by Carlos Mondragon
Director, Alcor Foundation
As presented at the Cryonics and Life Extension Conference, Ontario, California, November 5th, 1994
For persons entering cryonic suspension in the twentieth century, and for some decades beyond, the success of their venture will be determined primarily by two contingent future circumstances: the development of repair technologies; and the survival of the organizational vehicle which they selected to transport them into the future when those technologies will exist. It is the latter of these factors over which all consumers of cryonic suspension services have some degree of choice and control, and with which this paper is concerned.
There are some very optimistic cryonicists who foresee the arrival of "full-blown" nanotechnology (or perhaps more appropriately, Nanotechnology) very possibly within the time they have left before cryonics becomes a personal necessity. I am not among them. I believe that it may very well take centuries -- a multiple of maximum human lifespans before anyone suspended with the best of current methods will be repaired and revived. And notwithstanding the accuracy of this assumption, it is still the wisest course of action to plan and proceed as if it were a given. The creation of organizational vehicles that will survive us and our immediate successors is thus an imperative.
We are seeking not just to establish a successful business enterprise, but rather an institution. An institution that will survive with its vision and purposes intact, one that will always value the potential lives of its charges and never lose focus on its mission of restoring those lives. Yet it must be an institution that will be flexible enough to make adaptations appropriate to evolving human society. And it must be an institution strong enough to withstand trials that we cannot, at the moment, foresee.
An often heard objection by those considering cryonics for the first time is that very few non-governmental organizations endure for centuries. True, but there are some. The oldest of these is, of course, the Roman Catholic Church (though for over half its history it functioned as a government). There are a few robust universities that were chartered over a thousand years ago, and many that are at least three hundred years old. And there are scores of hospitals, special interest societies, and charitable foundations that have also made it past the three hundred year mark. In Europe there is no small number of profit making businesses that are equally old. One will not find a structural, i.e. constitutional, arrangement common to all the examples listed above. They do, however, share one important common feature: a sense of "apartness" (in some cases alienation) from the environment in which they exist, and even from the communities they service. This comes from a shared belief in, and enthusiasm for, the purpose and/or mission of the organization on the part of its human controllers. There may be myriad psychological factors which maintain this attitude (religious fervor, egotistical elitism, family loyalty, etc.), but fortunately, finding this focused, single-minded sense of purpose in cryonics is not a problem if our priorities are set starting with our longest range problem.
In addition to the far-in-the-future organizational goal of restoring suspended patients to life and health, the cryonics consumer must also consider the issue of his/her own entry into cryonic suspension. In the past two years, there's been much discussion in the "cryonics media" of the apparent or potential dissonance between the interests of those who are already in cryonic suspension and interests of those who have arranged for that eventuality. It's been often repeated that "members" and "patients" necessarily have differing priorities.
The obvious point most often made is that an organization that holds as its first and absolute priority the long-term care and survival of its suspended patients must, by definition, give "only" second priority to its ability to serve its animate members. Leaving aside the mundane and day to day services of providing information, publications, and adequate legal preparation, just what exactly is the "service" that a member expects?
Barring a case of sudden deanimation, we expect that our bodies will be promptly, competently, and with the best available technology, be prepared for our descent to a cryogenic temperature that will, with any luck, seem like only a long sleep. And because state of the art cryonics technology is a long way from anything any of us would call "perfected," we also anxiously expect progress in this area. It is here that competing interests are perceived.
This perceived competition is not so much for resources, time or attention: these are priorities that each of us as free-acting individuals can directly affect regardless of the structures of the organization(s) with which we have contracted. Rather it is the assumption that there will occasionally be available courses of action expected to benefit the about to be or newly deanimated patient, and that these actions may not be in the best interests of "older" patients. Conversely, it has been postulated that enormous funds held as capital needed to indefinitely maintain patients could be managed so as to benefit animate members at the expense of patient safety.
