By Alan Mole

For a dying person, to avoid terminal agonies and deterioration of body and brain, and to die at a known time so cryo procedures can start promptly, and to die of hypothermia so brain deterioration is delayed for 45 minutes or even for several hours, Oregon's Assisted Suicide Law may provide a solution.

Or, in Michigan, suicide is not illegal and no forms are required, so in many cases that would be a better choice. I will discuss Oregon first, and Michigan at the end, but if the details get boring the reader may want to skip to Michigan because in most ways it is a better choice -- near CI and does not require the patient be within six months of natural death.

A person with early Alzheimer's, not wishing to go through the whole long miserable process and fearing his mind will be irreparably destroyed long before his body dies, might wish to end his conventional life in Michigan and be frozen while his mind is still mostly intact. Other states too may allow suicide, and this should be researched.

The person would go to Oregon, meet the requirements of the law, and fill out a form for assisted suicide. A 15-day waiting period would pass. The doctor would provide the drugs and stand by. The patient would slip into a comfortable warm bath, take the drugs -- and open the cold tap moderately. Within three minutes he or she would lose consciousness and never notice the increasing coldness of the water. Within half an hour the water would be cold, and within an hour or two he'd die of hypothermia, perhaps with a core temperature as low 20 C. When his heart stopped the doctor would immediately pronounce death and the cryo team begin its work. There would be minimal delay from heart stoppage to cryonics stabilization procedures, and plenty of time to work before brain deterioration began.

This also avoids the danger that the next of kin, though he has promised to call the cryonics organization, reneges and has the body cremated, perhaps because he stands to gain the money cryonics would have cost. With this plan the patient is present and alert right up to the point the drugs kick in, and the physician and cryonics people are standing by as witnesses.

Too many cryo patients die, then lie around for hours before they are discovered to be dead, a doctor is summoned and pronounces them so, and the rescue team arrives and work starts at last. And since they die at normal body temperature, the brain deteriorates beyond recovery by conventional medical technology in as little as four minutes. This is not promising.

Far better to die at a prearranged time and place with everyone present, and to die cold so brain deterioration is delayed for a long time.

Oregon allows assisted suicide. One goes to a doctor and proves he is a resident of Oregon. The doctor examines him and affirms he is within six months of death. A second, doctor confirms this independently. A psychiatrist may have to examine him and pronounce him sane. He affirms his wish to die in front of two witnesses. Forms are filled out and submitted. (Maybe not submitted until after death; this part is not clear to me.) A fifteen day waiting period elapses. The doctor prescribes a lethal dose of drugs, and either provides them or the patient gets the prescription filled. The patient takes the drugs and becomes unconscious in about three minutes. He dies in one to three hours, usually.

The above fills all requirements except cold. For that we modify the scenario: The patient gets into a bath of pleasantly hot water. (The law says nothing about location except that it not be a public place.) He puts a support under his armpits so he won't slip into the water and drown. He turns on the cold tap and then takes the drugs. He goes to sleep while the water is still nice and warm, so he never feels it as the water grows colder and colder. The tub does not overflow because bathtubs have overflow drains near the top. (The operation of the drain should be checked days before, since an overflow could be disastrous.) But gradually the water becomes colder and colder. So does the patient. His core temperature could go as low as 20C before his heart stops. (Recoveries from as low as 9C have been reported, but the heart had stopped at 20C or above.) This takes an hour or so, while death from the drugs now used usually takes one to four hours. (Barbiturates are now out; there are newer, better ones.)

Actual time to die of hypothermia depends on water temperature, body shape (fat insulates), robustness of subject etc. In some cases the heart might stop before the core temperature was this low -- also because the drugs might kill faster. And vasodilators -- drugs that open the blood vessels beneath the skin and allow faster cooling -- may be used to hasten this. Alcohol is one, but if it interacted unfavorably with other drugs, then the physician might be able to administer vasodilator drugs. The water should be as cold as possible -- i.e. a town with cold tap water is best. All this could use some more research. Perhaps someone could find a location getting water from the mountains where the water is quite cold. Though even if the core temperature were a little high, it should still be well below normal.

