[ExI] Signing your death warrant

Fri Aug 7 03:38:19 UTC 2020

On Sun, Jun 7, 2020 at 3:07 PM Brent Allsop <brent.allsop at gmail.com> wrote:

>
> Thanks for bringing this up Rafal,
>
> I'm completely frustrated with not knowing what to do with this, or what
> kind of "advanced life directive" I need.  I'm signed up with Alcor, and
> expected they would provide me with one.  I asked them, probably only once,
> in passing, quite a while ago, so it is probably my fault, but I am
> completely frustrated that they aren't at least providing a sample one, and
> telling me what is and isn't important, for Alcor to be most likely able to
> do what they need to do.
>
> Where does one go, to find a sample "advanced life directive" that is
> compatible with being signed up with Alcor?
> Do any of you  Alcor people out there have one?  Could I see a copy?
>
>
### I wrote my own advanced life directive with the help of my lawyer. It
is supposed to work with my POA (power of attorney) for medical decision
making. Here it is:

Summary of instructions to medical providers

(excerpt from my MEDICAL POWER OF ATTORNEY FOR HEALTH CARE

DECISIONS)
Rafal Smigrodzki, MD

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.  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 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 (breathing machine), 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.

Rafal Smigrodzki, October 19, 2014

-----------------

It is extremely important to have a POA who is familiar with your cryonics
goals and is a powerful, smart friend - without a living person pushing to
have you suspended you are much more likely to suffer true death if you end
up in the hospital and doctors do their usual stuff.

Rafal
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