The Ethics of Living Forever and Its Effect on Overpopulation

As long as we have food to eat, water to drink, beaches to swim in, and gas to power our cars, we may not worry too much about whether we have enough resources. But, what if that weren’t the case? In the near future, our grocery stores could struggle to be restocked. Our beaches could be too polluted to swim in. An influx of fuel could severely pollute our air. In that case, what would potential solutions be? By then, it may have been too late to implement population or resource control measures. For this reason, it’s important for us to take preventative measures now to avoid future conflict– overpopulation could have implications on global issues like climate change too. As we start to develop new anti-aging technologies, we must consider what implications extending the human lifespan could have, and on who? With our growing population straining our available resources, the rise of life extension technologies could further complicate the issue. What effect would longer life spans have on population numbers in general? Do elders have a duty to the environment to die? The rise of advanced healthcare technology is inevitable, but it’s critical that leaders steer the ship in the right direction. This paper will focus primarily on the arguments against prolonging human life, discussing the ethical considerations of responsibility, the meaning of life, and justice.


Resources and our growing population

Economist Thomas Malthus predicted that population must inevitably outstrip food supply, and we will experience famine. He argued that population growth is exponential and our resources are finite, therefore, population will continue to grow while our resource supply will not. The outcome: a shortage of resources. Advancements in agricultural technologies and industrialization may make it seem like our resources are keeping up with our population growth. But, that may not be the reality of the situation considering the poor allocation of human resources. Though industrialization has helped our economy grow tremendously, the resulting environmental impact may not be as positive as we hoped. Industrialization is slowly destroying our resources, giving rise to issues such as air pollution, water pollution, loss of soil fertility and global warming. Not only do we have a finite resource pool, but our resource pool is being depleted at a faster rate because of human misuse. A prime example of human resource misuse that’s affecting our resource pool is overfishing. According to World Wildlife Fund, the number of overfished stocks has tripled globally in half a century. Through overfishing, humans are not only disrupting the marine environment but are also depleting the potential fish available for future fishes. This could potentially decrease fish food stock as well. Another example is water availability. Less than one percent of our world’s water can be used for human needs (“Why Population”). On top of already having limited access to fresh water, United States water consumption is the second highest in the world as Americans often waste water primarily for toilets and showers (“How We Use Water”).  As world population grows, the stress for freshwater increases and the issue of water scarcity arises. Human water wastage intensifies this issue and may cause water availability to be more scarce. Poor resource usage further limits the already finite resource pool available to us.

Our population is reaching level high numbers and the “rising human population threatens to make worse every problem facing both humanity and the environment” (Easton 196). A growing population could increase the strain on our resource pool. The UN Department of Economic and Social Affairs predicts that the “world population is projected to increase by more than one billion people within the next 15 years, reaching 8.5 billion in 2030, and to increase further to 9.7 billion in 2050 and 11.2 billion by 2100.”  Though when looking at the population growth rate of the world and the United States, we see that it is decreasing (“Population Growth”).

World population growth rates are slowing down to about 1.1% per year while United States population growth rate is slowing down to 0.7% per year. So, must we still worry about controlling population? Yes, because there still remains the issue of carrying capacity or the size of population that the environment can support or “carry.” The precise number is dependent on several factors: choice of diet, use of technology, standard of living etc (Easton 196). Carrying capacity can also vary from country to country as a country with a large amount of land and small population can be still be overpopulated in terms of resource availability. More than a precise number that we must be worried about, carrying capacity is a long term concept that we should be wary of. To conclude, even though, our growth rate is slowing down, our population is still growing which could affect the carrying capacity of our environment.

Adding to complexity of population growth is the increased life expectancy of the elder population. In recent years, our elder population is living longer partially due to smarter health choices and advancements in medicine and technology. Another factor is population momentum where previously high growth rates are causing a temporary increase in the elder population. The exact cause of the increase in the elder population is unknown but is significant to our overall population growth. According to the National Institute of Health in their article “The World’s Older Populations Grows Drastically,” the world’s elder population continues to grow at an unprecedented rate. Today, 8.5 percent of people worldwide, 617 million, are aged 65 and over. This percentage is projected to increase to about 17 percent of the world’s population by 2050 to about 1.6 billion. The report also says that the global population of the “oldest old” — people aged 80 and older — is expected to more than triple between 2015 and 2050. Zooming into the United States, a graph from the U.S. Census Bureau’s 2017 National Population Projections shows that the number of elders in our population is projected to surpass the amount of children under 18 by 2060.

In 2016, the percentage of older adults (people 65+) was 15.2% while children under 18 was 22.8%. However in 2060, the percentage of older adults jumped to 23.5% while the percentage of children under 18 dropped to 19.8%. A similar graph released shows how the growing elderly population could alter age distribution as well. We may have as many elders as children in 2060, causing potential affects to our economy. For example, living longer may imply requiring longer pensions which could strain the government budget (Schwartz). Society would have more elders requiring Medicare too. This raises the ethical issue of who we should allocate our money to: the elders or the younger population. Spending more government money in one area, Medicare or pensions, may mean spending less money in another sector such as education. There is always a trade off when deciding to invest more into a certain sector. Deciding where to allocate our resources will shed light onto whose lives we value as a society. I believe that because of our issue with population growth already, life extension research should proceed with caution when considering the values of responsibility, meaning of life and justice.

