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19 Feb, 2021 06:57

We should be able to choose when to die – cryonics advocate

If you were offered the chance to be revived after dying someday in the far-off future, would you go for it? Well, it may sound like the far-fetched realms of sci-fi but it is the reality of cryonics. We talk to Max Moore, philosopher, futurist and the current ambassador and president emeritus of Alcor Life Extension Foundation.

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Sophie Shevardnadze: Max More, philosopher, futurist, the current Ambassador and President Emeritus of Alcor Life Extension Foundation. Max, it's really great to have you with us today. Welcome.

Max More: Thank you, Sophie. Glad to be here.

SS: Alrighty. So what a topic – look, what amazes me about cryopreservation is that it looks more like putting death on halt, rather than simply freezing the dead body. Can you explain how it works?

MM: Yeah, that's actually a good description. The basic idea is, let's make the analogy: if you go back to the 1960s, and you were walking around with some people, and one of them suddenly clutched at the heart and fell over and stopped breathing, and the heart stopped beating, back then we would go and attest the person’s death, there's nothing we could do. Today, of course, we jump on and do CPR, defibrillation, those things and resuscitate them. So although we said someone was dead back in 1960, by today's standards, they're not. So in our view, when your body gives out, and the doctor declares you’re legally dead, that's not the same as being biologically dead. It really means that given today's technologies and medical techniques, we don't know what else to do for you. So what we say is turn them over to us, we're going to protect the cells against cold, we're going to remove the blood, replace it with essentially a medical-grade antifreeze and then we can, to simplify the process, drop you down to extremely cold temperatures – about minus 320 degrees Fahrenheit, minus 196 degrees Celsius. At that temperature, you can wait literally for decades, until hopefully, we’ll one day develop the technology that can repair the cells and revive you in good condition to carry on living.

SS: Well, how much time do cryonics specialists have to complete all cryopreservation procedures after the person is pronounced dead?

MM: Well, there's no real set time, what we do know is the sooner we do it, the better. Obviously, the first stage is very important, because the warmer you are, the faster your body's going to fall apart. So it's very important to cool people just like we do in hospitals right now. We've been doing cold temperature surgeries, especially people with gunshot wounds and other things or brain surgery that actually cool you down about 10 degrees because it slows everything down. For every 10 degrees C drop in temperature, everything slows down 50%. So we're gonna drop you down, not below freezing, by the way, but as quickly as possible using circulating ice in an ice bath, by restarting circulation and respiration, giving first medications, very quickly, we want to bring you down close to freezing. So that can be done in about, I think, our record shows declaration of legal death to arrival at our facility and getting down to about 10 degrees in about 35 minutes. So we can go pretty fast. And then we have to take time to do the surgery to access the vascular system, remove as much water from the body as possible, replace it with this cryoprotectant solution, the medical-grade antifreeze if you like, and that takes a few hours, and everything will slow down a little bit more once we get you down to about minus 90. So really, there isn't a limit. But we know that if we don't reach you – even if you’re being kept cool– if we don't get to you within about 16 to 24 hours, the blood-brain barrier breaks down. And then we probably can't protect the brain, which is not good because it's going to be a lot of damage.

SS: Right. So this procedure that's called ‘vitrification’ when blood and all body liquids are replaced with some sort of antifreeze, which prevents ice from damaging the cells... When the day arrives to actually bring the cryopreserved person back to life will this antifreeze be replaced with blood again?

MM: Yeah, most likely. Actually, this isn't … People think, well ‘How would you do that?’, but we do it today actually in certain surgeries and certain experiments, you can remove all the blood from somebody and replace it with a saline-based solution and then put the blood back in. And there's a lot of research going on in that area right now. A lot of people think, how can you possibly take the body below freezing and bring it back and I like to point out, we actually have millions of people walking around today who were cryopreserved – they were just embryos at the time. And of course, we also cryopreserve corneas, heart valves, skin cells, many of the tissue types. So the problem is not that we can't reverse it in principle, it's that with large organs like the brain and a whole body, it's very hard. It's not practical today to reverse that, because of the speed you need to rewarm. That doesn't mean it'll be forever impossible. And of course, we're not going to bring someone back until we can fix the ageing problem too, because we don't bring you back as a 90-year-old just to have your body give out again. So it's gonna be a long time to solve these problems and the ageing problem. And of course, it may never happen. We are not guaranteeing this will definitely work, which is better than the alternative, we think.

