From Cryonics, April 1993

Beginnings of Winter: Suicide and Cryonics

The tragic case of patient A-1401

by Ralph Whelan

Week One

In the middle of January of this year, an Alcor member residing in Texas called Alcor and informed staff member Mike Perry that he wished to commit suicide and be cryonically suspended. A conference call with myself and Carlos Mondragon quickly ensued, during which the member, "Robert Daly," explained that he had pneumonia, but that he would not be seeking treatment, because he preferred to take advantage of this opportunity to die an anticipated death and be cryonically suspended. Mr. Daly was 48 years old.

During the many conversations of that and subsequent days, Carlos and I explained that the death by pneumonia of an otherwise healthy individual is a sure recipe — in this day and age — for autopsy. Though Mr. Daly was concerned about this, he was very determined to die. Unfortunately, as the days ticked by and pneumonia failed to claim Mr. Daly, he was forced to share his conclusion that it was in fact merely a stomach flu, and no match for his immune system.

Not so easily daunted, though, Mr. Daly's stomach flu gradually mutuated into "a strange ailment that prevents me from eating or drinking," in his own words. Unsurprisingly, this development arose shortly after Mr. Daly learned that other Alcor patients — members with underlying terminal conditions like cancer or AIDS — had intentionally dehydrated to hasten "the end," usually to improve the quality of their suspensions. Mr. Daly began insisting that he was not capable of ingesting any food or fluid, and that he would need suspending within one or two weeks.

By this time, we had learned some interesting things about Mr. Daly by taking a closer look at his Application For Cryonic Suspension. After first providing various details of his medical and personal history, Mr. Daly had used "wite-out" to conceal the things that he had apparently thought better of telling us. Some crack detective work by Tanya (she held the various pages of his Application up to a light) revealed enough for us to understand that Mr. Daly had a long history of clinical depression which apparently had not responded to any of the many medications he had tried.

Over the course of several days, with many conversations each day, I did my best to convince Mr. Daly that his situation was sufficiently unlike those of the other Alcor members who had dehyrdated that it was not advisable in his situation. Almost without fail, he responded by insisting that I answer this question:

"Do you believe that I have this ailment that prevents me from eating or drinking?"

"What I believe," (I would respond), "is not relevant, because it's clear that you are dehyrdating yourself, whether by choice or otherwise. I just want to help you understand what will happen to you once you lose consciousness and the medical establishment intervenes."

"So then you don't believe me?"

"What I believe is not relevant. What is relevant is what will happen to you if your dehydration continues. If you are hospitalized while still alive, the doctors will rehydrate you. If you are found already dead, you will be autopsied."

"But I have this ailment, you see. Do you understand that I have this ailment?"

"Forget about what I understand. Do you understand what happens in cases of unanticipated deaths? They get autopsied. You will be autopsied."

To make matters worse, it was clear to us (as soon as we determined that Mr. Daly was in fact suicidal, and not suffering from pneumonia or this "strange ailment") that Mr. Daly's life insurance was not going to pay if he killed himself. He'd had the policies (two of them) for almost exactly one year, and they both had two-year suicide exclusion clauses. This meant, of course, that death by suicide would void the policy, in which case Alcor would not receive the Suspension Fund, and would be unable to cover the costs of suspending him. Additionally, though, Mr. Daly had $10,000 in trust for Alcor at a bank near his home. This trust fund would eventually turn out to be his saving grace.

The exchanges between Mr. Daly and I continued to deteriorate. There was no hostility, that I could detect, on the part of either one of us. But the frustration level would escalate in each phone call, with Mr. Daly losing patience with the Byzantine requirements his dying process would have to meet to facilitate his suspension, and with myself growing despondent at my seeming inability to convey to him the constraints on his position. The life insurance situation was a source of great confusion and despair for Mr. Daly. He would call me several times in one hour with successively weirder and less defensible interpretations of the suicide exclusion clauses, hoping to convince me that the insurance companies would in fact pay Alcor if we suspended him. I eventually derailed these advances by explaining that even if we knew that the insurance company would unwittingly pay us, we would not assist him in defaulting on his contract with them (i.e., we would not accept the money).

