Euthanasia and Cryonic AutoSave

Individual Autonomy is Great, But Let's Use Cryonics to Cancel Permadeath Mode

Cryogen (Vladimir Manyukhin).

To avoid a lengthy and overdone discussion on the ethics of euthanasia, suffice to say that I mostly agree with

Richard Hanania

’s interpretation of euthanasia as moral progress. Voluntary euthanasia is overwhelmingly used by the genuinely terminally ill and suffering. Euthanasia opponents claim they are protecting “human dignity” but I do not see how that squares with promoting de facto torture which we would not inflict on an aged dog or horse. Most any worldview that centers secularism and individual autonomy would be positively inclined towards euthanasia, and this is validated by the world map of the relevant legislation, where many of the richest and most progressive regions/countries such as Benelux, Canada, Iberia, and ANZAC allow active voluntary euthanasia while the procedure is complete banned in the ethical paragons that are Russia¹, Belarus, and Tanzania.

However, I am not an uncritical fan of Hanania’s performative deathism, and acknowledge that

Noah Smith

raises legitimate points about the perverse incentives that could arise from overly permissive regulations. Although I agree that it is very bad and maladaptive to involuntarily impose the burdens of looking after incapacitated and incontinent parents on their children, who would be better served pursuing their vocation or devoting their time and energy to their own children, the flip side of the coin is that immoral and avaricious children looking to unethically accelerate their inheritance do exist and they can pressure their ailing parents to exit the game before they’re done playing. In addition, euthanasia is much less costly than cutting-edge treatments with a legitimate chance of succeeding, so doctors working in public healthcare systems can be incentivized to privilege public financial interests over the patient’s in not dying (e.g. see this recent case in Canada). It can also be an easier fix for chronic depression than figuring out treatment. Depressed people are, by definition, in an altered state of mind in which they are less capable of making rational decisions in their own interests, and a doctor who recommends or suggests euthanasia can be what finally tips them over the edge².

In my view, the most elegant solution to resolving the contradictions between individual autonomy while protecting vulnerable groups from getting scammed out of a worthwhile life is technological. As I have publicly argued since at least 2019, cryonics - human cryopreservation - should play a much more important role in the ethics and practice of euthanasia. This can be reduced to three proposals:

1. Requalify cryonics as a medical procedure.

2. Make cryopreservation a legal requirement as a condition of undergoing euthanasia in those cases where it is not an obvious ethical imperative, as with the terminally ill.

3. Legally mandate euthanasia providers to offer the cryonics option to the terminally ill as well.

In the rest of this essay I will spell out the case for this policy.

First, this would collapse the costs of cryonics and stimulate cryonics research. As of the present day, cryonics is the only real bet you can make on immortality; you won’t get there by sleeping well and following the Blueprint Diet or whatever. This is, of course, a form of Pascal’s wager, since it assumes that technological progress will make it possible to revivify the body and cure the original ailment, insert the brain into a new healthy body, and/or upload it to a digital substrate while reigniting consciousness. This is perhaps not a very good bet, but even 1% is better than 0%, and multiplied across the potential near-eternities of posthuman existence, the utilitarian gains are profound³. Just as human intelligence enhancement (nooceleration) is an insurance policy against the current generation of life extension researchers not being smart enough to figure out life extension (and AI failing to come to the rescue), so cryonics can also be viewed as a kind of insurance policy for aspiring immortalists who are sadly too far advanced on the mortality curves to make it to the Singularity without cryonic time travel.

Underrail

However, even aside from these “fringe” transhumanist preoccupations, there is little doubt that cryonics research would constitute an extreme net benefit to the world. There are obvious applications to medical procedures, such as emergency response, trauma surgery, or organ storage. If we are to engage in long-term interstellar colonization projects while remaining biological, it might be necessary to store the colonists in cryonics pods to reduce caloric requirements (indoor farming is very inefficient with current technologies) and lessen the risks of mutiny on long voyages in cramped spaces with little in the way of interesting things to do and only the infinite black void outside. Even more speculatively, smart future people might want to keep some percentage of their population cryopreserved and hidden away in remote terrestrial vaults or asteroids to serve as insurance against existential risks like hostile aliens.

The current collective “market cap” of the main entities within the cryonics space - Alcor and the Cryonics Institute (USA), Tomorrow Biostasis (Germany/EU), KrioRus (Russia), CryoDAO (crypto/global) - is in the mere $10Ms. As with life extension and nooceleration, I consider this to be wildly disproportionate to what a serious global civilization would allocate to this sector. Binding cryonics to euthanasia even just within the very limited subset of developed world MAiD deaths that non-terminally ill patients would increase the overall market by 2-3 orders of magnitude⁴. And this would be just the start, as exponentiating economies of scale collapse the costs of cryonics and drive adoption beyond that initially narrow demographic. More cryonics companies will appear, spurring competition and improved standards of service. Meanwhile, cryonics itself will become more reliable and scientifically grounded due to much more “practice by doing” and the flood of R&D technocapital that will pour into the sector.

