Self-Euthanasia by a Terminal Cryonics Patient

Excepts from an Alcor Case Report (A-1990)


(Information is derived from multiple sources and is all converted to Mountain Standard Time (MST))

Norman Hardy, a non-confidential, neurocryopreservation Alcor member was pronounced legally dead on October 30, 2018, in Mountain View, CA. This case was the first time the newly enacted California End of Life Option Act (EOLOA) was used to reduce the potential ischemic damage that can result from a prolonged dying process.

Alcor's Medical Response Director (MRD), Alcor's Chief Medical Advisor (CMA), and other Alcor staff worked for over a week after being notified of the member's end of life choice to make sure that all legal requirements were in place. The hospice facility and the family members were all cooperating with Alcor to make this case as flawless as possible, legally, logistically, and technically.

The cryoprotective perfusion was relatively successful. Perfusion flow rates were high throughout the procedure. However, the post-cryopreservation CT scan showed poor cryoprotection and extensive CT-visible ice formation in the cerebellum, and incomplete cryoprotection with a small amount of CT-visible ice formation in the frontal lobes.

Patient Assessment and Pre-Deployment

The member was an 85-year old Caucasian male, 6′4″ in height and weighing approximately 160 lbs. He had been diagnosed with Stage IV prostate cancer that had metastasized to his bones and lungs. While living with his daughter and ex-wife, he had been admitted into an in-home hospice program. The member had been on Alcor's Watch List for several months but failed to notify Alcor that he planned to end his life by using the newly enacted EOLOA (End of Life Option Act)

Monday, October 22, 2018

Alcor received a call from a northern California Alcor member who stated that his friend planned to use the EOLOA to legally end his life. He further stated that the member had received his aid-in-dying (AID) medications from the State of California and was planning to take those medications on Wednesday, October 24, 2018, just two days hence.

This created a logistical problem for Alcor. It would be the first time an Alcor member used EOLOA in conjunction with their arrangements for cryopreservation. It was imperative that Alcor make sure the laws were followed exactly and two days was not enough time to do that proficiently. The member agreed to postpone taking his AID medications but only for a few days. Additional time would have given Alcor more confidence that no legal requirements had been overlooked.

Preparation and Deployment

Tuesday, October 23, 2018

There was extensive discussion on Slack (Alcor's internal communication system for the team members) about making sure that all legalities were handled properly and sufficiently. That included having Suspended Animation (SA) do the Standby, Stabilization and Transport (SST) since this case took place in California and having Alcor's new Medical Response Director (MRD) involved for additional training and experience. It was also decided that the MRD would deploy the next day to evaluate the situation and the member's condition and to collect Health Insurance Portability and Accountability Act (HIPAA), Advance Directive and end of life paperwork.

There was also discussion about how to best time the arrival of SA with the member taking his prescribed AID medications, the fact that SA and Alcor personnel could not be in the room with the member when he took the AID medications, and how long after ingestion before the medications would take effect. Several northern California Alcor members volunteered to assist with this case.

Alcor's MRD spoke with the family in an attempt to get a signed HIPAA form to enable Alcor to obtain the member's medical records and to ensure that the member was fully compliant with the legal requirements pertaining to the EOLOA legislation.

Wednesday, October 24, 2018

Alcor's Chief Medical Advisor (CMA) sent two citations to the team, one of which was the legislation itself and the other contained two required forms. There was a discussion about the need to acquire: 1) a signed form from the two physicians who confirmed that they interviewed the member and approved him to use the EOLOA, 2) documentation that the member had made two requests 15 days apart, and 3) documentation from the physician who prescribed the AID medications.

The member had earlier planned to take the AID medications on Thursday, November 01, 2018, but had gone for blood work that morning and had a near-syncopal episode. That caused him to become agitated and he voiced his desire to take his AID medications earlier than planned. His family gave him some prescribed Dilaudid for his pain which subsequently calmed him and allowed him to sleep.

Alcor's CMA requested information about the member's then current pain medication and dose, requested a phone number for hospice and asked if a signed HIPAA form was in place so that he could speak with them. The MRD was still en route to California but replied that as soon as he got off the plane, he would try to get more information; the hospice staff was supposed to have gotten the HIPAA form signed the previous day.

SA requested contact information for the member's physicians as this would be needed in order to expedite the death certificate and the transit permit. They also requested a copy of any form to be signed by the designated power of attorney (DPOA).

The MRD arrived at the member's home that afternoon and met with the member and his ex-wife. They spoke briefly as the hospice nurse (RN) and the home health aide (HHA) were changing the member's dressings on two kidney shunts. One of the shunts was constantly draining and caused him discomfort.

There was a discussion between the RN, the HHA and the family about the member's Dilaudid, how much he could receive over each four-hour period and the importance of maintaining the narcotic log, which had not been filled out prior to that conversation. All entries into that log prior to October 24, 2018, at 15:00 hrs were an estimate of time and dosage. All entries after that were accurate for dosage and administration time. The hospice RN gave the MRD a copy of the Authorization for Use and/or Disclosure of Member/Patient Health Information form.

During this meeting with the family, several outstanding concerns were addressed regarding the AID medications. The main concern was that the member had no access to any of his medications. He also needed to, per the laws of the State of California, provide a 48- hour notice prior to ingesting the AID medications and he needed to sign a letter of attestation stating that he was of sound mind and body. The law stipulated that no food and only a little liquid was to be ingested within 12 hours of taking the AID medications. The member had chosen the following AID protocol: diazepam 1 gram (to relieve anxiety), digoxin 50 mg (to decrease HR), morphine 15 grams (to relieve pain) and propanolol 2 grams (to decrease HR). That same afternoon SA had spoken with the San Jose coroner's office and because the member was in home hospice the case would not go to the coroner as long as all the proper documentation was on hand, the member's physician had signed the death certificate, and the designated Power of Attorney (DPOA) had signed off to release the remains to Alcor.

