The following article by Nils Hoppe, Professor for Regulation in the Life Sciences and a Director of the University of Hannover’s Centre for Ethics and Law in the Life Sciences, appeared in the BMJ Journal of Medical Ethics blog and is cross-posted with permission.
Re JS (Disposal of Body)  EWHC 2859 (Fam)
This unusual and sad case concerns a court application by a 14-year-old girl, JS. 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. The other parties involved in the application were JS’s parents, who were acrimoniously divorced. JS had no direct contact with her father after 2008.
Knowing that she would soon die, JS carried out online research into commercial cryogenic preservation techniques, defined in the judgment as “the freezing of a dead body in the hope that resuscitation and cure may be possible in the distant future”. Such techniques are not uncontroversial, being regarded with scepticism by the majority of the medical and scientific community. They are also not cheap: the judgment describes the costs associated with the basic cryopreservation package as being in the region of £37,000, or, as Mr Justice Peter Jackson put it, “about ten times as much as an average funeral”.
Of most significance to the court application was the fact that the proposed procedure required the cooperation of the hospital in which JS was a patient. This concern was described in the following terms by the judge:
“The body must be prepared within a very short time of death, ideally within minutes and at most within a few hours. 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. These bridging arrangements are offered in the UK for payment by a voluntary non-profit organisation of cryonics enthusiasts, who are not medically trained. Evidently, where the subject dies in hospital, the cooperation of the hospital is necessary if the body is to be prepared by the volunteers. 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” .
JS, described as bright, intelligent and articulate, decided that she wanted her body to be cryopreserved after her death. Her mother supported this wish: her father did not initially, though his views changed. By the time the matter went to court, JS’s 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.
In these circumstances, Mr Justice Peter Jackson was asked to make an order permitting JS’s mother to make arrangements for the cryopreservation of JS’s body after her death and, conversely, preventing her father from intervening. In doing so, he considered a range of legal and ethical issues.
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. At 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. The 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. The question of what is then done with her body is at this stage of secondary importance only. She may request to be interred in a family tomb, be incinerated, or donate her body for scientific purposes. In this case, she would like to be cryopreserved. The 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. Her 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. Her bet also extends to that new technology permitting her successful resuscitation. It extends to her mental faculties surviving the procedure so she can meaningfully engage with her surroundings post-resuscitation. And it also extends to a cure having been found for the condition which caused her first ‘death’.
Any one of these bets is so risky as to be legitimately thought of as unlikely. In 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? Most jurisdictions, including England and Wales, are clear that the death of the individual must be ‘irreversible’ to be normatively meaningful. Where this is the case, what is done with the body afterwards is very much a matter for the concerned individual and her family. There 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.
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. It seems clear that there is very little sensible argument which would allow the Court to deny her final wish. The 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.
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. Mr Justice Jackson did so, and he did so with commendable sensitivity to the subject matter before him. The decision is the right one to reach. The 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 resuscitated remains for another time. But there is an exciting point here: unless the law is changed ex ante, cryopreservation companies will suddenly have custody of hundreds of comatose patients, rather than dead bodies – with all of the entailing legal and moral obligations.
Cite this article as: Nils Hoppe, “Justice Cryogenically Delayed is Justice Denied?” in BMJ Journal of Medical Ethics blog, 18 November 2016, http://blogs.bmj.com/medical-ethics/2016/11/18/justice-cryogenically-delayed-is-justice-denied/.