It would really be fantastic if medical examiners would please stop preventing people from accessing high-quality brain preservation
Michael Friedman was a 38-year-old lawyer living in Los Angeles who was signed up for cryonics with Alcor. On May 31, 1992, he had a conversation with Dave Pizer about the possibility of filing a lawsuit in LA County to establish the right of a murdered cryonicist to avoid autopsy prior to their cryopreservation.
Tragically, the next day, before he could take any action on this, Friedman was shot in the head by a disgruntled client. His body was transferred to the office of the LA County Medical Examiner’s Office where it underwent an autopsy. Alcor successfully negotiated for them to not section the whole brain, but they did remove it from the skull and cut into it to remove the bullet. His body was not released for 26 hours.
In my view, this period of ischemic delay may have directly led to his information-theoretic death. That’s uncertain, as we don’t know how long this takes in the average case, and also there is likely to be variability between people.1
Sadly, there have been other such cases. Consider the case of Michael Miller, a 48-year-old disabled Navy veteran, who in 2009 was found legally deceased in his Florida apartment. He was signed up for preservation with Alcor and he was wearing a medical bracelet which said “No Autopsy.” His body was autopsied anyway. The stated rationale was that there was a “reasonable possibility” of accidental overdose that needed to be investigated. A few quotes from the county medical examiner Vernard Adams about sums it up:
“Adams said the estranged wife’s request for an autopsy did not influence his decision. Nor was he swayed, he said, by any personal beliefs about cryonics.
"I don't care how people dispose of a body," he told the St. Petersburg Times. "The autopsy comes first. Then they get the body for disposition." …
"I'm handling it the same way I would any other objection to an autopsy," Adams said. "There’s no point in being a hard case about it."”
I guess one has to keep the trains running. Alcor tried to fight to prevent the autopsy in court, but that was a failure and in my view a mistake, because it led to a delay of more than a week before his body was released and could finally be preserved.
It doesn’t seem that these cases are becoming any less frequent. In 2020, a 56-year-old man signed up with Alcor had an unattended legal death at his home. Despite Alcor presenting paperwork stating his wishes to avoid autopsy, he underwent a death investigation and autopsy. His brain was sectioned into pieces before his body was released.
These are a few examples. But they shouldn’t be dismissed as rare outcomes. Problems with preservation due to the process of medicolegal death investigation have happened frequently and will continue to happen until something changes. That’s the subject of the review we just published, in which we argue that people should have the right to opt for immediate preservation if they so desire.
To explain why, let’s look at how this process actually works, at least in the US. The first step is that legal death is pronounced by a healthcare professional, who decides whether the legal death needs to be reported to the medical examiner’s office. In Oregon, reportable reasons include apparent homicide or suicide, drug use, or accidents.
Around 30-40% of legal deaths in the United States are reported to medical examiner offices, meaning that those cases go down the right side of this algorithm. For younger people who legally die unexpectedly, it is especially likely.2
Once reported, the medical examiner office decides whether to accept the case or not. The question is how long this process takes. The answer is usually on the order of minutes (e.g., an especially quick denial via phone call) to hours (scene response) to 1-2 days (full death investigation, even if expedited). The problem, of course, is that all of these delays lead to direct decomposition of brain cells and also make it much more difficult to perfuse the brain effectively with preservative chemicals.
Sometimes medical examiner offices are overwhelmed by these reports. One of my friends who works in an NYC ED told me that they are usually denied, potentially alongside some sarcastic remarks about whether the report was even necessary (ah, New Yorkers). That would be a good outcome for someone desiring preservation.
Most of the pushback I have gotten on this topic is that people don’t think that preservation could actually allow for revival one day. I understand where they are coming from. And of course, whether it could actually work is totally uncertain. But plenty of other things are uncertain, yet we still act upon them. Consider CPR. The success rates in many circumstances are abysmal. Yet it is not only allowed, but it is actually required for certain professionals to perform it. Or consider AI x-risk. Obviously, this has never happened before. Yet some governments around the world are enacting legislation around preventing it. This is reasonable idea! I only wish that there could also be efforts to remove barriers that prevent people from accessing brain preservation.
If the government is really going to prevent us from being allowed to consistently access high-quality preservation, I think that the least they could do is to explain why they don’t think that it could work. Which they never have done.