Aging and Aging Interventions

I want to start with some scientific background as to what aging is before diving into anti-aging medical treatments and the ethical discussion. According to Matteo Tosato et al., aging is defined as the “accumulation of diverse deleterious changes occurring in cells and tissues with advancing age that are responsible for the increased risk of disease and death.” There are multiple theories as to why agining could occur– the one “correct” answer is yet to be discovered. The three major theories are the free radical theory, the immunologic theory, and the inflammation theory that all work together to provide an understanding of the physiological changes occurring with aging. Instead of viewing these theories as mutually exclusive, they should be seen as complementary processes working to explain the complex issue. Many new medical technologies are working to slow down the aging process to increase human longevity. It is important to note, though, there is no proven way to prevent the human aging process despite companies and media admitting to have done so. “Anti-aging” treatments seems to be buzz-word as there isn’t a fully effective way of stopping or reversing aging. However, it is possible to delay the effects of aging. For example, a better diet can reduce the risk of heart disease. But, delaying the onset of a single age-related disease does not necessarily mean delaying the whole aging process. It is also possible to live longer. For example, better nutrition can make you live longer. A better diet can help prevent the offset of issues such as heart disease, hypertension, cancer, and cataracts. But, living longer does not necessarily mean that the aging process has been slowed down. It can increase your mortality over your life span but that does not mean it has impacted the aging process. So what determines whether an intervention delays aging or not? According to Dr. Pedro de Magalhães, a given intervention is anti-aging if it delays the pace of multiple age-related pathologies and changes. The confusion of anti-aging medicine can be used by companies to mislead the public. For example, anti-wrinkle cream may get rid of wrinkles caused by aging, but it does not delay the aging process as a whole neither does it increase mortality. For these reasons, we must be careful when interpreting life- extension technologies.

I chose to focus on the anti-aging interventions of stem cells, hormone therapies, and telomere based therapies as they meet the above criteria of life extension technologies. Stem cells are cells that have the unique potential to differentiate into many cell types. They lie dormant in our bone marrow and when cells our damaged, cytokines send signals that trigger them. Stem cells travel to the damaged area and differentiate into the specific form of cell required to help heal. A stem cell transplant is the transplanting of stem cells, usually from the bone marrow or umbilical cord blood, to help replace, regrow, repair our bodies on a cellular level. Currently, companies are using blood and bone marrow-derived stem cells to eradicate autoimmune and cardiovascular diseases. Emerging companies such as Celularity,  Juno Therapeutics, and Kite Pharmaceuticals are working to augment immunity and longevity by amplifying body’s ability to fight disease, heal, and regenerate itself. Celularity’s Car-T/NK/Car-NK cell therapies and Juno’s well known Car-T cell therapies are being used to fight cancer which have shown tremendous potential. The second intervention is hormone therapies. As we grow older, many of our hormones level decrease. Hormone therapies is the reinjection of hormones such as growth hormones and DHEA to bring the levels back to normal in elders. Growth hormones can increase muscle mass and strengthen the immune system while DHEA has shown to help elders with improved memory, a better immune system, and more muscle mass. The last intervention is telomere based therapies. Telomeres, end of our chromosomes, shorten over time so telomere based therapies involve the reactivation of an enzyme telomerase to extend the tips of chromosomes. Many of these anti-aging medical interventions are in enfant stages of research so understanding their full mechanism of action is difficult. After evaluating the ethical considerations of these interventions that will be discussed below, we must consider if life-extension technologies should be continued to be researched or not.

Should we prolong human life?

Responsibility

The first ethical consideration I will discuss is responsibility.  Philosopher John Harwig believes that as a matter of distributive justice, people hold the duty to die when they reach a certain age, severe disability or very poor health. The duty to die supports a natural death not an inflicted death where elders simply refuse life extension measures. He believes that an individual is not the only person who will be affected by their decision to live or die—their decision will impact their families and the greater community as well. Therefore, in 1997, John Harwig wrote in the prestigious Hastings Center Report that “A duty to die is more likely when continuing to live will impose significant burdens—emotional burdens, extensive caregiving, destruction of life plans, and yes, financial hardship—on your family and loved ones” (“The “Duty to Die” Advances”). An increased life span can mean a financial burden due to the necessity of senior homes for seniors. With the young working class becoming busier nowadays, they have less time to look after their elders. The solution: senior homes. But, senior homes can range from about $1,500 to $6,000 a month in addition to other special care services. An alternative to caregiving at senior homes is caregiving at home. But, the cost of medications, other resources, and the physical burden can cause caregiving at home to be expensive as well. On top of that is the emotional burden of seeing loved ones in pain. In these cases, we ask ourselves: is it worth continuing to live if the burden on our caregivers may surpass an elders contribution to society.

The slippery slope to this argument is that if there is a duty to die, is there “duty” not to give birth too? This could significantly alter population growth too. Just because elders have the responsibility to the greater community to allow life to end do parents have the responsibility to the greater community to limit family size? Harwig may argue that there is more a duty to die for elders than a duty to limit family size because elders will sacrifice less of their lives compared to a non-existent hypothetical child by allowing life to end. Connecting to the meaning of life discussed later, elders have lived a sufficient quality and quantity of life allowing them to have a duty to die. As we grow older, our contribution to the betterment of society may decrease as our physical and mental ability decreases too. At that point, Harwig implies that elders have a duty to ease the burden on their families and provide for the younger generation and environment around them.

