Principles of Medical Ethics
One of the most common objections to euthanasia grounded in medical ethics appeals to the Hippocratic Oath, which states that the purpose of medical practice must always be to heal, never to kill. Although classical versions of the oath specifically prohibit euthanasia , it is mostly excluded from modern official medical oaths,3 which tend to be more vague. Many supporters of the Hippocratic Oath would argue that since euthanasia is generally viewed as a personal choice, it should thus be a personal (or at least non-medical) responsibility to perform it. Many also argue that even in countries where euthanasia is legal in some form or another, physicians should and in fact do retain the right to refuse requests to perform or assist in euthanasia , in the form of “conscientious objection”. In fact, all the legislations in the world that allow some form of medical assistance to dying include conscience clauses that recognize doctors’ rights not to take part in this form of assistance.
The degree to which cryothanasia is consistent with the prescriptions of the Hippocratic Oath depends in part on how one defines death. Cryothanasia would certainly involve bringing about clinical death, but it would not cause information -theoretic death (we defined this account of death in Chap. 1), and would even seek to actively prevent it. Being ancient in origin, the oath of course does not specify any particular definition of death, so we would need to determine which conception of death is more morally relevant in the case of cryothanasia, with regard to consistency with the aims and scope of medicine. It seems plausible that, consistently with the prescription of the Hippocratic Oath, the kind of death which involves the permanent loss of a human life is what medicine should try to avoid or prevent as much as possible. Thus, once the option of cryothanasia is introduced, it is the information -theoretic death, and not clinical death, that medicine should try to avoid or prevent. We can thus easily imagine a modern physician who, without any internal conflict, swears by a strong form of the Hippocratic Oath without having to oppose cryothanasia.
Besides, even if we assume a clinical definition of death as the morally relevant one, it appears there are still cases in which cryothanasia would adhere to the Hippocratic Oath. Modern versions of medical oaths often contain an obligation to apply “all measures required” for the benefit of sick patients, avoiding both “overtreatment and therapeutic nihilism”. In scenarios where cryothanasia truly is the last chance of survival for a dying patient, and where the overarching goal is to ensure their recovery to the best of one’s ability, it is difficult to see how the procedure would not qualify as a required measure for the patient’s benefit. At the very least, it would seem no less acceptable than other last-ditch efforts to save patients from certain death, including various experimental treatments with low odds of success. Of course, one could also argue that since cryothanasia is both extremely invasive (involving total replacement of all bodily fluids, among other measures) and very expensive, it would amount to overtreatment even when proposed as a last resort; conversely, however, one could argue that refusing cryothanasia in such cases would amount to a weak form of therapeutic nihilism, that is, a failure to do whatever is in the power of medicine to prevent a patient’s death.
Another objection based specifically on medical ethics is the one according to which when patients ask for euthanasia in order to be relieved of grave physical or psychological suffering, we should in reality provide them with better palliative care rather than hasten their deaths. In this view, requests for euthanasia indicate a failure on behalf of palliative care in offering adequate relief therapies to suffering patients, and euthanasia would be unnecessary if adequate therapies were available.
But while euthanasia , palliative care, and cryothanasia do share the goal of relieving suffering, cryothanasia also has a unique and second goal which neither palliative care nor euthanasia have and which is supported by principles of medical ethics, namely that of benefitting the patient by extending her lifespan. Patients who request cryothanasia would not be doing so only out of a lack of palliative care, but also out of a desire to live beyond their current prognosis—albeit in a more remote future. It should also be noted that palliative care is compatible with cryothanasia to some extent. Indeed, any palliative care treatment that do not significantly damage the patients’ chances of a successful cryopreservation and revival would be advisable in the days and weeks leading up to cryothanasia.
Some also argue that euthanasia gives doctors a power over life and death that is by itself improper, and that further unbalances the already skewed power relationship between doctors and patients.
While it may well be the case that doctors should not exercise undue power over patients, it is not at all clear that euthanasia , and much less cryothanasia, would be examples of such power. Doctors normally have great power in choosing what diagnoses and treatments to give each patient. Patients, in turn, trust that doctors will always have the patient’s best interests in mind when using their expert judgement in making treatment recommendations, which patients are then free to either accept or refuse. With euthanasia and cryothanasia , however, this relationship is turned upside down. Each patient personally decides on a specific intervention, and then suggests the intervention to their doctor, who can then choose to fulfil the request personally or delegate the matter to someone else, in case of a conscientious objection. Therefore, the issue of doctor’s undue power does not arise in the case of euthanasia or cryothanasia.