SS: Alright, so in the sci-fi that I read people who are, like, still living, went into cryochambers to wake up centuries after, not dead people. But do we have a technological and maybe even legal way to freeze people who just want to do it right now? Not people who are dead?

MM: No, not really. Because the procedure that we use would have to stop the heart and it would be considered homicide. So no, we can't do that. The closest we can do, there are certain jurisdictions in the United States, in Canada and other countries like Switzerland, where if you’re terminal, which basically means you have two doctors agreeing that you have no more than six months, and it's going to be miserable six months, you can choose when to go, you have to administer the medicine yourself to stop your heart. So that's actually very useful for us, we've done a couple of cases like that, where we can actually schedule the cryopreservation procedure rather than rushing urgently across the country, or across the state to get to the bedside, we can actually be there ready with our equipment. And the person says, ‘I'm going to go next Wednesday at five o'clock, can you be there?’ And that way, we can start immediately after the doctor's declared legal death. So that's the closest we can come to that at this point.

SS: So cryonics, as I understand it, is built on the idea of betting that future generations will figure out how to revive living organisms after death, something that is so far deemed impossible. So why do you think they will make it happen? Like, what research exists in the science of today that builds up those great expectations?

MM: Well, first of all, it's not really after death, I have to qualify it as after legal death, because in fact, almost everything is still alive. If you think about it, there are people who are legally dead, who donate their organs, you may take the heart, the lungs, the kidneys, and those are still alive, they can be given to other people. So I want to qualify if you're really dead, then you're not going to come back to in the true meaning of the term. But to get to your question, there's a number of lines of evidence. One is the research, you know, things I already mentioned on cryopreserving embryos and skin and various other tissues and reversing that – we can do that. Those are single tissue types, which is much easier than organ, which is easier than an organism. So it's really a matter of pushing the boundaries. There's also some successful research, actually, by one of our research partners, who actually licensed their cryoprotectant formula. And they've been able to take a rabbit kidney, which is, you know, a pretty large mass, cryopreserve it, hold it there for months, rewarm it, implanted in the rabbit and it functions. So that's all very promising. And there's a lot of research now underway to enable reversible cryopreservation of human organs  because you can imagine right now, if you need a heart or a lung, it's very hard to get one. You have to find a tissue match, you have to fly it across the country on ice. And you may not make it in time. Tens of thousands of people die every year because they can't get an organ. What if you could cryopreserve organs in the hospital and pull them out as needed? So that's the goal. And I think we're probably within five or ten years to be able to do that. So that's some pretty good evidence, we also have other kinds of evidence. In the last 10 years, we've been doing CT scans about patients’ brains at liquid nitrogen temperature. And until then, we couldn't really tell how well we cryoprotected the cells. Now we can actually look at the scans and we can see how much ice, if any, there is in there. And it's a wide variety. In some cases, it looks fantastic. In others, it's not so good, depending on how long the delay was and the cause of legal death. There are also other kinds of studies. We can do electron microscope studies looking at more deep level, and we can see in certain studies that the neurons and the connections within cells are in fact, intact, in good cases, at least. And so what we know is that we preserve the structure of the brain. And that's, that's where you live, that's where your mind is and your memories are. So really, it's just a matter of how do we reverse that in the future. And that really, you know, obviously, that's speculative, because it's in the future, but we think probably some kind of nano medical devices, nanorobotic devices will go into the cells, with a map of what it’s supposed to look like and repair tools. Just like we have in our body naturally to make repairs, these will be programmed and be able to clear out the damage, and eventually, hopefully, revive you and bring you back.

SS: Right. Okay, so the whole idea of bringing someone to life after decades or hundreds of years of cryopreservation can really work out in the end only if the brain remains undamaged. And I mean, I've talked to so many neuroscientists, and they all tell me that, you know, despite all the scientific advancements, they still have no idea how our brain actually functions. I mean, how it functions exactly. Do we know how brain tissues behave if it's stored at the measure or a temperature of 196 degrees below zero or 300 degrees below zero?

