This article is for my (J.P.s) sister.

Shes always been the one in my family most vocal about her concerns with the pros and cons of immortality.

Particularly the cons.

And I think the potential problems of increased life expectancy that she identifies are concerns a lot of people share.

Because once you get past the question of if radical human life extension is even possible, the inevitable next question is, Should we do it?

In fact, there are a lot of ethical arguments against life extension (as my sister is wont to remind me).

Im sure youve heard, or even thought of, many of them yourself.

What if only the rich can afford it?

What about overpopulation and the environment?

Wont you just get bored?

Who would want to live to 150 if youre just old and decrepit and in a nursing home all that time?

In this post, were going to try and address all these longevity objections, and more (Immortal dictators! Religious concerns! Social Security!), but first we should talk about that last question (being old and decrepit for decades) briefly.

Many people, when they think about life extension, assume the process will simply extend the tail-end of our lives, adding more years on to that period when we are beset with frailty and age-related mental and physical decline.

Stuck in a wheelchair, youll have to play bingo for an extra fifty years while youre forced to stay alive through uncomfortable tubes up your nose or something.

And believe me, no one, myself included, wants that.

But what spanners and other people interested in human longevity want is not just extended lifespans, but extended healthspans.

As we said in our very first article on human life extension here:

Human life extension addresses both chronological and biological aging; it asks not just how can we live longer, but how long can we live well. Healthspan, or the years of our lives when were unencumbered by disease or disability, addresses just that. What if you could have the body you had at 25 well into your 80s or 100s or 120s? What more could you do with those extra rich years of life? Who could you become?

The technical term for this is compressing morbidity: shortening the decrepit, morbid years and extending the healthy ones. And, as we also discussed in our first article, theres plenty of scientific evidence to suggest that anti-aging interventions can do just this in both animals and in humans.

So what well be talking about throughout the rest of this article on the ethics of life extension is not extending the unhealthy years of our lives, but extending our healthy, active, vibrant years and why (quite a few, actually) people think that could still be a bad thing.

Because this is a (really) long post, feel free to jump to the section youre most interested in, rather than read through everything.

Does death make life meaningless?

Tolstoy and Nietzsche would argue that thats absolutely the caseand theyve gotten plenty of attention for it, especially in Western culture, because it runs contrary to an unspoken assumption that death itself is what gives life meaning. Christians look forward to heaven. Jews see death as a terrible but necessary part of Gods plan. Buddhists believe death leads only to rebirth. In so many philosophical traditions, death is essential for life itself to have meaning.

Some even go as far to claim that death is required for life to have meaning. Theythe likes of the late Holocaust survivor Viktor Frankl and philosopher Sir Bernard Williamspresent three major arguments against life extension:

Lets break them all down.

Religious fatalism is the belief that an individuals health is predetermined by a higher power; the individual can not and should not intervene. Religious fatalism isnt something relegated only to cults or extremists. Its significantly correlated with race, people with lower incomes, and people with lower levels of education. Religious fatalism is distinct from fatalism, in that it refers specifically to healthcare decisions. Many who believe in destiny or fate will also argue that they are predetermined to suffer from an illness or disease, and recovery will not hinge on medical interventionits up to the universe.

And, if fate does have a role in medical outcomes, intervening would be foolish. Why waste the money and resources on doing so if youre just going to die anyway? Using this logic, aging should be embraced as a natural part of life.

Following that line of thinking, the medical field should cease to exist. Forget cancer researchclose the childrens hospitals and ER rooms and eliminate the FDA. Life-sustaining drugs like insulin, Albuterol, and Levothyroxine should be banned along with seatbelts and helmets.

Of course, many who believe in religious fatalism dont necessarily want to be so prescriptive to the rest of society. They might see it as an important personal choice, but not something to put on others. Orand I find this common among my circlesits the elimination of age-related death altogether thats off-putting. Theyre completely comfortable with, say, finding a cure for Alzheimers, cancer, and diabetes, but when age itself is indicated as a major precursor to all these diseases, they shrug it off. Ageing is an essential part of life. Its not to be tampered with.

