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BOOK REVIEW |
International Longevity Center-USA 60 E. 86 Street New York, NY 10021
Aging, Death, and Human Longevity: A Philosophical Inquiry, by Christine Overall. University of California Press, Berkeley, CA, 2003, 276 pp. $44.95 (cloth).
Enough: Staying Human in an Engineered Age, by Bill McKibben. Times Books, New York, 2003, 288 pp., $25.00 (cloth).
Redesigning Humans: Choosing Our Genes, Changing Our Future, by Gregory Stock. Houghton Mifflin, Boston, 2003, 277 pp., $14.00 (paper).
The Future Is Now: America Confronts the New Genetics, edited by William Kristol and Eric Cohen. Rowman and Littlefield Publishers, Lanham, MD, 2002, 355 pp., $19.95 (paper).
In March 2003, at precisely the moment when the United States was beginning the war with Iraq, the President's Advisory Council on Bioethics (2003) offered guidance not on war but on another pressing public issue of the day: whether it would be a good thing for human beings to live longer, a lot longer, maybe even achieve immortality.
Immortality? Somehow the news media missed this story, perhaps preoccupied with the all-too-real mortality involved in going to war. But why would a learned government advisor, Dr. Leon Kass, Chairman of the Bioethics Council, spend time arguing whether human immortality was desirable? Isn't this an example of philosophers engaging in ridiculous debates?
Debating Immortality
When I was in graduate school specializing in medieval philosophy, I finally learned why medieval philosophers took seriously the question about how many angels could dance on the head of a pin. Today we dismiss that question as a sign of the ridiculous topics taken up by philosophers. But the Scholastic debate in its own day was a serious dispute. It was part of a deeper philosophical question we recognize today as the mind-body problem: namely, how can an immaterial substance (mind) be related to spatial extension (body)? The question is still very much with us (e.g., in the field of artificial intelligence and cognitive science). It is not a question to be dismissed at all.
Similarly, the broader public, and perhaps even gerontologists, may think it's ridiculous to debate the question "Would enhanced human longevity—even immortality—be a good thing?" Don't we all want to live longer, maybe even as long as possible? But the question only seems ridiculous because fear of death has been nearly universal and world religions have appealed to immortality as our deepest wish. Why then should ethicists now question whether immortality is a good thing in the first place? The answer is that contemporary advances in biotechnology, for the first time, are making life span extension—or prolongevity—a matter, not of religious aspiration but of human choice. The collective choices made in biotechnology will affect all of us and will decisively shape what becomes of aging in the 21st century. We'd better take the question seriously (see Juengst, Binstock, Mehlman, & Post, 2003).
But there's something weird about this whole "debate." Leon Kass's arguments about immortality—or, in more incremental terms, life span extension—are best viewed as a kind of shadow boxing, a proxy debate. Think about the way that opponents of abortion have argued vociferously against experiments about cloning. They favor, or oppose, one thing because it stands for something else. In the same way, the debate about life span extension, or prolongevity, should be seen as a kind of shadow boxing that disguises genuine political debates such as the following:
I regard all three issues—generational equity, stem cell research, and anti-aging medicine—as significant political questions. Politics is about who gets what, when, and how (Lasswell, 1958). Or, as one wit put it, "politics ain't beanbag": in other words, it's deadly serious business. So we had best take these disputes seriously, in the same way as we have learned to take seriously the argument about when human life begins (abortion) or when it ends (euthanasia and assisted suicide).
Gerontologists in particular need to take the emerging issues of prolongevity more seriously. Arguments about generational equity, stem cell research, or regulation of anti-aging medicine are already debates with huge implications for Medicare, the NIH budget, and the future of biotechnology in America. Far from being angels dancing on the head of a pin, this shadow boxing will have real consequences for us and for our children's children. To appreciate the magnitude of these debates, look at the excellent treatment of biotechnology and contemporary life span extension efforts documented in Stephen S. Hall's (2003) Merchants of Immortality: Chasing the Dream of Human Life Extension. But Hall's book is a narrative account, not an inquiry into whether we should be pursuing life extension in the first place.
In this brief space, I will consider several books helpful for gerontologists to understand debates about life span extension, which I will henceforth label prolongevity. This term, which is not in common use, comes from Gerald Gruman's (2003) book, A History of Ideas About Prolongation of Life. The books reviewed in this essay are Gregory Stock's Redesigning Human: Choosing Our Genes, Changing Our Futures; Bill McKibben's Enough: Staying Human in an Engineered Age; Christine Overall's Aging, Death and Human Longevity: A Philosophical Inquiry; and William Kristol and Eric Cohen's The Future Is Now: American Confronts the New Genetics.
