The Ethics of Cryonics

by Francesca Minerva

  Finally, given that only a tiny minority of people currently choose cryonics (and the majority of them choose neuropreservation, anyway) it seems that, at least for now, the impact of cryonics on the availability of transplantable organs is negligible. If one is committed to solving the problem of scarcity of organs for transplantation, attacking cryonics seems to miss the target. There are more effective ways to increase the number of organs for transplant, such as legislation requiring all citizens to be organ donors unless they explicitly opt out. Of course, if the number of people who opted for cryonics drastically increased over time, the impact of cryonics on the availability of organs would be quite significant. Hopefully, by the time cryonics becomes a mainstream option, it will be possible to manufacture organs in vitro from stem cells of the person in need of the transplant, thereby eradicating organ scarcity altogether.

  Waste of Money That Could Be Used for Donation to an Effective Charity

  When human life is at stake, how should money be spent to realize the greatest good? This is a very touchy subject, as it confronts us with moral paradoxes in some of our most deeply held values.

  For example, if one had to choose between one strategy that might save some lives but sacrifice others and another with a different mix of expected lives saved and lost, which should one choose? The choice would be complicated by details such as the expected quality and length of the lives to be saved or extended, versus the deficit for the lives lost. The perceived rightness of each alternative could be heavily affected by such issues as one’s religious beliefs (or lack thereof), whether oneself or loved ones are part of one group but not the other, or other values and perspectives one may have or lack.

  Imagine a cryonicist who has a high degree of confidence in the likelihood that cryonics will work. To such a person, cryosuspension at clinical death would appear to be a means of powerfully extending one’s life in a state of good health. Cryonicists often reject the notion that current limitations on lifespan are anything but a terrible tragedy, and wish for the abolition of practices that sacrifice chances of revival after what is (mistakenly, according to them) considered death, such as burial and cremation. The cryonicists could have a very different perspective on issues of life and death than someone who is not a cryonicist and who does not normally contemplate the possibility or desirability of extending life beyond present natural limits.

  With these thoughts as a caveat, we can consider some of the pertinent issues in deciding about cryonics versus donations to charity. First, let us consider the cost of cryonics. A membership at Alcor is about $700 a year; at the Cryonics Institute, it is about $120 per year. Whole-body cryosuspension with Alcor costs about $200,000; neuropreservation is cheaper, at $80,000. The Cryonics Institute only offers whole-body cryosuspension, but with a substantially smaller fee of $28,000. That fee, however, does not include an in-field cryoprotection followed by transportation to their storage facilities (a package they offer for an additional fee of around $90,000), nor does it include an automatic contribution to a trust fund, as with Alcor, so one would probably have to save money in a personal trust fund. Alcor uses about half of its $200,000 whole-body fee to fund a Patient Care Trust meant to ensure the continued operation of their facilities—and hence the safety of their cryopatients—even in case of a severe financial crisis and subsequent lack of funding. Since such problems have caused other cryonics service providers in the past to close down and lose their patients (Perry, 1990/2015), Alcor has tried to develop preventive measures that would avoid such an outcome.

  All in all, the total cost of cryonics—ranging between $28,000 and $200,000—is not negligible, but is not prohibitive, either. Indeed, it is accessible even to people with a relatively low income, especially considering that some insurance providers have cryonics packages that cover costs with a monthly fee between $30 and $100, depending (like most insurance prices) on one’s age and state of health at the time of enrolment. Still, it is hard to escape the fact that cryonics is, all things considered, expensive. The $200,000 fee required by Alcor for full-body cryosuspension would instead make a generous donation to an effective charity and save the lives of many people.

  According to the meta-charity GiveWell, “As of November 2016, the median estimate of our top charities’ cost-effectiveness ranged from ~$900 to ~$7,000 per equivalent life saved (a metric we use to compare interventions with different outcomes, such as income improvements and averting a death)” (“Cost-Effectiveness”, 2017). The saving of lives often amounts to effective treatments for diseases or parasitic infections that are rampant in some parts of the world, such as malaria and schistosomiasis. For the would-be cryonicist, this means that between 28 and 220 lives could be saved with the same sum of money that is necessary for full-body cryonics at Alcor. The cheapest option, the $28,000 fee of the Cryonics Institute, if invested in donations to effective charities, would potentially save between 4 and 31 people.

  So between 4 and 220 lives could be saved if a cryonicist gave up on plans to be cryopreserved and instead donated the same amount of money to effective charities. These considerations could be seen as good reasons to choose charitable giving over cryonics, especially if one is a utilitarian and thinks that there is no particular moral reason that justifies being partial towards one’s own life over someone else’s. But even if one is not a utilitarian, and considers partiality towards one’s own life to be morally permissible, there would still be an unjustifiable discrepancy between the value one can reasonably attribute to their own life and the value they should attribute to the life of other people—especially when we are considering saving as many as 200 lives.

