Cryonic-Hibernation In Light Of The Bioethical Principles Of Beauchamp And Childress
Charles Tandy, Ph.D.
The first part of the present report introduces the reader to the term "cryonic-hibernation." The second part of the report summarizes "the bioethical principles of Beauchamp and Childress," based on their highly respected text. Part three considers "cryonic-hibernation in light of the bioethical principles of Beauchamp and Childress" and arrives at a conclusion or considered judgment in the matter.
Cryonic-hibernation (also known as cibernation or cryonic suspension or cryostasis) is the experimental long-term suspended animation of a patient, human or animal, who is clinically dead or terminally ill, for the purpose of possible future restoration to full life and youthful health. The assumption of the cryonicist is that future biomedicine may be more advanced (better able to reverse damage) than present biomedicine -- and that cryonic-hibernation may serve as a kind of "time machine" to transport the patient to such a future. Thus, cryonic-hibernation may be viewed as a radically conservative biomedical procedure -- as compared to the alternative (e.g., burial or cremation of the patient). To assist in summarizing the conclusion (in part three) of the report, the term "cryonics patient," will be used to mean a terminally ill or clinically dead patient who was competent and freely chose to complete (and did complete) proper financial and related arrangements for the purpose of undergoing the biomedical procedure of cryonic-hibernation.
The present cryonics movement was founded by Robert C.W. Ettinger in the 1960s. The movement to cryonics went slowly until the 1980s. Today, however, it seems clear that the movement will continue even if its founder deanimates (i.e., becomes clinically dead) or cibernates (i.e., is placed in cryonic-hibernation).
The latest (i.e., fourth) edition of the highly regarded Principles of Biomedical Ethics (Oxford University Press) by Tom L. Beauchamp and James F. Childress was published in 1994. According to Beauchamp and Childress, there are at least four sets of factors (i.e., ethical principles or sets of ethical principles) to take into consideration when making an ethical biomedical decision. These four factors are: 1) respect for autonomy; 2) nonmaleficence; 3) beneficence; and, 4) justice. No one factor is necessarily more important than the others, although the reader may note that "respect for autonomy" comes first in the text.
Also note that the first factor is not "autonomy" (i.e., self-rule) but "respect for autonomy." The principle of respect for autonomy can be used to protect nonautonomous persons from self or others. Indeed, thinking of a person as simply autonomous or nonautonomous is too simple. Yet we can think of a person as competent or not to make a particular (or particular kind of) decision. If the patient is competent, then there is a prima facie obligation to respect the patient's voluntary decision even if the biomedical professionals strongly disagree (e.g., respecting the decision of a Jehovah's Witness to refuse blood transfusions). "A prima facie obligation is binding unless overridden or outweighed by competing moral obligations." (p. 33) Both liberty and competence are essential for autonomous choice or self-rule: "personal rule of the self that is free from both controlling interferences by others and from personal limitations that prevent meaningful choice, such as inadequate understanding." (p. 121)
The second factor is nonmaleficence. There is a prima facie obligation to not inflict evil or harm on the patient. According to some bioethicists, inflicting evil can be either an active or passive decision on the part of the biomedical professional; nonmaleficence thus tends to lead to beneficence. Other bioethicists say that nonmaleficence (as distinguished from beneficence) involves prohibitions rather than benefits. There is a prima facie case for not harming --for not setting back the interests of -- the patient; pain, disability, and death are examples of harms. Harms, even if unintentionally caused, are nevertheless harms -- thus the bioethical norm of "due care." According to the authors' analysis, and contrary to much previous "wisdom," the following distinctions are bioethically irrelevant: 1) withholding life-sustaining treatment vs. withdrawing life-sustaining treatment; 2) extraordinary ("heroic") treatment vs. ordinary treatment; and, 3) life-sustaining artificial feeding vs. life-sustaining medical technologies. Rather, the authors call attention to respect for autonomy and quality of life, and to a relevant bioethical distinction: optional treatment (either morally neutral or morally supererogatory) vs. obligatory treatment (either wrong not to treat or wrong to treat).