Second, qualifying cryonics as a medical procedure bypasses tired bioethical debates. It would make euthanasia no longer euthanasia or suicide, but “euthanasia” or “suicide”. (Indeed, the very term “MAiD” becomes moot, and this would be for the best, since it strikes even me as a bit creepy with its connotations of buxom serial killer nurses running about with lethal injection pens). This would be especially true for the rarest but most controversial cases, which also obviously happen to be the ones that get the most public attention, as with the very sad case of Zoraya ter Beek, who recently underwent the procedure after years of crippling depression. Unrepresentative as they are, these cases figure disproportionately in anti-euthanasia polemics, contributing to the maintenance of policies that result in vastly more net suffering regardless of the merits or demerits of individual edge cases.

Now in fairness, I do not expect this to have any influence on the reigning bioethicist mafia. Consistently opposed to the advance of civilization from COVID challenge trials to embryo selection for intelligence, I expect their outlook to be no less morally bankrupt on cryonics.

Although countering their ruinous sway over biopolitics is beyond the scope of this essay, I am reasonably confident that most basically reasonable, rational people who are positively inclined towards euthanasia but have misgivings about its potential for abuse on the part of cost-cutting states or avaricious children against social groups that are vulnerable through the very fact of them being eligible for euthanasia will be open to this idea. Though my followers on X are hardly a representative sample, I would note that their support for MAiD went up from 42% to more than 50% when offered to bundle it with cryopreservation.

Furthermore, these policies would not only collapse the costs of cryonics and improve its efficacy, but a much larger percentage of cryopreservation operations will be performed under ideal or near-ideal circumstances. The first thing anybody in cryonics will explain to you is that by far the most important factor is the length of time between clinical death and the beginning of vitrification. Wait more than a few hours, and the brain starts turning into mush, as the neuronal connectome that makes you “you” degrades into irrecoverability even with the most magical future technologies. So time is of the essence. One hour is better than several hours, and immediately after clinical death is better still. Best and most ideal would be for cryopreservation to be an integrated part of the euthanasia process, but that is, of course, universally illegal in our bizarro world. And even as regards minimizing delays, the narrow window of time in which the neural connectome can be meaningfully preserved is often squandered by bureaucratic regimes that offer no legal provisions for a service with no formal legal status, or by family members who privilege their religious or moral sentiments over the wishes of their supposedly beloved deceased, and refuse to surrender their bodies to the cryonics recovery teams.

The only potential downside that I can see is that it would make euthanasia in those cases where the patient is mandated or chooses to undergo cryopreservation substantially more expensive. However, it will not exactly make it unaffordable. The global market cost of assisted suicide represented by a one-way trip to Switzerland is now around $20,000. In comparison, the cost of cryonics tends to range from the mid to high $10,000s out of pocket for just the brain and $200,000 for the whole body, and as discussed above, they should come down hard in the context of greater economies of scale. Moreover, this is if anything feature, not bug, since one of the more legitimate criticisms levied against MAiD is that euthanasia is relatively cheap compared to lengthy treatment regimes, and creates perverse monetary incentives for state-owned healthcare systems that privilege their accounts over objective patient interests, or the interests of inheritor children not being entirely aligned with those of the parent donors. Best of all, this money doesn’t go into some useless pit as with many regulations that “protect” consumers, but directly subsidizes some of the most life-affirming and civilizationally important research imaginable.

At the broadest level, I see this pairing as part of a grand project to void topical ethical debates by BUIDLing new tech. Just as cost-competitive artificial meat would herald the end of factory farming, probably the single greatest evil of our time, while artificial wombs would largely void hand-wringing over surrogacy, as well as giving the women the option to avoid the rigors of pregnancy and childbirth, so I would advance that coupling euthanasia with cryonics would enhance public acceptance of the individual autonomy represented by the former while adding an insurance layer against the tragic and horrible mistakes that will inevitably accompany it.

There’s no good reason we have to keep playing this game in permadeath mode. Let’s add an AutoSave.

At the KrioRus cryonics facility in Sergiev Posad, Russia in 2019 with qualia researcher Mike Johnson (center) and transhumanist/EA activist Igor Kirilyuk (far left); the latter sadly died in 2022, but his brain was cryopreserved and will hopefully be restored later this century.

1. Also anti-democratic. While Hanania notes that 72% of Americans support voluntary euthanasia for terminally ill patients, even in Russia, the one poll I’ve seen on this topic shows 50% support vs. 40% opposition.

2. For the record, I lean against legalizing euthanasia for physically healthy people with crippling depression or “unhappiness”; at the end of the day, if your existence is so unbearably bad that it constitutes a kind of existential torture, then I trust you to vote with your feet (off a bridge) or your trigger finger.

3. Personally, I think it’s currently somewhat higher than 1%, though less than 10%. But more importantly, the more that cryonics is actually practiced, the more R&D happens in the sector and the more prospective this treatment becomes. For instance, just the other day, a new company co-founded by Laura Deming demonstrated electrical activity in neural tissue after cryopreservation.

4. There are currently ~500 cryonics patients worldwide, with another 4,000 on waiting lists. In Canada, 4% of all deaths (330,000) are MAiD deaths (13,000), of which 2% accrue to people without terminal conditions (270 deaths). So just that narrow Canadian demographic by itself would double the world’s number of cryonics patients within a couple of years, to say nothing of the downstream adoption impacts from much greater visibility and affordability.