Fight Aging!

It is fair to say that medicine, like much of our technology, is an expression of the urge to immortality. The rise to civilization is arguably a process of identifying and fixing the problems that kill people, starting with the most pressing and moving on until there are no more problems that kill people. Now that we are in an era in which age-related diseases - and aging itself given that it causes those diseases - collectively form the most pressing problem, it will be worked on. As the authors of the open access paper I'll point out today note, this whole business of medicine, technology, civilization is "based on the assumption that longevity is valuable and that an early death is worse than a late death." That assumption certainly appears to be the basis for the way in which people act when viewing the big picture, but I wish you luck in trying to get any randomly selected room full of people to agree that longevity is valuable and death is a terrible thing, always to be avoided.

A large part of the challenge facing the development of rejuvenation therapies, treatments for aging that can prevent and reverse age-related disease by repairing the cell and tissue damage that causes aging, is that most people don't appear to be particularly enthusiastic when it comes to avoiding natural aging and death. This in turn means that there is little funding, as over the long term and the large scale, public support and interest determines funding for research and development. It is puzzling when compared with the evident, overwhelming support for, say, cancer research or the defeat of other specific age-related disease. You'd be hard pressed to find someone who will say in public that cancer research should be halted, or is pointless, but that is exactly the response from most people regarding research aimed at extending healthy human life by treating aging. The views of the public at large, and many individuals, are incoherent and contradictory on this topic: the fellow who proudly states that he doesn't want to live longer than his parents, and that 80 is long enough for anyone, also thinks that cancer and heart disease should be cured. What is aging without age-related disease? It is youth, because the only way to remove the medical conditions is to remove the damage that causes them, and that damage is one and the same as aging.

The best explanation to date appears to be the widespread mistaken belief that treating aging to extend life would result in ever-increasing decrepitude rather than prolonged youth and health, stemming from all sorts of misunderstandings about what aging actually is under the hood. There are plenty of other theories, however. The modern culture of environmentalism probably has a role, coupled as it is to incorrect Malthusian beliefs about economic development and technology. Also the widespread view that limited funds should be devoted to the young or indeed any cause other than helping old people: in many ways older people are considered less valuable, or to have had their chance. These are pernicious and damaging viewpoints. Certainly, the need for advocacy to support research fundraising efforts is as great as ever.

Can we even all agree that death is bad and something should be done? Not so much, unfortunately, and a sizable fraction of any group of people dissent from that view in one way or another - though when compared with their actions the degree to which they mean what they say is always a question mark. The paper quoted below summarizes some of the philosophical underpinnings of medicine, down at the lower level of asking why we even undertake these efforts to save lives and avoid death, and why there is support for saving some lives but not others, curing some diseases but not treating aging. Like many of these discussions, the authors don't escape the idea that younger lives are worth more. This is unfortunate because it is the basis for a vicious circle: when less work is undertaken to save the lives of the old because they are considered to be worth less than the lives of the young, then there will be slower progress towards rejuvenation biotechnologies capable of granting a long and healthy future to everyone, and therefore equal value to all lives. Everyone loses. So I think it is potentially useful to consider these things occasionally, given the strange and inconsistent behavior and opinions voiced about aging and age-related disease. Somewhere in all of this lies a better way to persuade the world to fund rejuvenation research, and to speed up the slow bootstrapping process of reaching prototype therapies.

The badness of death and priorities in health

The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic fields of priority setting and badness of death. Our primary aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities. All health care systems share two basic goals: saving lives and improving the quality of life. The first goal gives rise to two essential questions: (i) Why should we save lives? (ii) Which lives should we save first? In the health priorities literature, the second question has received the most attention. We believe (i) and (ii) are closely connected, and that an answer to (ii) presupposes an answer to (i). In order to make claims about which lives to save first, we need an account of why we should save lives in the first place. One justification for saving lives is simply that death is bad. Saving lives entails postponing death, which is justified on the assumption that an early death is worse than a late death. One could, however, argue that we should justify saving lives with reference to considerations of fairness. Although we do not deny this, our aim is a different one, namely that of investigating the reasons we have for saving lives that stem from considerations of the badness of death.

