From Cryonics, November 1989

Worst Case Scenario

by Mike Darwin (with Carlos Mondragon)

On August 19, 1989, a 21-year-old woman experienced sudden cardiac arrest at a resort hotel off the coast of Spain. She was a Spanish national, young, apparently healthy, and with her whole life seemingly before her.

Five thousand miles away, life proceeded at its usual hectic pace at Alcor. The young woman, her life, and her predicament were unknown to us. In Spain, a frantic search and a desperate effort had begun. The parents of this young woman, wealthy, influential, and possessed of iron-willed determination, had made an incredible decision: to have their daughter placed into cryonic suspension.

The Struggle Begins

In the face of great opposition they enlisted the aid of their family physician and persuaded their Coroner to limit the scope of the autopsy. Further, they persuaded the Coroner to cool their daughter to a temperature a few degrees below freezing (-3°C).

The parents, their daughter-in-law, and the family physician began a frantic effort to reach an American cryonics organization and facilitate the cryonic suspension of their daughter. The odds against them, by any measure, were astronomical.

They placed calls to leading American medical centers and hospitals such as the Mayo Clinic. They called cryogenic companies in large American cities searching desperately for a lead.

Finally, on August 25th the phone at Alcor rang. It was a Maryland cryogenic equipment distributor who had talked with the parents' daughter-in-law (a young woman we'll call Alicia Tomas in this report—Alicia Tomas is a pseudonym, as are the names of the patient and the patient's family members). The distributor remembered an article about Alcor which had appeared a few weeks before in the July issue of People magazine. Mike Darwin took the call and explained that Alcor did not take cases where non-members had experienced legal death and relatives were trying to facilitate their suspension. "You tell these people that." the distributor replied, "their grief and determination are unbelievable; it's their daughter they're calling about and these people have tried everywhere. They don't intend to take 'NO' for an answer." The distributor went on to ask if we would at least talk to them.

At 7:00 AM on the morning of August 26th the phone rang in the apartment of Alcor President Carlos Mondragon. It was Alicia, the daughter-in-law of the couple whose daughter had died. The details of the case began to emerge.

The young woman's name was Laura Tomas. She was the daughter of two Spanish hoteliers and she had experienced cardiac arrest unexpectedly and for as yet unknown reasons while at work at one of her parents' hotels. She had been unsuccessfully resuscitated and then taken to the Coroner's office where a "limited thoracic autopsy" had reportedly been performed. We were told that due to the family's and the family physician's influence, the scope of the post-mortem examination had been limited to her chest only, and she had been frozen to -3°C by air cooling in a refrigerated morgue. At the time of the call we were told that she was being maintained in the Provincial morgue (private mortuaries do not have refrigeration or embalming facilities in most areas of Spain) and that the authorities reportedly were willing to cooperate in transferring her to the United States for cryonic suspension.

Carlos talked with Alicia at length and explained Alcor's policy regarding non-member suspensions. Alicia was knowledgeable, articulate, and persistent. To every one of Carlos' objections she offered an answer.

"You must reconsider your policy in this case," she told us.

At 7:45 A.M. Mike Darwin's phone rang (Mike is Alcor's Director of Research). It was Mike's turn to try and dissuade Alicia and the rest of the family, by explaining not only Alcor's policies, but the enormous amount of injury such a delay at high temperatures after cardiac arrest would have caused.

Mike was also impressed by Alicia's determination, by her understanding of the issues, and by the philosophical position taken by the family, which Alicia relayed to him. Their attitude was typical of that of so many cryonicists: The Tomases understood that the injury was enormous, but as they pointed out, "burying Laura or cremating her wasn't going to make it any better." There was obviously a great deal of structure left, and even if the fidelity of recovery was very low, in their opinion something was better than nothing. But most of all they kept saying that they "simply could not give up if there were any chance for Laura, any chance at all." Since it was impossible to know if there was any chance, let alone to quantify it, they felt obligated to proceed.

The Tomases are substantial people, and they were forceful in pointing out that the $100,000 minimum Alcor requires for whole body cryonic suspension was not an issue for them; and that in any event cryonic suspension for Laura was morally compelling to the Tomases despite the dismal circumstances.