MM: Yes, we do. What we know is nothing's happening. At that temperature, it's so cold that you go through a phase transition where you become some solid diamond at minus 110 degrees, something like that. And so there was actually zero metabolic activity whatsoever. We know for sure if people have seen the movie ‘Vanilla Sky’ where Tom Cruise has these lucid dreams. That doesn't happen in reality, there is no metabolic activity, no brain activity. No deterioration, except a little bit of theoretical deterioration cosmic rays zipping through the atmosphere and dislodging molecules occasionally, there's really nothing happening. So we know that's the case. And again, with these scans and other studies, we can see, we can look at the brain tissue, we can do biopsies and actually see that the structure is intact. So I think the neuroscientists you're talking to, are either exaggerating or being a little modest, because we do know a lot about the brain. What we know is that... we know that everything except short-term memories, maybe the last 20 minutes or so, are stored in physical changes in the brain. And we know from these electron microscope studies that we are preserving them at fairly good conditions. So it's just like going back from general anaesthesia, you are not going to remember the last 15 or 20 minutes, but so long as we preserved you well enough and we have the repair tools, you should have everything else still intact. Of course, that's a big IF, most likely in reality, there's going to be some damage for many people, and some loss. And that's just a fact we'd have to deal with.

SS: Okay, so let's presume the technology's there to wake you after this cryo-sleep in hundreds years. Have you thought about what it would be like to wake up to a completely different world? I mean, I'm sure you have.

MM: Yeah, yeah, I have a lot. There are different levels of which you can think about that. We've actually fairly recently formed a group which focuses on exactly that question – on the other end of the process. Obviously, it's a long way off but it's important to think about now because frankly, the thing that scares people most about this is that it might work. And they say, ‘Well, I might come back in the future that's radically different that my skills will be obsolete, and I don't know anybody’. So we have a group that's actually addressing those issues, very specifically, having you take the memories with you, preserve your relationships, who's going to take care of me on the other end. And it’s part of Alcor’s mission, by the way, to actually help to rehabilitate people. It will be like someone coming out of a coma after a long time, you can't just push them out the door, you're going to give them some help. That's that's one level of the answer. I think, on the other hand, you know, I'm something of a futurist, I've studied futures, forecasting methods, I'm studying history. And my view is that the general questions, we have no idea what it'll be like, because we can't forecast that far ahead. It's not possible. What we can see general trends, we can look back at human history, and I know it's not probably to believe this these days, people always complaining about how bad things are, but this is the best time ever in human history. We live longer, we're freer, we have more opportunities than ever. And I think we'll see this trend over time where things do get better. And we have these ups and downs occasionally, but you can't really think of a time in the past where you'd want to live if you're realistic about the way the world was, when we didn't have anesthesia or didn't have antiseptics, when women couldn't vote, where a lot of people were slaves, when we beat people relentlessly, the past was a pretty awful place. So by extension, unless we can really mess things up badly, I would think that the future, if we come back should be a pretty decent place. It's not going to be utopian, but it's a place where I’d fully enjoy starting again. And it does take a sense of adventure, no doubt about it. A lot of people are not going to want to do this, even if they're sure it’ll work because they just don't have that much of a sense of adventure. So it tends to appeal to people who are not worried about having to restart things. Maybe people who have changed countries or made cultural shifts like this.

SS: Would you be ready to do it right now if the technology was in place?

MM: I don’t want to do it unless I had to do it because the idea of sitting in a vat of liquid nitrogen unable to control my destiny is not very appealing. I want to control my destiny. So it's a last resort. Something when nothing else is possible. I'm hoping desperately that life extension science will get going faster, it really had very little funding until now. And maybe just maybe if I can live another 40 years, I might start gaining enough time that I won't need to be cryopreserved. But I'm getting kind of pessimistic of a pace of things. So I think unfortunately, likely I will need to be cryopreserved. But no, I don't want to do it. It's just I'd rather not be buried in the ground or incinerated. So this is my backup option.

SS: Talking about the timeframe, you say bringing the person back to life after cryopreservation is not a matter of physics, but technology that one day will be in place. I heard some scientists say this may take hundreds and even thousands of years. What timeframe do you have in mind?

