Life-extension through decelerated or arrested ageing: a bioethical analysis

By Matija Conic

Very few people would disagree that alleviating pain and reducing mortality due to age-related diseases is the path that modern medicine should be going along. Indeed, the primary goal of medicine has always been to maximally postpone death by ameliorating health. However, when it comes to curing ageing itself – one of the final frontiers of biomedical science – an irrational sense of discomfort often emerges. It appears that ageing is an unavoidable feature of our existence, so we refrain from the thought of putting a brake on it. 

A lot of terminology within biogerontology tends to give rise to ambiguity and public misperceptions. Ageing has been surprisingly hard to pin down by scientists, which is why the statistical definition, used by Richard A. Faragher, is possibly the most accurate, describing it as “the sum of all processes within an organism which result in an exponential increase in the probability of dying and sickness with the passage of time” (Faragher, 2015). 

Many scientists agree that the notion of immortality is unhelpful, as it is biologically unattainable – immortal organisms could never be killed by any intrinsic factor, whereas non-ageing ones could, and they do exist (albeit with a low, non-increasing probability). Another source of public misperception is discussing anti-ageing solely in terms of increased lifespan, which is why gerontologists prefer the term healthspan as anti-ageing treatments cannot, by definition, extend life without simultaneously extending the period of mental and physical well-being. 

I will start off by considering the arguments of Leon Kass, a well-known bioethicist. He has a stance on the issue which not only appeals to our instincts but justifies them as sufficient to argue against anti-ageing. 

Revulsion is not an argument; and some of yesterday’s repugnances are today calmly accepted … In crucial cases, however, repugnance is the emotional expression of deep wisdom, beyond reason’s power fully to articulate it.
(Kass, 1997) 

Many people will suggest that Kass is wrong because his claim doesn’t follow from argumentation (Kimberly, 2002). Nonetheless, quite a few ethicists, like Gregory Kaebnick, defend the meta-ethical view called emotivism in the context of life extension, claiming that an entirely rational approach to morality is an oxymoron (Kaebnick, 2008). Emotivism suggests that moral sentences (like “killing is bad” or, in this case, “life extension is bad”) are emotional responses to the world rather than propositions, which is a non-cognitivist belief. 

Without delving into the psychology of morality, Aubrey de Grey, a transhumanist, observes that certain aspects of our moral system have increased in internal consistency over time and suggests that the key attitudes are those that remained most invariant to history. De Grey claims that reliance on cognitivism in discussions leads to a belief that the immorality of anti-ageing hasn’t yet been articulated simply because we have not identified a sufficiently powerful counter-argument – a rhetorical trick sometimes used to defend ideas like racial or sexual hierarchy. He suggests that we are more than capable of coherently defending anti-ageing treatments in the present day from more central ethical claims (De Grey, 2005). 

Why do we claim that a longer life is a good in itself? Our lives necessarily involve other people – the way we interpret our relationship with those people has philosophical implications on how we assess the value of a life. Liberal anthropology considers human beings as first and foremost individuals, for whom other people have a merely instrumental value. A good life is only a good one for the individual and the community is evaluated by how much it facilitates the realisation of one’s personal goals.
Conversely, some argue the determinants of a good life are actually the relations we form with other people. Communitarian anthropology claims that the social context isn’t simply a means of achieving our personal ends, but the defining feature which makes our lives valuable. 

If life with other people is the valuable life, then the only way an extended life can gain any worth is if it extends our time as communal beings, implying there is nothing intrinsically good about the sheer continuation of biological life. The real challenge, communitarians advocate, isn’t increasing the quantity of our lives, but improving their quality by bettering our society (Pijnenburg and Leget, 2007). These two projects are not, however, incompatible and could potentially go hand in hand.

Another point regarding the perceived quality of life is once again raised by Leon Kass who questions whether the pleasures and joys of living would retain their value, were we to postpone our death for a sufficiently long time period. He questions how meaningful life would become in this scenario and claims that the very fact that our time is short and limited gives us the impetus to make the most of it. 

Alexandre Erler, a Hong Kong philosopher, objects to Kass, indicating that it is precisely the fact that we push mortality outside of our everyday awareness that enables us to lead fulfilling lives (Erler, 2010).

Kass opens up another debate, taken up by philosophers like Larry Temkin and Bernard Williams, on the problem of boredom. Would life get increasingly unbearable the longer we live it (Temkin, 2008)? Williams thinks that it might not be a matter of life itself getting boring, but rather a life with one’s self, assuming a determinate character. In other words, he presumes that the self sets constraints on the possible experiences which can bring about enjoyment. Therefore, the life is either one of tedium (with a static character) or one of variety, but without a fixed personality (Williams, 1973). 

In the latter case, which is more convincing, ethicists pose another question: what would be the motive of such a person to enhance itself were it to become another person altogether with completely different motives? Since our memory is finite, the self which strove to prolong its duration would cease to exist anyways. 

Elvio Baccarini offers an explanation: he suggests that we could still assume that person A can rationally aspire to become person B, if B is better equipped to pursue his life project and still supports the same concept of good held by person A (Baccarini, 2007). Additionally, even though the self would change as time goes by, a continuity of consciousness would be retained which can in itself be seen as valuable. 

Even if we assume a fixed character, some indicate, we cannot generalise the exact moment of the onset of tedium to everyone, so pursuing life-extension can give people an opportunity to live however long they like. 

Additionally, tedium does not simply occur in a vacuum – it is highly dependent on the state of society. With increasing alienation in the modern economy, maybe the cure for such emotions is not to let people die earlier but alleviate their suffering by making their environment less hostile. 

Labelling a condition as pathological implies the ethical desirability of developing a treatment, so some scientists suggest that a paradigm shift is needed to ensure substantial progress in research. 