The Tomases had heard of cryonic suspension many years ago and had decided on its rationality at the time. They had simply not given the matter any further thought until the untimely cardiac arrest of their daughter.

Making A Difficult Decision

After their conversations with Alicia, Carlos and Mike conferred at length, and several other Alcor Directors were contacted. Many issues were considered: the fierce dedication and formidable will already shown by this family, the advantage to Alcor in having a "trial run" overseas case, since we have a rapidly growing population of overseas members and virtually no experience in transporting them into the United States, and of course the powerful negatives of lack of background information and questionable informed consent.

This core group of Directors made a very difficult decision: to accept Laura as a suspension patient, providing a number of critical milestones could be met. The first and most important milestone was to get approval of all of the other Alcor Directors before making an exception to the long-standing Alcor policy of not accepting non-members for suspension.

Another milestone was insuring informed consent. Somehow, across 5,100 miles with nothing but a telephone and a fax machine, Alcor must convey the essentials not only of cryonic suspension, but of Alcor's operational principles and the reality of our situation; including our legal problems and the questionable legal status of cryonics itself. And all of this must be done with the language barrier as an added complication. At least Carlos spoke fluent Spanish and Alicia spoke fluent English. The Tomases spoke only Spanish.

The first step was to fax core Alcor paperwork and literature to the family and provide them with instructions to further reduce Laura's temperature and prepare a shipping container for her safe, subzero transport to the United States. The next step was to have Carlos speak directly with the family, at length and in Spanish, in order to clarify the situation and give them the vast amount of information they would need. This was done early on August 27, and approval for an exception to Alcor's policy of not accepting non-members for suspension was given by the Board of Directors the same day.

Problems In Spain

Efforts to reduce Laura's temperature by cooling her to -79°C proved impossible. Dry ice simply was not available in such quantities on the resort island where she was located. The best that could be done was to reduce her temperature to -25°C with the morgue cooler. But a new problem had arisen. The Provincial authorities had announced that Laura would have to be embalmed before she could be shipped into the United States since this was "Spanish law." If such was to be the case, they could not cool her further until she was embalmed. After much additional negotiation it was decided that external disinfection would be sufficient and that her temperature could be reduced to -25°C. But exactly when it would be possible to further cool her was not made clear.

The next difficulty that began to emerge was that the Spanish authorities were reluctant to allow Laura's transfer to the United States for legal and political reasons which were not completely clear to us on this end. Early on the afternoon of August 28, Carlos called the United States Department of State to attempt to facilitate the paperwork and reassure the Spanish authorities that no problems would result as a consequence of the Tomases and their daughter's "remains" entering the United States for purposes of Laura's cryonic suspension.

The State Department cabled the Spanish authorities, stating that Laura's cryonic suspension presented no inconvenience to the government of the United States. We then faxed a letter to the U.S. embassy in Madrid and the U.S. consulate in Barcelona stating that Alcor would accept custody of Laura's "remains".

Unfortunately, that was hardly the end of the problems. After several other communications with the U.S. embassy and a delay of several more days, paperwork was secured from Spanish authorities to release Laura for transport to the United States. In the interim, Laura's temperature had been reduced to -25°C and a special, modified casket was constructed with styrofoam insulation to facilitate safe shipment. Due to the intransigence of both the Spanish authorities and Iberia airlines it was not possible to ship Laura packed in dry ice. The Spanish authorities insisted she be in a hermetically sealed box (which as it later turned out, not only wasn't hermetically sealed, but actually had a charcoal-filtered vent on it!) and Iberia insisted that they could not allow that amount of dry ice to be shipped in the cargo hold of the aircraft!

What ultimately happened was that 60 kilos of dry ice were placed around the outside of the insulated box in an uninsulated and vented crate (the irony of this is that had the dry ice been placed inside the well-insulated shipping coffin, the amount of carbon dioxide generated in the aircraft would have been a tiny fraction of what was generated as the dry ice sublimed away in an uninsulated container, and Laura would have probably been colder on arrival, rather than warmer!). Thus Laura arrived packed in water ice at a temperature of -5°C at 4:00 P.M. on September 3 (even though all the dry ice had sublimed long before her arrival).

