Faculty of Law
University of Edinburgh, UK
To be published as a Chapter in Aging Interventions and Therapies
(Edited by Suresh Rattan, World Scientific Publishers, Singapore; 2005)
Why include an ethical chapter in a scientific text? What is the relevance of ethics to the pure research and practice of biomedical gerontology? If relevant, what are the main issues, and how may they be addressed? My purposes in writing this chapter are twofold: firstly, I wish to answer the above questions, and thereby to convince the reader that certain philosophical and ethical questions and issues are prior to, coincident with, and consequent upon the research and practice of biogerontology, and should be seen as inseparable, necessary and beneficial components of the discipline. Secondly, I wish to provide the reader with a basic guide to approaching and dealing with these perhaps somewhat unfamiliar aspects of the field.
While the ethics of pure scientific research may be interesting in themselves, they are on the whole not germane to the kind of concern which is popularly expressed both by the general public, and by ethicists, when aging research is discussed. Therefore, I shall, for the purposes of this paper, assume that research implies application, and that there exists an intention to intervene in the processes of aging, and so focus upon the ethical implications of this. There are two possible motivations for this intervention: The first is to mitigate the disabilities, infirmities, discomforts, and impairments of the aging process. The second, which according to some thinkers in the field neither ought nor can be disentangled from the first, is to obviate the aging process partially or altogether, and thereby achieve life-extension itself. The scope of this essay is necessarily limited. Since life extension is implied by both motivations, either as a goal or an effect, and since intervention in the pathologies of aging themselves is less controversial, I shall concentrate for the main part of what follows primarily upon the ethics of life extension per se, though the ethics of aging intervention will of necessity be discussed inter alia.
In order to assess the ethical aspects of the notion of life extension, one must first address the problem of value. If there is no value to be gained in extension of life, or to put it another way, if life extension has no value in itself, then a defense of its pursuit becomes difficult, or impossible, in the face of any risk or disvalue which may be posited. In order to properly assess the value of life extension, we must first examine the nature of the action itself, taking into account not only effect, but motivation, in an attempt to find a value which underpins it. We shall see that this turns out to be the instrumental value of living.
Can death in itself be argued to be something so negative that its very occurrence may be used as a justification for life extension? If biogerontologists seek to extend life, are they mainly, as well, or at all seeking to stave off death itself? It has been argued that life extension is death postponement. While the postponement of death may explain a person’s motives in seeking to extend a life, it is not the case that “life extension” and “death postponement” are one and the same concept. I may be tired of life, and find no instrumental or intrinsic value in its extension, but nevertheless wish to postpone my death. Such a desire is not motivated by a wish to extend life but rather from some notion of the disvalue of death. Perhaps death in such a case is feared as something negative in itself as a kind of anti-life, just as darkness is conceived in Milton as a kind of anti-light, or “darkness visible.” Or else perhaps it is feared, as in the case of Hamlet, simply because it is an unknown quantity:
To die -- to sleep --
No more; and by a sleep to say we end
The heartache, and the thousand natural shocks
That flesh is heir to. 'Tis a consummation
Devoutly to be wish'd. To die -- to sleep.
To sleep -- perchance to dream: ay, there's the rub!
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil,
Must give us pause. There's the respect
That makes calamity of so long life.
Equally but very differently, I may conceive of death as being nothing to be feared at all. This may be so if I accept, based on available empirical evidence, that death is not even comparable to the unconsciousness of dreamless sleep, but rather is a total oblivion and non-existence in which there is no longer an “I” upon whom suffering or disvalue may alight. The Greek philosopher Epicurus argued for just this conclusion:
Make yourself familiar with the belief that death is nothing to us, since everything good and bad lies in sensation, and death is to be deprived of sensation… For there is nothing to be feared in living for one who has truly comprehended that there is nothing to be feared in not living… So [death] is nothing to the living and nothing to the dead, since with regard to the former, death is not, and as to the latter, they themselves no longer are.
In the latter case, postponing my death would appear to have no particular import from the perspective that death is a bad thing in itself, since death is no thing in itself. So in the case of a person who accepts this view, action taken which happens to postpone death could only be fairly said to be motivated by the intention to extend life, since motivation to postpone death on its own would be unintelligible.
We do not have, and probably will never have, evidence as to the possibility or nature of death as an experienced state of being. Thus we should bracket any concerns along these lines, and go with Epicurus’ view on the badness of death, instead concentrating upon what is valuable in life, as the only reasonable justification for efforts to extend it.
Some of you are perhaps scratching your heads and wondering if it really can be that death is not bad in any way. How can that be? Are all our fears about and distaste for death unfounded? And what of prohibitions concerning death? If death is not bad in itself, could such a view not remove the badness from murder, provided it is conducted suddenly, and without expectation or pain? More relevantly here, if death is not bad, then why make special efforts to prolong life?
Well, of course, there is a way in which death may still be accounted as bad. On this view death is not bad in itself, but rather the badness of death becomes relative to what it negates, namely the continuance of life. Death is bad because of what we lose by it. So, if we want to assess the ethics of life extension, we must consider the value of life, rather than the disvalue of death.
The Value of Living: Life Extension and the Relative Badness of Death
There are two possible modes in which life may be said to have value: the intrinsic and the instrumental. While some notion of the intrinsic value of life may be germane to the question of whether or not we should actively take a life, it does not appear to tell us anything about why a continuing life, so life extension should be valuable. If life has intrinsic value, it is neither diminished nor increased by added time. The value of continuing life derives from the value of living. The value of living should be understood as instrumental value. It is about what we can do with a life, not whether we are alive at all.
So then, we must establish a basic category of creature for whom life may be said to have instrumental value, such that extension of a life is valuable. It appears trivial that non-conscious life cannot have instrumental value. What about conscious life? For conscious life to have instrumental value to a creature, a creature must have the capacity to value. There are certain features which, added to consciousness, allow us a capacity to value. These other features of a conscious being are to be summarized as follows: a capacity for self-conscious, rational, autonomous will. These features put together constitute a basic category, the possession of whose characteristics is commonly known in bioethics as personhood. So we are left with a question of what about living, then, is valuable to persons?