Stock and McKibben are opposing bookends in the debate over prolongevity. Stock believes that humanity is on the verge of scientific breakthroughs that could permit dramatic extension of the human life span and the abolition of aging as we know it. McKibben, like Leon Kass, believes that biotechnology, including prospects for prolongevity, threatens our integrity as a species and could do damage to the meaning of human existence. Christine Overall, a philosopher writing from a feminist perspective, believes that longer life is a good thing but must be balanced by deeper appreciation of claims for social justice that demand philosophical argument. And Kristol and Cohen have edited a volume in which politicians, celebrities, and public intellectuals express their views on cloning.
Redesigning the Life Course
Just how likely is it that we could radically extend maximum human life span—that is, could we see a world where humans routinely lived to be, say, 150 instead of 120 years of age? Reputable scientists differ on this question. But the prospect is enough to have provoked serious debate in learned scientific journals and to have evoked controversy in the field of gerontology (Binstock, 2003; Cole & Thompson, 2001–2002). Beyond forecasting or technology assessment, there is a philosophical question: Is it really desirable to dramatically extend the human life span? In popular books, Bill McKibben and Gregory Stock answer this question in opposing ways.
McKibben's Enough is an exercise in what traditionally was called "philosophical anthropology," namely, a meditation on what it means to be human. McKibben is worried about new technologies, such as genetic engineering, robotics, and nanotechnology. These innovations, he believes, could threaten our existence as a species. Some of his fears are akin to what environmentalists conventionally worry about: for example, that tiny, unrestrained nano robots will get out of control and envelop the world in "gray goo" that destroys all life on earth—the ultimate toxic waste spill on a planetary scale.
But other fears are more philosophical in nature, closer to what Bill Joy (2000) worried about in a classic article in Wired magazine titled "The Future Doesn't Need Us." McKibben is concerned that genetic technologies may lead us to enhance human traits to a point where we cease to be human. Instead of a techno-utopian future, McKibben wants us to accept limits, and he argues, like Leon Kass, that the very meaning of human life lies in our finitude. Finitude ("Enough!"), then, is the motif of McKibben's book, and that's the reason he rejects a pain-free world of enhanced, nearly immortal human beings promised by the prophets of the techno-utopian future. Although McKibben does not spend much time worrying about prolongevity, it is clear enough that the search for technologies of life span extension would not meet with his approval. Enough is enough, we should simply say.
Stock's Redesigning Humans brings exactly the message that would horrify McKibben. Stock's basic assumption is that humanity's future is "inevitable." His book is subtitled Choosing our Genes, Changing Our Future but his message is not one of choice so much as destiny—accepting what is inevitable. Just as the human race has gradually attained greater power over the natural environment, so in time humanity must take control of its own biological evolution and destiny. The idea is simply that once certain technologies are discovered, we will have no choice but to use them, and hence to enhance and then redesign the human species. The path toward this goal will come through specific interventions such as embryo selection, cloning, transgenic development, and, most ominously, germline modification, innovations that will decisively change the genetic character of the species.
Stock's view is that application of these new genetic technologies is not only inevitable but desirable, indeed something to be greeted with enthusiasm. Does this claim sound familiar? It should. Stock's endorsement of technology resembles other claims of historical inevitability, for example, the transition from utopian socialism to Marx's historical determinism. The train has left the station; the future is here. But "enhancement" technologies, as Stock describes them, are precisely what Leon Kass is most afraid of, namely, a means by which humanity will eventually cease to exist. Indeed, a whole school of futurist prophets who call themselves "transhumanists" have explicitly rejected the idea that humanity represents a value to be celebrated or cherished as a pinnacle of cosmic evolution. On the contrary, human nature, for transhumanists, is something to be transcended, as Nietzsche evoked in his image of the "Over-man" (Ubermensch) or as Soviet ideologists evoked the image of the "New Man." Alas, the history of the 20th century—including both Nazi and Communist totalitarianism as well as proponents of eugenics in America—is a dismal story of this appeal for transcending "ordinary" humanity in favor of something better.
But let's note that Stock's argument is based on two assumptions: first, that application of transhumanizing technologies is "inevitable" and, second, that it is "desirable." We can question and disagree with both assumptions. Are there examples of technologies that seemed "inevitable" but were, in fact, spurned by human beings? Yes, the supersonic transport aircraft (the late lamented Concorde) was rejected by Americans (and subsequently abandoned by the British and French). The use of gas in warfare was avoided by all parties during World War II. The future of humans in space, which once seemed "inevitable," is now very much in question. Nations in the European Union have decisively rejected human cloning (and not on the same grounds that anti-abortion proponents in the United States have done so).
