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Dr. Michael Fratkin on Life, Death and Palliative Care

Michael FratkinWhether we like it or not, the current reality is that every day 150,000 people die. And while I have no doubt that one day humanity will defeat death of old age, like anyone else, I am not guaranteed that I will be alive to benefit personally from such a radical development. And so, while I am hoping for the best, I am doing what I can to get ready for the worst. In my case this entails planning for a number of contingencies – such as death where my brain has been destroyed or not, and taking a number of pro-active steps such as writing a will and signing up for cryonics. In this context I thought it may be useful to bring in a guest who meets daily with death so that we can at least open up a conversation about a topic that is often considered a taboo in our sanitized society.  While both me and Dr. Michael Fratkin have very strong personal biases as well as established thinking on the topic of death, I wanted to see if and what we can each take away from such a conversation so that we are both better off in the end. I have to say that I was not disappointed and I hope you will find something beneficial for you too.

Dr. Michael Fratkin is a palliative care physician and during our 2 hour conversation we cover a variety of interesting topics such as: his personal story, motivation and medical background; whether we are more than our physical form or not; palliative care, completing life and ResolutionCare; the definition of death; why he is a “presentist” and not a futurist; the origins of my own personal biases against death; his take on cryonics; Zoltan Istvan‘s Transhumanist Wager and on-going presidential campaign…

(You can listen to/download the audio file above or watch the video interview in full. If you want to help me produce more high-quality episodes like this one please make a donation!)

Who is Michael Fratkin?

Michael FratkinFather, husband, brother, son, and physician, Dr. Fratkin is dedicated to the well being of his community. Since completing his training, he has made his home and built his family in rural Northern California. He has served his community in primary care in a community clinic system, as a medical director of our local hospice, as a leader in the community hospital medical staff, and a transformative voice for improving the experience of people facing the end of life.
At a time of great demographic and cultural change in our society, Dr. Fratkin has created ResolutionCare to insure capable and soulful care of everyone, everywhere as they approach the completion of life.

ResolutionCare leverages partnerships with existing healthcare providers and payers to provide telehealth applications that bring greater quality of living and greater quality of dying. The Palliative Care team at ResolutionCare openly shares our expertise and mentorship so people can receive the care they need where they live and on their own terms.

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  • Dan Radu

    There is a Merry Cemetery in Transylvania, Romania. That is right, its not a sad place at all. It started with a local artist creating crafty and colourful tomb stones with stories of the people who died. Very interesting take on life and death, some of the stories are really witty and quite personal.

  • Very interesting – never heard of such a cemetery before 😉

  • ernest101

    This was a very interesting and thought provoking interview. It was refreshing to have a guest that is actually on the front lines of death.

    First, with regards to the definition of death, even the American Heart Association (AHA) has difficulty in defining “irreversible death” – which implies that there is such a thing as “reversible death” – for those being certified in advanced resuscitation techniques. Their definition in which resuscitation should not be tried are (1) victims of decapitation, (2) persons in whom rigor mortis has set in, and (3) those which have started to decompose. Obviously, these are extreme circumstances.

    However, most physicians pronounce a person dead based on the context of the circumstances in addition to several clear cut signs. The two most important are the absence of pupillary and corneal reflexes (outside the setting of paralytic and sedative medications). These findings imply damage to the mid brain and brain-stem respectively (from which the associated cranial nerves arise) and hence “irreversible” death. The same can be said of “brain death” in which most neurologists accept damage to the brain stem (with or without cortical damage) as the definition of death.

    However, in the end (no pun intended), society accepts the judgement of the physician pronouncing the patient’s death. As you pointed out, it is not infallible.

    Secondly, along the same lines, I am assuming that when considering cryonics at the time of death, we are accepting the judgment of those that will revive the patient. Dr. Fratkin made a good point in noting that he may not want to be revived in a horribly dysfunctional future world? Who is to say that future generations may absolutely know how to revive someone flawlessly? Will there be no learning curve? What would they do with those revived individuals that may be “flawed” or “suffering” as a result of an incomplete restoration process? Even worse, what about malevolent future generations that may use those in suspension for experimentation? Could it be that the odds of survival based on the good intentions of future generations are equal to or outweighed by the odds of future generations being malevolent?

    I am a pessimist and I sometimes question the ethics of those that you have interviewed as some seem to be interested too much in the entrepreneurial aspects of technology and not so much in the ethics.

    Keep up the good work though as you have a wonderful set of interviews.

  • Thanks very much for your good words and great points of contribution my friend – I really appreciate it. I also agree with you that many of my guests are preoccupied with the entrepreneurial aspects of technology and not very much with the ethics as well as other great implications for our civilization in general – which is my main and growing criticism of Singularity University…

  • ernest101

    I am reminded of a passage from James Barrat’s book, Our Final Invention, (whom you interviewed in Podcast 122), in which he attributes the following quote to Eliezer Yudkowsky : “They [AI makers] do not want to hear anything that contradicts that [a bliss-full AI enhanced future]. As the old proverb goes, most damage is done by people who wish to feel themselves important. Many ambitious people find it far less scary to think about destroying the world than to think about never amounting to much of anything at all. All [italics in the original] the people I have met who think they are going to win eternal fame through their AI projects have been like this.”