If the Spanish bureaucracy had proved tedious to deal with in getting Laura out of Spain, the U.S. bureaucracy proved unbelievably fast and efficient by comparison. It took a little less than two (yes, that's two) minutes to get Laura moved through U.S. Customs and freed for transport to the Alcor facility.


Opening the insulated shipping container from Spain. Jerry Leaf and Arthur McCombs take tissue samples. Note the charcoal filter over the vent inside the lid at the far end. Photo by Saul Kent.

While Laura was still packed in subzero water ice, biopsy samples of skin and muscle were taken for histological evaluation of her ischemic deterioration. She was then instrumented with thermocouples, photographed, given a rapid external exam (we were extremely anxious to avoid rewarming her), and prepared for placement in Alcor's silicone oil (Silcool) controlled cooling bath.

The recommendation of our professional cryobiologist was that we cool Laura fairly rapidly to dry ice temperature, by starting with a surface-to-core temperature differential of -40°C, maintaining it until it tailed out, and terminating at -79°C.

Unexpected Problems, Part I

Despite the fact that the Tomases had been thoroughly briefed about Alcor's policies, our size, the character of our physical plant and the general status of cryonics, they were unprepared for what they saw when they arrived.

The small size and relative crudeness of Alcor's facilities in relation to what their expectations were deeply distressed them. They had expected that even though Alcor was small and controversial, we would be housed in a hospital-like or clinic-like environment. They were completely unprepared for a mixed-use industrial building with no private conference rooms and a patient care area which resembles an industrial plant more than a medical facility.

While courteous and pleasant, the Tomases were obviously disturbed and unhappy. They immediately began to inquire about alternatives such as transfer of their daughter to their care in Australia, where they live half of the year and own additional business property.

While still in Spain, the Tomases were advised that they would be given several days to evaluate Alcor and consider whether they wanted to pursue cryonic suspension with us, or even to pursue it at all. It quickly became apparent that while the Tomases sincerely wanted cryonic suspension for Laura, they were not at all happy at the notion of Laura being cared for by Alcor and they declined to sign the Alcor paperwork or to transfer funding for Laura's cryonic suspension without much additional discussion.

By this time it had become apparent that Alcor was confronted with a troublesome and potentially serious situation. We were in the position of having a patient in our physical custody for whom we had no executed cryonic suspension paperwork, no funding, and relatives from a foreign country who were uncertain about proceeding with the suspension, or at least were uncertain about proceeding with it under the auspices of Alcor.

It was decided that Alicia, the family, and representatives from Alcor would meet to discuss the situation at length, review the options, and try to come up with a plan of action. A meeting was set up at the home of Saul Kent on the evening of September 4. This meeting proved something of a watershed. It lasted four hours and was emotionally and intellectually demanding. Simply put, the Tomases had a number of concerns about
Alcor, most of which were not unreasonable.

They were concerned about almost every aspect of Alcor's operations. What guarantees did we have that such a small organization would be able to care for Laura over a long time course? What about the adequacy of the financial arrangements? Why must they surrender control of Laura to Alcor when they, her parents, were making the arrangements and paying the bill? What kind of assurance did they have that if Alcor was being mismanaged they would be able to take possession of Laura and move her to safety elsewhere? Why must Laura be placed in the cryogenic storage unit head down? Why couldn't periodic viewing of the patient be arranged for the purpose of identifying her and verifying her continued cryogenic care? On some of these items the Tomases were very adamant and it was clear that major differences existed. It seemed possible that no agreement would be reached that would not compromise Alcor's principles and yet be acceptable to the Tomases.

During the course of the discussion, the Tomases were repeatedly told of other cryonics organizations and assured that Alcor would assist in transferring Laura to another organization should they choose this course of action. It was also explained that, due to the unique nature of the situation and their enormous grief and emotional distress (they had not slept adequately for nearly two weeks and had virtually no sleep at all for three days), they would be given a reasonable amount of time to make a decision. Carlos and Mike Darwin repeatedly urged the Tomases to consider and to contact other organizations which did not have Alcor's policies with regard to control of the patient after suspension. But it was made clear that Alcor could not and would not compromise on these issues. We must have control of Laura's suspension and we must have the ability to offer the kind of care we feel is in the patient's best interest.