Being a person is not simply being an entity, it is an ongoing, time-extended process. This process is composed of desires, wishes, hopes, preferences, thoughts, plans, actions, experiences, emotions, memories, etc. These and their kind are the goods in a person’s life, and they constitute the value of living.
Of course, there are also evils in living, and things such as pain, sorrow, remorse, fear, etc. which contribute to disvalue in living. Can these things cancel each other out? Is there a basic value in living that is there no matter what misfortunes a person suffers? The words of the eminent philosopher Thomas Nagel are useful at this point:
The situation is this: there are elements which, if added to one’s experience, make life better; there are other elements which, if added to one’s experience, make life worse. But what remains when these are set aside is not merely neutral: it is emphatically positive. Therefore, life is worth living even when the bad elements of experience are plentiful, and the good ones too meager to outweigh the bad ones on their own. The additional positive weight is supplied by existence itself… like most goods, this can be multiplied by time: more is better than less.
So the process of living may be regarded as essentially good. But what is it that makes or allows it to be good? The present and backward-directed elements of the process of being a person, such as experience and memory, have forward-looking counterparts: hopes, desires, plans, etc. Hoping, desiring, and planning are intrinsically future-directed. Hoping for, desiring, or planning our past is meaningless or futile. These aspects of the process of personhood involve projection into a multiplicity of possible futures. The temporally extended process which is definitive of a person’s life involves both the existence of these future-directed elements and their objectives, and the possibility of those objectives being realized, thereby becoming the objects of the counterpart elements of experience and memory. On this view, then, there is then no point in time at which the continuation of a person’s life may be said not to be valuable, since these forward-directed elements are intrinsic to the process of being a person. As such, the process of being a person is intrinsically open-ended. Nagel expresses a similar view:
The situation is an ambiguous one. Observed from without, human beings obviously have a natural lifespan and cannot live much longer than 100 years. A man’s sense of his own experience, on the other hand, does not embody this idea of a natural limit. His existence defines for him an essentially open-ended possible future… Viewed in this way, death, no matter how inevitable, is an abrupt cancellation of indefinitely extensive possible goods. Normality seems to have nothing to do with it, for the fact that we will all inevitably die in a few score years cannot by itself imply that it would not be good to live longer. …If the normal lifespan were a thousand years, death at 80 would be a tragedy. As things are, it may just be a more widespread tragedy.
In this way, it would appear that there can be no arbitrary upper limit on the good of the extension of life to a person. There is no point at which being a person does not involve the future-directed elements and their involvement in the process of interchange with the present and past elements. An attempt to set or discover such a general limit would appear to involve a misunderstanding of the nature of the process itself. That we may know some facts about human biology which suggest that we indeed have an end in store, and even how far in the future that end is likely to be, in no way impinges upon the intrinsic nature of the elements of hoping, desiring, planning, which are fundamental to the process of being a person. These all point towards the ever-distant horizon of the possible.
If no general limit can reasonably be set or discovered, could one be set by a person upon themselves? That my desires, hopes, and plans may fix upon particular objectives does not in itself seem to suggest that I can easily, or at all, fix these elements of myself purely upon and continent within some set of particular objectives, so that they end with the completion of this set. No matter what I specifically plan for, desire, hope for, it seems that these aspects of my psychology overflow the limits of their particular objects without any particular act of will on my part. A person whose self-professed sole hope, desire, and plan in life was to stand atop Mount Everest is nonetheless likely to find himself filled with some other such by the time he has reached the bottom again, or indeed to discover that he already had many in store, which had merely been obscured by this overriding one. Furthermore, willing these aspects of ourselves to be contained within a fixed, time-limited framework would seem to be a very difficult task indeed, if possible at all. I may seek to direct or curtail my first-order desires (those which simply “I desire”) with my second-order desires (those by which “I desire that I do or do not desire”), but that a second-order desire to have no desires should be effective would seem a tall order, to say the least. And as to a self-imposed limit to the temporal extension of these elements of oneself, try to imagine a person setting a particular date beyond which she will be free of all plans, hopes, desires, etc. Such a picture strikes one as ridiculous. So, it does not seem that very reasonable that a person may even set a limit to the good of their own future extension in time. Nonetheless, it will be useful to consider the effect that this might have, should it be possible, or should it happen as a matter of brute fact.
Without the constant interchange between the future, present, and past elements of the process of being a person we should be fixed, and frozen, ourselves objectified and unable to fulfill our autonomous will or formulate rational designs and desires, let alone actualize them. Our rationality, should we still possess it, would become purely analytic of past objects, stripped of instrumental potency, our autonomy stripped of meaning. The process of being a person would cease, and the continuance of being itself would thereby be stripped of its value. Should we lose these future-directed elements of ourselves, then, we would no longer be persons, and living would have no value.
I do not suggest, however, that this is impossible. Indeed, I think it is both possible and perhaps does happen, albeit probably rarely in the extreme, owing to the difficulties outlined above. Perhaps the case of Elina Makropulos discussed in a later section of this essay is an example of just such a person, though in this case fictional. When such a case does occur, I would argue that, for that person, death is not bad in any way, since they have lost their ability to value instrumentally their own futures, have stopped being a person, and so are to that extent dead in any case. More, or future life holds no further benefit, since even a desire for pleasure taken in contemplation of the past, involves a desire that this pleasure should extend into the future.
For such a being, Epicurus’ conjecture concerning the badness of death becomes the only consideration, and death is not bad. Death at a particular time takes nothing more from them than it would at a later time. They are constituted to be only present and past directed. Their future is meaningless to them.
