The shades of grey
What are the most pressing ethical issues of an aging society?
Lily E. Frank: If we look at an “aging society” as a scenario in which life spans are extended without a similar increase in the number of healthy years, one of the most pressing issues is the question of distributing societal resources. In philosophy, this issue falls under the term “distributive justice”. Some are in favour of restricting the resources that go into caring for the elderly. American bioethicist Daniel Callahan has argued that rationing publicly funded life-extending care based on old age is justified once a society accepts the idea that “government has a duty, based on our collective social obligation, to help people live out a natural life span, but not actively to help extend life beyond that point”. But Callahan’s position is ambiguous because it relies on the concept of a “natural lifespan”, something that has changed and will continue to. Others consider rationing healthcare due to age a form of discrimination.
Nikolas Rose: We will have to overturn a way of thinking about our life course that has come to seem natural to us: First we are children, then we’re adolescents, then we’re grown ups who work, then we retire, then quite soon we die. This pattern is an established part of the way we’ve come to think about so many features of our society: it underpins how we’ve designed a number of societal systems like pension, healthcare and education. But this pattern has only existed for around 100 years and now it is radically changing. We should change the organization of our societies accordingly. Politicians are addressing minor parts of this challenge, e.g. through a flexible age of retirement, but no one is really acknowledging the magnitude of this challenge.
Should scientists continue their efforts to prolong life?
Lily E. Frank: Yes, particularly if the life is one with increased health. Generally, people consider being alive to be a good thing and a prerequisite for enjoying everything else. And people who do not wish to extend their life, health or youth span can opt out.
Nikolas Rose: To be completely frank, I believe the efforts of a few scientists targeted at prolonging life are of little significance in relation to these major changes we are facing. They might have a small effect on a small number of people, but the real changes will be brought about by social, political and economical factors. Not from high-tech science, but the way we live our lives and they way we organize societies. These changes will happen no matter if some scientists are successful in their mucking around with telomeres. On the other hand, I do believe that scientists must face the real challenge of how to keep us healthier for longer, by researching dementia, cancer and other age-related diseases.
Can you imagine a world in which people routinely live to 140?
Lily E. Frank: Absolutely, and I welcome it! British philosopher Bernard Williams famously wrote that if people could live forever they would become painfully bored. Callahan remarked that “If you have made it even into your 60s, you’ve probably had a chance to experience most of the joys of life.” I think both statements are wrong. We don’t know what awaits us in much longer lives, nor can we assume that we can experience even a fraction of the possible joys of human life in 60 years. At the same time, living longer and healthier lives may provide us countless opportunities that are not captured by the notion of “joys” – opportunities to cultivate our virtues, to produce knowledge or to improve the quality of life of our fellow human beings and the lives of other sentient beings, just to name a few.
Nikolas Rose: My colleague Jean-Pierre Changeux, a neuroscientist, points out that when Homo sapiens first emerged life expectancy was around 40 years. Now life expectancy at birth for a boy child in many countries is over 80 – longer for a girl child. We have already experienced a revolution! But imagining that we’ll routinely live to 140 is too speculative. I’d rather focus on the challenge that we will be confronting in the next 25-30 years: imagining a world where we live well until we reach 100.