If there is a danger that the drugs could kill him before he is very cold, then he could take a large but nonfatal dose so as to sleep deeply without dying of the drugs. This would force death to be by hypothermia, as desired. (The doctor can hardly be expected to see whether he takes all the drugs or just half of them.) (This too should be discussed. In case hypothermia does not kill the subject, he does not want to linger for weeks in a coma from an inadequate drug dose .)

Here is another way of assuring sufficiently cold water. One could buy a tall tank or 50 gallon drum, fit it with an overflow hose near the top, and fill it with blocks of ice. Turn on a cold tap and run the water via a supply hose to the bottom. The overflow hose near the top would discharge into the tub. The person would get in the tub and take the drugs. It takes some time for the tank to fill to the level of the overflow, and then very cold ice water flows in and fills the tub. Due to the very great heat of fusion of ice, blocks would last a long time and cool lot of water from tap temperatures to almost-freezing. (It takes as much heat to change one unit of ice at freezing into water at the same temperature, as it does to raise the temperature 80 Deg C.) One could do the same by making a platform in the tub below the level of the overflow and high enough for a person to slip under it with legs and torso, and then putting the ice on the platform. When the water rises to that level it contacts the ice and becomes very cold.

I spoke with an Oregon counselor for Compassion in Dying. She said there is never an autopsy -- they are rare to begin with, and in the case of a person known to be dying, and attended by a physician, they are unheard of. She also said there is no reporting requirement as to where the patient died -- that is private between him and his family. If there were, one could honestly say "He said he wanted to die in a bath. He slipped into a nice comforting warm tub, took the pills and slept." There is no more need to tell the water temperature when he died than to tell, if he died in bed, whether the blanket was pink or blue. Thus the public need never know about this choice, and if they somehow learned, well, most people find baths warm and fuzzy, not at all like Dr. Kervorkian and "those terrible suicide machines." Note in the law below, the reports filed are NOT public.

I found the actual Oregon statute at

http://www.leg.state.or.us/ors/127.htmlhttp://www.leg.state.or.us/ors/127.html

Here is the residency requirement:

127.860 §3.10. Residency requirement. Only requests made by Oregon residents under ORS 127.800 to 127.897 shall be granted. Factors demonstrating Oregon residency include but are not limited to:

(1) Possession of an Oregon driver license;

(2) Registration to vote in Oregon;

(3) Evidence that the person owns or leases property in Oregon; or

(4) Filing of an Oregon tax return for the most recent tax year. [1995 c.3 §3.10; 1999 c.423 §8]

I think if one rents an apartment or stays with a friend so he has a legal address, he can get a driver's license on day one. In fact the law usually demands it. Obviously if one rents even the cheapest apartment or room he'll get a copy of a lease and be able to show it. With enough advanced warning he could even file a tax return, using a friend's address as "home". But the tax return should not be necessary.

As for voter registration, one can do that on day one but the card will not be mailed (to the address provided) for four to six weeks.

Note that not all the above (1, 2, and 3) could be required and any one is probably enough. Consider an old woman who has spent her whole life in Oregon, but who does not drive, is not registered to vote, and lives in her daughter's house. Neither 1, 2 or 3 and probably not 4 apply to her, yet she in undeniably a resident. So if you did 1, maybe 2, and 3, surely you'd be OK. Thus, although indeed the Oregonians do not want people coming from all over to use their law, I think residency is a paper tiger and would prove to be no obstacle.

You could quite honestly say: "Here is my lease to show I live here now. And I plan to live here for the rest of my life!"

Information on Hypothermia may be found at:

http://www.tc.gc.ca/marinesafety/TP/Tp13822/chapter-1.htmhttp://www.tc.gc.ca/marinesafety\TP\Tp13822\chapter-1.htm

1. Initial immersion or cold shock

On initial immersion, there is a large inspiratory gasp followed by a four-fold increase in pulmonary ventilation, i.e. severe hyperventilation. This on its own can cause small muscle spasms and drowning. Along with this, there is a massive increase in heart rate and blood pressure. These latter cardiac responses may cause death, particularly in older, less healthy people. These effects last for the first two to three minutes, just at the critical stage of ship abandonment.