MM: I'm always very cautious in how I answer that because, you know, there are some people who like to say, well, in 30 years we'll have superintelligence, or in 50 years we'll have this. I don't know. I think it's like asking someone in 1900, “When will we land on the moon?” And how would you answer that? You know, it's possible, because, while it’s also physics, but it has to do with the life support systems and the engines and the computers which didn't exist. So it's, you know, if I'm pressed, I'll say, I'm guessing, it's probably we won't bring people back for somewhere between 75 and 125 years. And that's as close as I'm going to get to give a specific forecast. And I could be well off.

SS: Well, that's the whole point. Because so far, bringing people back to life from the dead frozen state isn't something that science knows how to do. And nobody who signed up today, as well as nobody who's doing the freezing will naturally live to the day when science figures it out which is already a big IF, right? So there's like nobody really to check on the future. Where's the guarantee Alcor will even exist 100 years down the road and that all the frozen-up bodies won't just disappear somewhere?

MM: Well, that's a good question. I actually just finished writing a two-part article on that for our magazine, looking at what kind of organisations live for 100 years or more. And Alcor is modelled, it was very carefully designed to last for a very long time and we've been around for almost 49 years at this point. We have certain structures in place, we have nonprofit structure, which tends to last longer than for-profit organizations. We have several different boards that, you know, we have one board of directors that just looks after the money that's used to pay for people to be cryopreserved and stay cryopreserved, and eventually to be revived. So there's a lot of levels of protection ... with a lot of details on that. And, you know, we know people who were cryopreserved and there'll be people who know us. So there'll be a direct incentive to bring people back in and they'll have people they want to bring back. You know, for instance, Linda Chamberlain, our co-founder who is working with us now. Her husband is cryopreserved, her mother is cryopreserved, Fred’s father is cryopreserved. So there's some very direct personal stakes. But some people actually set up trusts and they can get an incentive, we can see if and when it's possible to revive me, you can have X percent of this trust, which is used to give them some money when they come back. So there's kind of a lot of different ways that we can incentivise that.

SS: Here's another thing that's bothering me. Obviously not everyone can afford the procedure because so far, for now, this is something that is only open to affluent people. What makes you think that it won't stay this way, that it won't become the sort of like, I don't know, elite preserving barrier of sorts?

MM: Well, when you say “affluent”, that's true, depending on how you define it. And I signed up for cryonics when I was a pretty poor grad student. It's something that's afforded by most people in Western societies, let's put it that way, mostly, because very few people just hand us a chunk of cash $80,000 for preserving the brain or $200,000 for the whole body. Most people use life insurance policies. And that's not a very large life insurance policy. So if you have, you know, a reasonable income, you can do that. But yeah, it's not cheap. There are possible ways of making it less expensive as time goes on, if we have economies of scale. One of our directors, Ralph Merkle wrote a piece about cryopreserving everyone, and he really thought through that. For instance, there are certain industrial fluids, that are kept in these massive tanks. And you can imagine, instead of having three or four people in a container, what if you had thousands of them? What would that do to your costs? There are ways of doing that. So hopefully, we can reduce the cost but there's an inevitable cost in what we call the standby and the transport, getting your team to the bedside, that can be expensive together. Then we've got the surgery, there's all these procedures that do cost, and of course, the upkeep, which we’re gradually reducing in the course of that. So it's never going to be super cheap, I don’t think. Not until we have machines that make everything for us if we get that lucky. But it's not as expensive as people think.

SS: Okay, in that case, if it's affordable for everyone, and it's at some point like with cell phones, for instance, freezing yourself to be revived in the future will become commonplace, won't humanity be stuck at some point with like a whole lot of frozen ancestors waiting to be revived? I mean, will there be enough space for us and our children but also our dead?

MM: Yeah, I think there'll be plenty of space. One thing a lot of people don't realise it's kind of odd to me that we're still thinking that population growth is a problem. And actually, as you know, in Russia, your population is not growing. It's not growing anywhere in Eastern Europe. It's stopped growing in a lot of Western European countries. In fact, I think over 40% of the world's populations are now stopping growing and starting to shrink. So in 1969, it was the peak of fertility. Ever since, we've been going down and down and down. And even the UN, which has consistently overestimated population growth, even the UN is projecting into the range that sometimes later in the century, global population will stop growing, many countries will already be shrinking by then, because Japan is shrinking quite drastically now. So the problem in the future will be underpopulation problem, which is actually harder to deal with economically. So I don't think there's any lack of room, there'll be plenty of room as energy gets more abundant, which it does, I think we'll be to afford to do this. So I'm not really worried about that issue.

