<div dir="ltr">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.<div><br></div><div>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. </div><div><br></div><div>Here is an excerpt from my power of attorney, containing the cryonics-relevant parts:</div><div><br></div><div>
<p class="MsoNormal" style="text-align:justify;text-indent:0.5in;line-height:150%"><span style="font-family:Arial">In addition, I wish to specifically
instruct my healthcare agent about life prolonging treatment as follows:</span></p>
<p class="MsoNormal" style="text-align:justify;text-indent:0.5in;line-height:150%"><span style="font-family:Arial"> </span></p>
<p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:Arial">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. </span></p>
<p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:Arial"> </span></p>
<p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:Arial">I ask my agent and my
medical providers to:</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">1)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">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.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">2)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">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.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">3)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">I disallow autopsy, brain biopsy, organ donation or any other
post-mortem procedures unless explicitly agreed to by authorized Alcor
employees.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">4)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">In case of witnessed normothermic cardiac arrest, resuscitation must be
stopped if there is no ROSC (return of sustained circulation) at the <b>5 minute</b> mark, given the known poor
likelihood of good recovery after more prolonged period of brain ischemia (</span><a href="http://www-ncbi-nlm-nih-gov.proxy.library.vcu.edu/pubmed/24464303" title="Current cardiology reports."><span style="font-family:Arial">Curr Cardiol Rep.</span></a><span style="font-family:Arial"> 2014 Mar;16(3):457) and given my post-mortem preservation goals.
No medical provider shall be held liable for adhering to this instruction.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">5)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">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. </span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">6)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">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 <b>life
support treatment should be stopped immediately, even if brainstem reflexes are
preserved</b> and I do not fulfill criteria for brain death.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">7)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">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 <b>all</b> 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.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">8)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">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.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">9)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">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.</span></p>
<p class="" style="text-align:justify;line-height:150%"><span style="font-family:Arial">10)<span style="font-stretch:normal;font-size:7pt;line-height:normal;font-family:'Times New Roman'">
</span></span><span style="font-family:Arial">Alcor personnel may be consulted pre-mortem for advice regarding optimal
conditions for brain preservation.</span></p>
<p class="MsoNormal" style="margin-left:0.5in;text-align:justify;line-height:150%"><span style="font-family:Arial"> </span></p>
<p class="MsoNormal" style="text-align:justify;line-height:150%"><b><span style="font-family:Arial">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.</span></b></p>
<p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:Arial"> </span></p>
<p class="MsoNormal" style="text-align:justify;line-height:150%"><span style="font-family:Arial">In addition, I wish to
instruct my healthcare providers and agents as to the following:</span></p>
<p class="MsoNormal" style="margin-left:0.5in;text-align:justify;line-height:150%"><span style="font-family:Arial">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</span></p>
<p class="MsoNormal" style="margin-left:0.5in;text-align:justify;line-height:150%"><span style="font-family:Arial">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. </span></p>
<p class="MsoNormal" style="text-align:justify;text-indent:0.5in;line-height:150%"><span style="font-family:Arial"> </span></p><p class="MsoNormal" style="text-align:justify;text-indent:0.5in;line-height:150%"><span style="font-family:Arial">(end of excerpt)</span></p><p class="MsoNormal" style="text-align:justify;text-indent:0.5in;line-height:150%"><span style="font-family:Arial"><br></span></p></div><div><p class="MsoNormal" style="text-align:left;text-indent:0.5in;line-height:150%"><span style="font-family:Arial"><br></span></p><p class="MsoNormal" style="text-align:left;text-indent:0.5in;line-height:150%"><span style="font-family:Arial">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?</span></p><p class="MsoNormal" style="text-align:left;text-indent:0.5in;line-height:150%"><span style="font-family:Arial"><br></span></p><p class="MsoNormal" style="text-align:left;text-indent:0.5in;line-height:150%"><span style="font-family:Arial">Rafal</span></p></div><div><p class="MsoNormal" style="text-align:justify;text-indent:0.5in;line-height:150%"><span style="font-family:Arial"><br></span></p><p class="MsoNormal" style="text-align:justify;text-indent:0.5in;line-height:150%"><span style="font-family:Arial"><br></span></p>
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