Friday, September 20, 2013

What if we never had to die?

This week's Kingston Whig-Standard column.

This week a team of researchers at the University of California reported that they were able to reverse human ageing at the cellular level. They investigated the impact of a healthy lifestyle, including exercise, a vegetarian diet and even meditation on a small group of men with biopsy-proven, low-risk prostate cancer. Essentially, they separated the patients into two groups, one living a strict, health-conscious lifestyle, the others living their lives as they lived them before.
It turns out that after a five-year period the men in the group living the prescribed and monitored health-conscious lifestyle had “younger cells” than those who did not. The cellular changes the investigators noted were at the endings of the men’s chromosomes. Their telomeres were longer than those of the other men who did not change their lifestyle. The length of our telomeres is seen by many researchers as predictive of our ageing process, diseases and even premature death.
Of course, a study involving 35 men, of whom only 10 were subject to the actual intervention, is sufficiently small that these results could be coincidental. No doubt larger-scale studies will investigate whether a different lifestyle might permit us to slow down our ageing process significantly.
These, and other findings like them, give rise to a whole set of interesting questions, don’t they? Say, would you be willing to live your life as a vegetarian, engaging in meditation and yoga, if it could buy you a few additional years toward the end of your life?
Leaving aside for a moment the good ethical reasons why we should live a vegetarian lifestyle, I suspect most of us would actually decide to forgo a few extra life-years (or healthier life-years toward the end of our lives) if we had the choice.
The reason I say this has to do with the many lifestyle choices that we make that we know perfectly well are detrimental to our health. Whether it’s the hectolitres of diabetes-inducing soft drinks that we drag home from the supermarket, the extra salt we add in the restaurant to the already-generously seasoned hamburger ... the list goes on.
We know that all of this is bad for our health, but that doesn’t stop most of us from doing that sort of thing anyway. It appears to be the case, then, that the length of our lives is not the only thing that matters to us. And that is probably a good thing. It serves no purpose to live an above-average length of life if our quality of life suffers a lot to achieve that.
Whether the enjoyment of junk food is causally linked to us enjoying our lives more than we would without junk food is for us to decide individually. That’s not to say that public health professionals should not try to persuade us to live healthier lives, and if eating that stuff leads to higher public expenditures on health care, taxes should probably increase on junk food items to make up for the cost produced by the unhealthy choices that we make.
There are broader questions to be asked, though. Should we invest research dollars into figuring out what makes us live longer? Should we possibly develop drugs that would permit us to – say – double our life expectancy, if we could? What if we never had to die?
Well, most of us don’t want to die. Strangely, that does not necessarily mean that we mind being dead. It seems we are – rightly – scared of the process of dying; being dead is less of a concern to many of us.
The religious don’t mind going to their respective afterlives. The atheists accept that not being around is not something to worry about, given that by the time we are dead, well, we just don’t exist to even regret our non-existence. Problem solved.
And yet, death is not something we strive for either, regardless of the process of dying. Given the choice, while I consider my life worth living, I would almost certainly choose to carry on living. While there are evolutionary reasons why we act in this manner, it is true that even people with a very low quality of life tend to cling to their often-times miserable existences.
That would appear to be a good reason then to support research on life-extending drugs. We strive to live longer, so why shouldn’t we if we could? From what I gather, current research indicates that our additional life-years would be life-years lived fairly healthily, too.
That would matter, because if we suddenly ended up with people living much longer, but at a lower quality of life requiring a lot of medical and other resources to support their existence, we might not be able to pay for this.
This week’s report by the Health Council of Canada on needed health-care reforms showed that for many indicators our health care system is delivering less than the health care systems of comparable economies. Adding a lot of people to that system might be unsustainable. It seems as if much would depend on the quality of the life-years future drugs could buy us.
There are other considerations to keep in mind, too, before we jump head-long into a life-extension research agenda. What about future generations? Our planet can only sustain so many people, so what would our ability to live much longer mean for the sustainability of our species’ existence on this planet?
If we were able to live much longer, we would probably also have to work many more years to sustain our final pension years. Well, where should all the new entrants into the job market go if we elderlies continue holding on to our jobs? There don’t seem to be easy answers to any of these questions.
Also, given that, at least initially, the new, life-extending drugs would likely be very expensive, should they be publicly funded to guarantee equitable access, or would we as a society be comfortable with the wealthy being able to buy extra life years while the poor would be left to die premature deaths?
Perhaps we should try to address these questions prior to investigating how to extend our life-expectancy. What’s your take on this issue?
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University. He tweets @schuklenk

1 comment:

  1. Should we ask second-order questions before doing first-order research? My guess is that, for affluent knowledge economies, there is little danger of the second order question 'crowding out' first order work provided that such work is 'deeply and widely distributed'- i.e. has multiple drivers and support structures. I imagine that to be the case in America- with its well endowed Universities, strong Venture Capitalist culture, not to mention the power and resources of the 'Military Industrial' complex.
    However, at the margin, more especially for Developing countries with a tradition of dirigiste government intervention, second order questions can crowd out first order Research Programs with highly unethical consequences. In the case of India, I need only mention the role of Vandana Siva and Amartya Sen to convey the sense that second order theorizing contributes to a concurrency deadlock or 'race hazard' type problem such that Research becomes impotent to help transform people's lives.
    In the West, Public Discourse can attain a level of sophistication such that ordinary people can make up their own minds and the Democratic process can break the concurrency deadlock of deciding what we ought to be deciding to decide. However, a naive faith in Public Justification for emerging Democracies like India is surely misplaced because poorer people are likely to have
    1) stronger risk aversion
    2) higher cost of information processing.
    The danger is that Environmental, Gender and Development, or Bioethical discourse can become subject to negative feedback loop such that higher risk aversion at the margin distorts the relevant utilitarian calculus by reason of the far larger number of people living in the Underdeveloped world. Thus, if Vandana Shiva or Amartya Sen is taken to speak for 1.5 billion South Asians then their views become prescriptive even if the relevant Econ theory shows that this is sub-optimal.
    A different approach to this question militating to the same conclusion (viz. that second order problematization should be 'sparse'- i.e. encoded within an open first order problem- and consume few resources)is one which moves away from a Substantive notion of autonomy towards a Darwinian view which emphasizes phenotypal plasticity and capacitance diversity such that epigenetic canalisation (of preferences, 'life-styles', modes of production, norms etc)emerges from within the 'lebenswelt', so to speak, rather than being imposed from above by some Substantive calculus.
    My feeling is that what we might all choose from behind the Rawlslian 'veil of ignorance' is Borges's 'lottery in Babylon'. Indeed, it is interesting that the folklore of any actual living society always has some 'immortals'- so it may be that we all vote for a world in which that outcome is feasible even if we know our own chance of getting the winning ticket is zero. During the Depression, poor people used to queue up to see the bride at High Society weddings. It was enough for them to know that someone was leading a glamorous life to feel some mitigation, or passing relief, from their own dismal living conditions.
    In any case, as the old Yiddish joke has it- 'if the rich could pay poor people to die for them, there would be no poverty.'