Weirdness and Repugnance
As we saw in the first chapter, when new technologies are introduced to the public, they are often perceived as “weird” or “unnatural” or “yucky”. There are two senses in which cryonics and cryothanasia certainly come across as weird to many of us. First, they are weird in the sense of being unusual, that is, options that we have never had to deal with before and about which therefore many of us do not have strong intuitions, either in favour or against. Second, they are weird in the sense that they radically change our paradigmatic views of what it means to be dead and to be alive, by introducing a third option that shakes many of our fundamental ethical and religious views about the meaning of life, death, and (im)mortality; and, as is the case with most novelties of this kind, people tend to experience an intuitive and emotive rejection of the option in question not so much by virtue of its distinguishing aspects, but because of the novelty itself. This reaction can be explained by a negativity bias, that is, the tendency to see the negative aspects rather than the positive ones in any situation, which generally characterizes conservatives’ approach (Hibbing, Smith, & Alford, 2014), and a status quo bias, that is, the tendency to prefer the options that preserve the status quo over the options that alter it.4
The first obvious reply to this consideration is that it is obviously fallacious: that something is or seems weird does not constitute a good reason for considering it morally wrong, at least if we believe that the morality of an action or of a practice is at least in part independent of our psychology. The second, and related, reply is that many medical practices which are today commonly accepted and indeed sometimes considered morally good looked very weird when they were first introduced; two obvious examples are heart transplant and in vitro fertilization . Therefore, the weirdness of cryothanasia does not mean that this practice also will not one day be accepted and indeed considered by many as morally good. Finally, practices which are considered weird from outside certain specific groups, such are circumcision and refusal of blood transfusion, have become part of medical practice despite not aligning with mainstream medical ethics, and there is no reason to think that the same ethical reasons that motivated the introduction of these practices would not justify performing cryothanasia as well.
Unlikelihood and Futility
Another relatively obvious objection to cryothanasia is that it is unlikely that cryonics will ever work. Therefore asking to be cryopreserved and to lose some certain lifetime in the hope to gain an unlikely future extension of life is a risk not wor
th taking, and people should not be offered the option to choose to take risks not worth taking. This argument applies differently in the case of cryonics performed upon natural death and in the case of cryothanasia. The risk in the former case is always worth taking regardless of the likelihood of the success of cryonics, because the person who naturally dies has nothing to lose and everything to gain; the risk in the case of cryothanasia does not seem to be worth taking, at least if the person who chooses cryothanasia had quite a long life ahead of him or her before natural death, and if the foreseeable quality of this lifespan were good enough.
However, three considerations can be put forward to respond to this type of objection. First, it is very difficult to estimate the actual likelihood of success of cryonics and cryothanasia; until the point at which success is very close, it would remain very difficult not only to predict this success but to estimate its actual likelihood—therefore, whether the success of cryothanasia is really so unlikely is something we cannot simply take for granted. Second, even if the chances of success are very low, cryothanasia could still represent a risk worth taking for those for whom natural death would be close anyway and/or the expected quality of the expected remaining lifespan is sufficiently low. Third, even if the risk were not worth taking, it could be argued that a principle of liberty should prevail and that, therefore, people should be free to take the risks they autonomously choose to take. The important aspect, in this case, is that the choice of the person who opts for cryothanasia should be really autonomous; that is, there should be no form of coercion, including psychological pressure, from other people to choose cryonics. The real ethical problem would then become not one about the unlikelihood of success of cryothanasia, but one about the possibility of coercion. However, this is not an exclusive problem of cryothanasia: it applies also to euthanasia and indeed to any kind of medical intervention. There is no reason to think that it should be more of a problem in the case of cryothanasia than in the case of any other medical intervention.
These kinds of responses, and the first one in particular, should also address a related concern, namely the concern about the futility of cryonics and cryothanasia as medical treatments. They would be equivalent to any other kind of futile medical treatment that is normally considered not morally permissible. However, are cryothanasia and cryonics really futile? Futility is defined as “a situation where the evidence shows no significant likelihood of the treatment conferring a significant benefit ” (Minerva & Sandberg, 2017). But in the case of cryonics the evidence is simply missing, either in one sense or in the other. Therefore, the treatment is not futile, but experimental. Being so, the lack of evidence about likelihood of success, far from being a reason for not undergoing the treatment, is a reason for welcoming people who voluntarily choose cryothanasia, as they would give scientists the opportunity to try an experimental treatment and gather evidence about the likelihood of its success—indeed, experimenting cryothanasia on volunteers will increase, in an ethical way, the chances that cryothanasia will at some point be successful. Thus, there are reasons to think that cryothanasia should be protected under so-called right to try laws, at least in the case of terminally ill patients whose only alternative is an immediate death, and for whom therefore a treatment with even a slightly more than zero chance of success (like cryothanasia) would be in their best interest (ibid.).
