Friday, June 15, 2012

How to Put Aging and Biogerontology in the "Justice" Spotlight

Over the past decade I have worked at the intersection of issues in political philosophy/theory and the medical sciences. I have tried to help bridge what I take to be a troublesome divide between the field most concerned with ideals of justice and equality, and scientific advances (especially in the field of biogerontology) which could profoundly improve human health and prosperity. These two things are linked in important ways, but there is very little actually written by theorists on these kinds of topics.

Bridging this gap is an up-hill struggle for a variety of reasons. The theoretical concepts and normative theories developed in political philosophy over the past 4 decades either ignored the realities of morbidity (e.g. like the fact that aging is a major risk factor for disease) or just assumed people went through their complete lives as "healthy and productive members of society". This meant the (almost exclusive) focus of theories of distributive justice was on the distribution of wealth and income. A fair society could be measured, so went the reasoning, to a large extent by the pattern of the distribution of a society's wealth. And the extent to which theories of justice have expanded, in the last 2 decades, to tackle topics like global justice and health, they are still constrained by the original assumptions and limited perspectives/concepts with which the dominant normative theories were originally devised. In other words, taking a theory of domestic justice designed to apply to a healthy and affluent society and then trying to make a few modifications once you take disease and debt seriously is not, imho, a recipe for success (though much more would have to be said about what constitutes "success" for a theory of justice).

Rawls's method of "reflective equilibrium" prioritized the importance of our "moral intuitions" about justice, something which has further marginalized the importance of well-ordered science to debates concerned with justice and good governance. We come hardwired with intuitions about the distribution of food and importance of social status, but a host of cognitive biases and limitations impair our ability to think sagely about issues that go beyond our primal moral instincts. Such instincts are unlikely to help us navigate the complex challenges facing today's aging world.

This has created an enormous challenge for me as a scholar, as I have been working on a book-length project for over a decade now on the social and ethical implications of the genetic revolution and have struggled to find an adequate normative framework which will do justice to the complexity of issues that arise in this context. When I first started working on these issues I envisioned taking a "top down" approach, by which I mean I had a normative theory in mind (broadly Rawlsian), and envisioned extending and applying that theory to advances in the biomedical sciences. And 3 years into the book I had a near complete draft of this project completed. But as time went on, and I learned more about the empirical realities of human biology (especially aging) and the advances in the biomedical sciences, I came to appreciate how impoverished my initial approach was. If the goal of a normative theory is to help us diagnosis the problems and challenges we have in the real world, both today and in the near future, a "top down" approach will be of little help. And I didn't want to write a book that would be of little to no use.

So instead I have opted for a "bottom up" approach. I began to pay closer attention to the empirical discoveries being made, and the potential interventions these discoveries could lead to, and then began to fashion and develop a normative theoretical framework from this. This "bottom-up" approach certainly requires a great deal more empirical work, patience and interdisciplinary competence, but I believe the payoff will be worth it as one's contribution will better exemplify the intellectual virtues (e.g. attention to details, understanding, etc.) than a contribution misinformed or aloof to the subject matter in question.

Those who have followed my posts over the past 5 years will know that aging and biogerontology have been a central focus of my research for the past few years. But one would find very few (there are some) papers written by philosophers and theorists which address the justice issues raised by aging populations. But global aging is among one of the greatest challenges facing developed and developing countries this century. And if political philosophers/theorists hope to develop theories and principles which take the realities of today's world seriously we must begin to take these considerations seriously.

Before turning to the main point I wish to make in this post, it is worth pointing out that the case for tackling aging and prioritizing the study of the biology of aging is easy to make from a utilitarian perspective. Utilitarianism maintains that we should maximize the greatest happiness of the greatest number. When we adopt the lens of minimizing pain and suffering in today's aging world it is very easy to see why the science of aging ought to be a top priority. I have emphasized this point in various other papers and posts so I won't re-hash that point here.

Utilitarianism has of course fallen on hard times in the past 40 years in ethics and political philosophy (at least in academia). And so much more elaborate theories and principles have been derived that make the commonsensical aspiration of aspiring to stave off the chronic diseases of late life much less obviously a moral requirement or duty of justice. Consider, for example, infectious disease and poverty. These of course have been a reality for human populations for all of our species' existence. Humans living in a "state of nature" died from communicable diseases, malnourishment, etc. This unfortunate state of affairs does not have to be construed as "human-made" before our moral sensibilities kick in. And yet today many professional philosophers have constructed elaborate theories and debates which aspire to reveal the insight that poverty and disease are the result of global capitalism and thus ought, as a matter of justice, to be redressed.

