Wednesday, November 22, 2017

A debate on the pros and cons of aging and death.

I want to pass on the final comments from a debate between Allen Frances (a professor emeritus at Duke University who was the chairman of the DSM-IV task force) and his grandson Tyler, who participates in genetics and stem cells research relevant to extending lifespan. Frances’ article gives a point by point summary of their ongoing debate, and is well worth reading.
There is a disturbing myth from ancient Greece. Aurora, the immortal goddess of the dawn, falls so deeply in love with a mortal man that she cannot accept losing him to death. She pleads successfully with the Olympian gods to grant him immortality, but forgets to request that he also be gifted with perpetual youth. Her human lover Is thus punished with the worst of fates- interminable life, daily made more intolerable by progressive aging and deterioration. Jonathan Swift illustrated the same chilling issue in Gulliver’s Travels and also tragically in his own long, tortured, and undignified death from dementia. 
Modern medicine has cursed an increasing percentage of our aging population to suffer this miserable fate- an artificially prolonged life preventing a natural and peaceful death. Medicine is, so far, much more advanced in keeping elderly people alive than in keeping them well. Our goal should be enhanced health, not a longer existence if that existence is painful and has lost all meaning. Medicine should help people live well, but also let them die peacefully and with dignity. 
Tyler is much more optimistic than I that we will soon have the technical means to prolong youth and postpone death- and that we should use them. I am more accepting of the limits of life- eager to improve its quality, rather than expecting to extend its duration. Tyler trusts scientists to make scientific decisions. I believe that scientists have conflicts of interest that make them uniquely unqualified to judge the ethical implications of the scientific opportunities open to them. If scientists can do something, they will do it- fairly heedless of unintended consequences. Tyler has the optimism and enthusiasm of the young. I have the pessimism and caution of the old. 
In a final flourish, Tyler trumped my argument that aging and death are somehow natural to the evolutionary scheme of things with the paradox that evolution has also given us the power to control aging and death and that surely we are programed to use it.
He is probably right. I don’t think our debate will be settled on ethical or theoretical grounds. History provides precious few examples of a society voluntarily rejecting the application of a powerful new technology- e.g., China burning its navy in the fifteenth century; Japan banning guns in the seventeenth. But both were closed societies whose conservative decisions were governed by internal political concerns; they were much less responsive than ours to economic and scientific competition and pressure. 
My guess is that scientists will be given the freedom and the funding to follow every possible path to the fountain of youth and to doubling the lifespan.
If they succeed, some chosen few of humanity will enjoy great benefits, while the masses may suffer even more than they do today and our environment may decay even faster than it already has. But I find aesthetic comfort in the firm belief that the scientists won’t be able to deliver on their extravagant promises. Although our knowledge base is increasing exponentially, the more we learn about the body, the more we appreciate how difficult it is to translate basic science into clinical application. Our bodies are remarkably complex and carefully balanced machines. Scientists can tinker with them, but I suspect that the basic cycle of life and death will be very hard to change.

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