Death is bad, then, because of what it takes from us, and what it takes from us is our-future directed elements, and their objectives. It shears from us our possible futures. This is surely what is referred to by the common intuition that death for the young is worse than it is for the old. For a person of the biologically present human form, death at a hundred years of age cuts him off from fewer possible future goods than does death for a normal seventeen-year-old. But this should not lead one to think that death for a person of unlimited future extension in time is far worse than it is for an ordinary person, since while the future-directed elements make life’s continuance always a good, this simply implies some continuance. The degree to which this may be seen as beneficial at any one time has much to do with the objectives of these future directed elements, though it is certainly true that with unlimited scope, some such objectives would doubtless be more distantly located.
Some of you might at this point be wondering why Epicurus’ model should not also annul and make irrelevant to us the value of the future goods as well. Bernard Williams’s elucidation of the basic class of forward-directed desire is useful here:
…a man might consider what lay before him, and decide whether he did or did not want to undergo it. If he does decide to undergo it, then some desire propels him on into the future, and that desire at least is not one that operates conditionally on being alive, since it itself resolves the question of whether he is going to be alive. He has an unconditional or (as I shall say) a categorical desire. …It is not necessarily the prospect of pleasant times that create the motive against dying, but the existence of a categorical desire and categorical desire can drive through both the existence and the prospect of unpleasant times.
So even if death is nothing to us when we are dead, death most certainly is something in relation to the categorical desire for future goods. Death is the desire’s frustration, and its denial, and its tragedy is the loss of the desire and the goods which are its objective. This is what is bad about death. Life is instrumentally valuable to us as persons, and so long as we are persons, and possess future-directed elements in the form of desires, hopes, plans, and the like, death is bad insofar as it deprives us of these and their objectives. The value of life consists in the value of living, and living as a person is an intrinsically time-extended process with indivisible forward-projected elements. As long as these elements exist for us, we are persons, and life extension will be valuable to us. And for persons, it is a value without limitation.
Now that we have established a basic framework in which to ground the value of life extension, I will very briefly outline and address some standard and one or two unusual objections to the aims of aging intervention and life extension.
A. Natural Aging and Human Intervention
One common claim encountered in both lay and professional philosophic conjecture is that any intervention which seeks to alter the arrangements of how things have always been, may be seen as being an attempt to change what is “natural,” and is therefore to be condemned.
As it applies to biogerontology, the premises-conclusion structure of this argument may be summarized as follows:
P1: There is a category of objects and powers in the world describable as “natural.”
P2: The category of “nature” is in some way intrinsically “right” and “good.”
P3: Such a category may be infringed by human intervention in a way which harms the fact of its inherent “naturalness,” and thus harms its good.
P4: The ordinary trajectory of and other basic facts about human lifespan and aging fall within the category of the “natural.”
C.: Aging interventions are wrong and bad since such intervention harms something “natural” and good.
There is often a further premise relating to the proper province of medicine, which attempts to separate “natural” aging from disease. I consider this to be a variety of the same argument, and so vulnerable to the same objections I will make to the basic argument. I suggest that the above outlined argument, and its cousins are unsound and should be rejected.
Apart from anything else, this argument falls foul of a standard objection in philosophy known as “the naturalistic fallacy”. This objection states that it is always illegitimate to make any moral statements based purely upon empirical statements about things in the world. So then, just because such and such a state of affairs happens to be the case, (it “is” so) never means, on the strength of this evidence alone, that one may then conclude that it is morally the good or bad (it “ought” or “ought not” to be so). This is because moral statements and factual statements constitute entirely different conceptual categories. In and of itself, each tells you nothing about the other. Humans may age and die in a fairly standard manner and time. This appears to be a fact, though a hazy one to be sure. But there is nothing about this fact which tells me that this “ought” to be the case.
Aside from this, the argument from “nature” fails, since it either does not refer to an intelligible distinction, or if it does, makes unsound or absurd assertions concerning that distinction, as we shall see.
There are two possible types of claim that can be made about nature in this context. The first is that “nature” may be defined as a set comprising any object or power which is within time and space. If this definition is accepted, neither humans, nor anything they can ever do, nor any arrangement of themselves or things in the universe they can ever make, will be anything but natural. The second type of claim that may be made is that “nature” is that set of things with which humans have not yet interfered, and that human interference creates “unnaturalness,” which is usually characterized as bad. Aside from its arbitrary nature, and the oddness of the fact that a possible universe in which there never were humans would on this account have no defining condition by which it could be called “natural,” there are several awkward, or unreasonable consequences of this. As regards moral claims about “unnaturalness,” if we allow the general assumption to stand that “nature” is good, and any interference in it is presumed to be bad, then it would appear that anything that humans can ever do is bad. This is so because, on this view, the “natural” course of events, or whatever we don’t interfere with, becomes an absolute moral standard, and all human action is by this definition “unnatural” or counter-natural. We may not take refuge in the notion that it is “OK” to interfere with things we have already interfered with, since if we cease our interference, “nature” takes its course once more. Such a conclusion is absurd.
Most devastatingly, it is impossible for a defense of this argument to be mounted once one begins to inquire just where this boundary between the natural and the unnatural lies. Are humans really unnatural in some deep sense, or is it just their actions which are? If humans are entirely so, how did they arise from a “natural” universe? If only their actions, how can a being which is wholly natural, itself act “unnaturally”? If certain facts about humans, such as their aging and life trajectory, are “natural” then what can be “unnatural” about our own interference in them? Such a claim relies upon something in humans being unnatural. But what? The problem becomes crystal clear when the argument is applied to manipulation or alteration of the human genome. For such intervention to be “unnatural,” the genome itself would need to be defined as “natural.” But the genome in question is our genome, and the source of this purported unnaturalness, ourselves. Considering that our abilities, insofar as they are different from the “wholly natural” animals, are different only because of differences in our genome, the absurdity of this line of reasoning becomes inescapable.
