"Early death, disease, disability: pro or con?"
How could someone seriously be in favor of early death, disease, and disability? Ask Francis Fukuyama, professor of international political economy at Johns Hopkins University's School of Advanced International Studies and author of Our Posthuman Future: Consequences of the Biotechnology Revolution.
"Early death, disease, disability: pro or con?" is how Fukuyama characterized what was at stake in our recent debate on the ethics of dramatically extending human lifespans. (The debate was sponsored by the American Association for the Advancement of Science and the Alliance for Aging Research in Washington, D.C., as part of their Science of Aging Crossroads policy forum. The full debate is available as a webcast or transcript at the SAGE Crossroads Web site.)
He may not openly love death, disease, and disability, but Fukuyama is very, very worried about the effects that a biotech revolution leading to longer lifespans might have on human beings. And he does take seriously the arguments made by intellectuals strongly in favor of mortality. For example, Leon Kass, the chairman of the President's Council on Bioethics, has asserted, "The finitude of human life is a blessing for every individual, whether he knows it or not." Or listen to out-of-the-closet thanatophile Daniel Callahan, co-founder of the bioethics think tank the Hastings Center, who has declared, "There is no known social good coming from the conquest of death."
What worries Fukuyama about longer human lifespans? Chiefly three things. First, he fears that our efforts to extend human life will create a nursing home world, filled with aging, miserable, debilitated people draining resources from the young to keep themselves alive. Second, he worries about the social consequences of longer lifespans and finally, he thinks that the "quest for immortality" will undermine our very humanity.
Let's tackle these worries. In defense of his fear of a nursing home planet, Fukuyama points out that as many as 50 percent of those who reach age 85 may have Alzheimer's disease. Of course, this disease is terrible, but keep in mind that the National Institutes of Health point out that Alzheimer's "is not a normal part of aging."
Our already successful efforts to lengthen life have led to the increase in Alzheimer's disease, because people are now living long enough to get the disease. Yes, Fukuyama has medical science dead to rights: Our efforts to lengthen life by preventing or curing disease have been spectacularly successful. According to the January 19, 2003, New York Times, statisticians at the National Institutes of Health "calculate that if death rates were the same as those of 30 years ago, 815,000 more Americans a year would be dying of heart disease and 250,000 more of strokes." As horrible as Alzheimer's disease is, the fact that millions of people now live long enough to get it represents a real benefit: the additional years of healthy life they had in order to get old enough to contract the disease in the first place.
The cutting edge of medical life-advancing technology could slice through Fukuyama's nursing-home fears by aiming directly at preventing aging, not just ameliorating the diseases such as cancer, Alzheimer's, and heart disease that often accompany it. The point of aging research is not to make us older longer, but to make us younger longer.
Now for Fukuyama's second fear, of the unbearable social consequences of extending lifespans. Specifically, he made the curious argument that "life extension seems to me a perfect example of something that is a negative externality, meaning that it is individually rational and desirable but it has costs for society that can be negative."
Living longer as a negative externality to society? For a man who has a very sophisticated understanding of political philosophy, this argument is surpassingly strange. After all, philosopher Thomas Hobbes made the point in his Leviathan that individuals form society for the purpose of making sure that their lives are not "solitary, poor, nasty, brutish, and short." In other words, individuals do not exist for society—society exists for the happiness of individuals.
Fukuyama needs to keep in mind that past generations have already chosen to more than double average human life expectancy over the past century. Our ancestors, that is, our grandparents and parents, did not ask our permission to do so; they just went ahead and did it. It is unlikely our descendents will have any more reason to regret our decision than we have to regret our forebears'.
Fukuyama also worries about how to dislodge set-in-their-ways geezers clinging to the top positions in our society if they live much longer than they already do. Actually, our society is already organized to do just that. Consider that Bill Gates didn't work his way up the ladder at IBM; he started his own company before age 40. Or that human genome sequencer Craig Venter didn't wait his turn to become head of the National Institutes of Health. He went out and created the Institute for Genomic Research, Human Genome Sciences, and Celera. Our society already makes sure that dead wood gets cleared out pretty regularly. Sure, longer average healthy lifespans will create novel social problems, but I suspect that most people would be happy to cope with them.
Fukuyama's final concern is that we are undermining human nature by extending lifespans. He worries that people will be "eager to continue his or her mediocre life for as long as possible without worrying about some of these higher questions about what life is used for." His comment mirrors one from the president's favorite bioethicist Leon Kass, who said in The Washington Post, "The pursuit of perfect bodies and further life extension will deflect us from realizing more fully the aspirations to which our lives naturally point, from living well rather than merely staying alive."
Setting aside Fukuyama's and Kass' harsh judgments of the characters of their fellow human beings, they offer a false dichotomy. To live well, one must first stay alive. I seriously doubt that people granted longer lives will fritter away their extra time watching reruns of Gilligan's Island (though some might, and it would be their business). Instead, they may well engage in longer-run projects such as ecological restoration or space exploration.
Finally, Fukuyama ignores that the effort to extend lifespan is a perfect flourishing of a uniquely human nature. The highest expression of human dignity and human nature is to try to overcome the limitations imposed on us by our genes, our evolution, and our environment. Future generations will look back at the beginning of the 21st century with astonishment that some very well meaning and intelligent people actually wanted to stop biomedical research just to protect their cramped and limited vision of human nature. They will look back, I predict, and thank us for making their world of longer, healthier lives possible.