering.

Given current and ongoing scientific advancements, cryonics is an important issue that deserves increased attention. Cryonics presents a unique case for the medical system and society, with the prospect of preventing a permanent death. However, it is necessary to carefully consider the multi-dimensional impacts of suspending death, and how the potential negative outcomes of cryonics can be mitigated. Several ethical concerns have been illustrated in this short article, in part, to promote a larger dialogue around the possibility of immortality. Although cryonics is not yet practiced globally, it is increasingly attracting more clientele, and as a result, there is an ethical obligation to carefully consider the potential positive and negative consequences.

Kristina Smith is a PhD Candidate in the Faculty of Kinesiology and Physical Education, and is completing a collaborative degree with the Joint Centre for Bioethics at the University of Toronto.

Andria Bianchi, PhD, is a Bioethicist at the University Health Network.