Another common conjecture is that increased average longevity will clearly lead to overpopulation. Aside from the fact that this is mostly a practical, rather than an explicitly moral concern, it doesn’t actually seem to be borne out in practice. It would appear that there is ordinarily an inverse relationship between life expectancy and population growth. In poorer countries where life expectancy is low, and in other historical situations where life expectancy has been low (though less directly related to relative wealth) the birth rate has, and is seen to be high or very high. In modern societies where the average life expectancy is longer than at any time previously, the birth rate is below replacement level in many cases. The baby boom occurred in response to (or at least simultaneous with) a perceived sudden and dramatic lowering of average life expectancy in the groups who subsequently boomed. If greatly enhanced longevity would go hand in hand with increased reproductive lifespan, there still appears no definite reason for alarm. One may well ask what the effect of the ability to safely reproduce anytime, say, in the next 150 years might have on the average educated and career-minded woman. I would suggest that the effect would be both positive and welcome, and would be unlikely to lead to a flood of babies. When taken to its extreme this worry can be linked to the common misconception that radically successful biogerontological intervention will lead to true immortality. Even when endogenously unlimited longevity is disentangled from its mythological cousin, I suspect that most readers of this essay will ruefully recognize what a distant prospect that is. Even if the various Gordian conundrums facing biogerontology are solved, there remains the ever-present specter of cancer, which appears, at least to this commentator, more like a category of cell-state than a single disease, and is not likely to be tractable by a simple or singular “cure.” This is not to mention the scourges of accident, infectious disease, war, famine, etc. Given these sorts of considerations, overpopulation as a result of life-extension seems a luxurious, gratuitous kind of worry.
It is worthy of note, however, that it would appear that if these conjectures are valid and sound, then the consequence of generally and greatly enhanced longevity would be a decline in the frequency of children in the population. I account this to be both a serious, sad, and perhaps morally significant consequence.
Mythic Immortality vs. Life Extension: Problems of Finitude, Striving, Boredom, and Personal Identity
It would seem a trivial observation to notice that no aim of biogerontology can be to make persons immortal in the mythic sense of being both eternal and invulnerable. Despite this, such a confusion is very common, and is apparently made even by prominent commentators in the bioethical field. For example, consider these lines from a recent and influential essay by Leon Kass on the value of a limited life, and the reason we shouldn’t seek to extend it too much:
Homer’s immortals – Zeus and Hera, Apollo and Athena – for all their eternal beauty and youthfulness, live shallow and rather frivolous lives, their passions only transiently engaged, in first this and then that. They live as spectators of the mortals, who by comparison have depth, aspiration, genuine feeling, and hence a real center in their lives. Mortality makes life matter.
The confusion here is obvious, and while Kass clearly acknowledges elsewhere that life will never be unlimited and that whatever biogerontologists achieve, biological persons will remain mortal, he appears not to notice the importance of this distinction. The point I would like to make here, which is relevant to many of the critiques of life-extension to be found in current literature, is that Kass and his fellow antagonists of biogerontology’s life-extending potential do not take this distinction seriously enough. It is not a trivial distinction. It is vital, and categoric. Simply put, the distinction is one between an infinite set, and a finite set of presently undetermined or uncertain extent. To see the importance of this, we need to examine one or two aspects of these critiques more explicitly.
It is often held that finitude is vital to our aspiration, engagement, commitment, and striving in our lives:
…the remoteness of the midnight hour might influence negatively how we spend our days. For although the gift of extra time is a boon, the perception of time ahead as less limited or as indefinite may not be. All our activities are, in one way or another, informed by the knowledge that our time is limited, and ultimately that we have only a certain portion of years to use up. The more keenly we are aware of that fact, the more likely we are to aspire to spend our lives in the ways we deem most important and vital. … Many of our greatest accomplishments are pushed along, if only subtly and implicitly, by the spur of our finitude and the sense of having only a limited time. A far more distant horizon, a sense of essentially limitless time, might leave us less inclined to act with urgency. Why not leave for tomorrow what you might do today, if there are endless tomorrows before you?
A careful reading of these passages reveals the sleight-of-hand. We move from a mere sense of indefiniteness, to a definite sense of endlessness. But what about indefiniteness? Does the fact that I have a limited lifespan constitute the only condition for my doing anything in life? It seems an odd argument to assert that I go out to engage in a game of football today, only because I am aware that I cannot do it three centuries hence. Such an argument appears to miss the point of the process of living: it is the movement, shepherded by our autonomous will, of the forward-planned objectives into the objects of present experience and past recollection that we value. Just because I could put my game of football off indefinitely, does not seem to matter. I won’t, because I want to experience it. After all, it is true that I could put it off until next week, next month, next year, perhaps next decade, or further. But then, of course, if I continue to do so, even if I had unlimited time, I shall never play my game of football. This applies equally to prioritization of important, over trivial activities. There are many who exist with our presently limited span who do little or nothing with their lives. Seen in this way, such arguments may easily be re-characterized as the arguments from laziness. Such an argument has no real force.
But more importantly, the point is just this: it is the very indeterminacy and uncertainty which is vital to remember here. Even if we were functionally immortal --biological creatures with no endogenous limit -- we would still be mortal and vulnerable. We will never know, just as we do not now, with any degree of certainty, when the “midnight hour” will strike! The war poet Keith Douglas says it best, describing the death of a young man by his hand:
How easy it is to make a ghost.
The weightless mosquito touches
Her tiny shadow on the stone,
and with how like, how infinite
a lightness, man and shadow meet.
They fuse. A shadow is a man
when the mosquito death approaches.
Nothing that biogerontology can achieve will change this fact. We are biological entities, and whether we are old and decrepit or young and hale, we will remain frail, mortal, and vulnerable.