On September 6, after two days of consideration, the Tomases signed the Alcor paperwork and began arrangements for electronic transfer of funds to Alcor's account.

The following day, Carlos took Alicia and the Tomases to visit Los Angeles and see the sights. This was no small thing. The Tomases had been in a terrible state of turmoil since their daughter's unexpected cardiac arrest 18 days earlier. They had been confronted with one frightening and unsettling thing after another, not the least of which was battling Spanish bureaucrats and then having to confront the uncomfortable realities
of the state of cryonics in the United States. The trip to Los Angeles was the first break in a nightmare stretch of uncertainty and difficulties. They had made their decision, Laura would be suspended with Alcor. Their daughter was at dry ice temperature and was soon to be placed in long term liquid nitrogen storage. For the first time they could have some peace. Unfortunately, their respite was not to last for long.

Unexpected Problems, Part II

One of the things which had caused considerable concern was the fact that the autopsy incision did not match what Alicia had told Mike and Carlos on the phone from Spain. The incision apparently extended from the sternal notch to the pubic symphysis instead of being confined to just the chest.

Owing to the patient's subzero arrival temperature, and a thick head of hair saturated with partially frozen formalin, it had not been possible to evaluate the scalp for incisions. But the family physician, Laura's parents, and Alicia all assured us that no post-mortem cranial examination had been performed. "They did not touch her brain," we were assured.

The presence of what appeared to be a full autopsy incision caused us great concern. Having had some experience with the integrity of American coroners, we had reason to wonder about their Spanish colleagues. After some discussion it was decided that a full-body radiologic evaluation needed to be undertaken to determine the extent of the dissection and to rule out any possibility that a cranial autopsy had been performed without the family's knowledge.

Arrangements were made with a portable X-ray service to bring out an X-ray unit. A procedure was worked out whereby Laura could quickly be transferred from the Silcool bath to a sleeping bag which had been precooled with liquid nitrogen. The company also did some test shots to insure that the Silcool which would likely remain pooled on and/or in the plastic bags surrounding the patient would not cloud or obstruct the film. Once it was determined that this would not be a problem, the X-ray examination was scheduled. As an additional precaution we prepared dry ice packs by filling cloth pillow cases with crushed dry ice. These were to be packed around Laura's head while the chest and abdominal films were being taken.

The X-ray company offered as a routine part of their service on-the-spot processing of the film so it would be available for a quick evaluation by Alcor staff. The film would then be evaluated by a Board-Certified Radiologist with military-forensic experience (i.e., experience in reading films made on cadavers both before and after autopsy).

On September 8th at 11:30 A.M. the radiology service arrived and shot anterior- posterior films of Laura's head, chest, and abdomen. A lateral shot of Laura's head was also made. Within 15 minutes the film was processed and was put on the X-ray viewer in the Alcor operating room.

There was a stunned moment of silence. Laura's cranial vault was empty -- except for a homogenous mass occupying the posterior 1/3rd of it; apparently blood/fluid that had leaked into the empty cavity after her brain had been removed.

The abdominal and chest films revealed no cardiac shadow, abnormal bowel gas patterns and no evidence of a right kidney. Laura had been completely autopsied.


Conventional radiogram of the patient's head. The posterior 1/3rd of the braincase is filled with frozen body fluids. The discontinuity at the upper forehead and the cuts in the back of the skull indicate the way the top of the skull was cut to remove the brain during the patient's autopsy.

Breaking The News

Carlos had a lunch date with the Tomases at 1:00 P.M. Evaluation of the films was completed by Jerry Leaf and Mike Darwin at approximately 12:30 P.M. A decision was quickly made to inform the Tomases of the results of the radiologic examination immediately, and to carry out a more exhaustive search for the missing brain using a CT scanner. Jerry Leaf set out to locate a mobile CT scanning company willing to make a house call on a weekend. A courier was sent with the processed film to the radiologist for a final and professional interpretation. Carlos and Mike Darwin proceeded to the hotel where the Tomases were staying and explained that they had bad news for them.