Language like "futile procedure" or "pointless treatment" — or, "kill" or "let die" — are bioethically dangerous terms. Rather, the patient and the biomedical professional should dig deeper and consciously articulate the scientific from the ethical and pragmatic factors in the case, rather than ambiguously combining the factors. Respect for autonomy -- for the patient's value system in terms of self-rule -- seems to demand this more clear-headed approach. And the biomedical professional has an obligation to specify alternatives, such as hospice care or increased medication. Moreover, sometimes patients are incorrectly diagnosed as hopeless. The legal right to privacy is one way to defend the moral right to die. "If competent patients have a legal and moral right to refuse treatment that involves health professionals in implementing their decision and bringing about their deaths, we have reason to suppose they have a similar right to request the assistance of willing physicians to help them control the conditions under which they die." (p. 226)
The third bioethical factor is (the prima facie obligation of) beneficence. If nonmaleficence ("no" to doing bad) tends to lead us to the further principle of beneficence ("yes" to doing good), then "positive beneficence" (providing goods or benefits) tends to extend to further considerations of "utility" or the balancing of goods (benefits) and bads (drawbacks). Typically, both goods and bads result from an action. Yet, utility is constrained by other ethical considerations -- just as utility may constrain the other moral values. So when we attempt to do good, we will wish to consider the net balance of goods (benefits) over bads (costs) as one moral value ("utility") among other moral values. Thus, cost-benefit analysis does not tell us which decision is ethically preferable; it is simply one tool among other ethical tools -- as we attempt to do good. Also, cryonicists, please note that the authors consider it ethically important that "risks" and "uncertainties" be considered as two separate entities for analysis.
If utility seeks the net balance of benefits over costs, then justice, the fourth bioethical factor, seeks a just societal distribution of those benefits and costs. Distributive justice is a prima facie obligation under conditions of scarcity/competition. In the United States, at least, each citizen should have equal access to an adequate (not maximal) "tier one" level of health care -- the market economy would serve as "tier two" in the double-tiered system of health care envisioned by the authors. For today's United States, our bioethical authors believe that their two-tiered system is preferable to a one-tiered system, whether all-government or all-market controlled.
A review of part two above, as applied to cryonic-hibernation, yields the following results:
If the terminally ill or clinically dead patient was competent and freely chose to undergo the biomedical procedure of cryonic-hibernation, then the bioethical factor, respect for autonomy, produces a prima facie obligation for cryonic-hibernation (and against burial or cremation) of the cryonics patient.
While it is presently unclear as to what extent the biomedical procedure of cryonic-hibernation may inflict damage on the patient, it seems obvious that it inflicts less damage than the alternative (e.g., burial or cremation). Accordingly, the bioethical factor, nonmaleficence, produces a prima facie obligation for cryonic-hibernation (and against burial or cremation) of the cryonics patient.
In terms of the value system of a free and competent cryonicist, cryonic-hibernation is a relative good, not a bad, as compared to burial or cremation. Moreover, in terms of utilitarian concerns, cryonic-hibernation results in no significant population-resources-environmental problems, as accurately articulated by Ettinger decades ago. Moreover, it will be the "quick," not the "deanimated," who will determine if or when a patient's cryonic-hibernation ceases or resuscitation begins. If cryonic-hibernation is relatively "risk-free," it is also a relatively "uncertain" enterprise. The biomedical factor, beneficence, then, produces a prima facie obligation for cryonic-hibernation (and against burial or cremation) of the cryonics patient.
If the competent and free patient can personally afford cryonic-hibernation and accordingly so arranges, then the fourth bioethical factor, justice, produces a prima facie obligation for cryonic-hibernation (and against burial or cremation) of the cryonics patient. What is less clear is whether American society has a "just" obligation to make available, as appropriate to its citizens, the biomedical procedure of cryonic-hibernation as part of the "free" system of "tier one" health services; this issue will not be explored presently.
Each and every one of the four bioethical factors or principles articulated by Beauchamp and Childress, taken individually, produces a prima facie obligation for cryonic-hibernation (and against burial or cremation) of the cryonics patient.
The above considerations yield the following conclusion: The bioethical principles of Beauchamp and Childress — 1) respect for autonomy; 2) nonmaleficence; 3) beneficence; and, 4) justice — produce congruent, rather than conflicting, prima facie obligations to the cryonics patient. This four-fold congruence means that biomedical professionals have a strong (not weak) and actual (not prima facie, but binding) obligation to help insure cryonic-hibernation of the cryonics patient.