As the first week of this came to a close, Carlos and I spent a great deal of time discussing the ethics of the situation. Clearly, one of our members was in dire need of help, of one sort or another. But how far could we go in helping him before our "help" led to encroachment of his personal freedom? We considered calling a Suicide Prevention Center, but discussions with knowledgeable members led us to believe that most of these Centers would take action, if possible, to have Mr. Daly restrained and sedated, should they be unable to "talk him out of it." As rather staunch libertarians, we found ourselves squirming at the notion that one of our members might call us for help or advice, and soon find himself in a straight jacket and a rubber room. Clearly this was unacceptable. And yet, perhaps a qualified psychiatrist could really help Mr. Daly. Was there any way we could facilitate this without risking his freedom?

Feeling just a bit out of our element, we (Carlos and I) decided to call JoAnn Martin, a local Alcor member who runs the Riverside Manic Depressive and Depressive Association. JoAnn explained to us what we were already acquiring a visceral knowledge of: that at this point, Mr. Daly would care about one thing and one thing only, and that was ending his pain. It was encouraging that he even cared about getting a decent suspension, but it was clear to us — and clearer still with each conversation — that his interest in getting a good suspension was waning with every hour, as it became harder and harder for him to avoid the grim fact that today, on planet
Earth, you just can' t choose when you want to be suspended, unless you've only weeks to live anyway.

A few days prior, Carlos had asked Mr. Daly if he could involve other Alcor members in the situation, should we decide that it would be "helpful." Mr. Daly had agreed, and we decided that having JoAnn call him "just to chat" wasn't stretching this permission too much, so Carlos asked JoAnn to call him. Mr. Daly was not interested in discussing his personal situation with JoAnn, and was apparently a bit annoyed at the call. This was about as far in the direction of We Know What's Best For You as Carlos and I wanted to go; there would certainly be no calls to medical authorities, or "the men in the white coats." (Carlos, Steve Bridge, and I wish to extend our heartfelt thanks to JoAnn for offering her expertise and assistance in this situation.)

Week Two

After a solid week of banging our heads against his intransigence, Carlos and I began to catch on to a powerful mechanism in Mr. Daly's psychology: he obsessively and relentlessly sought out resolutions to each obstacle of which he became aware. Admittedly, his insights were childlike in their simplicity and naivete, but could his determination be made to work in our favor? Perhaps a clear, detail-oriented, harmless objective would consume his thoughts to the point that he would stop calling us with substanceless questions and comments. (It was becoming clear that the phone calls, for the most part, were a defense mechanism designed to delay his own acceptance of the harsh reality that he would not be able to kill himself and be uneventfully cryonically suspended.)

Plus, I couldn't help suspecting that having short-term goals and working toward them is healthy and life-affirming, even if the long-term goal is proclaimed to be oblivion. As long as Mr. Daly was attempting to interact with and affect his environment, I thought, he could not evade some visceral understanding that things still mattered to him, that life still mattered to him. Perhaps the psychological rewards for choosing and reaching some well- defined goals would remind him of this.

To this end, we informed Mr. Daly that even if he could find a way to make his insurance pay, and even if we did decide to accept the money, he would be autopsied for sure if his death was unattended. The only way to avoid autopsy would be to find a physician willing to sign a death certificate and indicate "natural causes" (or some such) rather than "suicide" as cause of death. And the only chance he had at having such an attending physician lay in enrolling himself in a home hospice program.

I'm now convinced that the goal of hospice enrollment added several days to Mr. Daly's life. When I first explained the hospice concept to him, he excused himself from the conversation practically before I finished my sentence, assuring me that the hospice plan would be enacted by Monday (it was a Friday). Later that day he called to pass on more information about the hospice company with which he was negotiating. He seemed, on the one hand, to want us to call them, but then he vacillated, and finally told us to do nothing until we heard back from him.

Complicating things significantly at this point was a change in management here at Alcor. At 4 p.m. on that Friday afternoon Steve Bridge became C.E.O. of Alcor, replacing Carlos, who had been heavily involved in the proceedings with Mr. Daly. I briefed Steve on Friday, and told him we could expect at least a couple of dozen calls from Mr. Daly over the weekend.