So far, all organizations which are accepting legal and (in most cases) financial responsibility for the long-term care of patients have incorporated themselves as non-profits for two obvious reasons. First, the English speaking world (where both the idea and practice of cryonics originated) has had an old and firmly established body of legal tradition which recognizes these forms of incorporation. Second, the profit motive, while respected by nearly all cryonicists, only serves to create an efficient market when checked by the free ability of consumers to withhold or change their patronage, and frozen patients are by definition helpless wards. At times there have been close associations between these organizations and for-profit business that provided various degrees of service.
A brief summary of extant variations will provide context, before attempting to analyze options:
The discussion of organizational models has been revolving around the classifications of "full-service" versus "unbundled." This division, while having the virtue of being an easily understood absolute, is a gross over-simplification. Any organization that so much as purchases chemical supplies from outside vendors is not completely vertically integrated. And one can also apply that reduction to the unbundled mode. Further, the concept of an independent service contractor includes both providers selected and employed by the cryonics organization, and those that might be selected and employed directly by the client: a distinction that becomes important as we proceed.
Following the typical (and admittedly idealized) course of actions and events which comprise the cryonics concept will reveal all the points at which the use of an unbundled service provider might be proposed.
Marketing: Exclusivity not being the goal of any organization, marketing or some sort of public relations function is needed to attract members or clients. At a minimum, organizations wishing to keep their existing supporters produce regular publications. Beyond that, selling efforts can run from the extreme of avoiding all publicity (as Alcor did prior to 1988) to outright nationwide advertising (as Alcor does now). Contractors can be used to provide this service, and when economically feasible it makes sense that organizations would make the ordinary business decision of either using them or hiring professionals as employees, or both. My opinion is that there is no rationale for putting this decision into the hands of organizational supporters, except insofar as they may occasionally make a directed contribution or take action independently on behalf of their organization.
Legal Arrangements: A person arranging their own cryonic suspension, having selected an organization, must complete legal paperwork. Every organization currently handles this task internally, though it is perhaps one of the jobs most easily assumed by a contractor. Aside from the issue of cost to the member, the cryonics organization must consider the quality and honesty of the sales efforts that contractors employ. This would at the outset place a limitation on the client's choice of providers since no organization (or so I would hope) would want to accept members whose understanding of cryonics had been mainly supplied by a questionable marketer.
Financing: In tandem with doing the paperwork, financial provision must also be made. Since no cryonics organization has seen fit, as yet, to provide a life insurance product, all consumers who use this overwhelmingly popular form of funding have many options. The potential economic and administrative advantages to offering a life insurance product are great, however. I have no doubt that once the risk factors can be affordably dealt with, this facility will be integrated into an existing organization's services.
Emergency Response Capability is much more interesting. Given the geographic dispersion of cryonicists, this is the one task for which independent contractors would be most useful. Unfortunately, the most likely candidates to take on this job are existing paramedic and emergency room networks -- no help there. . . yet. Very likely the first truly capable providers of this service will evolve from regionally defined groupings of cryonicists (there is some evidence for this already). There is no apparent reason for cryonics organizations not to encourage the establishment of independent emergency service providers, giving the widest possible selection to the consumer. It's just that the same economic constraints that prevent the cryonics organization itself from building widely dispersed emergency capabilities will also inhibit their independent formation for some time to come. But progress is inevitable.
Since emergency response is considered the "riskiest" stage of the suspension process, both legally and logistically, some advocate that the cryonics organization should accommodate any emergency response selection made by the client. The organization that does so should be cognizant of the fact that such acceptance is an implied and explicit endorsement: The "client" can only be legally touched by a human actuator from the emergency service provider upon legal death. At that point, the client is a patient of the cryonics organization into whose legal custody his/her body has been entrusted. Whether or not the provider is somehow affiliated with the cryonics organization, or is as distanced as legal machinations can make it, has no impact on the responsibilities of patient care.