The Tomases reacted to the disclosure of their daughter's condition with shock, outrage, and total horror. It is not possible to describe the grief and anguish of the Tomases, or for that matter to communicate the grief and anguish that we felt. Everyone was in tears. A few rapid phone calls were made to Spain. Carlos was assured "that no such thing was done in Spain! Under no circumstances would her brain have been removed. Always when there is an autopsy in Spain the organs are put back where they belong!"

The implication might well have been that Alcor did it! (Of course if we did, why would we tell them?) When the Tomases recovered sufficiently to think coherently, they wanted to know what had happened to Laura's brain. Were we sure that the mass in the posterior part of her cranial vault was really fluid? Was there any chance that her brain had been returned to her chest or abdomen with the other viscera following the post-mortem exam?

We suggested that the pathologist who conducted the autopsy be contacted (as opposed to the coroner, with whom they had been dealing) and asked some rather pointed questions. We also told them of our intention to have CT scans done to try and resolve if tissue had been returned to the body cavity and perhaps, as a long shot, to try and identify the brain if it was there.

After much effort, Carlos was able to contact the pathologist who had performed the autopsy. With the Tomases' connections it had proved possible to get his home phone number and he was rousted out of bed at 3:00 A.M. in Spain. He confirmed that a complete autopsy had been performed, further stated that Laura's brain had been bisected laterally, with a sample taken for microscopy, and confirmed that, to the best of his knowledge, his assistant had returned the brain to one of the body cavities with the rest of the viscera. The question now was: could he be believed? At this stage, after so many lies, could anyone be believed?

Needless to say, the Tomases were told that this discovery of a heretofore unsuspected level of injury, so likely to be obliterative of Laura's identity, released them from the Alcor Cryonic Suspension Agreement which they had signed on September 6. It was explained that after the results of the CT scan, they would be given a reasonable amount of time to consider their options and if they chose not to proceed with Laura's suspension there would be no charges beyond those incurred in cooling her and arranging for her radiologic evaluations ($6,000).

On the morning of September 9, Laura was transferred out of the Silcool bath into a large, "intermediate-weather-rated" military-style sleeping bag which had a bed of dry ice in it. Laura was then completely surrounded with a layer of pulverized dry ice and the bag was closed. She had been previously instrumented with an array of external thermocouple probes (and one internal, deep sinus probe) so it would be possible to monitor her temperature during the CT scan for any temperature rise.


Lifting the patient from the Silcool bath to place her in a dry ice cooled sleeping bag for CAT scanning. Hugh Nixon, Mike Perry, Carlos Mondragon, Steve Bridge, Mike Darwin. Photo by Saul Kent.


Prior to the CT scan, the patient was placed in a sleeping bag and covered with dry ice. Photo by Saul Kent.


The patient has been placed in a sleeping bag with dry ice, and placed in the insulated Spanish shipping container to await the arrival of the van. Scanner technician, Jerry Leaf, Carlos Mondragon, Mike Darwin, Hugh Hixon. Next to Jerry are the x-rays taken the previous day that show the extent of her autopsy. Photo by Saul Kent.

Shortly after Laura was positioned in the sleeping bag, a mobile CT unit in a large van, with its accompanying 275 KW power unit on a smaller truck, rolled up to Alcor's front door. Laura was then placed on an ambulance cot and wheeled out of the Alcor facility and into the parking lot and the waiting CT unit. Axial scans were made at 10 mm and 5 mm intervals of Laura's head, chest, abdomen and pelvis.


Mobile CAT scanner at Alcor. The 275 KW power unit truck sits in front of the scanner van. Photo by Saul Kent.


Waiting to load the patient into the scanner van. Scanner technicians, Steve Bridge, Hugh Hixon, Carlos Mondragon, Mike Darwin. Photo by Saul Kent.


View inside the CT scanner van. The patient has been posit- Toned in the imaging unit I-to-r, Mike Darwin, scanner technician, Mike Perry. Photo by Saul Kent.

It is hard to describe the mixture of emotions that confronted the Alcor staff as they watched the images materialize on the CT screen. There were seven people crowded into the control room of the CT unit: Suspension Team Director Jerry Leaf, Mike Darwin, Hugh Hixon, Dr. Mike Perry, the CT technicians, and Alicia (who was present as the family representative).