As mentioned earlier in the paper, living longer may imply greater allocation of money to the elderly and less of an allocation to other resources. For example, more money allocated to Social Security may mean less money for education– there is always a trade-off of where we put our money. More money for Social Security adds a strain to the laborers who contribute to the system through payroll taxes. When looking at the dependency ratio, we can see the extent at which the labor force needs to provide for the elder population.

The dependency ratio of United States in 2017 is increasing to about 52%. The higher the dependency ratio, more money needs to be allocated to the elder population. In our case, significantly more money is needed in the Social Security system to sustain the growing life span of the elder population. We must ask ourselves whether we agree on this allocation of government money. It is true that elders have paid into funds like Social Security and are contributing members of society. Social Security can be seen as something owed to them. While it may be owed to elders in the ethical sense, the money they pay into the Social Security system is not the money they receive out of system. The money that elders would have put into the system through their payrolls taxes automatically goes to an eligible recipient. Financially, the money elders receive is not owed to them because it’s not their money in the first place. Even if some still think that Social Security is something that’s owed to elders, more social security for all would tremendously increase the strain on the federal budget. Where would we get more money to pay the recipients if they start to live longer? When taking a consequentialist approach, living longer could negatively affect our economy.

The counter argument to the duty to give up one’s life is autonomy. Critics may say that people have the right to their own life path– that they do not have the duty to give up their lives for non-existent, merely potential people. Why should I be denied a treatment because of its effect on future generations? When thinking about these future people as your children or grandchildren, people may feel more emotionally inclined to care about the issue and likely feel the need to provide for them. After this discussion, we must asses the responsibility of the elders in our community and whether their contribution is or valuable or not.

Meaning of Life

The second ethical consideration is the meaning of life. Though human life is worthy and should not be taken, there is an idea that humans miss the meaning of life by focusing too much on their self perseveration and their ego (Pijnenburg and Leget). For example, in the Christian tradition, “the notion of eternal life does not refer primarily to a prolongation of earthly life… rather, it refers to the fullness of a human life that can be reached to the extent that one’s goal in life is no longer the preservation of the self, but the communion with and service to God and one’s neighbour.” Christianity, Judaism, Islam and Hinduism all share the idea that eternal life should be focused on the fullness of human life by helping others and society rather than focusing on our own prolongation of life. The overlapping wisdom of several religious texts sends a more powerful message that the quality of life is not measured by the length of life rather through the fullness of the life lived. Living a meaningful life full of happiness and dedicated to the betterment of the society may be superior to an extended human lifespan that is susceptible to potential illnesses. Age can be a risk factor for the development of several diseases and these diseases can physically or mentally prevent one from doing activities that they love whether that be playing a sport or spending time with loved ones. It is then that some may argue that their quality of life has decreased, so it is worth taking measures to extend life span? For example, age can significantly decrease testerone levels in men, causing fatigue, irritability, and affected memory. If this prevents one from living an energetic life, should they consider a testerone replacement therapy? Testerone replacement therapy may make him feel younger short term, but can increase the risk of cardiovascular issues in the long term (“Is Testosterone Therapy Safe?”). The meaning of life argues the a better quality of life trumps a longer quantity and potentially decreased quality life.

The counter argument that can be made, though, is that quality of life is subjective and can change overtime. For example, if a child has suffered an unhappy childhood does that mean it isn’t worth for them to live into their 80s? Or if an adult has suffered a depressed adulthood does that mean it isn’t worth it for them to live longer? Who’s to say that their quality of life can’t increase as people grow older. Some may believe that more quantity of life means more opportunities for a better quality of life.

It is also crucial to note that working towards the outcome of longer human life will take hundreds of years, and is by no means definable in our time. Because of this, the ethical consideration of the meaning of life simply focuses on enhancing the natural human lifespan rather than the prolongation of life as increased quantity of life may not always equate to an increased quality of life. Using the word “natural,” though, can be tricky as most medical technologies can interfere with natural human body processes. What makes life-extension technologies seen in a different light than innovations like vaccines or antibiotics? Ultimately, this debate comes down to the number of people that can be impacted by the solution. The positive impact of immunization on the greater population makes the technology more useful unlike life extension technologies which may only positively affect one individual. On the other hand, antibiotics such as penicillin can treat multiple bacterial infections making the usage of the drug more widespread, whereas life extension treatments are more specialized. Vaccines and antibiotics are also more accessible than life extension treatments which are only available to few. Rather than creating entirely new pieces of medical equipment or even allocating resources towards that sector, we must instead work with what already exists in vaccinations, antibiotics, and more established techniques. The impact and accessibility of other medical innovations make life extension technologies seen differently and potentially unfavorably by some.

To conclude, an interesting paradox mentioned in Martien A M Pijnenburg’s paper is: “the more life is experienced as meaningful, the less we are aware of time.” Activities that bring us satisfaction and happiness such as playing sports, spending family time, or reading books all require our attention, and it is when we are doing what we love that we become less aware of the passing time. We forget about the time past, as the time spent bought us satisfaction. As humans, we seek meaningful experiences, not more time to live. Through the activities that bring us joy, our quality of life increases and the potential desire for self preservation decreases.