A related kind of worry is the concern about boredom, which involves a further concern about personal identity. The worry here generally runs like this: if we lead greatly extended lives, either we will become bored, since we will not be able to find enough variety in either life or in our own approach to it to sustain us indefinitely, or else we will, by varying our personalities and experiences so much, lose touch so completely with whom we were originally that the further life we gain cannot any longer be said to benefit the person who we were. The problem is thus presented as a dilemma. One horn of the dilemma is that life will become so repetitive and our boredom will be so extreme that we will no longer have any forward-directed desires, hopes, plans, etc. and life will become valueless to us. Such a case is depicted in the Karel Capek’s 1922 play “The Makropulos Case,” where the character Elina Makropulos possesses an elixir of life. In the words of Bernard Williams, in his essay of the same name:
At the time of the action she is aged 342 years. Her unending life has come to a state of boredom, indifference, and coldness. Everything is joyless: ‘in the end, it is the same,’ she says, ‘singing and silence.’ She refuses to take the elixir again; she dies; and the formula is deliberately destroyed by this young woman, among the protests of some older men.
Such a case is importantly different from the worries expressed in the legends of Tithonius, and the story of the Struldbrugs in Swift’s Gulliver’s Travels, who attain immortal life, but not eternal youth, and so suffer the untold horrors of an unendingly increased decrepitude. It is quite clear that it cannot be among the aims of life-extension or more obviously of the aging intervention aspect of biogerontology to achieve a Struldbrugian style of existence. Such an outcome is explicitly contrary to biogerontological aims. Elina is depicted as rather being both physically vigorous and healthy, and frozen in the state of character she was in when she originally took the elixir.
The other horn of the dilemma is that if we do in fact find sufficient variety in our involvement in the world, in doing so, we will, over time, become so different from the way we had been, that it is no longer possible to assert that life extension into the indefinite future will be useful or good to ourselves as particular persons. If this is the case then why not leave things the way they are, since if I will not be me in future, but someone else, then I may as well be dead, and someone else, of a future generation in the ordinary sense, may just as well exist in my future-self’s place.
Must indefinite life-extension necessarily fall foul of this dilemma? In order to examine this effectively, it is necessary to analyze the two horns more closely. In the case of the first horn, given the enormous presently existing variety of human endeavor and avenues of interest in the vast universe, and the fact that new avenues are perpetually being generated, while the old (especially in empirical or intellectual disciplines) are rarely or never exhausted (and indeed are often self-regenerating), it does not seem reasonable that the world itself should lose its interest. Surely, what is taking place in such a scenario, then, is that the person themself fails in some way to meet or find exciting these endless challenges, intrigues, and possibilities. So the problem may be redefined as one of individual personal character. It may simply be that Elina Makropulos was bored essentially because she was boring. Seen in these terms, is it necessarily the case that all persons would be so troubled? I submit that it is not. While it may be true that some styles of character are bored with life almost from the get-go, and find no particular continuing interest in life even in the full bloom of youth, others very clearly do not fall into this category. Did Newton lose interest in his studies or activities as he aged chronologically? Did Einstein? Plato? Da Vinci? Churchill? Peter the Great? Do any such polymathic characters, at all? It seems that some characters at least are well suited to lives which would extend very far, indeed, beyond the normal lifespan limits. I for one feel that had I a dozen times my presently projected span, I should hardly have time adequately to pursue all my avenues of interest. I, and no doubt many others, feel deeply cramped by the shortness of span, forced rather arbitrarily to prioritize certain few among very many possible interests, to the near or total exclusion of many others. I do not account this a benefit, as the long quotation above might suggest I should. Evolutionarily speaking, in this context, the human brain (unique in the known universe) within the human frame (a typically aging mammalian model) may be seen to be maladapted to each other: a bit like a jet engine mounted on a bicycle. There is a dreadful mismatch between power/potential and physical restriction. Why ought we to accept the confused dictates of our random biological heritage? Perhaps part of the aim of biogerontology may be seen as an attempt to mitigate the bad effects of this mismatch. The fact that some characters, such as Elina, decline into a psychological old age early in life or when still vigorous may simply be part of the gerontological conundrum. Biogerontology, in combating physical aging, may very well combat psychological aging as well. To deny this outright is to suggest a kind of Cartesian mind/body dualism.
Another common suggestion that psychological aging is beneficial as a palliative to the prospect of death is neither comforting nor convincing. Prior to execution, I might be administered a drug which lessens my concern about my own impending doom, but in such a case would I not have as much reason to fear and despise such a drug as the execution itself? Such an intervention simply co-opts and thus reduces my autonomous will. As regards physical aging, if I do not will it to happen to me, the analogy holds. Given what we have established about the value of living, it would seem that this is a primary evil. As Dylan Thomas put it, lamenting his previously fierce father’s decline into meekness prior to death:
Do not go gentle into that good night,
Old age should burn and rage at close of day;
Rage, rage against the dying of the light.
It is therefore not within the remit of biogerontology to preserve aging as a palliative to death. Nor can it be within the remit of the discipline to attempt to alter the conceptual facts about the badness of death. These are not tractable within the scope of biology.
As regards whether the fulfillment of such hardly-bounded interests of a psychologically youthful character-type, as described above, would necessarily involve their becoming someone else, it appears self-evident that they would not, since such interests are their own, present, and immediate interests. The situation should be examined in the light of an assertion I will now make: no normal person who has ever lived has died having fulfilled their potential. That some characters have little or no interest in fulfilling that potential seems irrelevant to the question, aside from the further question of whether they may be suffering a prematurely or unwarrantedly aged psychological state, or else are just plain lazy. Furthermore, it may be seen that the situation at present itself limits the scope of our interests. There are many projects that I or others do not find interesting or will not undertake simply because we are aware that we can never finish or even significantly further them. A greatly expanded lifespan-prognosis would, I submit, expand, rather than diminish both the range and scope of our interests.
So what of the problem of personal identity? A full rehearsal of the philosophical ground is beyond the scope of this essay. But I feel that I have already addressed one issue regarding this. It is clearly the case that with some characters, who they presently are furnishes sufficient largesse of variety of possible engagement in the world to obviate the worry that they need become some other person in order to continue to be so engaged for a greatly extended period. As regards the deeper questions of personal identity in a lifespan, I suggest that since who I am now is, very nearly in no way at all, who I was when I was three, twelve, fifteen, etc., or who I will be when I am eighty; the problem is not exclusively one of indefinite life extension, but rather both fully pertains to our present situation, and, what is more, does not appear to trouble us overmuch.