Part of the reason is because being old without being healthy is horrific. Think wheelchairs, struggling to open Jell-O cups, and slowly losing your senseseach one a tragic loss for a 15-year-old but an inevitability for someone over 90. But this goes to show that we just dont consider the elderly as human as those younger than them. Frailty is a tragedy for anyone, not just for those deemed young enough for it to be uncommon.

Thus, the indefinite extension of healthspan, or the years of our lives when were unencumbered by disease or disability, is really the ultimate goal of life extension. And many find that option far more palatable; if one practices yoga or avoids processed carbohydrates in an effort for a longer healthspan, the prospect of a lengthened lifespan becomes far more palatable.

And in the end, the ethics of life extension require that no one is forcing anyone else to live longer than they would like. Just like anyone can deny medical interventions, so too can they choose not to live longer than they believe they were destined to. That is, in my view, nothing but a personal choice.

If we were immortal, we could legitimately postpone every action forever. [] But in the face of death as absolute finis to our future and boundary to our possibilities, we are under the imperative of utilizing our lifetimes to the utmost, not letting the singular opportunities whose finite sum constitutes the whole of life pass by unused.

Frankl, in the quote above, argues that with all the time of eternity, nothing could get done. One could, theoretically, indefinitely put off confessing a love, writing a novel, or starting a company. Of course, discomfort should also be a part of the conversion; while one could choose to never eat because the process takes action, hunger is a tremendous motivator, even if one is nowhere near close to dying from starvation.

Some contemporary psychological studies support Frankl. For example, a 2007 article published in Personality and Social Psychology Bulletin found that those who encounter death over a long period are more likely to be intrinsically motivated (and actually write that novel theyve always wanted to). That said, the threat of death isnt necessarily a requirement for intrinsic motivation in general. Realistically, there is a range of reasons why people do thingsfor praise, for accomplishment, or to just do it,and very few of them have to do with the inevitability of death.

In fact, philosophers like Heidegger have argued that most people live their lives in denial of their death. One study on mortality salience (awareness of ones own death) found that research participants actively tried not to engage with their own mortalitya reaction that may be a biological response. It would be tough to argue death is the sole reason for any significant actions people take throughout their lives if theyre actively avoiding considering it.

Lets say that immortality has no effect on your motivationin fact, you have the curiosity of a 25-year-old and the body to match. Youve ticked off your bucket list. You live where you want, work where you want (if you want), and you do what you want. Life is splendid. And boring.

Desperately boring.

This could be one of the major cons of immortality, but Brooke Alan Trisel points out that not all of life is meaningful. He writes, most of our lives are neither meaningless nor meaningful, but lie somewhere between these two extremes.

I would amend his argument further to say that most moments of our individual lives are neither meaningless or meaningful, but lie somewhere in between. For example, celebrating your wedding day might be tremendously meaningful, but the hours spent visiting florists might not be.

Its true that old people experience boredom, and that that boredom can be detrimental to their health. The boredom that they experience, however, often has to do with perils of aging: loneliness, immobility, and declining faculties.

I doubt anyone would advocate that we euthanize everyone over 80 because they might suffer from boredom. Finding interest in new activities, engaging with curiosity, and experiencing excitement, joy, and contentment are all pillars of mental health. Boredom, itself, is a health issue, and not necessarily a reason to prevent life extension.

Weve all seen those dystopian sci-fi stories.

While the rich lead lives of unimaginable luxury in their space stations, enjoying near-immortality and all the sexbots they can afford, the poor toil in the spice mines below, dying early from Spice Lung or malfunctioning cheap cybernetic implants.

No one wants to live in that worldand not just because it would entail having to endure more of Matt Damons terrible acting.

And with rising concerns about wealth inequality, its entirely understandable that many people ask the question:

What if only the rich can afford life-extension treatments?

Because while global wealth inequality has actually been declining for the first time in two centuriesdue largely to the rapid economic growth afforded by technological innovation and the opening of markets, particularly in Asiasome measures of wealth inequality within countries have shown worrying rises.