    The use of the word “all” in his statement is hyperbole. However, there is a kernel of truth to his statement.

  • billy lee

    Dear Nik & Michael

    Thank you so much for this interview.

    Thank you Nik for linking me to this content.

    I certainly feel and admire the work Michael does, and of course you Nik- I would not have met you and would not have chance for this dialogue without SingularityWeblog. My appreciation for your work is and will be an ongoing thing and will always be interested, curious and wish for all good things that help to make this experience possible, and most human. To go a little bit further, I feel connected (as one) as I can see parts of my human experience engraved from what I can sense in your interactions. It certainly has the possibility to go beyond, with possibility of time, and this is what excites me and gives me hope for future. Also the one that we can help to make better.

    I feel excited to hear from Michael of his work. I would be very interested in stepping in closer to your world of human interactions at such critical and definite stage that all of us face. I sense the immense satisfaction and gratitude you feel towards the work that you do. I would love to see into stepping into your worlds with hopes of gaining greater insight, with hopes of building better narratives for ourselves and for the rest of the world to become more conscious, to be present, responsibly responsive with our time and our surroundings. I think about transitions.

    Death is an important topic to me. It is something that I’ve pondered for over a decade during the times of existential exploration, asking the big questions. It became basis for foundations of my being.

    With that said, how do we live? What strategies, thoughts, mindset, or mental framework is helpful for better construction of our lives in its time?

    The popularized concept of “Live Your Day As If It Is Your Last Day” as an example, regardless of how in-depth it goes into in any books, in practical sense, it may not have the outcome or potential that is in line with (my) ideas on evolution of human growth- the one that is necessary, the one that helps to create the best narrative for transitions that contribute to continuous and consistent adaptation and implementation of human thinking today. While I do believe that such trendy phrases of reminder does hold power to disrupt our thinking and behavior from time to time, I reject this notion and popularizations of because we humans have tendency to draw circles, to form most concrete understanding of any equations using one’s own experience and ability to produce input at the expense of its own time span for consideration.

    At the same time, I realize that I lean towards negation and rejection because it is not presented in our world in more balanced approach. It is not totally useless but by itself, it is perhaps wasteful attention of our time, the one that lacks long term vision and transitional thinking and guidance.

    On that note, I believe a concept that could use more investment of our thinking and design is on figuring out the times or situations, and narrative or content through readily accessible platforms to intercept and help us to question our emotional reactions, cognitive habits, its manifestations within our body externalized to the outer world through expressions, perceivable by our senses and creates cycles of different time spans and outcomes.

    With the ideas related to quantified self, we are starting to build and design technologies that are capable of “expanding time”. Which will be able to collect data through monitoring our state and situations, put into algorithms to give us options for better understanding of how we react for a chance of reflection. The game changer is when there is curated content that speaks to our senses. Much like how Nik was able to make the suggestion to me on my Facebook post, but this taking place with help of our intelligent designs and machines. Emerging time.

    It’s becoming more important now than ever, for us with great extensive abilities and insights to have a clear vision, at least at the back of our minds as we work through our days. We must be mindfully aware of exponentially accelerating number of inevitable changes pushed by the state of human existence. and the challenges it will bring… the signs that are showing now which will no doubt have impact on the single most important thing we all care to understand and improve- human experience, it is no brainer that we must continue to build and learn with this reality and goal in mind. Expand time.

    I am sure that you have all thought of much of what I’m sharing with you. With luxury of choosing my own time to compose and recompose my thoughts, below are some of what I’ve picked up from your words and some comments. Again, I am grateful and impressed by the quality of information and delivery of thoughts during this interview.

”The experience that people have at the end of their lives is far less than it could be. And there are so many.”

    Michael mentioned that he is drawn to intensity… of doing the moment. “Expanding time.”

    “I’ve got forever to be dead. For this moment, in this life, in this present moment, the best i can do is to pry my eyes, heart, mind as wide open as possible to receive all the information that’s right here on this side of the veil. and then follow my passion. which is to put that into work. helping and serving other people.”

    quick thought: space without constraints of time but self to fully actualize to one’s best capacity and imaginations, carried out, communicated and validated

    comment: I cannot agree more. This is a sign that our concept and use of time is misaligned. On this note, I think it is important for each individual to consider what and how we might consider to be important when we die, and keep questioning ourselves until we come up with more realistic scenario that speaks to our soul. For me, it is how I would feel about my life, my past. I do not wish to have regrets, and for that I am learning to be comfortable with myself not doing anything and when doing, doing everything with my best of abilities while “expanding time” almost as exactly as you have put it Michael. I collect as much data as I can, think of possible scenarios, prioritize my options, and practice taking them to action, with room for stabilization for observation, more response and reflection for most efficient communication that is mindful of my unwavering and strategic delivery of intentions which becomes second nature with practice- satisfying experience as we are truly learning to break ourselves out of traditional, suffocatingly conventional and constricting concept and barrier of time.