Finally, it is useful to point out what Elina Makropulos, we presently, and any future life-extended person have in common is an exit strategy. We will never be mythically immortal, and should we find that life ceases to be meaningful and fulfilling to us, we may always end it, as Elina does in the play. The opposite is, to put it mildly, not so easy, hence the protestations of the “old men.” Seen in this light, the action of the young woman in destroying the elixir is both foolish and wanton, and also curiously paternalistic, since it presumes to make Elina’s personal decision, for all. We may conjecture all we like, but we will never know until we have the opportunity to see for ourselves, and should we not like what we find, a remedy is always at hand. Providing the opportunity to make that choice voluntarily may be at least part of the aim of biogerontology.
The Problem of Incumbency and the Social Value of Life-Extension
Briefly put, the worry is that, assuming aging-intervention and life-extension are both effective and widespread in their uptake, then those who are chronologically precedent, or older in this way, will have no incentive to make way for the young, and indeed, given the above considerations, may be positively driven by their faculties and abilities to remain incumbent in positions of power and authority indefinitely. The problem is most stark when one adds to the scenario the conjecture that at least some of these persons will be of bad character, as described by David Gems:
This is why I fear research into aging. If treatments had been available in the twentieth century that halved the rate of aging and doubled lifespan -- as some mutations do in C. elegans -– Mao Tse Tung might still be alive. He would be the equivalent of fifty years of age, and might not be expected to die a natural death until 2059. Worse still, Joseph Stalin would be “sixty-three” and would live until 2027. Do we really want anti-aging therapies in the hands of Robert Mugabe, Fidel Castro, or Kim Jong Il? Historically, a great benefit of aging has been deliverance from tyranny.
While one cannot but have sympathy with the view that such tyrants’ demise is beneficial, is the question really one about aging or lifespan intervention? Such an argument might suggest that in order to achieve political turnover, one ought in general to shorten the average span of human life! In addition, it may be noticed that it was the demise of others, such as Lenin, which brought these tyrants to power in the first place. What has it fundamentally got to do with aging intervention that one good or bad character may be replaced by a better or worse? We value the longevity of the good as much as the demise of the bad. Perhaps more. Surely, these questions are more about political structure than lifespan per se, and it would be a very strange argument indeed to suggest that we ought not to seek a cure for cancer simply because it may also benefit a tyrant, and thereby keep him in power longer.
The worry has been expressed more generally elsewhere, as here in the previously quoted “Ageless Bodies” section of the Report of the President’s Council on Bioethics:
The mature generation would have no obvious reason to make way for the next as the years passed, if its peak became a plateau. The succession of generations could be obstructed by a glut of the able. The old might think less of preparing their replacements, and the young could see before them only layers of their elders blocking the path, and no great reason to hurry in building families or careers... Families and generational institutions would surely reshape themselves to suit the new demographic form of society, but would that new shape be good for the young, the old, the familial ties that bind them, the society as a whole, or the cause of well-lived human lives?
This does seem to be a concern more applicable to the ordinary structure of modern societies. But once again, it is a structural, rather than an essential concern. Its nature is political, and it is not in any case a new problem. After all, for the majority of the history of humanity, power was concentrated into the hands of a few families, the aristocracy, who handed power from one generation to the next precisely as though the son of one was his father of the previous generation. The problem is the same, at one remove, that of inter- as opposed to intrafamilial incumbency. Though as to the latter, I think it is an unfortunate turn of phrase to speak of my parents continued living as merely “blocking [my] path”! In the intrafamilial case, simple kindness, consideration, and love would appear to provide the answer. Also, it might simply mean that offspring have to shift for themselves a little more than they presently do. Would this be antagonistic to “the cause of well-lived human lives”? As to the interfamilial case, could such a problem not be tractable in like manner as with the problem of the aristocracy, with incumbency in many or all positions of hierarchical authority being limited from below, by some political constraint similar to democracy? The suggestion is simply that the process, begun in politics itself, be spread to the organizations of all hierarchies. Not, in principle, an unattainable end, and one which might be both desirable and more urgently demanded, and thus more likely, if intergenerational interchange is indeed slowed. As to that last point, it has already been accepted that should life-extension become generalized, the interchange of generations would be slowed, but it surely would not be stopped. For it to be so, one must revert to the model of “mythic immortality” which has already been shown to be irrelevant.
The problem might be seen to be more acute where land ownership is a question. And yet, once again would the situation be much different than the presently existing one, with the vast majority of the land in a minority of hands? Once again, the problem is pragmatic, not essential, and the answer likely lies in land reform, perhaps in quantitative limiting of private access to ownership of land. But in the interfamilial case, this is the same kind of question we already face, where land is heritable from one generation to the next. If the above conjecture regarding the birth rate holds, it may be that there are fewer overall people, and the problem will then be less acute than it presently is in any case.
In addition to this, returning to hierarchies of authority, it should be noted that while I may have various interests, which will be benefited by my continuation into more lifespan, I will inevitably remain a unitary individual, and will not be able effectively to wear very many hats of practicing authority at once. That I may have more time overall, does not suggest that I have more days in a week, or more hours in a day. So as the complexity of human endeavor and knowledge grows, as disciplines become more and more numerous and fragmentary, so will the need for more and more individuals to devote their whole attention to each discipline in any one period. This is of course not to disdain the enormous integrative benefit which will likely be gained by many more very experienced persons being present per capita in society, but rather that the various disciplines will thereby be better able to communicate. If this picture is correct then what we may end up with would be a far more integrated society, with more highly experienced subalterns, and fewer generals, with less power. In short, society may become a more cooperative and more egalitarian whole. Such a picture may appear overly rosy, but I submit that it is at least plausible, and I paint it in order to set it against the arguably overly gloomy picture painted in the above quotation.