We will briefly clarify the concept of death before we proceed. "Death" can refer to at least four dimensions: "the prospect", "the process", "the incident" and "the loss". The prospect refers to our knowledge of being mortal, which as far as we know is unique to human beings. The process of dying is an event that may be filled with pain, as in some instances of cancer, or it may happen abruptly, as in a traffic accident. The incident of death is when someone goes from existence to non-existence. Finally, there is a permanent loss when death occurs because there is no future for that individual. Although many tend to focus on the process of dying, our focus will be on the loss. Arguably, if dying had not been followed by permanent non-existence, then perhaps dying would not be so bad after all. Interestingly, the loss dimension of death seems to play an important role in current health priorities debates. One example is the estimation of health loss due to both morbidity and mortality in traditional cost-effectiveness analyses; another is the Global Burden of Disease project. If the loss dimension is accepted, the question is for whom death represents a loss. There are two rival theories to this question: Epicureanism and Deprivationism. Epicureanism refers to a contemporary view on the badness of death inspired by the ancient philosopher Epicurus, which states that death is not bad for those who die. Both theories are compatible with the idea that death can represent a loss for others (such as family, friends, and society), but only Deprivationism accepts that death represents a loss for those who die.

The two arguments normally offered in favour of Epicureanism are the experience argument and the time argument. The experience argument is best illustrated by the expression, "What you don't know won't hurt you". One interpretation of this is that in order for something to be good or bad for us, we must experience its goodness or badness. But of course when we are dead, we cannot experience. Therefore, death cannot be good or bad for us. There are at least four views one can adopt in responding to this argument. One view is that death is bad before it occurs, another is that death is bad when it occurs, a third is that death is bad after it occurs, and a fourth is that death is bad at a time which cannot be easily identified. One can successfully object to the time argument on the basis of one of these four views. We believe the fourth view is the best strategy for responding to the time argument. Here are some cases of analogy in support of the fourth view. For example, never having an education, freedom, or children can be bad even if its badness cannot be ascribed to a specific time. Moreover, at times, people may be grateful for not being a victim of accidents or suffering from severe sickness, even if "the evils that they never suffered" cannot be so easily located in time. If one accepts either the experience- or the time argument, it follows that death cannot be bad for those who die. What does this imply with regard to health priorities? If death is no loss for those who die, it matters less whether we suffer a premature or a late death. Consequently, age will play a less significant role (if any role at all) to health priorities. With Epicureanism we are, however, left with the option that death is bad for third parties such as family, friends, and society. This implies a higher emphasis on saving lives for the sake of others. Moreover, this suggests that what matters from a moral point of view are things like the emotional attachments and investments of family, friends, and society. In addition, the death of individuals can be bad by virtue of being a loss of caring relationships, productivity, or simply in terms of the world being deprived of a person.

When it comes to Deprivationism, some things in life can be good or bad in themselves, such as pleasure and pain. Death, on the other hand, is a different kind of evil. Suppose you suffered from paralysis in both your legs as a result of an accident. This accident deprives you of the chance to do a lot of things, like walking or playing tennis. In a similar way, death deprives us of the opportunity to continue with our lives. And assuming that continued life contains value, death is bad for us. Deprivationism explains how we can make judgments concerning the badness of death by comparing at least two different outcomes: (a) how well off individuals would have been if they continued to live and (b) how good it is for individuals not to continue with their lives. As long as (a) is better than (b), death is an evil. Deprivationism is the standard view on the badness of death. We suggest that Deprivationism is relevant to health priorities in at least four areas. First, Deprivationism brings attention to the kinds of values that are lost when death occurs. Secondly, it emphasises that age matters. Thirdly, Deprivationism will favour a person-affecting theory. Fourthly, it may say something new about who the worst off are. Jointly these four areas can provide reasons for saving lives. Though the idea that age matters to health priorities has gained a certain acceptance, there is bound to be disagreement about which age groups to prioritise. This issue is the subject of contemporary debate. Our claim is that in order to prioritise between age groups, it is relevant to consider the question of when it is worst to die. To this end, Deprivationism can provide theoretical support.