Cross-section after cross-section appeared on the CT screen. The level of detail was astonishing. Here, for the first time, a suspension patient was imaged by state-of-the-art non-invasive medical technology. Gradually the interior of the patient was being revealed a slice at time. The images were surreal and breathtaking; each cross-section showed not only the patient, but the surrounding cocoon of dry ice and sleeping bag, and the wires of the thermocouples and their shadows.

The first images confirmed the absence of brain tissue within the cranial vault. All that was present was a nearly uniform mass of ice occupying the posterior third of the cranial cavity. As the scan progressed, it was possible to make out irregular but unidentifiable tissue masses within the chest and abdomen. It was apparent that a large amount of tissue had been returned to Laura's body cavities, but it was not possible to determine what kind of tissue it was. At least it was possible to determine that tissues were present in the chest and abdomen (a very real possibility was that there were none, since some coroners simply discard the removed viscera and replace it with absorbent packing and a plaster/ paraformaldehydebased mortuary product called hardening compound).


CT scan through the patient's head. The autopsy cuts are obvious as discontinuities in the skull. Enhancement of the scans indicated that some floating waste or absorbent material (gauze sponge, paper towel, etc.) was placed in the empty braincase before the top of the skull was replaced.


CT scan through the lower chest. Unidentifiable organs and packing. The white masses outside the body are the dry ice that surrounded her.


Transverse CT scan of the patient's head and chest. The gravel-looking effect is the dry ice placed around her.

Due to our dry-ice-and-mummybag insulation, Laura's temperature did not rise at all throughout the entire two-hour CT scan procedure. Following the CT scan, Laura was returned to the Silcool bath for temporary storage at -79°C until a decision could be reached concerning her further care. The Tomases were told of her condition and of the inconclusive results of the CT scan. They were left in the horrible position of having to rely on the word of people who had lied to them repeatedly in the past, and what's more, had absolutely no reason not to lie to them now concerning the location of Laura's brain and the extent to which it had been dissected.

Mike Darwin spoke to the Tomases and advised them that professionally speaking it was hard to justify proceeding with the suspension if they expected recovery of their daughter in any usual sense of the word. The degree of injury from freezing, ischemic delay, and autopsy were, by any current or projected technologies, probably beyond repair. Granted, the exact molecular nature of memory was not yet understood, but what was understood was that there would be massive degradation of brain cells with likely disruption of membranes, as well as break-down of cell components. The most reasonable conservative advice we could give would be not to proceed. He explained that any other assessment on the part of Alcor would be both technically and morally indefensible. It was made clear that we were holding out no hope whatsoever.

The Tomases stood fast. They explained their position simply (I am paraphrasing them here): "Since the possibility exists, we have to assume that our daughter's brain is in suspension. We know the damage she has sustained is massive, but what we do not know is what will be possible in the future. If there is any chance at all, we want to take it. The money is simply not an issue. We could not bear to walk away from here knowing that we did not take the most conservative action possible, which in this case is to continue to care for whatever is left of our daughter. We want to proceed with the suspension."

Once this decision was made, the Tomases seemed at peace for the first time. The following day, September 10th, they returned home to Spain. On September 16, cooling below dry ice temperature was started, and she was placed in liquid nitrogen on the 21st. She was positioned head-up in the dewar to facilitate identification, since the usual reason (protection of the brain from warming to vapor temperature in an emergency where liquid nitrogen service was disrupted) clearly did not obtain in her case.


Preparing to transfer the patient from the dry ice bath to the sleeping bag for N2 cooling. Mike Perry stands by. Hugh Hixon controls LN2 to Mike Darwin, who cools down the insulation the patient will be placed on for her preparation prior to going into the sleeping bags at right rear. Photo by Elleda Wilson.


Picking up the patient with a crane rigged through the open skylight of the patient care bay. Carlos Mondragon and Mike Darwin steady the patient. Hugh Hixon stands by on the vaults, with Dave Christensen guiding the thermocouple wires. Jerry Leaf controls the crane. Through the skylight, Saul Kent takes photographs. Photo by Elleda Wilson.