The closely related worry that a slower interchange of generations will lead to a slower rate of change of ideas, is predicated upon the notion that the old have fewer and fewer “fresh” ideas, becoming more and more set in their ways, and that the young are needed to inject freshness and novelty into the world. The distinction between freshness and novelty will be seen to be important. But first, this worry seems directly related, to the Makropulos concern about the ossification of character, and may equally be irrelevant to some, and tractable in others, if psychological aging is likewise biologically predicated. The fact that lambs become sheep in a year, while for humans it takes many more, and some humans never really become “sheep” at all, suggests that the last stated possibility is, indeed, likely true.
Beyond this, the notion that new ideas are always better than old seems an odd sort of approach from the conservative point of view which seeks to keep the aging picture the way it presently is. Are “new” ideas necessarily always better? Should we not think that there may be some merit worth keeping in the counsel of those who have been alive longer? And are “new” ideas in any case always really “fresh”? The chronologically young have a bad track record of thinking that they have made some new discovery of approach, while they are in fact merely repeating the same bad courses of action their elders or past societies rejected long ago. Many prima facie “new” ideas turn out on closer examination simply to be variations on a well-worn theme. In this way, it may be harder than the proponents of this argument suggest, to have truly “new” ideas at all, and it may be easier to have genuinely “fresh” ideas only when one has been around long enough to recognize them as such. Thus, it may be that by the innovation of intervening in aging, and expanding human lifespan, we may make the world both more stable, and more profitably conservative, in the sense of being wise, while retaining the benefits of youthfulness and energy for the discovery of truly “fresh” ideas, facilitated by both expanded knowledge and the banishment of the ossification of physical aging.
Problems of Unity: Distributive Justice, Parallel Populations, and Parallel Species
I have reserved until last the set of problems which I consider to be most serious, and perhaps least tractable. Briefly put, assuming age-retarding and life-extending treatments are effective and safe, the problem is one of uptake. The less egregious version of this problem is that not all will wish to be treated, and so there will be biological disunity. The more egregious version stems from the assumption that either the treatments will be expensive, or at the very least, even if they aren’t, they will not be available to all, given world poverty and population mass. It may be seen, then, that the rich, or those in richer areas of the world, will begin to use their economic advantage to buy biological advantage.
The basic problem has three aspects: an economic, a moral, and a political aspect.
The economic problem is clear. It is one both of distributive justice in a straightforward sense, and also of a new kind of problem of this sort. The basic distributive problem has been stated, is obvious, classic, and needs no further treatment here. But I would suggest that since the kinds of changes which will likely be necessary involve not just supplements, but changes to the biological structure of individuals, which may very well then be heritable by reproduction, the situation is quite different from anything heretofore encountered in human history. If part of the biological advantage that the wealthy buy confers advantages in terms of endogenous capability and potential, and thereby potential for both wealth, knowledge, and skill acquisition at a level which is simply beyond the physical capabilities of the non-enhanced then competition in an ordinary sense will no longer be possible. Consider, for example, the relative advantages of a family who, by ordinary biological facts, needs to breed three to five times a century, as compared to a family who need to breed only once a century, or less. The very advantages which have been suggested in the above sections, and which are so tempting, may cause the enhanced population to be in a situation of advantage which is unreachably beyond the physical means, and indeed the potential, of the lives of the unenhanced. The gap would no longer simply be between rich and poor, but would rather become a categorical gulf. The poor world would be a world which is not only exogenously, but endogenously disadvantaged. Interventions such as the provision of medicines, food aid, and a stable local economic climate would no longer be sufficient to give even the basic circumstances of those in poorer situations parity with those with enhanced biologies. The case is the same in ordinary conditions of voluntary lack of uptake. In the rich/poor divide, one may of course suggest that there would be a trickle-down. But this is far from clear, and it appears quite clear that in the medium term at least, the gap would widen dramatically, and unprecedentedly. So there would appear parallel populations in a sense which has never yet been encountered.
There is also a special kind of moral problem here, one which I shall call the problem of harm by contextual devaluation. The fact is that despite the differences in life expectancy between rich and poor nations, every human population on earth enjoys a roughly statistically identical potential life span. There is a unity in this sense. If some begin to enjoy a potential lifespan which is either greatly enhanced, or unlimited, the picture may be significantly morally different than it presently is. To understand this, we must return to the idea that death is bad relative to the loss of potential futures. If, as things presently stand, a ninety-year-old and a seventeen-year-old lay unconscious in a burning building, and only one could be saved in time, the instinct of a firefighter would most likely be to save the younger. The intuition upon which such a decision is based is the one just stated. But consider an alternative case, one in which two seventeen year olds are in the burning building, one with a presently normal lifespan prognosis, and the other with a greatly enhanced lifespan potential. Which one should the firefighter save? On the ordinary intuition, he should clearly save the enhanced. Could it be that by altering the background conditions of human life -- what I shall call the absolute space of lifespan, at present unified -- we will be uncoupling human populations and creating an unprecedented moral disunity? Could it be that we will alter the relative value placed upon the lives of the parallel populations? I consider this problem to be serious. One mitigating factor has been discussed in the section on “The Value of Living” above, but the question is too complex for a full treatment here. I will suggest one possible general solution below.
The moral problem thus described has, of course, a political dimension. Once again this is too complex for a full treatment here, but I will attempt a brief analysis. If we become biologically disunified, will we have either incentive, or more importantly justification, to remain politically unified? The problem may be most acute in cases such as the United States’ model of democracy, which is founded upon principles of natural law. The Declaration of Independence begins:
When, in the course of human events, it becomes necessary for one people to dissolve the political bonds which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the laws of nature and of nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation. We hold these truths to be self-evident, that all men are created equal…
The sense of these words is clear. It is the “natural” or in other words, biological equality, the biological unity of humanity, which underpins political unity. The dissolution of political bonds spoken of in the document does not reach to the more profound level which is suggested. If this does not appear clear, some research concerning the philosophical bases of this document should clarify our assertion. Of course, there are different bases upon which political unity may be founded, but we must have an eye to the possible consequences within at least this one fairly dominant framework and possibly others as well. Should the biological unity of humanity be seen to be fragmented, serious questions may arise concerning the validity of aspirations to political unity.