2.. Short-term immersion or swimming failure (Of no interest here)

3. Long-term immersion or hypothermia

After thirty minutes or more of immersion, death may occur from hypothermia. The reason for this is that water has a specific heat 1000 times that of air and a thermal conductivity of about 25 times that of air. Thus, when a body is immersed in water below body temperature (37ºC), it will inevitably cool to hypothermic levels at a rate dependent on:

Temperature differential

Clothing insulation

Rate of agitation of the water

Body heat production produced by shivering and exercise

Ratio of body mass to surface area

Subcutaneous fat thickness

State of physical fitness

Diet prior to immersion

Physical behavior and body posture in the water

As the deep body temperature falls, humans lapse into unconsciousness. Death may occur in two ways – drowning through incapacitation, and cardiac arrest. Death from drowning will occur in a lightly dressed individual even wearing a lifejacket, approximately one hour after immersion in water at 5ºC, or two hours in water at 10ºC, or in six hours or less at 15ºC (Reference 19).

If the deep body temperature continues to fall, death occurs on average from cardiac arrest somewhere below a body core temperature of 24ºC. The lowest recorded survival temperature in an accidental victim is 13.7ºC (Reference 13). However, after surgical induction of hypothermia, there has been one reported incident of resuscitation from a body core temperature of 9ºC (Reference 48). Survival predictions were made from experimental data and case histories from shipwrecks.

[But the heart stops at 20ºC or above.]

It appears that in 40-50 F water, survival time is around 40 minutes to an hour for a healthy person without a survival suit, but this is not perfectly clear. More research is needed.

Heart Monitoring -- how will the doctor know when death occurs?

Someone has written me that heart monitoring by ECG won't work -- "ECGs are a bad idea because

a) They are not a standard cryonics field item

b) They are not a standard field item because of the risk of EMD (electro-mechanical dissociation), which a heart physically stops beating, but the ECG merrily bleeps along for a long time showing a normal *electrical* rhythm, but without any pumping blood.

c) They won't work well under water.

What is really wanted is probably a remote-video-monitored finger-tip pulse oximeter, like the one in the photo at

http://www.alcor.org/AtWork/p1field.html "

Here is the URL to the full Oregon law.. The Assisted Suicide part is at the end so work backwards, it's a very long law.)

http://www.leg.state.or.us/ors/127.htmlhttp://www.leg.state.or.us/ors/127.html

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After I had posted discussions about Oregon on Cryonet, Robert Ettinger wrote "In Michigan suicide is not illegal, although assisting in a suicide is. Also, in hospice programs the red tape is much reduced. It should only be necessary to persuade the medical examiner, in advance, to have a representative on hand when requested, to pronounce death, after assuring himself that the patient is competent, and waive autopsy. Everything could be set up for the cryonics team to go to work immediately."

An excellent point. I would like to know in what other states suicide is not illegal. Especially, Arizona or states near Alcor? The Immortalist says that as far as they can find, assisted suicide is illegal in all states except Ore., Utah, North Carolina, and Wyoming. But where *unassisted* suicide, suicide itself is legal they do not say. Maybe most places allow suicide, which would mean, I guess, that you could explain your intentions to the authorities and avoid complications and autopsy.

This may make Michigan a better choice than Oregon. Oregon requires red tape, and that you be within six months of natural death. But if you have been diagnosed with early Alzheimer's you may be near brain death but a decade from full death. So Michigan would be better, at least if you could make the critical arrangements yourself, without involving "assistance" in the suicide itself.

It thus appears that when you are near death you might go to Michigan and rent a place near a cryonics facility. Then, since suicide (but not assisted suicide) is legal, you could set things up yourself. Not hard, since all that is needed is a bathtub and drugs. The Hemlock Society used to recommend getting a prescription for barbiturates and saving them up, to the lethal dose for suicide. If you plan to go by hypothermia and need only enough to ensure unconsciousness, that shouldn't be too hard. (In Oregon they prefer drugs other than barbiturates now; you'd discuss this with your physician.) Then you call the cryonics rescue people and the medical examiner or physician to stand by, which appears legal so long as they don't assist. Then get in the tub, turn on the water and swallow the drugs. This would allow full cryonics procedures by experts to begin immediately, not just blood replacement and initial cooling, and your body would not have to be transferred by plane.

There are probably even easier ways to do all these things and I invite people to think about them, and to discuss the issue. The law seems be much more tolerant of such things than I had imagined.