Simple human dignity and self-ownership demands the right to end one's own life on one's own terms, and to be able to help others achieve this goal where they are not capable of doing so themselves. Yet these acts remain forbidden to most people in most parts of the world. Painless, effective euthanasia requires medical assistance, and providing that service remains largely illegal. This state of affairs is slowly starting to change in the US, however, and so late last year the first cryopreservation following voluntary euthanasia took place.
Cryopreservation is the only presently available end of life option that offers a chance at life again in the future. It is an unknown, high risk chance, but it is the only option on the table for those who will age to death prior to the advent of rejuvenation therapies. Given a sufficiently high quality preservation of the brain, using vitrification techniques, then the fine structure that stores the data of the mind can be preserved indefinitely at low temperatures. At some future date, technologies of restoration based on advanced molecular nanotechnology will become plausible, then possible, then used. The preserved individuals have all the time in the world to wait for that to come to pass.
There are challenges, however. The important challenges in cryopreservation are twofold, and ultimately stem from the presently small size and non-profit status of cryonics organizations, which ensures that progress towards technical improvement occurs only slowly. Firstly, cryopreservation as a service is expensive and uncertain because of the inability to assist in euthanasia in most parts of the world. Patients must be watched by standby teams, and any meaningful delay following death allows for greater damage to brain tissue. Further, many forms of age-related death in fact destroy areas of the brain: stroke, neurodegenerative disease, and so forth. Secondly, the quality of vitrification of the brain remains far from perfect. The case here illustrates the point; even with perfect timing due to the assisted death process, there remains some ice formation in the brain. These are challenges that are best solved through growth in the size of the cryonics community, and success in branching out into commercial ventures, such as reversible vitrification of tissues for transplantation.
On October 30, 2018, Alcor performed its 164th cryopreservation. It was an otherwise unremarkable moment for the nonprofit organization, save for the way Norman Hardy of Mountain View, California met his demise. Hardy was diagnosed with terminal metastatic prostate cancer, and it had spread to his bones and lungs. As noted in Alcor's case summary, his "pain had been poorly managed," so he opted for assisted death, which was legalized in California in 2016 through the End of Life Option Act (EOLOA).
For Alcor, the case was the first time EULOA was used to "reduce the potential ischemic damage that can result from a prolonged dying process," as the foundation noted in its official case report. Indeed, the quicker a patient can be put into cryonic suspension following death the better, as the sudden shortage of oxygen starts to destroy tissues. For Alcor, time is trauma. In this case, Hardy's choice of when to die allowed his neural tissues to be rapidly preserved following his death, or at least, preserved as well as modern cryonic technologies allow.
The procedure to prepare Hardy's head for long-term suspension in a vat of liquid nitrogen was "relatively successful," noted Alcor in its case report. CT scans following preservation showed some ice formation in the cerebellum and frontal lobes, which isn't ideal. That said, the quick turnaround from the declaration of death to placement in one of Alcor's stainless steel dewars meant that decompositional damage to Hardy's brain was minimized. In a best case scenario, Alcor's response team begins the cryopreservation process within seconds after death is declared. But that doesn't always happen.
Alcor has published a case report on Norman Hardy, A-1990. This case was the first time the newly enacted California End of Life Option Act (EOLOA) was used to reduce the potential ischemic damage that can result from a prolonged dying process. The cryoprotective perfusion was relatively successful. Perfusion flow rates were high throughout the procedure. However, the post-cryopreservation CT scan showed poor cryoprotection and extensive CT-visible ice formation in the cerebellum, and incomplete cryoprotection with a small amount of CT-visible ice formation in the frontal lobes.