{"id":3098,"date":"2016-11-18T12:32:39","date_gmt":"2016-11-18T11:32:39","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3098"},"modified":"2016-11-18T12:32:39","modified_gmt":"2016-11-18T11:32:39","slug":"justice-cryogenically-delayed-is-justice-denied","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/11\/18\/justice-cryogenically-delayed-is-justice-denied\/","title":{"rendered":"Justice Cryogenically Delayed is Justice Denied?"},"content":{"rendered":"

Guest Post by Nils Hoppe<\/strong><\/em><\/p>\n

Re JS (Disposal of Body) [2016] EWHC 2859 (Fam)<\/em><\/p>\n

This unusual and sad case concerns a court application by a 14 year old girl, JS.\u00a0 In 2015 she was diagnosed with a rare form of cancer which proved terminal and, at the time of her application, she was receiving palliative care as an in-patient at a hospital.\u00a0 The other parties involved in the application were JS\u2019s parents, who were acrimoniously divorced.\u00a0 JS had no direct contact with her father after 2008.<\/p>\n

Knowing that she would soon die, JS carried out online research into commercial cryogenic preservation techniques, defined in the judgment as \u201cthe freezing of a dead body in the hope that resuscitation and cure may be possible in the distant future\u201d. \u00a0Such techniques are not uncontroversial, being regarded with scepticism by the majority of the medical and scientific community. \u00a0They are also not cheap: the judgment describes the costs associated with the basic cryopreservation package as being in the region of \u00a337,000, or, as Mr Justice Peter Jackson put it, \u201cabout ten times as much as an average funeral\u201d.<\/p>\n

Of most significance to the court application was the fact that the proposed procedure required the cooperation of the hospital in which\u00a0JS was a patient.\u00a0 This concern was described in the following terms by the judge:<\/p>\n

The body must be prepared within a very short time of death, ideally within minutes and at most within a few hours.\u00a0 Arrangements then have to be made for it to be transported by a registered funeral director to the premises in the United States where it is to be stored.\u00a0 These bridging arrangements are offered in the UK for payment by a voluntary non-profit organisation of cryonics enthusiasts, who are not medically trained.\u00a0 Evidently, where the subject dies in hospital, the cooperation of the hospital is necessary if the body is to be prepared by the volunteers.\u00a0 This situation gives rise to serious legal and ethical issues for the hospital trust, which has to act within the law and has duties to its other patients and to its staff.\u00a0(at paragraph 12)<\/p><\/blockquote>\n

JS, described as bright, intelligent and articulate, decided that she wanted her body to be cryopreserved after her death.\u00a0 Her mother supported this wish: her father did not initially, though his views changed.\u00a0 By the time the matter went to court, JS\u2019s father was prepared to agree to what she wanted, subject to certain conditions, including that he be permitted to see her body after her death (which was objectionable to JS), and that he not be financially liable for the cryopreservation process.<\/p>\n

In these circumstances, Mr Justice Peter Jackson was asked to make an order permitting JS\u2019s mother to make arrangements for the cryopreservation of JS\u2019s body after her death and, conversely, preventing her father from intervening.\u00a0 In doing so, he considered a range of legal and ethical issues.<\/p>\n

The whole concept of halting decay after death in order to wait for a miracle cure is predicated on the potential for future scientific progress. \u00a0At the same time, it was clearly right for Mr Justice Peter Jackson to work on the basis of science as it stood at the time the matter came before him. \u00a0The cessation of the JS’s life is, in the current scientific context, irreversible and fulfils the criteria we use to diagnose death in a legally meaningful way. \u00a0The question of what is then done with her body is at this stage of secondary importance only. \u00a0She may request to be interred in a family tomb, be incinerated, or donate her body for scientific purposes. \u00a0In this case, she would like to be cryopreserved. \u00a0The court ought to only engage with this issue in detail if the proposed use of the body after death raises issues which touch on public morals, such as Lord Avebury’s memorable attempt to bequeath his body to Battersea Dogs’ Home, or Jeremy Bentham’s installation as an autoicon. \u00a0Her wish to place a very expensive bet on an unknown future technology becoming available is her business alone and may even be a fully acceptable, if unusual, desire with which a court ought not interfere. \u00a0Her bet also extends to that new technology permitting her successful resuscitation. \u00a0It extends to her mental faculties surviving the procedure so she can meaningfully engage with her surroundings post-resuscitation. \u00a0And it also extends to a cure having been found for the condition which caused her first ‘death’.<\/p>\n

Any one of these bets is so risky as to be legitimately thought of as unlikely. \u00a0In sum, they are sufficiently unlikely to not raise a significant problem in the proceedings before Mr Justice Jackson: If he thought that her death was, on the balance of probabilities, reversible at a future point in time, would he be entitled to decide this issue on the basis that she is dead?\u00a0\u00a0Most jurisdictions, including England and Wales, are clear that the death of the individual must be ‘irreversible’ to be normatively meaningful. \u00a0Where this is the case, what is done with the body afterwards is very much a matter for the concerned individual and her family. \u00a0There is only a reserve right for public institutions to intervene if the proposed use is deemed so inappropriate as to negate her right to decide what to do with her body after her own death.<\/p>\n

Indeed, where the discussion at some point centres upon what the best interests of JS are it seems clear that it must be ever so slightly more in her interest to preserve an opportunity of resurrection, albeit enormously remote, than it is to be interred and decay irreversibly. \u00a0It seems clear that there is very little sensible argument which would allow the Court to deny her final wish.\u00a0\u00a0The mere fact that we feel the promises made by the cryopreservation industry amount to a most grievous form of quackery is insufficient to justify an interference, just as we do not have to like or agree with the reasons why adherents to some religions used to refuse blood transfusions.<\/p>\n

The Court was required to work on the basis of what is scientifically possible at this point in time, and be agnostic as to any future developments. \u00a0Mr Justice Jackson did so, and he did so with commendable sensitivity to the subject matter before him. \u00a0The decision is the right one to reach. \u00a0The theoretical question of what becomes of all those cryopreserved in facilities across the world if technology advances to the point where they can effectively be rescuscitated remains for another time. \u00a0But there is an exciting point here: unless the law is changed ex ante<\/em>, cryopreservation companies will suddenly have custody of hundreds of comatose patients, rather than dead bodies – with all of the entailing legal and moral obligations.<\/p>\n","protected":false},"excerpt":{"rendered":"

Guest Post by Nils Hoppe Re JS (Disposal of Body) [2016] EWHC 2859 (Fam) This unusual and sad case concerns a court application by a 14 year old girl, JS.\u00a0 In 2015 she was diagnosed with a rare form of cancer which proved terminal and, at the time of her application, she was receiving palliative […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2153,2146,511,591,576],"tags":[],"class_list":["post-3098","post","type-post","status-publish","format-standard","hentry","category-guest-post","category-in-the-courts","category-in-the-news","category-life-and-death","category-the-art-of-medicine"],"yoast_head":"\nJustice Cryogenically Delayed is Justice Denied? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/11\/18\/justice-cryogenically-delayed-is-justice-denied\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Justice Cryogenically Delayed is Justice Denied? 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