Resource Use
Another objection holds that cryothanasia and cryonics in general will use up resources that could be destined to more urgent needs than that of extending someone’s life indefinitely. This objection tends to come up whenever a new medical option promises outcomes beyond the scope of traditional medical practice (think, again, of the case of in vitro fertilization ). However, to keep a person cryopreserved for a long time is relatively cheap, as it only requires fortnightly liquid nitrogen refills. The start of the prevention process itself would certainly be expensive: however, apart from the fact that it would be paid by the patient themselves (I am not going to discuss here whether or to what extent cryonics should be paid for by a public health system), it is worth noting that cryothanasia, especially if it becomes relatively popular, would free up many resources currently used for end-of-life care. Therefore, not only does the resources objection not provide an argument against cryothanasia, but actually it could be used to put forward a counterargument: cryothanasia might indeed reduce the need for medical resources.
It seems that the objections we have examined here—including those derived from the standard objections against euthanasia —either do not apply or are not strong enough to outweigh the reasons in favour of cryothanasia. Cryothanasia seems more strongly ethically justified in the case of terminally ill patients. Now, in one sense, every one of us is terminally ill, because ageing itself is a terminal condition. However, it seems that for those who have a likely long lifespan ahead, cryothanasia is not worth the risk, and it is not a rational choice, even if one of the possible (though we do not know how probable) outcomes is the possibility of living an indefinitely long life once revived. This does not mean that there are sufficiently strong reasons to deny those who would nonetheless autonomously choose cryothanasia in such circumstances the possibility of carrying out their plans (ibid.). But there might be good reasons to at least try to dissuade these individuals from undergoing cryonics. In the case of terminally ill patients with a very poor prognosis and a short lifespan ahead, however, not only would there be no good reasons to prevent or dissuade them from undergoing cryothanasia, but indeed there would be good reasons to encourage people to choose cryothanasia as the option that is in their best interest.
References
Bostrom, N., & Ord, T. (2006). The reversal test: Eliminating status quo bias in applied ethics. Ethics, 116(4), 656–679. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17039628
Bridge, S. W. (2015). Why a religious person can choose cryonics. In A. De Wolf & S. W. Bridge (Eds.), Preserving minds, saving lives: The best cryonics writings from the Alcor Life Extension Foundation. Alcor Life Extension Foundation. Retrieved from https://market.android.com/details?id=book-6QgvjgEACAAJ
Giubilini, A. (2013). Euthanasia: What is the genuine problem? The International Journal of Applied Philosophy, 27(1), 35–46. Retrieved from https://www.pdcnet.org/ijap/content/ijap_2013_0027_0001_0035_0046
Hibbing, J. R., Smith, K. B., & Alford, J. R. (2014). Differences in negativity bias underlie variations in political ideology. The Behavioral and Brain Sciences, 37(3), 297–307. https://doi.org/10.1017/S0140525X13001192
Keown, J. (1997). Euthanasia examined: Ethical, clinical and legal perspectives. Cambridge: Cambridge University Press.
Minerva, F., & Sandberg, A. (2017). Euthanasia and cryothanasia. Bioethics, 31(7), 526–533. https://doi.org/10.1111/bioe.12368
Moen, O. M. (2015). The case for cryonics. Journal of Medical Ethics, 41(8), 677–681. https://doi.org/10.1136/medethics-2015-102715
Orr, R. D., Pang, N., Pellegrino, E. D., & Siegler, M. (1997). Use of the Hippocratic Oath: A review of twentieth century practice and a content analysis of oaths administered in medical schools in the U.S. and Canada in 1993. The Journal of Clinical Ethics, 8(4), 377–388. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9503088
Paul, P. J., II. (1984). Salvifici doloris. Ediciones Paulinas. Retrieved from http://catholicsociety.com/documents/john_paul_ii_letters/Salvifici_doloris.pdf
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Footnotes
1For an overview of the main ethical issues raised by euthanasia in the medical context, see Keown (1997).
2It should be noted that some religious people nevertheless consider suffering as a positive thing in certain contexts; see Paul (19
84).
3Orr, Pang, Pellegrino, and Siegler (1997) notes that only 14% of official medical oaths specifically prohibited euthanasia as of 1993.
4For a philosophical discussion of status quo bias, see, for example, Bostrom and Ord (2006).
© The Author(s) 2018
Francesca MinervaThe Ethics of Cryonicshttps://doi.org/10.1007/978-3-319-78599-8_6
6. Cryosuspension of Pregnancy
Francesca Minerva1
(1)Philosophy and Moral Sciences, University of Ghent, Ghent, Vlaams Brabant, Belgium
The Ethics of Cryonics Page 15