Saturday's calls from Mr. Daly were without substance, in the sense that he was back to hashing over insurance and suicide exclusion issues. Mike Perry and Hugh Hixon kept me informed by phone, since I was unwilling to sacrifice my first day off in some time fielding the same exasperating attempts to make something out of nothing.

Sunday, however, things got a little bit more serious. Mr. Daly called a little before 7 a.m. to report that he had stomach cancer, and that he could not drive to the hospital, but that he was enrolled in the hospice program. Mike Perry paged Steve, who had Mike page me, and both of us came in to talk to Mr. Daly. Mr. Daly gave us the emergency (off-hours) phone number for the hospice company, and suggested that we call and talk with "Diane," who was coordinating his case. Diane was not available, and we were informed that we could reach her first thing Monday morning. We were also informed, though, that Mr. Daly was not under their care.

Soon thereafter we were in conference with Mr. Daly again, and he became mildly agitated when I explained that while the hospice company had a file on him, he was not enrolled as a patient, and that things would not be "taken care of if the "stomach cancer" claimed him. This distressed him sufficiently that he asked us not to call the hospice company again until he called back to say that it was okay to do so. He seemed to find it necessary to call back at least twice shortly thereafter to reiterate that we should not contact them again until he said to do so. Of course, I was of the opinion that he would be doing his best to mislead the hospice company into believing that he was soon to die of stomach cancer, in hopes that they would mistakenly attribute his death to "natural causes." I was also of the opinion — though admittedly this was the purest speculation — that he had already begun dehyrdating himself, and the discomfort it was causing in him was prompting the call to us with the obviously indefensible assertion that he was a hospice patient.

We ended Sunday's conversations by promising to be "by the phone" by 8 a.m. Monday morning, so that we could call Diane at the hospice company (after receiving the "go ahead" from him). Monday morning at 8 a.m. sharp, he did in fact call, but he had not yet straightened things out with the hospice folks (how could he?), and directed us to continue waiting for his authorization to make that call. Steve was unsettled by this because we had told the hospice representative that we would be calling that morning to reach Diane, and he didn't want to leave them hanging. On my insistence, though, we respected Mr. Daly's directive, for the most part because I didn't feel right about interfering with his deliberations, even if I held the strong opinion that he was attempting to dupe them.

Week Three

We did not hear from Mr. Daly again for five days. On Saturday, January 31, while I again was at home, he called and spoke to Mike Perry. He informed Mike that he was "very dehydrated," that he was not taking any fluids but was eating food, and apparently he was becoming very uncomfortable. Mike informed him that food contains moisture, and that dehydration for the purpose of suicide requires starvation as well. Mr. Daly was sufficiently discomfited by this news that he asked Mike to suggest alternative means of suicide that would not compromise his suspension, still not accepting that various other factors (like the lack of insurance coverage, and the near certainty of autopsy) would almost surely preclude a viable suspension.

Mike, understandably, was nervous about providing Mr. Daly with advice on how to "safely" kill himself. He called me at home to explain the situation, and I rather emphatically insisted that he not provide Mr. Daly with any such advice, based on my growing fear that a perceived conflict of interest on Alcor's part in this situation could damage the organization. Specifically, I could easily see such advice from Mike (Alcor's Patient Caretaker) to Mr. Daly (a member with money in trust for Alcor) being construed by investigative "authorities" as veiled (or not-so-veiled) encouragement. Any organization that stands to receive large chunks of cash whenever any of its members dies is begging for scrutiny from "officialdom." When your members start calling you up and asking for advice on how to hasten this, you get nervous.