Claudius Galen, an Ancient Greek doctor, defined ageing as a natural, universal condition, as opposed to disease which is an abnormal occurrence in human physiology. Many modern scientists and bioethicists still hold the Galenic view when it comes to ageing, claiming that it is a natural process, which makes all efforts to cure it unnatural and thus undesirable.

A biogerontologist, Richard A. Faragher, indicates that this argument falls victim to the naturalistic fallacy. If we define “naturalness” as indicative to the set of things which humans have not yet interfered with, it follows that everything we change or modify is unnatural and therefore bad, which is absurd. 

Faragher adds that the universal nature of ageing doesn’t necessarily imply that it’s not pathological (Faragher, 2015). David Gems, a British geneticist, supports this, stating that ageing is a special form of disease rather than simply a “natural process” (Gems, 2011). Leon Kass, however, has a seemingly more nuanced naturalist viewpoint than most ethicists: 

To turn a man into a cockroach … would be dehumanizing. To try to turn a man into more than a man might be so as well. We need more than generalized appreciation for nature’s gifts. We need a particular regard and respect for the special gift that is our own given nature. 

(Kass, 2017) 

This approach, however, still rests upon the assumption that the post-human condition is a bad one (a state without “dignity”). Bioconservatives like Kass would need to construct a clear argument on why anti-ageing threatens not simply the naturally given features of humanity as such, but the features of humanity which ought to be seen as valuable. Nick Bostrom supports this claim, suggesting that conservatives often abuse the concept of dignity as a polemical device in substitute of clear argumentation (Bostrom, 2007). 

But what constitutes a disease? Daniel Callahan, a US biomedical ethicist, points out that even if we stick to the conventional definition of disease as a deviation from regular physiological function, ageing still qualifies – “old age” is a harmful, non-desirable condition which deviates from the more desired, youthful state of physical and mental capacities (Callahan, 1998). 

Some scientists would go even further, suggesting that the conceptual distinction between “ageing” and “age-related diseases” is entirely arbitrary, as ageing is the common risk-factor for all age-related diseases (Faragher, 2015). Accordingly, we ought to start considering age-related morbidities as symptoms of ageing rather than separate disorders. 

A biogerontologist Suresh Rattan, however, argues that labelling a process as complex as ageing a disease (which occurs largely due to semi-stochastic accumulation of molecular damage) is unhelpful. He dislikes the anti-ageing rhetoric and argues that we should be focused on preventing damage by maintaining health, or what he calls “homeodynamic space”, rather than looking for a technological fix to the problem when it’s already present (Rattan, 2014). 

Still, regardless of its complexity, there seems to be no reason why biogerontology should not fall under the scope of medicine.

What if certain claims of naturalness can be interpreted as attempts to justify phenomena in virtue of their purpose? There are two primary indicators of purpose: the functionality and the history of a phenomenon. According to Arthur Caplan, it is the latter we ought to be concerned with in ethics – not the “what it does”, but the “why it does it” (Caplan, 2005). Evolutionarily speaking, ageing serves no purpose whatsoever: it is simply a harmful by-product of natural selection. 

Alleles are quickly selected for if they have favourable effects on early life fecundity. Some of these alleles have a detrimental side to them which causes deleterious consequences in later life. By then, however, these alleles will have escaped the selective forces which could eliminate them from the gene pool. 

In other words, it is logically impossible for selection to eradicate ageing, as it can only operate on the reproductive stage. The described phenomenon is called antagonistic pleiotropy – a trade-off which is good in evolutionary terms (more offspring and DNA) can sometimes be a thoroughly miserable experience on an individual level (Gems, 2011). 

We could go even further and argue that evolution doesn’t create things to serve a purpose in the first place, as it is governed by chance processes. Even if it did, why should evolutionary purpose concern us, given that we’ve successfully been dodging selective forces for centuries? 

The final thing to consider is the context of these developments. Michael Marmot, an epidemiologist, has argued that we are on the route of extending the lifespan of precisely the wrong end of the longevity spectrum. While there might not be anything intrinsically wrong with anti-ageing, should we really discuss such matters in a vacuum? Having in mind that effective anti-ageing procedures will likely be extremely costly, who will have access to them? 

In addition, can we morally afford to invest substantial funds into enhancement research for the privileged knowing that the average life expectancy in Angola is still as low as 45.8 years? Worryingly large longevity gaps are also far from scarce in Western societies like the US, where differences in longevity correlate with inequality. Marmot calls this the status syndrome – the chances of heart disease, stroke, infectious diseases, as well as suicide or homicide are much higher if you’re working class and the issue may not simply be one of income or lifestyle. It is the psychological experience of inequality: how much control you have over your life and the opportunities you have to fully participate in society (Marmot, 2004). A bioethicist Alex Mauron adds that the best existing anti-ageing treatment one can possibly receive is simply “being born in an affluent, well-educated family in a Western country” (Mauron, 2005).

Some indicate bioethicists should not be dealing with political issues, but this view is often based on an out-of-date understanding of what bioethics should represent, according to others. In a globalising world, bioethics should not limit itself to setting up requirements for a certain treatment to be acceptable for application but expand its scope and aim to make the world more just (Pijnenburg and Leget, 2007). A classical utilitarian might not see an issue here, suggesting that it’s perfectly acceptable to treat a small fraction of the population due to a net increase in happiness, but this neglects many things, including the ability of a development to emphasise existing societal problems. 

Although anti-ageing treatments might not be as close as it often seems, it is certainly a subject worthy of our attention. Additional complexities arise when you add context to these developments, so it is debatable how beneficial these treatments may be in a hugely unequal capitalist society. In the scenario of equal provision, however, such developments seem to be an undeniable good, as they represent the ultimate alleviation of suffering and an extended enjoyment of life. 


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