There are plenty of ways that things could be changed for the better. One approach that I personally favor is treating the donation of the brain to science for preservation the same way that organ donation for transplantation is treated. This would allow for the brain to be preserved immediately, prior to the death investigation, just as organs are removed for transplantation prior to death investigation. For those who desire it, the rest of the body could also be preserved later, as this aspect is not as time-critical (at least in my view). This approach has been tested in real life for decades and it has been found that it allows for organ donation to proceed without causing any problems for criminal proceedings. Seriously — one review found literally zero cases where this approach was found to have caused any problems, even after it had been in use for years. So there is a way, if there were to be enough will.
For what it’s worth, I admire medical examiners and I believe they do extremely important work. In most historical cases, I believe that they have not acted with malice. And yet, as evidence continues to emerge about the potential of brain preservation for those who believe it offers a chance at continued existence, if medical examiners are unwilling to work with preservation organizations to adapt their protocols to accommodate these wishes, I believe they would share responsibility for any resulting harm. It’s a bureaucracy yes, it’s a systemic problem yes, but they obviously also have agency. And to be clear, we don’t want to prevent medical examiners and their team members from doing their jobs. Instead, we want to enable them to provide the reasonable accommodations that would allow for immediate preservation while still enabling them to fulfill their duties.
To be honest, there is a big part of me that now wants to wash my hands of this exceedingly messy, challenging, depressing topic and say something like “we made our position on the problem clear, and if society fails to implement a solution, that’s not my fault.” However, while I certainly do want to help out with the project of humanity, I am not interested in tallying up a score. Growing up my dad used to talk about the tombstone that said “he had the right of way.” That’s not what I want. My goal is survival — for my friends, my loved ones, myself, and anyone else who wants to come along on this uncertain journey. In other words, I don’t want to live indefinitely through my work, I want to live indefinitely through not dying. So unfortunately, I really do need this situation to change asap. Please contact me if you’re interested in helping. My hope is that this is just the start of the conversation, and that some of us can work together to improve the situation. Otherwise people are going to keep having their preservations horribly damaged due to the bureaucratic process of death investigation, quite possibly directly causing their information-theoretic death, and it will inevitably happen to people that I care about.
One might ask: wasn’t Friedman already information-theoretically dead due to the GSW to the head? Not necessarily. We don’t know that. While rare, people have survived gunshot wounds in the brain with most of their memories intact. And contemporary survival is beyond what is required for information preservation. The GSW damage would be localized, whereas the damage from the ischemic delay is throughout the entire brain. This sort of therapeutic nihilism is, in my view, very much a part of the problem.
Our review only discusses the public policy implications, but if one is interested in pursuing preservation for themselves, one “personal policy” implication is that this is another reason it is useful for one’s legal death to be predictable. Unexpected legal death → much higher risk of protracted death investigation → much lower preservation quality. This makes it useful to have a physician, regular check ups, stay on top of one’s health, etc. I am somewhat of a skeptic of most “early diagnosis” when it comes to cancer, mostly because I think length-time bias is criminally underrated, but understanding one’s health seems clearly helpful from this perspective. If you desire preservation and have a terminal illness, from the perspective of avoiding death investigation, you want to be in hospice care.
These autopsy cases are horrible. I would note, however, that Alcor has had quite a bit of success in persuading MEs and coroners to limit or omit destructive autopsies. I remember a case in the 2010s of a member in Phoenix area who died of uncertain causes alone. He had no known friends or relatives in the area. I went down to the Medical Examiner's office with an attorney and plead with them. They would not promise anything. A few hours later, they released the person after nothing more than an external exam.
In other cases, we have been able to get them to do a "virtual autopsy" -- a CT scan to look for trauma and a toxicology panel. There was even a suicide case in Alabama when the member was released to Alcor because the cause of death was clear and the person had left ample evidence of their intent. (He carefully shot himself in the chest, leaving his brain undamaged.)
Obviously, there are reasons for autopsies but, for people planning on biostasis, no moral hazard risk outweighs the terminal damage of autopsy.
Fantastic post Andy. We really have to keep highlighting these tragic cases, ideally at ME and Organ Donation Conferences. Most norms change only when challenged.