When what we might call the human-agency thesis [injustice = human actions which adversely affect the welfare of others] drives our normative theories it can pervert our moral sensibilities as well as distort our understanding of human history. And so there is something valuable to be gained by utilitarianism's simplicity. But alas I digress as the task today is to link aging with the human-agency view of justice. So let us return to that task.

Most theories of justice today focus on inequalities, disadvantages, etc. that are created by our social institutions. Feminists, for example, focus on role of the family and law in creating and perpetuating patriarchy. Egalitarians focus on the vulnerabilities and inequalities of capitalism. Libertarians might focus on the inefficiencies of government and what they take to be the potential "tyranny of the masses" of democratic government. The focus on the responsibility social institutions play in creating and promoting undesirable state-of-affairs stems from a commitment to the "human-agency" view of justice. This assumption is central to social contract theories of justice, for example, because the focus is on the terms of agreement that would be acceptable to all if all were equal participants in the social contract.

This author, for example, argues that the ordinary meaning of the word "justice" is associated with the morally appropriate, and, in particular, equitable treatment of persons and groups. As such justice is a concept utilized to assess social institutions, "a social system's practices or "rules of the game"" (37).

Claims to justice thus arise, according to the human-agency view, because human action has resulted in outcomes (e.g. patriarchy, inequality, inefficiency, poverty) that ought not to have occurred. Once social institutions are implicated in this fashion, a theory of justice will aspire to derive appropriate principles that provide guidance to help redress the shortcomings of the status-quo.

Is there a way to tell the story about the aging of the human species that resonates with the human-agency view of justice? I believe there is. And part of the difficulty in trying to expand the frontiers of justice to include modulating the rate of aging is that most people (mistakenly) assume that aging is "natural". That humans age today like they always did. And if humans aged in "the state of nature" like they do today then there is no "injustice" that needs the redressed.

Pointing out the mistakes in this assumption could thus be of some real value. Far from aging being "natural", it is actually very "unnatural", and a product of human intervention. This will no doubt strike many as counterintuitive, but this insight becomes evident once we adopt the lens of comparative biology.

Before I explain how aging is a product of human intervention, I first want to emphasize what my claim is NOT. I am not suggesting, as some do, that the problems of aging (e.g. diabetes, cancer, etc.) are created by our fat diet, inactive lifestyles, etc. While it is true that diet and lifestyle can help delay or accelerate the onset of morbidity, these are not the factors that *cause* aging. So then in what sense are humans responsible for aging?

Look around nature at, for example, wild mice, birds, and fish. Do we find the populations of these species aging? No. The birds you find sitting in the trees in your backyard, the field mice living in your garden shed, they are healthy and vigorous. In the wild they do not age because as soon as their health or agility begins decline they soon become dinner for one of their many and hungry predators. As Hayflick argues, aging is actually an artefact of civilization. Because we have, thanks to sanitation, antibiotics, increases in material prosperity, etc., significantly reduced early and mid-life mortality, we have created a very artificial environment for living things, not only for us humans, but also for our pets and other domesticated animals we protect.

So we can tell the story of aging and chronic disease as a story which implicates the human-agency premise: We have created environments that are so effective at mitigating the external threats to life for humans that our populations now experience aging. This would not occur naturally, in the "state of nature". Population aging is a product of human artifice. Aging is of course an unintended consequence of civilization. We did not create sanitation, more efficient crop production, modern medicine, etc. so that we could age. These interventions have helped postpone disease and death for today's populations. However, a consequence of these interventions is that the chronic diseases of late-life, which are often slow, expensive and painful ways to die, afflict unprecedented numbers of human beings. More human beings die year after year from chronic disease than from any other cause. And there is a duty of justice to do what we can to mitigate this tragic state of affairs.

By drawing attention to the fact that aging is a product of human action one can invoke the human agency thesis to help buttress the case for tackling the inborn aging process. It is shortsighted and arbitrary to limit the demands of justice to reducing early and mid-life morbidity and mortality. The interests children and young adults have in remaining healthy and vigorous does not decline as they enter the post-reproductive period of life. Justice requires us to prioritize the science which could significantly improve the health prospects of today's aging populations.