    Such a great question from Nik and response from Michael

    Nik: What’s your philosophy of approaching someone who is dying?

    “assume nothing”
    the loneliest thing for person facing death (Nik’s uncle),
    how overwhelmed you can become with projections of people around you,
    how lonely and isolating it can be,
    to have people presume they understand,
    or have them not understand

    ask (person facing death):
    how are you experiencing this particular moment in life?
    what matters most to you?
    how much are you suffering physically?

    (when suffering physically) impairs their capacity to feel as human being

    find out:
    if they are open, to exploring with them what matters most to them.

    then roll up your damn sleeves and find out if you can support them!

    most of the time it’s being present.

    who are you? what do you want people to remember you?
    how do you want to express yourself at the end?

    my meditation are the people that i serve, people that i work. the way that i approach everything is to try and continuously pry open my intention and awareness to be with what’s actually happening
    through that meditation, i seem to be making progress, growing up, accumulating wisdom that’s out there

    love the making of VHS tapes for special human events for her daughter after death
    stunning how “present” she was for her mother – level of attention and presence she put into the project

    this is such an important and amazing investment of time for enrichment of the daughter’s life

    i thought about how Ray Kurzweil has similar views about bringing back his father for the experience.

    on topic of defeating death
    from my point of view, with what i’ve experienced and thought of about death so far, we will never truly defeat “death” or become greater selves as long as we are locked in the concept and fear of death that is governed by our nature and nurture

    i’m glad and it was nice to hear your story nik. i love how attentive michael was during and was able to connect with you afterwards

    cryogenics tour – this was one of the first videos i saw of your blog nik 🙂

    “i am ready to die in 20 minutes from now and being able to think i’ve lived every sing moment of my life best i could and i am happy with my contribution to the world”

    I’d like to think that this is the way of an existentialist 😉

    expanding time!!!!!! timeless experience. so non”human”, unconventional, and beautiful.

    Nik, if I happen to live longer than you, I will remember how you were, other times I sensed of you and times of our interactions, and when you told Michael ACDC and listen to it while reminiscing what we’ve shared 🙂

  • Firas

    *The paragraphs below are my thoughts mixed with parts of the talk, If i watched this video last week or 2 weeks into the future then I probably would have expressed my thoughts differently. Disclaimer: I was not completely present while writing this, so read with caution 😀

    I am happy to see that people like Dr.Fratkin and BJ Miller are beginning this transition back to a more connected way of dying. By deeply listening to the person that is dying and asking them questions to encourage the release of psychological blockages in them, allowing them to ‘complete their journey’.

    It is beautiful how we as a species and as individuals have the ability to ‘design’ our lives. just as we ‘design’ our careful births. Dr.Fratkin speaks about designing for our death. He talks about how we can become more present and feel more at ease towards the end of our life.

    Despite its inevitability and obvious presence, death for most people usually comes as a surprise, because for most of our life we are not feeling/ thinking of it, then suddenly one day it shows up with an intense presence in the mind. I think we can design our lives in such a way that is more accepting to the process of death. An example of this could be practicing mindfulness from a young age (i.e. integrated into our schooling) to better direct our attention to where we want it to be, by doing this we can spend our time and energy on Earth fully towards expressing our true selves, which may allow us to accept dying more easily when it comes.

    I love how Nikola was so honest in describing why he is a naturally bias person when it comes to this topic due to his experiences during childhood. I think looking deeply at our childhood experiences (while remaining present) is a cathartic experience, that allows one to live more deeply in the present moment. Looking at old photos/ videos, and trying to deduce how we ended up the way we are right now helps in expressing ourselves more authentically in the now. Maybe that is what it feels like when Dr.Fratkin ‘patients’ begin to talk about their life and all the memories they had, he mentions how they become more whole, maybe by talking about them they are actually letting go of them for the very last time, accepting their transience.

    If we choose to do so, we can direct our attention towards designing our deaths using technology. Imagine hospitals that prescribe to their patients;
    1. Skyping with family/friends at least 2x/week
    2. Visiting the hospital gardens (in VR if incapacitated) at least 2x/week
    3. Talking with children at least 2x/week
    4. Visualising the world they will leave to their loved ones after their death and seeing how they will fit in (e.g writing their will in detail, a 10 page will expressing themselves, or like Nikola and Michael spoke about the music they would like playing during the funeral etc.)

    There are many things us humans that are fine at the moment can do to improve the lives of others during their last days. Practicing mindfulness I think will allow us to carry on making the best decisions we can at any given moment.

    Time is relative, we can easily live for 1000 years by travelling close to the speed of light, or visiting a solar system with a star a million times heavier than ours. But what matters is the process of one’s life, the journey, let’s focus on the process 🙂

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