Justice

The last ethical consideration I want to raise is justice. Stem cell transplants can range from costing $5,000 to $8,000 per treatment, and the low accessibility of the treatment makes it difficult for people in less privileged countries to gain access to.  This arises the issue of “unequal death” between developed and developing countries and the rich and the poor. Best said in a New York Times opinion article by Sunita Puri, “Death may be humanity’s great equalizer, but the inequalities suffered in life… become inequalities in the experience of dying as well.” Interventions like palliative care or at home caregivers require can be pricey as well, but the unusually high price of life extension technologies because of its newness makes it even harder for people to gain access to.

Also when thinking about life extension treatments, is it fair to grant the life extension ability to people who already have more? For example, the average life expectancy of people in Middle Africa in 2018 is about 60 years old while the average life expectancy of people in the United States is about 80 years old (“Average Life Expectancy”). The cause of this inequality can be attributed to a lack of sanitation and access to proper health care. Rather than focusing research money on life extension technologies, there should be a focus on increasing availability of basic health care to people in less fortunate circumstances. Measures should be taken to increase lifespan for people who have less, rather than granting the life extension for people who already have more.

The slippery slope to this argument is that there’s already a distinction between the Have and the Have-nots in our world. Because of this present distinction, is it right to deny the Haves of life extension technologies because the Have nots do not have access to it? Some may argue it isn’t fair to deny the Haves of treatments, especially if the treatments are more of a want, because doctors have no means to treat all patients. These treatments are expensive as they are multi-step specialized procedures.  Doctors providing these treatments also have costs such as expertise, work space, equipement access, and support personnel (“Why Is Stem Cell Therapy so Expensive?”). After taking into account all the costs, these treatments are bound to be expensive. For example, skin care can be expensive depending on the brand and treatment. Its high cost may prevent some people from getting access to it through a dermatologist. But, should the Haves be denied of a skin care options just because the Have-nots do not have access to it? Skin care may be seen as more of a luxury and with money does come different privileges. Access to birth control, on the other hand, is often seen as a basic healthcare need even though not many people have access to it. Rather than denying those who have access to birth control, measures should be taken to increase the accessibility of the treatment for the underprivileged. Denying treatments for the Haves may not be the best solution– rather society should work more diligently to increase worldwide access of important treatments.  Treatments that exist but are not available to everyone raise issues of justice. We must question who these treatments were made for. Who will it harm and will it increase health care inequality? Taking a utilitarian perspective, we must assess the benefit of the treatment before and whether it can be used to benefit the greater good or not. In addition to life extension technologies, other data driven medicines such as genome editing are increasing healthcare inequality (Tufekci). Successful health care should not be focused on advancing opportunities for few but increasing the average for everyone. We should work towards an overall healthy world.

Conclusion

Our population is reaching level high numbers, posing a potential strain on our resources. Allowing for longer life span could further complicate the issue. Though elders contribute wisdom to our society, the financial, emotional and physical burden of elders may cause us to reevaluate the extension of human life. I believe that elders have a duty to die for future generations of their children and grandchildren. The highest quality of life may been reached in adulthood as age most usually comes the onset of multiple illnesses. Because of this, there should not be a need to extend the quantity of life. Lastly, the issue of “unequal death” that this technology poses emphasizes the inequality of privileged and non privileged in our world. Research in life extension technologies requires massive funding, intelligence, and time. Their availability will be limited to those willing and able to pay. Because of this, the rich will be able to enjoy health benefits and possibility a chance to acquire more power and wealth. Some may say that the limited availability of the technology may only be in its initial stages of implementations like many other health technologies. But after taking account into the specialization of the treatment and the attention required by the doctor, treatment prices are not likely to change much, and if they do, it will take several years.

Rather than money being invested in a technology that will available to a small group of patients, medicine should focus on creating more accessible treatments to create a healthy world. A further area of research I would have considered would have been the safety and efficacy of the technology.  Clinical trials will be needed to determine the impact on life span which would need to be conducted over a long period of time and would be expensive (Lucke et al.). Additionally, because aging is a complex and multifaceted process, isolating the cause of lifespan extension would be tough. As advancements in medicine and technology continue, society must reconsider the goals of healthcare. Should we work towards focusing on developing more treatments that are likely to be accessible to a few (life extension being one of them)? Or should we work on building more hospitals, training more doctors, and getting medical technologies to low income neighborhoods? I suggest we slow down our race to innovation and reconsider healthcare technologies to work towards universal health care. Increasing access to simple birth control, for example, would be greatly beneficial to our society. I do agree, though, that medical innovation is crucial to societal progress. But, researchers and regulators must consider the long term impact of their technology. The impact of life extension technologies on population numbers is a very futuristic yet important connection. Technologies that are accessible to a few not only increase in inequality in healthcare but contribute to the overall inequality in our world. Instead, we should work to increase the overall healthcare average for all.