  If cryonics has only a small chance of working, the moral imperative of not choosing it would seem to be even stronger. But even if its chances of success were close to 100%, cryonics would arguably remain a choice between saving one life only (oneself) versus saving 4 to 220 lives, albeit not including oneself. There are other considerations, however, cautioning against a summary rejection of cryonics on moral grounds, as we shall now consider.

  To begin with, suppose for the sake of argument that we do, in fact, accept that giving to effective charities is a better use of funds than cryonics, and the preferred choice from a moral standpoint. So we should not choose cryonics. But then, on the same grounds, we would have to reject many other conventional yet costly medical interventions aimed at extending the lifespan of severely ill people.

  The use of intensive care units (ICUs ) for very old people seems an interesting comparison. According to at least one study, the cost of being treated in an ICU is about $5000 per day, admission costs are $32,000, and the average duration of one stay per elderly patient is around one week (Chin-Yee, D’Egidio, Thavorn, Heyland, & Kyeremanteng, 2017).2 Estimated ICU costs were $49,000 per survivor to discharge (i.e. for a person that left the hospital and did not die in the ICU ) and $62,000 per survivor at one year. However, only 33% of these patients survived for more than one year after the ICU treatment. This means that, to some people, the last week of their life cost roughly $67,000.3 Even those who survive for more than one year after their stay in the ICU are spending a significant sum of money to buy only a few months or years.

  This is only one of many examples showing how people are willing to spend considerable amounts of money to extend their lifespan by just a few years. Of course, to say that people do this rather than donate the same amount of money to save the lives of several others is not a good argument for either cryonics or ICUs . But this comparison suggests that cryonics is at least not a markedly more selfish attempt to extend one’s life than some widely accepted medical interventions.

  The case of Charlie Gard, an infant affected by a rare genetic disorder, was widely debated in 2017. Charlie’s health was severely compromised, and the doctors in the UK hospital where he was treated decided to stop life-support treatments and start palliative care. The parents disagreed and asked to try an experimental treatment available only in the Unit
ed States. While the judges were in the process of determining what was in the child’s best interest, Charlie’s parents raised £1.3 million in donations so that they could afford taking Charlie to the United States and try the experimental therapy. In the end, they were not given permission to go, and the child died soon thereafter. The debate around Charlie’s case touched upon various ethical issues related to autonomy, best interest, and parental rights. However, it was never debated whether it would be moral to try to save the life of one child when between 240 and 1700 people could have been saved if the same amount were donated to effective charities. This case, like many similar ones, shows that there are many instances where people feel it is morally permissible—or, at least, not morally blameworthy—to spend conspicuous sums of money to save one life rather than many.

  To say that people often fail to make the best decision does not mean they are absolved of responsibility for the choices they make. We do have a moral obligation to at least consider whether our money is being invested in the most valuable goal according to our values. If we care about saving lives, we should think about how to maximize the number of lives we can save, or, more precisely, how many quality-adjusted life years (QALYs) we can give those who need it most. But it is inconsistent to blame cryonicists for violating this principle in their attempt at life extension while not raising the same objection in cases of similar choices in other contexts.

  Deciding to bring a new individual into existence is yet another choice that we often tend to assume is always morally good, or at least morally neutral, and definitely more morally justifiable than cryonics. However, in the United Kingdom, raising a child up to the age of 21 is estimated to cost an average of £229,251 (Bingham, 2015). If this sum were instead donated to a highly effective charity, between 42 and 330 lives of people in developing countries could be saved. This case is particularly interesting because we are not weighing the interests of one person to have their life extended against the interests of several people to have their lives extended or saved. Instead, we are comparing bringing into existence someone who has no interest in existing—non-existent individuals cannot have interests, after all—over saving the life of many existing individuals who have an interest in continuing to exist. Still, most people think it is morally permissible to have children even though doing so would not address any problem of under-population (if anything, quite the contrary), and many existing people already struggle to survive.

  One could object that, unlike expensive life-saving treatments and having children, cryonics is an investment with no returns—if one assumes that cryonics has zero chance of working, that is. People who use their money to extend their lives even for just a few months or years usually benefit from the expensive treatment they pay for, which cannot happen for a treatment modality with no chance of success.4 However, the probability that cryonics will work at some point in the future at least seems greater than zero,5 so the argument needs adjustment. Cryonics may still have only a small chance of success, unlike other selfish but more conventional investments (medical interventions included), but the difference between no chance and a small chance could be a large one if the gain is potentially very large, as is certainly true with cryonics, where the potential to live hundreds or even thousands of years is at stake. In other words, even if the chance that cryonics will succeed is very low, its expected utility could still be very high.