As I have said, a full treatment of these issues is very broad in scope, and far beyond that of this paper. But I would like to suggest one possible route out of at least the moral and political, if not the economic, problem of disunity. It is, of course, suggested by the very notion of value which I have outlined in this paper: the value of “personhood.” No matter what biological changes may occur, we all, old biological forms and new, will be persons. It is this intuition above all which, for example, allows us rightly to treat those who are biologically different or lifespan-disadvantaged presently, as in the cases of Down’s Syndrome persons, or those suffering from Progeria, as entities worthy of full moral and political respect. We are, and will remain, all of us, persons. This is the unity upon which we must focus. And, it is a unity which cannot be broken.
I have attempted to lay out both the groundwork for a moral basis for aging intervention and life extension. I have also outlined and addressed some commonly raised issues, and have attempted to show that while some may be serious, others are illusory or unreasonable. There are of course issues which have not been addressed, such as the delimitation of disease, but an exhaustive treatment is not possible in an essay of this length. I hope that this paper has both demonstrated the importance of ethics to the practice of biomedical gerontology and also clarified the situation to some degree.
. Harris, J. (2002) Intimations of Immortality – The Ethics and Justice of Life Extending Therapies. In: Freeman M. (Ed.) Current Legal Problems. OUP.
. For those unfamiliar with the use of these terms in philosophy, what is meant by instrumental value is value for some further end or purpose, as opposed to intrinsic value, which is valuable in and of itself.
. Epicurus. Letter to Menoeceus (124-5). D. Furley (trans.) (1986) Nothing to us? In The Norms of Nature, M. Schofield & G. Sriker (Eds.) Cambridge.
. Though not, necessarily, with his other views on the matter, as Epicurus contends also that “the right recognition that death is nothing to us makes the mortality of life enjoyable, not by adding infinite time to it, but by removing the desire of immortality.” (ibid.) However he here seems to feel that desire for immortality, or life extension, may be located in fear of death. As I suggest, this is the wrong notion in any case.
. For the purposes of this essay, I shall not enter into further discussion of the subtleties of the ascription of personhood in boundary or marginal cases.
. Nagel, T. (1970) Death. In Nagel, T. (1979) Mortal Questions. Cambridge University Press, Cambridge: p. 2.
. Nagel, T. (1970) Death. In Nagel, T. (1979) Mortal Questions. Cambridge University Press, Cambridge: pp. 9-10.
. It may seem that plans should clearly be fixable by persons upon and continent within specific objectives. While this is true at one level, there are two observations to be made here: Firstly, that while we may fix the goal of a plan, we may not also fix, with any assurance, the temporal end-point or time-frame for that plan’s fruition. A plan which we may think will take us thirty years to execute, may in fact never come to fruition in our lifetimes but may actually have done so had we lived for two hundred and thirty years. Secondly, plans ride in on the coat tails of dreams, hopes, and desires.
. If this assertion is accepted, it would appear even more clear that willing ourselves to have no future-directed elements is indeed impossible, since the effective component of willing itself, on this account, appears itself intrinsically future-directed.
. And cannot be said to involve a desire in the normal sense, as indicated in the subsequent paragraph.
. Williams, B. (1972) The Makropulos case: reflections on the tedium of immortality. In: Williams B. (1973) Problems of the Self. Cambridge University Press, Cambridge (pp. 86 and 100).
. See: Caplan, A. L. (1992) “Is Aging a Disease?” If I were a Rich Man, could I Buy a Pancreas? And Other Essays on the Ethics of Health Care. Indiana University Press, Bloomington: 195-209.
. Moore, G. E. (1993) (f.p.1903). Naturalistic Ethics. In Principia Ethica, revised edition. Cambridge University Press: 89-110.
. Gems, D. (2003) Is More Life Always Better? The new biology of aging and the meaning of life. Hastings Center Report, 33, no 4: 31-39.
. Kass L. R. (Chair) (2003) “Ageless Bodies.” Beyond Therapy -- A report of the President’s Council on Bioethics. PCBE; Washington D.C.: 185-186.
. Williams, B. (1972) The Makropulos Case: Reflections on the tedium of immortality. In: Williams B. (1973) Problems of the Self. Cambridge University Press, Cambridge.: p. 82.
. Though best set out by Williams himself, for a presentation of this case in context of biogerontology see: Glannon W. (2002) “Identity, prudential concern, and extended lives.” Bioethics. 16(3): 266-83.
. Dylan Thomas [1914 - 1953], “Do Not Go Gentle into that Good Night.”
for a reading by the poet himself, using a RealOne Player. Thomas first visited the USA in January 1950 at the age of 35. His reading tours of the United States, which did much to popularize poetry reading as new medium for the art, are famous and notorious, for Thomas was the archetypal romantic poet of the popular American imagination; he was flamboyantly theatrical, a heavy drinker, and engaged himself in roaring public disputes. He read his work aloud with tremendous depth of feeling, and he became a legendary figure, both for his poetry and the boisterousness of his life. Tragically, he died in 1953 from alcoholism at the age of 39 after a particularly long drinking bout in New York City.
. Gems, D. (2003) Is More Life Always Better? The new biology of aging and the meaning of life. Hastings Center Report, 33, no 4: 31-39.
. Kass L. R. (Chairman) (2003) Beyond Therapy- A Report of the President’s Council on Bioethics. PCBE; Washington D.C.: p. 192.
. Harris deals at length with this problem: Harris J. (2002) Intimations Of Immortality – The Ethics and Justice of Life Extending Therapies. In: Freeman M. (Ed.) Current Legal Problems. OUP.