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Why has the tone of writing by ethicists on the topic of treating aging as a medical condition, with consequent extension of health human life span, shifted from from hostility to endorsement over the last twenty years? One possibility is that while a technological capability is thought to be a far future possibility, or unattainable, only those with an ax to grind will talk about it. The years since the turn of the century have seen tremendous progress towards implementing therapies capable of addressing mechanisms of aging, and in lockstep with that the scientific community, and a small but sizable fraction of the public at large, have come to understand that rejuvenation and slowing of aging are viable near future goals. Some of those people are ethicists lacking an ax to grind, and some of those ethicists write on the topic.
Another possibility is that we now know a great deal more about what the first age-slowing and rejuvenating therapies will look like, and many of them are cheap small molecule drugs. Many of those are repurposed from the existing spectrum of approved therapies, not new molecules, and so out of patent and cheap. Not all of the options on the table will eventually manufactured for cents per dose, given a world in which near everyone uses that treatment. Enough of the first generation interventions are in that category, however, to make it challenging for ethicists to view the treatment of aging as something that will be deployed only for the elites, or to employ the usual arguments made against progress: that it will cost too much; be too challenging to implement broadly; that only the wealthy will have access to these options.
Aging, Equality and the Human Healthspan
John Davis (New Methuselahs: The Ethics of Life Extension) advances a novel ethical analysis of longevity science that employs a three-fold methodology of examining the impact of life extension technologies on three distinct groups: the “Haves”, the “Have-nots” and the “Will-nots”. In this essay, I critically examine the egalitarian analysis Davis deploys with respect to its ability to help us theorize about the moral significance of an applied gerontological intervention.
Rather than characterizing, as Davis does, an aging intervention as a form of “life extension”, in this article, I argue that an ethical analysis of an aging intervention should focus on what the primary health impact of such an intervention would likely have on population health – namely, increasing the human healthspan so that the risks of disease, frailty, and disability would be reduced in late life. A by-product of such an intervention is that it may increase the number of years people also live.
Rather than deploying an egalitarian analysis into the far future of a potential new longevity-caste society, I believe it is more prudent and practical to deploy such an ethical analysis to the intrinsic health inequalities that exist between persons at different stages of the human lifespan, e.g., between young adults (age 20-30) and older persons (age 85+), as well as the health inequalities that already exist with respect to variations in the rate of biological aging.
In this essay, I will deploy a comprehensive “present-day” (vs. futuristic) egalitarian analysis that highlights the health consequences of the “status quo” of biological aging, including the health inequalities that exist between persons with “accelerated” aging (e.g., progeria), “normal” aging, and “retarded” aging (e.g., centenarians and supercentenarians). Doing so can help re-frame the ethical arguments concerning intervening in aging, so that an applied gerontological intervention is recognized as a significant form of preventative medicine, rather than a technology that raises serious concerns about radical life extension, boredom, or the creation of a new caste system between the “longevity-haves” and “have-nots”.
Like Davis, I believe “that developing life extension is, on balance, a good thing and that we should fund life extension research aggressively”. But unlike Davis, I do not believe the best way to promote societal discussion about, or the policy regulation of, an applied gerontological intervention should begin by contemplating the potential future inequalities radical life extension might potentially create. Instead, I believe an ethical analysis should begin from (1) the existing health vulnerabilities of today’s aging populations, (2) the existing inequalities of the “aging status quo”, and (3) address the most likely aging technology to be developed in the immediate future and reasonable empirical assumptions concerning its fair diffusion.
Aspiring to increase the healthspan, vs. merely delaying death, could constitute an innovative approach to human health and help us realize the noble aspiration of “adding life to years” vs. “adding years to life”. Given where the science is today, the goal of a century of disease-free life is a realistic and compelling aspiration. The priority should be on making an applied gerontological intervention a top public health priority for the world’s aging populations. If we do this, then the 2 billion persons over age 60 by the year 2050 could enjoy more health and a compression of disease, frailty, and disability.