Advanced Directives for Cryonics Institute Members

It is probably best for the same identical instructions to be placed in a Living Will and in a Durable Power of Attorney for Health Care (Medical Surrogate appointment). The Living Will defines the wishes and the Medical Surrogate is the living agent who is empowered to insist upon those wishes being carried-out. For simplicity the Medical Surrogate can be directed to ensure that the wishes specified in the Living Will are carried out.

Living Will and Medical Surrogate are primarily useful in a hospital. The Wikipedia DNR entry states:

"Many US states do not recognize living wills or health care proxies in the prehospital setting and prehospital personnel in those areas may be required to initiate resuscitation measures."

In a home, hospice or home hospice situation only a DNR form signed by a physician and patient (or Medical Surrogate) will prevent a paramedic from initiating resuscitation measures. If a cryonics patient has made arrangements for a standby team, and the team is not already on the scene, resuscitation efforts will be desirable. Even if no arrangements have been made for a standby team, resuscitation may allow to better prepare for the moment when death is to be pronounced (such as having adequate ice and ensuring that prompt pronouoncement can be obtained).

DNR Forms for specific states in the USA can generally be found by Googling:

"do not resuscitate form" [name of state]

The US federal Patient Self-Determination Act requires health care facilities that receive Medicaid and Medicare funds to inform patients of their rights to execute Advanced Directives. You can use an Advanced Directive to clearly stress your desire to be cryopreserved and for creating optimal conditions for your cryopreservation at the time of your legal death. You can include contact information to the Cryonics Institute (with your Member ID number). As long as you are conscious and can communicate, you can make your wishes known, but when you are still living but cannot communicate, the Advanced Directive takes over.

You should discuss your Advance Directives with your physician, lawyer and relatives to be clear that they can see your desires in writing and understand them. Copies should be in your file at the Cryonics Institute. You should ensure that a Medical Surrogate (Durable Power of Attorney) does not benefit financially from a failure to cryopreserve. You should appoint two or three Medical Surrogates (trusted friends or relatives) in prioritized order in case your first choice is not available at the time of need. In some states these documents expire after seven years, so they may require reaffirmation.

For Americans using the Advance Directives of your specific state will allow you to customize documents with which local medical personnel are already familiar. The use of Advanced Directives in every state is potenially different, and even within a state, local counties may have different practices. What follows are potential approaches that may or may not work in your case. You need to do your own investigation with your lawyer.

Advance Directives forms are only valid in the state in which the patient is residing. If a patient frequently visits another state, Directives for the second state should be obtained. On-line access to the Advance Directives forms of every state is available from both Caring Connections:

www.caringinfo.org/stateaddownload

and the US Living Wills Registry:

www.uslivingwillregistry.com/forms.shtm

A major problem with Advanced Directives is that they are not always readily available when needed. That problem has now been addressed by the US Living Will Registry, a privately-held organization that electronically stores Advanced Directives for 24/7 access on the World Wide Web. To maintain privacy, the Registry is only available to health care providers, such as hospitals and physicians. The service is available without cost, but to use it you must register. Once registered you are given a Registry number and labels with the Registration number that can be attached to your driver's license and insurance card.

Read the information on their FAQ page:

www.uslivingwillregistry.com/faq.shtm

and then go to the How to Register page:

www.uslivingwillregistry.com/register.shtm

As an example Medical Surrogate document, there is a standardized Durable Power of Attorney for Health Care for Michigan on the University of Michigan Health System website accessible from the US Living Wills Registry:

www.med.umich.edu/1libr/aha/umlegal02.htm

The NHPCO standardized form for Michigan presented includes such language as stating that in a terminal or "minimally unconscious condition" that:

I direct that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing treatment... However, I do want maximum pain relief, even if it may hasten my death.

Although there is space for additional information, the emphasis may not be appropriate for a cryonicist. The Michigan form for Medical Surrogate at the US Living Wills Registry simply allots space allowing a person to state exactly what she or he would want. As an example, following the words

"My specific wishes concerning health care are the following:"

a Cryonics Institute Member might put the following:

I have made arrangements to be cryopreserved with the Cryonics Institute, so please contact them at emergency number 866-288-2796 or Jim Walsh at 586-293-3390 telling them I am Member CI-24 and ask for instructions. I wish for life support to be continued unless my recovery is unlikely and maintenance on life support would be damaging. If there is no hope for my recovery do not remove life support until a qualified health professional can promptly pronounce death and a funeral director or cryonics rescue team can promptly apply cooling and other cryonics procedures, including injection with anti-coagulant, such as heparin. Autopsy is against my religious belief.

Certain states will only forbid autopsy if it is against religious belief. (See Avoiding Autopsy for Cryonics.) Members may want to say more about pain, state that they are Orthodox Jewish, etc. Be sure that the instructions are what you are most comfortable with — do not be satisfied with using words chosen by others if they do not entirely match your own wants.

Canadians should look at the Power of Attorney for Personal Care on the Cryonics Society of Canada website.