With the rise of new technologies, we focus on the furthering of society by finding new ways to to make our lives more efficient. Under this wave of technological advancements lies the intriguing and unprecedented innovation of life extension technologies. Extending human life span may sound fascinating and worthy of executing. However, as humans, we are so focused on satisfying human desires that we forget the environmental impact of our choices on the people and environment around us? In my paper, I layout our population issue and how life extension technologies could further complicate the issue. I then transition to discussing the ethical considerations of life extension technologies, focusing on responsibility, the meaning of life, and justice. Through this paper, I hope to share the complexities of this attractive technologies and its long term impact on our community. Should we even continue research in life extension technologies if the costs outweigh the benefits? I explore the idea of progress vs. preservation in healthcare and reveal the potential of life extension to create a idealistic present society and potentially harmful future one.


As long as we have food to eat, water to drink, beaches to swim in, and gas to power our cars, we may not worry too much about whether we have enough resources. But, what if that weren’t the case? In the near future, our grocery stores could struggle to be restocked. Our beaches could be too polluted to swim in. An influx of fuel could severely pollute our air. In that case, what would potential solutions be? By then, it may have been too late to implement population or resource control measures. For this reason, it’s important for us to take preventative measures now to avoid future conflict– overpopulation could have implications on global issues like climate change too. As we start to develop new anti-aging technologies, we must consider what implications extending the human lifespan could have, and on who? With our growing population straining our available resources, the rise of life extension technologies could further complicate the issue. What effect would longer life spans have on population numbers in general? Do elders have a duty to the environment to die? The rise of advanced healthcare technology is inevitable, but it’s critical that leaders steer the ship in the right direction. This paper will focus primarily on the arguments against prolonging human life, discussing the ethical considerations of responsibility, the meaning of life, and justice.

Resources and our growing population

Economist Thomas Malthus predicted that population must inevitably outstrip food supply, and we will experience famine. He argued that population growth is exponential and our resources are finite, therefore, population will continue to grow while our resource supply will not. The outcome: a shortage of resources. Advancements in agricultural technologies and industrialization may make it seem like our resources are keeping up with our population growth. But, that may not be the reality of the situation considering the poor allocation of human resources. Though industrialization has helped our economy grow tremendously, the resulting environmental impact may not be as positive as we hoped. Industrialization is slowly destroying our resources, giving rise to issues such as air pollution, water pollution, loss of soil fertility and global warming. Not only do we have a finite resource pool, but our resource pool is being depleted at a faster rate because of human misuse. A prime example of human resource misuse that’s affecting our resource pool is overfishing. According to World Wildlife Fund, the number of overfished stocks has tripled globally in half a century. Through overfishing, humans are not only disrupting the marine environment but are also depleting the potential fish available for future fishes. This could potentially decrease fish food stock as well. Another example is water availability. Less than one percent of our world’s water can be used for human needs (“Why Population”). On top of already having limited access to fresh water, United States water consumption is the second highest in the world as Americans often waste water primarily for toilets and showers (“How We Use Water”).  As world population grows, the stress for freshwater increases and the issue of water scarcity arises. Human water wastage intensifies this issue and may cause water availability to be more scarce. Poor resource usage further limits the already finite resource pool available to us.

Our population is reaching level high numbers and the “rising human population threatens to make worse every problem facing both humanity and the environment” (Easton 196). A growing population could increase the strain on our resource pool. The UN Department of Economic and Social Affairs predicts that the “world population is projected to increase by more than one billion people within the next 15 years, reaching 8.5 billion in 2030, and to increase further to 9.7 billion in 2050 and 11.2 billion by 2100.”  Though when looking at the population growth rate of the world and the United States, we see that it is decreasing (“Population Growth”).

World population growth rates are slowing down to about 1.1% per year while United States population growth rate is slowing down to 0.7% per year. So, must we still worry about controlling population? Yes, because there still remains the issue of carrying capacity or the size of population that the environment can support or “carry.” The precise number is dependent on several factors: choice of diet, use of technology, standard of living etc (Easton 196). Carrying capacity can also vary from country to country as a country with a large amount of land and small population can be still be overpopulated in terms of resource availability. More than a precise number that we must be worried about, carrying capacity is a long term concept that we should be wary of. To conclude, even though, our growth rate is slowing down, our population is still growing which could affect the carrying capacity of our environment.

Adding to complexity of population growth is the increased life expectancy of the elder population. In recent years, our elder population is living longer partially due to smarter health choices and advancements in medicine and technology. Another factor is population momentum where previously high growth rates are causing a temporary increase in the elder population. The exact cause of the increase in the elder population is unknown but is significant to our overall population growth. According to the National Institute of Health in their article “The World’s Older Populations Grows Drastically,” the world’s elder population continues to grow at an unprecedented rate. Today, 8.5 percent of people worldwide, 617 million, are aged 65 and over. This percentage is projected to increase to about 17 percent of the world’s population by 2050 to about 1.6 billion. The report also says that the global population of the “oldest old” — people aged 80 and older — is expected to more than triple between 2015 and 2050. Zooming into the United States, a graph from the U.S. Census Bureau’s 2017 National Population Projections shows that the number of elders in our population is projected to surpass the amount of children under 18 by 2060.

In 2016, the percentage of older adults (people 65+) was 15.2% while children under 18 was 22.8%. However in 2060, the percentage of older adults jumped to 23.5% while the percentage of children under 18 dropped to 19.8%. A similar graph released shows how the growing elderly population could alter age distribution as well. We may have as many elders as children in 2060, causing potential affects to our economy. For example, living longer may imply requiring longer pensions which could strain the government budget (Schwartz). Society would have more elders requiring Medicare too. This raises the ethical issue of who we should allocate our money to: the elders or the younger population. Spending more government money in one area, Medicare or pensions, may mean spending less money in another sector such as education. There is always a trade off when deciding to invest more into a certain sector. Deciding where to allocate our resources will shed light onto whose lives we value as a society. I believe that because of our issue with population growth already, life extension research should proceed with caution when considering the values of responsibility, meaning of life and justice.