So is it ethical to pursue life extension if its not accessible to everyone?

A 2016 study found that, The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years for men and 10.1 years for women.

However, it may not be as bad as it seems.

A more recent study that took into account income mobility (instead of assuming people kept the same income their entire lives) found a gap of only 2.4 years for men with different income levels, and just 2.2 years for women.

They did also caution that though the gap is not as large as originally thought, it has been widening slightly over the last 30 years, possibly due to differences in education levels.

In short: yes, there is already a (small) gap in the longevity of the rich versus the poor.

Will expensive life-extension treatments widen that gap so much that the poor will be doomed to die early?

The answer to that question has several components:

To answer that first component we can look at some real-world examples, both of existing anti-aging treatments already on the market, and of past medical innovations.

For instance, the diabetes drug metformin is a classic candidate for a possible anti-aging pill. According to a recent metformin meta-analysis, Diabetics taking metformin had significantly lower all-cause mortality than non-diabetics, and a host of other studies have shown other beneficial effects of the drug, like cancer protection and slower brain aging.

And the cost of this possible wonder drug?

According to GoodRx, retail costs for 60 tablets of 500mg of metformin (a 1-2 month supply) range from $9 to $16, even without insurance.

Thats about 15-25 cents a pill.

Other potential life-extension molecules are similarly cheap.

Resveratrol, another possible longevity compound, can be bought on Amazon for $16.99-$27.99 for a 30-90 supply .

Glucosamine costs as little as ten cents a pill, has been the subject of several recent studies showing it decreases all-cause mortality by as much as 39%, and may be as effective for longevity as exercise.

Aspirin (shown to extend life in male mice) costs $1 for 100 pills at my local Rite Aid.

And the list goes on.

All the ones listed above have been known about and studied for decadesin some cases over a centuryis there evidence that newly discovered and developed drugs would be similarly inexpensive?

Its likely. Take vaccines.

Vaccines are a good parallel to anti-aging medicines because they are developed to treat a deadly, widespread disease that impacts large swaths of the human population and they thus have a huge demand and a requirement to distribute to the most people possible. Both also represent huge net benefits to society compared to the costs of not treating the diseases they target (some research indicates slowing aging could save the U.S. $7.1 trillion over 50 years).

Developing a vaccine can cost as much as $2.8-$3.7 billion and yet many vaccines, including those for the most widespread diseases, are offered free-of-cost or at very low prices. For example, the flu vaccine is often free and almost always fully-covered by insurance.

Other vaccines can be had, even without insurance, for as low as $6.

Most of these vaccines have been developed only in the last few decades, and yet their cost is low enough that almost everyone can afford them. The combination of widespread demand and subsidies means that usually the obstacle to getting a vaccine is a lack of education or of desire, not of financial means.

And theres good reason to think new anti-aging treatments may be treated like vaccines. If the FDA labels aging a treatable disease (which may well happen), and since fully 100% of the population is afflicted by this disease, demand for effective longevity treatments will be so high that medical and pharmaceutical companies can afford to set prices low, since they will be selling their products to so many people.

But of course, there may be many different types of therapies and interventions that are developed to reverse and slow aging, and not all of them will be as simple or cheap as a pill or a shot.

What if more complex interventions are needed to reverse aging?

Things like gene therapy can cost millions of dollars. In fact, theres already an (unproven) gene therapy for aging on the market, similar to the procedure longevity influencer Liz Parrish of Bioviva performed on herself in 2015, and its price tag is $1 million.

Not exactly pocket change.

So lets look at how likely expensive longevity treatments are to stay expensive, such that only the wealthy can afford them.

In the last 17 years, the cost to have your whole genome sequenced has gone from roughly $1 billion in 2003, to as low as $299 today.

And most technological innovation follows this same pattern.

First an experimental, expensive innovation is developed. Wealthy early-adopters buy it (think investment bankers and car phones back in the 80s), and their purchases fund the research and development needed to improve the innovation, better distribute it, and make it less expensive. Soon, every person who wants one can afford it, and at a much higher level of quality than the original that was available only to the rich.

