[ExI] Medical power of attorney for cryonicsts

Rafal Smigrodzki rafal.smigrodzki at gmail.com
Wed Dec 3 07:18:04 UTC 2014


John, you made an excellent choice - I have been a neuropreservation Alcor
member for something like 8 years (A1941) and I am always happy to hear
about a new member.

Recently I have been working on setting up a set of advance medical
directives, AKA medical power of attorney. I think it's quite important to
have it if your ideas about proper medical care extend beyond the current
reach of medical practice.

Here is an excerpt from my power of attorney, containing the
cryonics-relevant parts:

In addition, I wish to specifically instruct my healthcare agent about life
prolonging treatment as follows:



I have made provisions for the preservation of my brain after I am declared
legally dead. Specifically, I authorized a whole-body donation pursuant to
Va. Code §32.1-289 et. seq., to Alcor, Inc. of Scottsdale, Arizona. In the
event of my legal death, Alcor is authorized to take immediate possession
of my body, without delay of any kind.



I ask my agent and my medical providers to:

1)             Call Alcor at 1-800-367-2228 immediately in any situation
where there is a substantial likelihood of my death or major neurological
injury, or if my body is delivered to their care. Contacting Alcor shall
not be delayed until I am declared incapable of making decisions in
writing, and providers are indemnified against any liability stemming from
contacting Alcor.

2)             Alcor Inc, its agents and employees, including persons
staffing the Alcor emergency contact telephone line 1-800-367-2228, and
staff on the Alcor Standby team, are cleared by me to receive medical
information privileged under HIPAA, insofar as needed to facilitate
coordination of care between Alcor and my medical care providers. Alcor
employees involved in my case may request and shall promptly be given
access to information, including but not limited to, my overall medical
condition, prognosis, extent of known damage to the brain, any issues that
may adversely impact post-mortem perfusion and stabilization, and may
request any available medical record information they deem useful in
performing their duties.

3)             I disallow autopsy, brain biopsy, organ donation or any
other post-mortem procedures unless explicitly agreed to by authorized
Alcor employees.

4)             In case of witnessed normothermic cardiac arrest,
resuscitation must be stopped if there is no ROSC (return of sustained
circulation) at the *5 minute* mark, given the known poor likelihood of
good recovery after more prolonged period of brain ischemia (Curr Cardiol
Rep. <http://www-ncbi-nlm-nih-gov.proxy.library.vcu.edu/pubmed/24464303> 2014
Mar;16(3):457) and given my post-mortem preservation goals. No medical
provider shall be held liable for adhering to this instruction.

5)             In case of traumatic brain injury, cerebral hemorrhage,
major stroke and other situations associated with severe brain edema and
impending brainstem herniation, all life support activities should be
stopped immediately.

6)             In case of unexplained coma not of metabolic origin, such as
status post unwitnessed cardiac arrest, an EEG (electroencephalogram)
should be performed promptly. If there is severe global brain dysfunction,
manifesting for example as burst-suppression pattern, electrocerebral
silence, treatment-refractory status epilepticus and other patterns
associated with poor prognosis, as assessed by the reading
neurologist, all *life
support treatment should be stopped immediately, even if brainstem reflexes
are preserved* and I do not fulfill criteria for brain death.

7)             In all other situations where it is reasonably certain that
I will not recover my ability to interact meaningfully with myself and with
those around me, I want to stop or withhold *all* treatments that might
prolong my existence.  Treatments I would not want include tube feedings,
IV fluids, CPR, respirator, kidney dialysis, and antibiotics. However,
venous access devices and endotracheal tubes should not be removed until
after authorized by Alcor.

8)             Immediately after I am pronounced legally dead, I ask my
medical providers to inject, if possible, 500 U/kg of unfractionated
heparin IV, to perform manual chest compressions for 5 minutes to
distribute the heparin, and to wrap my body including the head in a cooling
blanket set to the lowest available temperature, unless instructed
otherwise by Alcor personnel.

9)             If for any reason it is not possible or allowed for Alcor
personnel to start their stabilization and preservation procedures in the
facility where I die, I direct the facility to transfer my body as soon as
possible to another facility, chosen by Alcor representatives, where such
procedures may commence.

10)         Alcor personnel may be consulted pre-mortem for advice
regarding optimal conditions for brain preservation.



*In making decisions about the duration and extent of care, practitioners
and agents should use their clinical judgment to maximize the likelihood of
achieving a good post-mortem preservation of brain tissue, rather than
trying to prolong the duration of my unconscious life.*



In addition, I wish to instruct my healthcare providers and agents as to
the following:

1)        I do want pain medicine and symptom treatments to keep me
comfortable, even if it means I am unable to interact with others.  I want
treatment for such things as shortness of breath, agitation, and seizures

2)        As noted above, upon my death I direct that an anatomical gift of
all my body must be made pursuant to Va. Code §32.1-289 et. seq., to Alcor,
Inc, of Scottsdale, Arizona.



(end of excerpt)



If anybody has any comments, please do comment here, I intend to finalize
the PoA documents soon and advice is welcome: Do you think these
instructions are OK? Is there anything you would formulate differently or
add?


Rafal
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