Being an immortalist in the extreme, and one who views cryonic suspension as an important aspect of life extension, Mike was uncomfortable with this restriction. I was probably almost as uncomfortable, and I know that Steve was unsettled by the situation as well. But how do you help someone in a situation such as this, when you don't even know what help is? Obviously, Mr. Daly had been fairly consistently depressed for years. (A later conversation between Steve and Mr. Daly's mother confirmed that he had been deeply depressed since his teen-age years.) He stated specifically that "the doctors" had run out of anti-depressants for him to try, and none of them touched his depression. So, for liability reasons, we were unwilling to give Mr. Daly advice on the logisitics of an effective suicide. For ethical reasons, we were unwilling to forceab ly prevent him from making his own decision about what do with his life. This left one course of action: to continue to impress upon him the various deficiencies in his suspension arrangements, and answer any questions he had about how to address those deficiencies.

Later that day (Saturday), Mr. Daly called Alcor again, and Mike informed him that for liability reasons we could not advise him on alternatives to dehydration. (Not that we really had any alternatives anyway: three Alcor members — with underlying terminal conditions — have now gone the ugly, painful road of dehydration for lack of a better route.) This was the last call we received from him, and so far as we know the last time he spoke with anybody. Three days later, at approximately 3:30 p.m. on Tueday, February 2, Tanya answered a call from "J.R.," an employee in a Texas Medical Examiners Office, informing her that a man named Robert Daly had shot himself in the head with a .38 caliber pistol, and that he was wearing an Alcor Emergency Alert tag. (See Tanya's article elsewhere in this issue for the details of Mr. Daly's transport and suspension.)

Afterwards

In the weeks following Mr. Daly's suspension, there was frequent discussion on the topic of suicidal Alcor members. I am very thankful to Dr. Thomas Munson, Alcor Suspension Member, who took an entire day to drive up from San Diego and counsel the staff on how to deal with and understand suicidal members. I'm also grateful to Michael Riskin, Alcor Suspension Member, a therapist who has offered to deal with cases such as Mr. Daly's in the future, should we so desire.

Of course, the key issue was (and still is) the appropriate (i.e., the ethical) course of action to take in dealing with members who threaten suicide. Mr. Riskin's offer, for instance, is meeting with some resistance (at least on my part) because he is very up front in stating that he would have had Mr. Daly committed, and that once we turn a member such as Mr. Daly over to him for treatment, he will (understandably) proceed without consulting with us. It seems at present that there are basically two schools of thought on this issue: 1) that any suicidal member without an underlying terminal condition is mentally incompetent and should be restrained "for his own good," and 2) that wanting to enter cryonic suspension without a physi cal need to do so is not necessarily a sign of "craziness," and that it is not necessarily always our place to "forceably care for" (i.e., confine) those who desire this and want to coordinate with us in doing so.

It's sure to be obvious to readers of this article where I stand on this by now. While I may emphatically believe that the present is a better time to be alive than is any moment in the past that I know of, it is not necessarily better than the future, and it's no guarantee that life won't just suck for some people, no matter what, period. Opting out of the present, even on a wing and a prayer, is an option I wouldn't want to be labeled insane for pursuing. This doesn't mean I wouldn't thank someone who pumped my stomach if I succumbed to utter despair tomorrow and tried to end it; but if I spend ten or twenty years seeking therapy and treatment, and none of it works, and I continue to despair, there would probably come a time when I'd had enough. (Other members, even other staff members here, are sure to disagree with me on this issue.)

I've heard some people assert, by way of hindsight into this matter, that Mr. Daly would "obviously" have been far better off had we taken the liberty of "turning him in." That since he is now dead, and autopsied, and "straight-frozen" (rather than perfused), it "obviously" was a mistake to leave him to his own devices.

Had this depressive episode been an isolated incident for Mr. Daly, I (and the rest of us here) probably would've felt morally secure in having him committed, to receive proper psychiatric care. But he'd been down that road many times, and was now of the conclusion that there was nothing left for him there. Who were we — a group of cryonicists who'd never met or spoken with him (in any intimate sense) — to decide that what he needed was a set of restraints? When your sister Sally, who's happily married and basically a balanced person, suddenly chokes down a bottle of sleeping pills because she "can't take it anymore," you intervene forcefully, because you feel that she will thank you later. Would Mr. Daly ever have thanked us for such a maneuver? I didn't think so then, and I don't think so now.