Aging and Aging Interventions

I want to start with some scientific background as to what aging is before diving into anti-aging medical treatments and the ethical discussion. According to Matteo Tosato et al., aging is defined as the “accumulation of diverse deleterious changes occurring in cells and tissues with advancing age that are responsible for the increased risk of disease and death.” There are multiple theories as to why agining could occur– the one “correct” answer is yet to be discovered. The three major theories are the free radical theory, the immunologic theory, and the inflammation theory that all work together to provide an understanding of the physiological changes occurring with aging. Instead of viewing these theories as mutually exclusive, they should be seen as complementary processes working to explain the complex issue. Many new medical technologies are working to slow down the aging process to increase human longevity. It is important to note, though, there is no proven way to prevent the human aging process despite companies and media admitting to have done so. “Anti-aging” treatments seems to be buzz-word as there isn’t a fully effective way of stopping or reversing aging. However, it is possible to delay the effects of aging. For example, a better diet can reduce the risk of heart disease. But, delaying the onset of a single age-related disease does not necessarily mean delaying the whole aging process. It is also possible to live longer. For example, better nutrition can make you live longer. A better diet can help prevent the offset of issues such as heart disease, hypertension, cancer, and cataracts. But, living longer does not necessarily mean that the aging process has been slowed down. It can increase your mortality over your life span but that does not mean it has impacted the aging process. So what determines whether an intervention delays aging or not? According to Dr. Pedro de Magalhães, a given intervention is anti-aging if it delays the pace of multiple age-related pathologies and changes. The confusion of anti-aging medicine can be used by companies to mislead the public. For example, anti-wrinkle cream may get rid of wrinkles caused by aging, but it does not delay the aging process as a whole neither does it increase mortality. For these reasons, we must be careful when interpreting life- extension technologies.

I chose to focus on the anti-aging interventions of stem cells, hormone therapies, and telomere based therapies as they meet the above criteria of life extension technologies. Stem cells are cells that have the unique potential to differentiate into many cell types. They lie dormant in our bone marrow and when cells our damaged, cytokines send signals that trigger them. Stem cells travel to the damaged area and differentiate into the specific form of cell required to help heal. A stem cell transplant is the transplanting of stem cells, usually from the bone marrow or umbilical cord blood, to help replace, regrow, repair our bodies on a cellular level. Currently, companies are using blood and bone marrow-derived stem cells to eradicate autoimmune and cardiovascular diseases. Emerging companies such as Celularity,  Juno Therapeutics, and Kite Pharmaceuticals are working to augment immunity and longevity by amplifying body’s ability to fight disease, heal, and regenerate itself. Celularity’s Car-T/NK/Car-NK cell therapies and Juno’s well known Car-T cell therapies are being used to fight cancer which have shown tremendous potential. The second intervention is hormone therapies. As we grow older, many of our hormones level decrease. Hormone therapies is the reinjection of hormones such as growth hormones and DHEA to bring the levels back to normal in elders. Growth hormones can increase muscle mass and strengthen the immune system while DHEA has shown to help elders with improved memory, a better immune system, and more muscle mass. The last intervention is telomere based therapies. Telomeres, end of our chromosomes, shorten over time so telomere based therapies involve the reactivation of an enzyme telomerase to extend the tips of chromosomes. Many of these anti-aging medical interventions are in enfant stages of research so understanding their full mechanism of action is difficult. After evaluating the ethical considerations of these interventions that will be discussed below, we must consider if life-extension technologies should be continued to be researched or not.

Should we prolong human life?

Responsibility

The first ethical consideration I will discuss is responsibility.  Philosopher John Harwig believes that as a matter of distributive justice, people hold the duty to die when they reach a certain age, severe disability or very poor health. The duty to die supports a natural death not an inflicted death where elders simply refuse life extension measures. He believes that an individual is not the only person who will be affected by their decision to live or die—their decision will impact their families and the greater community as well. Therefore, in 1997, John Harwig wrote in the prestigious Hastings Center Report that “A duty to die is more likely when continuing to live will impose significant burdens—emotional burdens, extensive caregiving, destruction of life plans, and yes, financial hardship—on your family and loved ones” (“The “Duty to Die” Advances”). An increased life span can mean a financial burden due to the necessity of senior homes for seniors. With the young working class becoming busier nowadays, they have less time to look after their elders. The solution: senior homes. But, senior homes can range from about $1,500 to $6,000 a month in addition to other special care services. An alternative to caregiving at senior homes is caregiving at home. But, the cost of medications, other resources, and the physical burden can cause caregiving at home to be expensive as well. On top of that is the emotional burden of seeing loved ones in pain. In these cases, we ask ourselves: is it worth continuing to live if the burden on our caregivers may surpass an elders contribution to society.