The member's daughter was identified as being the DPOA, which was helpful with making various aspects of this case come together well.

Alcor's CMA worked with the hospice staff to better control the member's pain. Concurrently, Alcor staff urged the SST team to inform Alcor and all team members as soon as a time and date were chosen by the member and his family for ingestion of the AID medications.

There were planning discussions about which air ambulance company to use and the type of aircraft to use. There was also a discussion about whether or not to do the neuroseparation in California or wait until the patient arrived in Arizona. It was decided that except for unforeseen circumstances there would be no need to do the procedure in California.

Thursday, October 25, 2018

The MRD spent many hours working to obtain the needed HIPAA and EOLOA paperwork. In spite of being given inappropriate paperwork and being sent to incorrect locations, requiring additional trips, he finally accomplished the task. Upon returning to the member's home he found that the member had gone to the emergency department (ED) to have a draining shunt repaired. The member was comfortable and had no pain that morning. The hospice RN supervisor told the MRD that the AID medications should take effect within an hour after ingestion and hospice could be called to pronounce as soon as the member ingested the medications.

That afternoon there had been no change in the member's plan to ingest the medications on Monday, which was four days away. Once all the paperwork was in hand and verified, Alcor could then officially call a deployment that would give SA ample time to deploy.

Friday, October 26, 2018

That afternoon the MRD received documents from the hospice and there was extensive discussion on Slack about being sure that all the required paperwork had been gathered, who could act as witnesses, whether family members with an interest in the member's will could witness, and if not, that disinterested local Alcor members could fill that role.

Saturday, October 27, 2018

SA confirmed that their contract surgeon and perfusionist were flying to California on Sunday afternoon, and SA team members would drive from southern California to northern California in their mobile operating vehicle (MOV) on Sunday.

Alcor reminded the team that a video recording was needed that showed that no one from Alcor or SA was in the room with the member when he took the AID medications and not before he was pronounced legally dead. There was also a discussion about making sure all details were covered for obtaining the death certificate and moving the member from California to Arizona.

The member's ex-wife had asked the member to delay his ingestion of the AID medications since he was having less pain; the member was considering the request. That evening the member's daughter told the team that the date of ingestion had been officially changed from Monday to Tuesday. SA moved the arrival of the surgeon and perfusionist from Sunday to Monday.

Sunday, October 28, 2018

The member had slept well the previous night with little discomfort and was in good spirits. The member was still planning to take the EOL medications on Tuesday.

Monday, October 29, 2018

SA confirmed in the morning that they were leaving their southern California facility and on their way to the member's location. Stabilization operations were still scheduled for Tuesday. The MRD had spoken with the hospice supervisor; she informed him that due to a mandatory meeting from 9:00 hrs to 11:30 hrs on Tuesday no one from hospice would be able to respond and pronounce during that time frame. The MRD got the name of the hospice physician that would be on duty and forwarded that to SA as well as to the member's family. The member's daughter informed the MRD that she had informed her father about the time constraints and he planned to take his medications at 11:00 hrs on Tuesday.

Hospice personnel had made assurances that they were going to cooperate in every way possible. The CMA advised the team that the law specified that in cases using the EOLOA, for statistical purposes the death certificate should not state that the cause of death was either homicide or suicide. He asked that the physicians be advised of this since this legislation in California was new and the member's physicians may not already be aware of this. Standby

SA reported that they had just arrived in Mountain View and were with Alcor's MRD. Alcor's Arizona mortician had been updated on the status of this case and his staff was ready.

Tuesday, October 30, 2018

The MRD reported at 08:12 hrs that they were on schedule for medication ingestion at 11:00 hrs. The air ambulance had been scheduled to depart from Moffett Field. SA began setting up their equipment and drawing up the medications in preparation for the stabilization procedure.

The Alcor MRD and the SA team arrived at the member's house at 09:48 hrs. They set up the stabilization equipment in a part of the home separate from where the member was located. There was a locked door between the team and the patient. The rectal occluder and the nasopharyngeal wax were not in the vehicle and therefore not available to use on this patient.

Alcor's CMA instructed the team at 10:01 hrs that propofol, a standard part of the stabilization medications, would not be needed in this case since the AID drugs would accomplish the reduction in cerebral metabolism and suggested that the stabilization protocol begin with the infusion of sodium citrate or heparin. SA agreed to make the change to the protocol. At 10:30 hrs the member's friend informed the team that the member had taken a dose of Zofran which was to prevent the possibility of vomiting once the AID medications were ingested.

At approximately 11:20 hrs the MRD, SA and the hospice RN reviewed Alcor's post-mortem procedures and verified that all necessary paperwork was in place. Once the hospice staff was satisfied that the documentation was all in order, they said they would send a nurse out to the patient's bedside to pronounce. This information was relayed to the family. At 11:30 hrs the AID medications were administered by the family.

At 11:50 hrs the member's friend informed the team that the member had taken his AID medications. An hour later no hospice nurse had yet arrived; they were one hour into the wait and there was no update yet from the family. Shortly thereafter the hospice nurse arrived at the house. The member was still breathing but unresponsive. The hospice nurse reported that there was no blood pressure, respirations were shallow, and the heart rate was low.


The member was pronounced at 13:14 hrs. After the family left the patient's room, using his bed sheet, the team lifted the patient and carried him into the garage; the doors between the team and the family were closed behind the team. The patient was placed into the portable ice bath (PIB)

SOURCE: CRYONICS magazine, 2nd Quarter 2019, pages 12-15