For some people, this position is impossible to understand. They look at the end result — a suicide, an autopsy, and a sub-standard, brain-only straight freeze — and say that obviously a mistake was made somewhere. If not, they assert, things would've turned out better. Well I agree, a mistake was certainly made somewhere, probably several mistakes, but that was probably many, many years ago, possibly before Alcor even existed, and there's no telling now who made those mistakes or what they were (and which of them, for that matter, were present on a genetic level). The Alcor management inherited those mistakes, and dealt with them as
professionally, competently, and ethically as they were able. Mr. Daly did realize his last, dearest wishes: he has ended his pain, and he is in cryonic suspension, despite more obstacles than I even dare list. Who can assert that his situation had any reasonable chance of ending better? Sometimes things can go incredibly poorly, and still go as well as possible.

 

Transporting Patient A-1401

by Tanya Jones

Our first suspension of the year began with a call from a gentleman named J.R, who was calling from Texas. I took the call, and was dismayed to hear that J.R. worked in the County Medical Examiners Office. No good news was to follow. A member from Texas had committed suicide using a .38 caliber pistol and a shot to the head. It was nearly a day later that he was found, and the medical examiner was called.

"Robert Daly," A-1401, had been an Alcor member for just over a year. He believed his life a miserable existence, and despite the obvious detrimental effects on his cryonic suspension, planted a bullet in his brain in an effort to end it. Mr. Daly had a history of depression and had been threatening to take his own life since he was a teenager. Conversations with his relatives painted a tragic picture. He was never seen to be in a good mood. His family was, naturally, saddened to hear of Robert's actions, however, they were heartened to be told of his cryonic suspension arrangements. They had heard Robert mention his interest in cryonics some time earlier, but were unaware that he had actually pursued his sign-up.

Robert had completed his sign-up and was using life insurance as his primary method of payment for cryonic suspension. Unfortunately, his suicide occurred during the contestability period for his policy. (Two strikes against him: it was a suicide, and it was within the contestability period.) There is little doubt that Alcor will not be receiving the proceeds from his life insurance policy. The knowledge that his suicide took place during the contestability period nearly prevented us from being able to respond. Luckily, Mr. Daly had also arranged an irrevocable trust with Alcor as the beneficiary. The sum in the trust was just above the minimum requirements for perpetual storage, with no safety margin. It was deemed sufficient to cover the expenses of the transport, and still have the bare bones funding for the Patient Care Trust Fund.

All of this was determined before I flew to Texas to arrange for the transport. I was met at the airport by Paul Garfield, the only certified transport technician in the entire state. Paul had driven since the wee small hours of the morning to come pick me up. He was very excited about his opportunity to assist in this transport, despite the fact that few of the transport procedures that he learned in class would be applied. Most of what is taught in the transport course concerns treating a very- recently deanimated member. It was many hours before Mr. Daly's body was even found after his suicide. Also, in all states, certain manners of death are autopsied, and suicide is invariably one of those types. This understanding left us with a clear course to follow in pursuing this transport. Mr. Daly was to be autopsied, and we had to get to the Medical Examiners (M.E.) Office before they began.

We did arrive before they began the autopsy, and Paul and I were able to speak to the Acting Chief Medical Investigator and the Chief Medical Examiner. As is the case with all suicides, they intended to perform a complete autopsy. A complete autopsy includes the removal and sectioning of all organs, including the brain. With some fast explaining of the reasons why we were requesting a deviation from their standard procedures, we were able to persuade them to remove the brain for external examination, take photographs as evidence, and complete their examination without sectioning his brain. The county officials also graciously agreed to expedite the autopsy, making it the first one of the day.

If they hadn't agreed in advance to minimize the damage inflicted on the brain, I was prepared to request that I be allowed to observe the autopsy. This was a somewhat devious approach, where I hoped to get sufficiently friendly with the technicians that I might gasp in horror at whatever they did to Robert's brain and perhaps dissuade them from some of the sectioning with the excuse of a weak stomach and many assertions of how detrimental that would be for Mr. Daly's cryonics arrangements. It wasn't until I went into the lab to pack the brain for transport that I realized the magnitude of my good fortune (in being able to persuade them to forego sectioning without my physical presence at the autopsy).

