Friday, September 28, 2012

The Duty to Extend the “Biological Warranty Period” (Part 1)

Over the coming months I intend to post a few thoughts that I am developing for a new paper on the duty to extend the human "biological warranty period" (via retarding the rate of molecular and cellular decline).

The impetus for writing this paper came from a conference invitation to write a paper in the general area of moral philosophy. I thought long and hard about what to offer, as I have a few ideas and papers I am developing in that general area.

At first I suspected I wouldn't want (or need to) write another paper on tackling aging, given that I have recently written a number of such articles on that topic.

But then I asked myself if there was more I wanted to say about this topic, something that might appeal, specifically, to moral philosophers. I quickly realized that there is. I still yearn to write something substantial which could, hopefully, help spur more debate and reflection on these topics. So I began to reflect on what the nature of such a paper would be.

I turned to the field of applied ethics and asked myself the following question-- which philosophy paper in ethics has had the greatest impact in terms of bringing greater awareness to, and rationale reflection of, a pressing societal concern that was largely ignored (by philosophers and the general public)?. My immediate answer was this paper by Singer on global poverty.

Writing in 1971, Singer wanted to bring attention to the neglected issue of global poverty, and the duties the affluent have to mitigate the disadvantage of those in distant lands. The fact that the vulnerable live very far away does not erode the strength of the moral duty to aid them.

Many aspects of Singer's argument are important for my project, though my specific topic is different from his (i.e. tackling aging rather than poverty).

Firstly, Singer's moral analysis (even if one is not completely persuaded by it) takes seriously the empirical realities of the world. So it is a contextual ethical analysis. When thinking about "what we owe to others" we must take seriously the fortunate position of some, and the unfortunate position of others. This is one of the great appeals of Singer's contribution. It is a moral argument embedded in the challenges of its time. Its primary objective is to enhance our practical reason.

This methodological approach is one I myself am sympathetic with. For the 21st century, I think the aging of the human species is *THE* challenge of our times. Unlike poverty, which is a problem it is easy for most people to perceive as a problem (even if they do not do enough to tackle it), one has to do a great deal of work to make vivid the magnitude of the challenges of global aging. My strategy for doing this is to develop my argument through the lens of life history theory, so that we have a better understanding of the biological trade-offs involved in the pre-reproductive (childhood), the reproductive (adulthood) and post-reproductive (late life) stages of the human lifespan.

Natural selection prioritizes reproduction over longevity, which means we have greater opportunities for health in the pre-reproductive and reproductive periods of life, *provided we live in environments conducive to health*. Civilization has created such environments (though they are far from perfect). This has lead to a rise in life expectancy, from below 30 years (the historical norm for 99% of our species' history) to a life expectancy of around 67 in the world today. This means a child born in the world today can expect to live long enough to become a senior. This is great news, but it also brings formidable challenges (one which requires us to change the moral landscape in significant ways).

Sanitation, material prosperity, antibiotics, and changes in behaviour (e.g. birth control) have dramatically increased life expectancy but this has not altered our biological warranty period (which limits life expectancy to around 85 years).

Improvements to our environment, like access to clean drinking water and safe and affordable food, greatly reduces early and mid-life mortality. The same for immunizations against infectious diseases, small pox being the most obvious example. But promoting health in late life is a completely different challenge. As we age we are susceptible to multiple diseases and disorders- cancer, stroke, heart disease, arthritis, declining vision, bone fracture, muscle loss, cognitive decline, hearing loss, etc. Chronic disease is set to be the scourge of the 21st century, as we expect to have 2 billion people worldwide over the age of 60 by the middle of this century. The World Health Organization estimates that 220 million people worldwide will die from chronic disease in the decade from 2005-2015 (and 75% of these deaths will be among people over the age of 60). This figure is truly staggering, and the human and economic toll of chronic disease on such a large scale is difficult for us to even grasp (for nothing even comes close to it, not even all the wars of the 20th century).

Because it is difficult to grasp the magnitude of the harms of senescence most people simply take the current rate of aging, and the diseases and disability that result from it, as "a given". As if aging is natural, and death from aging something that has always happened to our species. But both of these assumptions are wrong. The aging of a species is not in fact natural, it is an artifact- a product of human intervention. The only species that age on this planet are those that humans protect from predation and starvation so that they live longer lives, and eventually expire the biological warranty period imposed by evolution through natural selection. Once a population begins to outlive the biological warranty period, there is an explosion in the prevalence of chronic disease, pain and disability. And this is the scenario of humanity today.

By drawing attention to the lack of available food, Singer brought attention to one (important) part of the story of how we can promote the opportunities for all humans to live flourishing lives. Singer formulates the following principle, which is the theoretical foundation of his argument for tackling poverty:

If it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable importance, we ought, morally, to do it

This principle, I argue, can also be applied to the duty to extend the biological warranty period of humans. Suffering disease and disability during the post-reproductive period of life is bad (just as it is bad to suffer these same afflictions in the pre-reproductive and reproductive periods of life).

To illustrate this point, we could modify Singer's famous example of a child drowning in a shallow pond. But imagine the person in need of help was not a child, but was instead the grandparent of the child. The grandparent slipped on a rock in the shallow pond while playing with her grandson and hit her head on a rock. Now, unconscious on the ground of the shallow pond, she will drown unless someone lifts her up and out of the pond (her grandson is too weak to do this).

Singer invokes the story of the drowning child to show that distance has no moral relevance to our duty to help. If the drowning child was your neighbour's child, or the child of someone living in a poor country on the other side of the planet, you still have a pressing moral imperative to help.

The same logic ought to apply to the duty to help people at ALL stages of the human lifespan (not just when they are children). And the form of assistance ought not to be limited to just the provision of food.

Now I realize there are numerous challenges which face extending a Singer-like argument to tackling aging. Here are some that I anticipate objectors making:

(1) There is a solution to eliminating poverty, but no intervention exists which can extend our biological warranty period.

(2) Singer's principle only requires us to prevent something bad (like starvation), but not to promoting good (like life extension).

(3) Singer's principle has the proviso that we are only obligated to prevent harm when doing so would not result in imposing burdens or harms that are of comparable importance. But extending the human lifespan could bring about consequences that are even more dire.

I intend to elaborate on, and respond to, these points in future posts. My brief response to each point is as follows:

1. Eliminating poverty, like retarding aging, is still in the experimental stage. So the objection (a) underestimates the complexity of tackling poverty and (b) underestimates the advances that have been made in the field of biogerontology over the past decade.

2. Extending the biological warranty period, just like the provision of food, can be described as either "conferring a benefit" or "preventing harm". In the case of food, providing basic aid could be described as "providing people with food (a benefit)" or "preventing starvation" (preventing a harm). The same can be said about the provision of an intervention that retards aging. Stated positively it is "expanding the opportunities for health in late life (a benefit)", but the same thing can be described as "preventing harm by delaying (and possibly compressing) morbidity and mortality".

3. Concerns that extending the biological warranty period of humans will cause overpopulation, exacerbate global inequalities, etc. must be premised upon sound empirical insights (rather than knee-jerk reactions) and we must have a sense of proportionality. Critics of aging interventions often underestimate the magnitude of the harms of the current rate of aging and overestimate the potential harms of slowing aging. So while there are legitimate concerns at play here, these are not likely to be weighty enough to constitute an objection to retarding the current rate of biological aging.

More to follow.