The slippery slope to this argument is that if there is a duty to die, is there “duty” not to give birth too? This could significantly alter population growth too. Just because elders have the responsibility to the greater community to allow life to end do parents have the responsibility to the greater community to limit family size? Harwig may argue that there is more a duty to die for elders than a duty to limit family size because elders will sacrifice less of their lives compared to a non-existent hypothetical child by allowing life to end. Connecting to the meaning of life discussed later, elders have lived a sufficient quality and quantity of life allowing them to have a duty to die. As we grow older, our contribution to the betterment of society may decrease as our physical and mental ability decreases too. At that point, Harwig implies that elders have a duty to ease the burden on their families and provide for the younger generation and environment around them.

As mentioned earlier in the paper, living longer may imply greater allocation of money to the elderly and less of an allocation to other resources. For example, more money allocated to Social Security may mean less money for education– there is always a trade-off of where we put our money. More money for Social Security adds a strain to the laborers who contribute to the system through payroll taxes. When looking at the dependency ratio, we can see the extent at which the labor force needs to provide for the elder population.

The dependency ratio of United States in 2017 is increasing to about 52%. The higher the dependency ratio, more money needs to be allocated to the elder population. In our case, significantly more money is needed in the Social Security system to sustain the growing life span of the elder population. We must ask ourselves whether we agree on this allocation of government money. It is true that elders have paid into funds like Social Security and are contributing members of society. Social Security can be seen as something owed to them. While it may be owed to elders in the ethical sense, the money they pay into the Social Security system is not the money they receive out of system. The money that elders would have put into the system through their payrolls taxes automatically goes to an eligible recipient. Financially, the money elders receive is not owed to them because it’s not their money in the first place. Even if some still think that Social Security is something that’s owed to elders, more social security for all would tremendously increase the strain on the federal budget. Where would we get more money to pay the recipients if they start to live longer? When taking a consequentialist approach, living longer could negatively affect our economy.

The counter argument to the duty to give up one’s life is autonomy. Critics may say that people have the right to their own life path– that they do not have the duty to give up their lives for non-existent, merely potential people. Why should I be denied a treatment because of its effect on future generations? When thinking about these future people as your children or grandchildren, people may feel more emotionally inclined to care about the issue and likely feel the need to provide for them. After this discussion, we must asses the responsibility of the elders in our community and whether their contribution is or valuable or not.

Meaning of Life

The second ethical consideration is the meaning of life. Though human life is worthy and should not be taken, there is an idea that humans miss the meaning of life by focusing too much on their self perseveration and their ego (Pijnenburg and Leget). For example, in the Christian tradition, “the notion of eternal life does not refer primarily to a prolongation of earthly life… rather, it refers to the fullness of a human life that can be reached to the extent that one’s goal in life is no longer the preservation of the self, but the communion with and service to God and one’s neighbour.” Christianity, Judaism, Islam and Hinduism all share the idea that eternal life should be focused on the fullness of human life by helping others and society rather than focusing on our own prolongation of life. The overlapping wisdom of several religious texts sends a more powerful message that the quality of life is not measured by the length of life rather through the fullness of the life lived. Living a meaningful life full of happiness and dedicated to the betterment of the society may be superior to an extended human lifespan that is susceptible to potential illnesses. Age can be a risk factor for the development of several diseases and these diseases can physically or mentally prevent one from doing activities that they love whether that be playing a sport or spending time with loved ones. It is then that some may argue that their quality of life has decreased, so it is worth taking measures to extend life span? For example, age can significantly decrease testerone levels in men, causing fatigue, irritability, and affected memory. If this prevents one from living an energetic life, should they consider a testerone replacement therapy? Testerone replacement therapy may make him feel younger short term, but can increase the risk of cardiovascular issues in the long term (“Is Testosterone Therapy Safe?”). The meaning of life argues the a better quality of life trumps a longer quantity and potentially decreased quality life.

The counter argument that can be made, though, is that quality of life is subjective and can change overtime. For example, if a child has suffered an unhappy childhood does that mean it isn’t worth for them to live into their 80s? Or if an adult has suffered a depressed adulthood does that mean it isn’t worth it for them to live longer? Who’s to say that their quality of life can’t increase as people grow older. Some may believe that more quantity of life means more opportunities for a better quality of life.

It is also crucial to note that working towards the outcome of longer human life will take hundreds of years, and is by no means definable in our time. Because of this, the ethical consideration of the meaning of life simply focuses on enhancing the natural human lifespan rather than the prolongation of life as increased quantity of life may not always equate to an increased quality of life. Using the word “natural,” though, can be tricky as most medical technologies can interfere with natural human body processes. What makes life-extension technologies seen in a different light than innovations like vaccines or antibiotics? Ultimately, this debate comes down to the number of people that can be impacted by the solution. The positive impact of immunization on the greater population makes the technology more useful unlike life extension technologies which may only positively affect one individual. On the other hand, antibiotics such as penicillin can treat multiple bacterial infections making the usage of the drug more widespread, whereas life extension treatments are more specialized. Vaccines and antibiotics are also more accessible than life extension treatments which are only available to few. Rather than creating entirely new pieces of medical equipment or even allocating resources towards that sector, we must instead work with what already exists in vaccinations, antibiotics, and more established techniques. The impact and accessibility of other medical innovations make life extension technologies seen differently and potentially unfavorably by some.