I'd never seen an autopsy victim before, except in training videos. I must say that it was one of the more gruesome sights of my life. And when I use the term "victim," 1 mean it. A more invasive procedure has never been developed. As with most sights, pictures don't do the reality justice.

About two hours after I arrived at the M.E. offices, the autopsy was complete. And the examiners had been true to their word: I received the brain nearly intact.

The bullet had been retrieved and nothing further had been done to damage the brain (save ischemia and, of course, the removal from the head). I put Robert's brain on ice, in a set-up very similar to the arrangements used with Michael Friedman (A-1171) last year. While I was waiting for the brain in the M.E. office, Paul had left to get dry ice for shipping, and he returned within one hour of my obtaining Mr. Daly's brain.

Robert was a neurosuspension patient, and the rest of his body had to be dealt with. Preparations for the cremation of the remains were a little more difficult, as the M.E. and the funeral home insisted on having the next of kin authorize my making these arrangements, despite having paperwork signed by Mr. Daly already providing me with that authorization. We waited for a few hours for the release to arrive. It was faxed and signed by Mr. Daly's next of kin with less delay than we had expected. Mr. Daly's family was very cooperative and pleased that the disposition was being taken care of (and paid for) by Alcor. (By this time, I had spent nearly five hours in the Forensic Administrator's office, completely monopolizing his time.)

With a signed release, I went to a local funeral home and made arrangements for the cremation of Mr. Daly's remains. The funeral home had refused to deal with me without the release, but once it was in hand, proceeded to set things up very quickly. Arranging for the disposition of his remains was the last thing I had to complete before returning to Riverside.

Every part of this transport went better and faster than anticipated, given the great cooperation we received. I was able to change my flight and return to California a full three hours sooner than we had scheduled. Once I arrived back at the lab, I found that although the brain was at a temperature below freezing, as evidenced by frozen water-ice, it was not nearly as cold as I had expected after nearly six hours on dry ice. I had followed Hugh Hixon's recommendations on how to insulate the brain from the dry ice, and much to my (and Hugh's) surprise, the dry ice maintained its solid state almost completely. We packed the dry ice a little too well, and it wasn't able to provide efficient heat transference on the level we'd been expecting. In the future, should we have similar cases, we'll know not to insulate the dry ice with anything but the newspaper it is wrapped in by the distributor. This should allow us to get a much steeper cooling curve.

Within a very short period of time after our arrival, we had the new neuro cooler set up and Mr. Daly's descent to liquid nitrogen temperatures began. He will eventually be stored in the cephelarium vaults with the only other isolated brain we have in suspension.

Paul Garfield was a tremendous help during the transport, and things would not have gone nearly as smoothly without his assistance. He braved a foot still sore from recent surgery, a constant downpour, and ungodly hours of driving to help suspend Mr. Daly. Thank you, Paul! Without your assistance, it would have taken many more hours to arrange for Mr. Daly's transport. There's no telling how many times I could have gotten lost in an unfamiliar city ....

Also, the county officials and the president of the funeral home were all very supportive. Most especially, the Forensic Administrator, who "entertained" myself and Paul as we monopolized his office for five hours awaiting the proper channels to clear the release of Mr. Daly. Although there were a few skeptical chuckles from one or two of the people we discussed cryonics with, the overwhelming atmosphere was one of excited interest. A new idea to rock a few world views. More than once I heard comments about how "I didn't know that people were actually doing this for real." I left Texas with not a single business card or copy of Cryonics: Reaching for Tomorrow or any of the literature I had brought.

It's unfortunate that Robert Daly elected to take his own life. He was aware of the ramifications that a suicide would have on his cryonic suspension, yet he proceeded. I sincerely hope that, despite the long ischemic episode, Mr. Daly's brain will one day be found to be sufficiently intact to enable reanimation, although there are no guarantees that this (or any) will ever come about. Living life to the fullest is what cryonics is all about, and from all accounts, Mr. Daly had few cherished moments in his life. It would be nice if he had a second chance, in a world where deep depression can be cured.