The argument that only the individual patient would be affected by the selection of an embalmer, or untrained volunteer, or psychopathically reckless emergency response provider is a fallacy. By accepting responsibility in perpetuity for the care of the patient, the cryonics organization has, at the very least, created an implied degree of warranted competence and expertise. Thus a fatal error at this point in the cryonics process not only rests on the shoulders of the cryonics organization, but also potentially effects all other patients and clients of that organization.
Should a brilliant legal mind at some time in the future succeed in fully insulating the cryonics organization from all possible consequences of unendorsed selections in this area, the idea then fails because other clients of the independent provider are potentially "naked" once an irresponsible or incompetent provider collapses.
Finally, the strongest argument in favor of the use of internal, affiliated, or endorsed emergency response providers is that they do and would bring with them the support of the cryonics organization (the issue of cost to the cryonics organization is addressed below). This support could make the difference between life and death for the individual patient. As a positive factor, this argument also applies to the next phase of the suspension process.
Cryoprotective Perfusion doesn't carry the legal risk of emergency response; however it is as logistically complex, and it necessitates a level of expert skill that is much harder to come by. Here, the need for multiple and geographically dispersed providers is minimal. Having a redundantly equipped perfusion capability in at least one location and another in a location distant from the first would suffice to meet all but the most unlikely contingencies. Given the capital required to establish this capability, multiple choices aren't on the horizon in the near future. But we can expect the availability of more providers in the future. In contrast to the probable evolution of some local groups into emergency response providers, we are more apt to find established medical facilities interested in providing perfusion service. Unlike medical emergency response systems, some hospitals with perfusion capability have the economic problem of under-utilized capacity, a problem that can be addressed within the financial limits of a cryonic suspension to mutual benefit. While growth and acceptance of cryonics will make the use of such providers possible, all the considerations applied above to emergency response are equally valid here. Ideally, cryonics organizations will continue to provide for cryoprotective perfusion services on behalf of their members as they do now, either internally, or by using contractors, or both.
Long-term Storage and Care providers as menu options available to members of the cryonics organization is even more problematic. The first obvious pitfall is the question of how a frozen person can make these choices. Scenarios for addressing the problem involve a series of "patient representatives" appointed by the member prior to deanimation. Even in well established trust law, there is no guarantee of perpetuating one's wishes beyond very near-term and specific directions. To expect that successive generations will continue to have an interest, let alone make decisions as we would, is hopelessly optimistic. These scenarios multiply the essence of the problem that is the focus of this paper by the number of people going into suspension!
Less problematic is the possibility that the cryonics organization, as legal custodian, would entrust the physical storage of patients to a contractor. But by doing so, the organization becomes disconnected from the reality of having that day to day responsibility and that disconnection would very likely lead to a bureaucratic attitude of administration that comes with having authority without responsibility. Not unlike people who produce offspring, but only see them for a few minutes a day -- after the nanny has cleaned them, fed them, dressed them up, and brought them downstairs for a ritual peck on the cheek.
Finally, assuming that the contractor is a profit-making firm, there is the constant pressure to contain costs. Thinking that oversight provisions could safeguard against any wrongdoing here is recklessly naive. And even if this were not a worry, the spectacle of a caring storage contractor going hat in hand to the cryonics organization for necessary, but extraordinary funds, or worse yet, having to go to the money-managing contractor (more on that below) is no less distressing. It is best that those who are supposed to care about you are also caring for you.
Financial Fiduciary Responsibility is the most intellectually challenging and time consuming duty of patient care (provisioning liquid nitrogen and physical security are relatively straightforward). Clearly, use of professional investment managers is a good idea. But for reasons alluded to above, turning over control and decision-making power to such professionals is unacceptably risky. Indifference, bureaucratic delay, or just plain lack of understanding is easy to imagine as a cause of problems. This does not preclude the use of legal instruments, such as trusts, to insulate and protect patient care funds from exposure to the risks of litigation or insolvency. Using any available legal mechanism for the protection of these funds would be prudent, as long as such mechanisms do not vitiate the actual mission of patient care.