  We need to remember that the long-term goal of cryonics is to transport individuals to a future time when technology will be able to extend human lifespan well beyond current limits, possibly even indefinitely. So a person embarking on a cryonics project is not gambling a large sum of money on the chance to live, say, only another decade or two, but rather on the chance to live for centuries, millennia, or maybe much longer still. Unlike the case of the ICU or other expensive conventional treatments aimed at extending the lifespan of the severely ill, cryonics has the potential to add very many years of life—QALYs, to be precise—to the person involved. Thus, if cryonics works, it will be arguably one of the most cost-effective investments one could make in terms of QALYs gained.

  If we assume that $200,000 (the cost of a high-end cryonics plan) could save 220 lives if donated to an extremely effective charity, and that each of these lives would be extended by 50 QALYs on average, we would pay $200,000 to gain 1100 QALYs. This would undoubtedly be a huge gain; but it is important to note that cryonics aims at achieving even more than this for each individual, possibly by an infinite amount (since their goal is to reach immortality).

  Now, let us assume, for the sake of argument, that cryonics will only allow people to add 200 years of life after revival in the future. Would it be morally justifiable to choose to add these years to the life of one single cryopreserved individual, instead of using the same resources to extend the lives of 200 people by 50 years each?

  As with the other cases, such a biased investment might not be morally justifiable, but it seems that it would at least be more justifiable than paying for intensive care (regardless of the age of the patient, because our current lifespan is far less than 200), or having a child (since individuals who do not yet exist do not have an interest in existing), or paying for an expensive experimental treatment to treat a rare disorder (which would usually extend the lives of a very few people, and only by a few years).

  Besides, using cryonics as the only term of comparison for selfish choices does not seem to be reasonable. People spend a lot of money—indeed, usually more than $200,000 over a lifetime—on goods that are not even necessary to their survival: big houses, fancy cars, fashionable clothes and jewellery, digital devices and gadgets, and trips to exotic destinations. One could argue that cryonics is a poorer choice than buying a fancy car because it has a very small chance of succeeding, whereas the fancy car will certainly give at least some joy to its owner, however fleeting it may be. But even though cryonics may have only a small chance of working, its goal is arguably less trivial and superfluous than driving a Ferrari or wearing a pair of Louboutin shoes.

  Some people claim that, once the average life expectancy is reached, cryonics or any other treatment aimed at adding years is superfluous, trivial, and selfish. But there are at least two further considerations to take into account: first, not all the people who opt for cryonics have reached the average life expectancy to begin with—indeed, some of them are only children—and, second, the average life expectancy of human beings is not fixed, but has increased slowly but steadily over centuries.

  One could then reply that cryonics might be morally permissible only if a person “dies” at a young age, when their full potential has not been reached. But this assumes that the ideal amount of time needed for a person to fulfil their potential corresponds roughly to the average human lifespan. If this were the case, it would be quite a coincidence indeed. It is instead far more likely that humans tend to plan their lives and set their goals within the realistic and seemingly inescapable confines of their life expectancy.

  For instance, most people have children before the age of 40 because it is very difficult for women to conceive after reaching that age. Most people argue that this is appropriate, since a person over 40 is too old to look after a child anyway. Yet, after in vitro fertilization (IVF ) was introduced, women started having children at an older age, without any noticeable negative effect on either the child or the women themselves. So it seems that people start to plan their lives differently as technology finds ways to stretch the natural constraints imposed by human physiology. Many women now plan to have children in their 40s, and to prioritize their career or romantic life until they feel ready to reproduce. Similarly, if lifespans were stretched to 500 years with the possibility of maintaining the bodily and cognitive capacities of a 30-year-old, people would probably make very different plans, and would have different aspirations and understandings of what a life lived to its full potential ought to look like. One might postpone having children until their second century or beyond,
meanwhile becoming expert in many different fields, travelling the world, and developing different skills. To someone with a quincentennial life expectancy, dying at age 300—without having seen the whole world, learned to play every classical instrument, mastered at least 40 languages, and having met one’s great-great-great-grandchildren—would seem both limited and tragically premature.

  It seems, then, that such arguments against cryonics, on the basis that it would be selfish for people over 80 to live longer, presuppose a fallacious view that the current average life expectancy just so happens to be the optimal amount of time required to live a full life. Moreover, this argument fails to take account of individual circumstances: to a woman living in a country where women are considered private property and are not allowed to study, work, or choose their partners, one could argue that her life would not fulfil its potential even if she lived for 100 years. In contrast, some people have very active, interesting lives that allow them to feel satisfied and accomplished by the time they are in their 30s. Of course, the more time a person has to live, the more likely he or she is to have the time to reach his or her goals and feel fulfilled; but the opportunities that come along during one’s life can be very different. It is also worth noting that one’s interests and goals may well expand over time, so that, as the end of life draws near, what may at first have seemed a sufficiently fulfilled life may not seem that way any longer.