High initial prices of a new product are thus almost an extended form of R&D funding (and clinical testing with data provided by early adopters). The rich are essentially paying the money necessary to further develop the product and get it to the masses. What the rich pay for with money, the poor pay for with time.

Its the reason the smartphone in your pocket only costs a couple hundred dollars, and you dont need to lug a car around to use it.

Its also the reason your Apple Watch isnt the size of a room, and yet can do way more health monitoring than the early electrocardiogram machines could (and at a significantly lower price).

In fact, Elon Musks business model for Tesla was explicitly written around this principle. He designed and built an impractical, expensive electric sports car (the Roadster) and sold it at exorbitant prices to the rich, in order to fund the research and development of his more affordable mass market car, the Model 3.

And the medical market is little different from the car market (or other technology markets) in this respect. Despite lots of hand-wringing about rising medical costs, especially in the United States, most of the increase in cost is due to increased consumption, not an increase in the cost of individual medical procedures, devices, or medicines themselves (obviously there are exceptions that get lots of media coverage, but in general this is the case). As we get wealthier, it turns out, we want to buy more medical care.

Intuitively, anti-aging medicine should even help lower the total cost of medical care for people, as individuals will have to spend less on treating the very expensive chronic diseases of old-age like Alzheimers or cancer. These health-cost savings from longevity medicine are often referred to as the Longevity Dividend.

Contrary to popular belief, the real money in almost any market is not in selling boutique treatments to a few billionaires, but selling commercialized interventions to the millions (and, globally, billions) in the middle and lower classes.

Globally, the middle class accounted for $35 trillion in consumer spending, and the lower class another $8 trillion, for a combined spending power of $43 trillion. The rich (those spending over $110 a day) accounted for only $11 trillion in total consumer spending.

Globally, the middle class accounted for $35 trillion in consumer spending, and the lower class another $8 trillion, for a combined spending power of $43 trillion. The rich (those spending over $110 a day) accounted for only $11 trillion in total consumer spending.

All else equal, which market would you rather develop an anti-aging product for?

But of course, despite all this there is still a slim chance that life-extension therapies could buck every historical, technological, and market trend ever observed and somehow remain insanely expensive forever.

So if anti-aging medicines and treatments turn out to be one of those rare types of goods that will only ever be available to the super wealthy, is it moral to ban them or prevent their development?

This philosophical question can be addressed from any number of different frameworks. Its an age-old ethical question: should some people (like the rich) be afforded more opportunities than others (like the poor)?

Bioethicist John Harris offers a utilitarian perspective: If immortality or increased life expectancy is a good, it is doubtful ethics to deny palpable goods to some people because we cannot provide them for all.

Harris further analogizes, We cannot and should not seek to prevent the development of [longevity treatments], any more than we should deny kidney transplants because there are not enough kidneys to go aroundin other words, we should develop life-extension even if we cannot provide it to everyone.

Philosophy professor John Davis, in The American Journal of Bioethics, argues that,

We accept the general principle that taking from the Haves is justified only if doing so makes the Have-nots more than marginally better off. If life-extension is possible, then one must weigh the life-years at stake for those who receive the treatment against whatever burdens making such treatments available might impose on the Have-nots, who cannot afford the treatment.

The greatest burdenis that ones death is worse the earlier one dies relative to how long it is possible to live. For example, a death at 17 is much worse than a death at 97. Because life extension changes how long it is possible to live, life-extension will make death at 97 tragic in a way it has never been beforeHoweverwhen this burden is compared to the number of additional life-years the Haves will lose if life-extension is prevented from becoming available, the burden to the Have-nots is marginal compared to what is at stake for the Haves. Therefore, Inhibiting the development of life-extension is unjustified, even though it will probably not be available to everyone for a long time.

In other words, if life-extension research alleviates aggregate suffering even a little, even if only for the wealthy, anti-aging treatments are a moral good.

The rest is here:
6 Pros and Cons of Immortality: The Ethics of Life Extension

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