The patient is lowered into the dewar by a crane rigged through the open skylight in the Patient Care Bay. Mike Perry braces the dewar, Hugh Hixon guides the patient into the dewar on her tray, and Dave Christensen guides the thermocouple wires. Photo by Elleda Wilson.


Initiation of N2 gas cooling. Hugh Hixon adds N2, while Mike Perry takes notes. Photo by Elleda Wilson.

Analysis

The title of this case report is "Worst Case Scenario". In many ways this not true, though this title adequately sums up what we felt in living through it. Emotionally, in some ways this situation was worse than the straightforward irrevocable loss of a loved one. In that sense it was very much a worst case scenario.

As this case began to unfold, it became clear to all involved that Alcor had bought into some serious risks. There were many points where things could have taken a turn for the worse, possibly exposing Alcor both to damaging press and damaging litigation. To those who were involved in both making and implementing the decision to accept Laura Tomas as a patient it was abundantly clear that we were playing with fire.

The reasons for Alcor's long-standing policy of not accepting non-members for suspension were and are good ones. This case, an exception, seems to have worked out well. But it is clear that if we are to make exceptions we had better have far better guidelines than we did in this case (which is to say almost none, aside from our personal assessment of the Tomases). Otherwise, we are likely to find ourselves embroiled in a
situation which is indefensible. Is there a way around the issues of informed consent in last minute, non-member suspensions? What degree of risk is it acceptable for us to take?

The Directors of Alcor still believe that our policy of not accepting non-members for suspension is a good one. The many problems the Tomases had in absorbing and dealing with Alcor's policies and the realities of cryonic suspension while under enormous emotional duress were evident to all involved. Witnessing their anguish and their difficulty in becoming informed under such adverse circumstances powerfully confirmed emotionally what we have known intellectually for quite sometime (and what our policy of rejecting nonmembers for suspension addressed): it is simply not possible for people to make a rational decision about committing to cryonic suspension with Alcor under the kinds of emotional and logistic pressures experienced by the Tomases. The risks to Alcor in such a situation are potentially very great.

On the other hand, how should other situations be handled where the risks are considerably less and the issue of informed consent is not an issue? As an example, what about someone like the experts who have declared in favor of cryonics, are thoroughly familiar with Alcor, and yet who have not signed up themselves and find themselves confronting the sudden loss of a family member over whom they have the legal right to control post-mortem disposition? Can we come up with objective guidelines that will serve us well in accepting non-members for suspension under such emergency conditions? And should we?

This is an issue that the Alcor Board will be considering in the near future. Your input as Suspension Members and as family and friends of Alcor members now in suspension is solicited. We want to hear from you on this issue today.

It is also wise to keep in mind that an incredible amount was learned from this suspension. The majority of Alcor Suspension Members have authorized their cryonic suspension "regardless of the degree of damage from autopsy, fire, decomposition..." Laura certainly represents the first patient we have taken who has been this severely injured. But she will almost certainly not be the last. We learned much about how to move patients from overseas into the United States, about the honesty, or rather the lack thereof, of some forensic officials in other parts of the world (we've already had a lesson about the honesty of some of them here!) and about the kind of assessment that needs to be made a routine part of our program in evaluating the condition of patients who have been in the custody of Coroners or Medical Examiners. Significant changes in Alcor procedures for evaluating and documenting the condition of its patients will be made as a result of this case.

Finally, the excellent cooperation and support Alcor received from the United States government was gratifying and very helpful. It is quite possible that without the intervention of the Department of State, Laura Tomas would never have been suspended.

In short, this was a valuable learning experience on every level. We do not regret having accepted Laura as a suspension patient. But it is clear that we must develop a framework which is both fair and protective of all involved. We must quickly find a way to maximize the advantage of such cases while minimizing the disadvantage.

It has been suggested recently elsewhere that there should be developed a formal program of offering non-member suspension services via a network of morticians. This idea, while interesting, is not likely to meet Alcor's unique needs or address the problems we are likely to confront when our phone rings. Laura Tomas' suspension is a salutary lesson here.

Hopefully, the coming months will bring some resolution to these issues and some much needed guidelines for future decisions.