Research that is relevant to cryonics can be targeted toward reduction of ischemic injury, development of reversible suspended animation, improved storage technology, incremental advances in these areas, and eventually revival technology. In all these cases, it makes little difference what organization does the work, or how it is funded. Although cryonicists will themselves provide the funds and impetus for research that is directly pertinent, an enormous volume of discovery and innovation has, will, and continues to be generated by "mainstream" investigators with no interest in cryonics. Only the prioritization of avenues of research brings moderate controversy within the cryonics community. The resolution to such disagreement is, as it should be, in the marketplace.
Revival (the physical act of, as opposed to the research leading to its possibility) is the reason for being of the cryonics organization that will have legal responsibility for suspended patients. This may seem axiomatic, but it isn't (at least not for some people). I have heard of some individuals developing schemes and putting substantial resources into attempts at personal control and/or influence. These schemes range from the potentially useful creation of supplementary financial trusts or auxiliary organizations (such as the Reanimation Foundation) to the idiotic (testamentary establishment of "the committee to reanimate Melvin York", the members of which are enticed with monetary rewards for success).
Organizational Evaluation, or the provision of objective consumer information is heretofore unknown in cryonics. And it is the most appropriate area for independent endeavor. Too bad there won't be enough of a market to support such an effort for some time. In the meanwhile, the would-be consumers of cryonic suspension services will have to fend for themselves by carefully reading each organization's literature, inspecting its facilities, and interviewing its personnel.
In the case of independent service providers, the profit-making model of organization is most likely to provide optimum economic and operating result. With the possible exception of an entity whose mission will be to provide objective consumer information, capitalism engenders ever improving quality of goods and services. The survival of particular service-providing companies is of far less concern than that of the ideal cryonics institution.
As for the cryonics organization itself, the major constitutional dividing line is whether control should be held by animate members or by a self-perpetuating governing body. Phrasing the choice as one between "democracy" and lack thereof, is misleading, since both forms are democratic. I addressed this issue once before in Cryonics (in the April 1992 issue), and to date have seen no effort anywhere to refute the arguments I made then.
The arguments of that article still hold, and there are others. Having a single vote only creates an illusion of control. Even in an organization where control theoretically resides in the collective hands of the animate membership, the reality is that it is the activists who run the show. And the danger remains that as the economic stakes get higher, resourceful villains can be counted upon to gather lots of votes. In the absence of such a blatant horror, a "democratically" controlled institution, unless it adopts the corrupt customs of the United States Congress, will experience frequent turn-over in control. If we figure that the average governor would be elected for no more than five successive two year terms, the organization will have one hundred percent magagement turnover every ten years! Hardly conducive to stability of purpose or retention of institutional memory when we are looking at a multigenerational time frame.
Economically, an institution dedicated to its own survival -- for the sake of its patients' lives and the lives of its members -- will have the benefits of being able to draw on its membership's support, but only to the extent that the membership shares a mutual self interest with the institution. Ideally, members derive greater security from being on a lifeboat that is becoming stronger and larger with time. To the extent that the organization having responsibility for patients is perceived as an island, with groups of members paddling toward it in uncertain craft, their immediate concerns will quite naturally overshadow the need to bolster that organization. The institutional lifeboat also has the advantages of one set of administrative overhead costs, versus several unbundled overheads. And the institution can optimally use the widest spectrum of volunteer labor skills. These economies more than compensate for the additional cost of "downward support" when a transport or suspension team is in need of assistance.
Any perceived differences in interests between the patients and the members of a cryonics organization are just that: perceptions. By virtue of having been born mortal, every member is a patient from the day he or she signs up. As harsh as it may seem, those members who fail to see themselves as patients, and whose decision making is negatively affected as a consequence, will find themselves on the losing end of the process of natural selection.
Much of the debate over organizational structure and control and over the canard of "membership choice" is rooted in the understandable need to feel some influence over one's own future. I submit that it is much more psychologically satisfying and safer to actually participate in the design of one's destiny, and that is an option which is only available (and has always been and will be available) by providing personal effort, regardless of the organization one chooses.