Wednesday, September 03, 2008

Bioethics Paper on Equality and Retarding Aging

Following on from my previous post on our aversion to inequality... One inequality that I believe we should have an aversion to is the inequality in health prospects that exists between the young and the aged. And thus longevity science should be something which egalitarians champion as an important and innovative strategy for combating these unchosen inequalities.

Why should the aged have a much greater risk of cancer, heart disease, diabetes, AD, infection and death? The aged do not deserve the cellular and molecular damage that accrues over time; and thus we should seek to mitigate these vulnerabilities. And so I think the aspiration to retard human aging is actually a requirement, not violation, of equality. And this is what I argue at greater length in my paper "Equality and the Duty to Retard Human Aging" which has been accepted for publication in the journal Bioethics. Here is a sample from that forthcoming paper:

Not all species age the same way. The maximal lifespan of mice, for example, is only a fraction of the maximal lifespan of monkeys and turtles. And even within a species there is some variation among the rate of aging. “The tiny chihuahua can live 12–15 years compared to six or seven for its larger cousin, the Irish Wolfhound”. And while it is true that every human being celebrates a new birthday each year, the lifelong accumulation of molecular and cellular damage we experience with the passage of time can vary dramatically. It is possible for some humans to reach the age of 100 years old free from the diseases (e.g. cancer, heart disease, diabetes) that kill most of their contemporaries decades earlier. Approximately 1 in 10 000 Americans are centenarians. And recent studies of centenarians and the impact of “longevity genes” suggests that there is a significant genetic component at play. Having a centenarian sibling increases one’s chances of survival to very old age. Furthermore, one recent study found that the offspring of long-lived parents had significantly lower prevalence of hypertension (by 23%), diabetes mellitus (by 50%), heart attacks (by 60%), and strokes (no events reported) than several age-matched control groups.

A number of biogerontologists, philosophers and policy advocates have begun to engage in a spirited debate concerning the priority of tackling human aging itself. And this paper seeks to add a new dimension to these debates by placing the duty to retard human aging within the framework of a theory of just healthcare. In particular, I consider two prominent theories which emphasis a principle of equality. Norman Daniels invokes the principle of fair equality of opportunity to outline an account of just healthcare that places great emphasis on the notion of “normal species functioning” and the treatment/enhancement distinction. Ronald Dworkin’s account of equality of resources emphasizes the importance of mitigating brute luck inequalities; that is, inequalities that people are not responsible for. Dworkin invokes the idea of a hypothetical insurance scheme to determine the range of medical provisions that should be provided by the publicly funded health care system.

I consider what both of these accounts of equality would say about the duty to retard human aging and conclude that both accounts of equality, once suitably amended and revised, actually support the conclusion that anti-aging research is important and could lead to interventions that ought to be considered “medical necessities”. Examining the relation between equality and anti-aging research should help enhance the interdisciplinary debate and engagement that is needed to ensure that philosophers, bioethicists, gerontologists and policy makers address the duty to retard human aging in a fair and proportionate manner.

....To remain faithful to the idea that normal species functioning provides a natural baseline for medical services, and yet to also spend billions trying to treat all of the various age-related disadvantages that we are susceptible to, is to be pulled in two contradictory directions. And the result is a sub-optimal and unfair response to our biological vulnerabilities. The current mindset will have dire consequences for societies (like the United States) that are set to have unprecedented numbers of senior citizens in the decades to come. To help us respond, in a fair and proportionate manner, to age-related disadvantage we must transcend the narrow limitations imposed by the notion of “normal species functioning” and the treatment/enhancement distinction.

A revisionist reading of Daniels’s account of fair equality of opportunity and just healthcare is one that will give primary importance to the impact aging has on the range of opportunities open to us...

....Once we add aging into Dworkin’s tale [of the hypothetical auction and insurance scheme] we see that aging itself can give rise to complaints that violate the envy test. Those who are more susceptible to infection, disease and frailty- like the aged- will envy the health prospects of the youthful and this inequality is unchosen. Furthermore, the age-related disadvantages that shall be visited upon the aged violate the requirements of the principle of equal importance. That principle stipulates that “human lives be successful rather than wasted, and this is equally important, from an objective point of view, for each human life”. Pathology, pain and suffering, these all compromise the success of a human live by limiting our ability to pursue our conception of the good and, ultimately, by ending our lives completely. The principle of equal importance does not say that human lives should be successful only for a fixed number of years, after which point people’s interests in remaining healthy have no ethical significance. And thus one ought, to be consistent with the logic of luck egalitarianism and the principle of equal importance, bring to the fore the importance of redressing age-related disadvantage.

....I conclude this paper with one final thought. Egalitarians might be tempted to complain that my analysis misses the mark. It does so, they might argue, because the primary egalitarian concern is that if anti-aging interventions should one day become possible this would exacerbate existing inequalities as only the rich would be able to afford to pay for them. This is a serious concern. However, the arguments I have developed in this paper are an attempt to ensure that we do not arrive at this situation. But showing how equality requires us to tackle aging I have sought to make a compelling case for investing, with public funds, in the science of anti-aging research. If we do this, and do it now, we are less likely to face the situation the egalitarian is concerned about. For that scenario is much more likely to occur if anti-aging interventions are not viewed as important medical necessities. In that kind of scenario not only will it take longer for such interventions to come into existence, but such research will be forced to rely very heavily on private funding. And this could have adverse effects on how widely available such interventions are. So the greatest threat anti-aging research is likely to have on equality would occur when such interventions are viewed as falling outside the scope of “medical necessities”. And thus it is imperative that we begin to have an informed, robust moral discourse on the importance of anti-aging research and its relation to equality and just healthcare.