SS: Okay. You know, this all sounds like a very appealing idea, especially if there's enough space for all of us in the future, and also looking at death as something reversible, and I understand very well why so many fall for it. But on the other hand, isn't dying part of the way things are on this planet? I mean, the circle of life, we're born to live, we die in the end, all living creatures have their lifespan...

MM: Yeah, but why should we accept that? Just because something has been the way for a long time doesn't mean we should accept that. I mean, slavery was considered natural for a long time, pretty much every society did it. It doesn't mean it's necessarily a good thing, right? We died a lot younger in the past. Is it natural to defeat heart disease or cancer or to have an antiseptic, so you don't die of a cut? So it's the nature of human beings to change nature. So I think the inevitability of death, is one of those last barriers, and it does kind of make people uneasy. But really, why should we be forced to die at the time just because nature decides to flip out your heart valve and put something in your brain? Why don't we get to choose that? And the goal isn't to live forever necessarily, we're certainly not offering eternity because that's probably not even physically possible. It's really saying that you should get to choose how long you live, rather than it being an accident of nature. So you may decide at 250 years, 200 years, you have done what you want to do, you've had enough, but I think it'd be nice for it to be your choice and the choice for your loved ones, too.

SS: Yeah, this whole cryo-thing is basically offering people what religion offers – a promise of an afterlife?

MM: No, because we're not promising anything. The difference is religion –

SS: But the hope is there. You think that there's no death, like, there's something after death: either I come back or there's like this eternity, and it's not like I go and it's finished. Religion does the same thing, like you're saying, “Once your body is dead there's something afterwards, so don't worry.”

MM: There’s a big difference, Sophie. That's one reason we don't have many people signing up for this, whereas religions have billions of people because they offer certainty and we don't. We emphasize that very strongly that we're not guaranteeing this will work, it depends on a lot of things in general and in your particular case, and that people don't like that lack of uncertainty. Religions offer certainty: you will definitely go to heaven or to hell, or whatever. We don't offer that. You know we don't guarantee what the world will be like, we're not guaranteeing you’ll go to some kind of heaven place. So it really isn't much like that. And it requires a good understanding of the science and technology behind it. If it was like a religion, or we would made it like a religion, we’ll be a lot more successful as an industry and organisation. But, of course, we don't believe in doing it that way, that would be unethical.

SS: But with all due respect, I mean, religions have existed for centuries, you’re just starting to actually operate and you're saying, “in the future, some time, it's just a question of time, we will have the answer of how to come back”. So, it's still, you know, to me sounds like religion where your promise is based on faith, because, you know, people will freeze themselves – those who choose to – believing that they'll come back. You don't see that?

MM: No, it's got nothing to do with faith. I don't like the word faith because I’m not religious. I'm a rationalist. There's a difference between – Again, it’s like saying somewhere in 1957, “we can land on the moon one day”. Was it a matter of faith? I don't think so. It's a matter of knowing that physics says, you know, you just have to propel yourself hard enough to get out of the atmosphere, and we know how hard that is; we have no idea how we're going to build rockets that big right now or life support systems, but in principle, it should be possible. And it was. The British Astronomer Royal in 1959 said that space travel was impossible. Well, he looked a bit of a fool 10 years later when we landed on the moon and he should have known better because it was a matter of engineering, not of science. So I don't think it has anything to do with faith. It would be if we were offering certainties, but we do the opposite of that. So I think it would be a disaster to treat it that way because then religions are not very good at questioning themselves, either. Because we're constantly questioning ourselves, we write case reports, we're constantly analysing our procedures and asking how we can do better looking at the research that's going on. So I wouldn't make that comparison at all.

SS: All right, Max. Thanks a lot for this really interesting chat. It's been great talking to you. Good luck with everything.

MM: Thank you. Thanks for having me on

SS: I hope we get to do this in a couple of years and you have some new updates for me.

MM: Yeah, we're doing a lot of research right now. So yeah, we'll have new things to tell you.

SS: Have a great day. Thanks a lot for being with us today.

MM: Thank you. Bye-bye.