To conclude, an interesting paradox mentioned in Martien A M Pijnenburg’s paper is: “the more life is experienced as meaningful, the less we are aware of time.” Activities that bring us satisfaction and happiness such as playing sports, spending family time, or reading books all require our attention, and it is when we are doing what we love that we become less aware of the passing time. We forget about the time past, as the time spent bought us satisfaction. As humans, we seek meaningful experiences, not more time to live. Through the activities that bring us joy, our quality of life increases and the potential desire for self preservation decreases.

Justice

The last ethical consideration I want to raise is justice. Stem cell transplants can range from costing $5,000 to $8,000 per treatment, and the low accessibility of the treatment makes it difficult for people in less privileged countries to gain access to.  This arises the issue of “unequal death” between developed and developing countries and the rich and the poor. Best said in a New York Times opinion article by Sunita Puri, “Death may be humanity’s great equalizer, but the inequalities suffered in life… become inequalities in the experience of dying as well.” Interventions like palliative care or at home caregivers require can be pricey as well, but the unusually high price of life extension technologies because of its newness makes it even harder for people to gain access to.

Also when thinking about life extension treatments, is it fair to grant the life extension ability to people who already have more? For example, the average life expectancy of people in Middle Africa in 2018 is about 60 years old while the average life expectancy of people in the United States is about 80 years old (“Average Life Expectancy”). The cause of this inequality can be attributed to a lack of sanitation and access to proper health care. Rather than focusing research money on life extension technologies, there should be a focus on increasing availability of basic health care to people in less fortunate circumstances. Measures should be taken to increase lifespan for people who have less, rather than granting the life extension for people who already have more.

The slippery slope to this argument is that there’s already a distinction between the Have and the Have-nots in our world. Because of this present distinction, is it right to deny the Haves of life extension technologies because the Have nots do not have access to it? Some may argue it isn’t fair to deny the Haves of treatments, especially if the treatments are more of a want, because doctors have no means to treat all patients. These treatments are expensive as they are multi-step specialized procedures.  Doctors providing these treatments also have costs such as expertise, work space, equipement access, and support personnel (“Why Is Stem Cell Therapy so Expensive?”). After taking into account all the costs, these treatments are bound to be expensive. For example, skin care can be expensive depending on the brand and treatment. Its high cost may prevent some people from getting access to it through a dermatologist. But, should the Haves be denied of a skin care options just because the Have-nots do not have access to it? Skin care may be seen as more of a luxury and with money does come different privileges. Access to birth control, on the other hand, is often seen as a basic healthcare need even though not many people have access to it. Rather than denying those who have access to birth control, measures should be taken to increase the accessibility of the treatment for the underprivileged. Denying treatments for the Haves may not be the best solution– rather society should work more diligently to increase worldwide access of important treatments.  Treatments that exist but are not available to everyone raise issues of justice. We must question who these treatments were made for. Who will it harm and will it increase health care inequality? Taking a utilitarian perspective, we must assess the benefit of the treatment before and whether it can be used to benefit the greater good or not. In addition to life extension technologies, other data driven medicines such as genome editing are increasing healthcare inequality (Tufekci). Successful health care should not be focused on advancing opportunities for few but increasing the average for everyone. We should work towards an overall healthy world.

Conclusion

Our population is reaching level high numbers, posing a potential strain on our resources. Allowing for longer life span could further complicate the issue. Though elders contribute wisdom to our society, the financial, emotional and physical burden of elders may cause us to reevaluate the extension of human life. I believe that elders have a duty to die for future generations of their children and grandchildren. The highest quality of life may been reached in adulthood as age most usually comes the onset of multiple illnesses. Because of this, there should not be a need to extend the quantity of life. Lastly, the issue of “unequal death” that this technology poses emphasizes the inequality of privileged and non privileged in our world. Research in life extension technologies requires massive funding, intelligence, and time. Their availability will be limited to those willing and able to pay. Because of this, the rich will be able to enjoy health benefits and possibility a chance to acquire more power and wealth. Some may say that the limited availability of the technology may only be in its initial stages of implementations like many other health technologies. But after taking account into the specialization of the treatment and the attention required by the doctor, treatment prices are not likely to change much, and if they do, it will take several years.

Rather than money being invested in a technology that will available to a small group of patients, medicine should focus on creating more accessible treatments to create a healthy world. A further area of research I would have considered would have been the safety and efficacy of the technology.  Clinical trials will be needed to determine the impact on life span which would need to be conducted over a long period of time and would be expensive (Lucke et al.). Additionally, because aging is a complex and multifaceted process, isolating the cause of lifespan extension would be tough. As advancements in medicine and technology continue, society must reconsider the goals of healthcare. Should we work towards focusing on developing more treatments that are likely to be accessible to a few (life extension being one of them)? Or should we work on building more hospitals, training more doctors, and getting medical technologies to low income neighborhoods? I suggest we slow down our race to innovation and reconsider healthcare technologies to work towards universal health care. Increasing access to simple birth control, for example, would be greatly beneficial to our society. I do agree, though, that medical innovation is crucial to societal progress. But, researchers and regulators must consider the long term impact of their technology. The impact of life extension technologies on population numbers is a very futuristic yet important connection. Technologies that are accessible to a few not only increase in inequality in healthcare but contribute to the overall inequality in our world. Instead, we should work to increase the overall healthcare average for all.

By Disha Karale

Works Cited

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