Stock is enthusiastic about prolongevity. He hopes that success in germline engineering will lead to slowing or reversing the process of biological aging in laboratory animals. Such success, he argues, could bring a shift in public opinion and help undermine today's sharp distinction between aging and disease. We would then come to recognize aging itself as a disease and a syndrome which is potentially "curable." Enhancement technologies, in Stock's account, will hopefully lead to a "war on aging," exactly the same agenda that proponents of anti-aging medicine have been calling for (see Binstock, 2003).
Despite Leon Kass's brooding about immortality, politicians and pundits aren't exactly falling all over themselves to debate prolongevity. But they are weighing in with opinions about advances in biology that could lead to life extension in the future, such as the new genetics of cloning and stem cell research that may give rise to regenerative medicine in the future.
Kristol and Cohen's edited collection, The Future Is Now, is probably the best source imaginable to find "everything you ever wanted to know about cloning" between two covers. It's a collection of articles that appeared mainly as op-ed pieces in newspapers, testimony in Congress, or in other periodical literature. If you really, really want to read what Orrin Hatch or Dennis Kucinich had to say about cloning, you'll find it here. Some pieces, such as Michael J. Fox's letter to the New York Times, seem more worth saving in a filing cabinet instead of in a book. But others, like Leon Kass's essay "Why Not Immortality?" are likely to be of perennial importance. The editors are nothing if not comprehensive in their coverage of what talking heads have to say as America confronts the new genetics. The senior editor, William Kristol, was once called "Dan Quayle's brain." So I would have appreciated a bit more brain power at work in selecting only the best from this vast clipping file. Still, if you want the whole story, you'll find it here. Unfortunately, there's little on life span extension, the issue of most interest to gerontologists. But aging research in the years ahead will be profoundly shaped by the science of stem cells, so this book does have its virtue as a one-stop-shopping site for readers who need the big picture.
We need this big picture in order to make reasonable judgments about the new genetics and their impact on human life. One puts aside Gregory Stock's book a bit impatient with his breathless enthusiasm and more and more curious about whether the author has seriously thought about unanticipated consequences of new technologies, including prolongevity. McKibben, by contrast, thinks all too much about unanticipated consequences. His fears about nano robots taking over the world could turn out to be true. But does that mean it's a bad thing for people to live into advanced old age or even push the limits on maximum lifespan? When we raise a glass to toast long life ("L'Chaim!"), do we also have to add "but not too much?" Where is the serious philosophical argument about where to draw the line?
From Here to Forever: A Philosophical Account
It is just at this point that a philosopher comes to the rescue with a thoughtful meditation on both sides of this ongoing debate. Philosopher Christine Overall opens her book, Aging, Death and Longevity, with a simple question. Acknowledging the tremendous gains in longevity in the 20th century, she asks, "To die at seventy or eighty or ninety seems better than dying at thirty or forty or fifty. If so, could it be even better to die at 100, 110, or 120?" She thinks it could be better to live longer, and so she comes down on the side of a (qualified) endorsement of prolongevity. But she understands all too well that the aspiration to living ever longer lives raises far-reaching questions: "What sorts of persons should we human beings seek to become? What kinds of lives should we live, and how, if at all, is the length of our lives related to what is possible and what is desirable for us?"
Overall wants to ask the questions that scientists and policy makers rarely get around to asking. The issue is not simply should we encourage more people to reach old age (an accomplishment of the 20th century) but whether it is wise to deliberately extend the lives of people who enjoy reasonable health and want to live longer, enabling old people to get even older. Following the work of Gerald Gruman, she contrasts two major positions in Western thought: apologism (prolongation of life is neither possible nor desirable) and prolongevity (the more the better). Contemporary apologists include Kass and Daniel Callahan, and Callahan comes in for much criticism by Overall in this book. The origins of scientific prolongevity go back to Francis Bacon (and earlier), and it remains a vigorously promoted strategy today, especially by figures like Aubrey de Grey, who believes that science may soon be capable of "engineered negligible senescence" (de Grey et al., 2002).
Overall's book is especially helpful for its sensitive historical treatment of its subject. For example, she traces the origins of apologism back to ancient philosophers like Epicurus and Lucretius and treats their arguments, and Callahan's, with serious attention, though she rejects them firmly. She specifically rejects arguments that try to show that very old people may have a "duty to die," an approach publicly promoted by former Colorado Governor Richard Lamm but argued in serious philosophical terms by figures like John Hardwig and Margaret Battin. Overall carefully considers arguments for prolongevity and finds that some, but not all, are successful. She has a fascinating chapter on immortality, considering carefully what this might mean for human beings. One of the strongest elements in Overall's book is her treatment of social justice and the implications of apologism or prolongevity agendas for vulnerable groups in society.
For gerontologists the great merit of Overall's treatment is not whether one side of this argument should prevail but what the argument tells us about an aging society today: "The debate about prolongevitism and apologism should motivate us to rethink social arrangements and the limits now placed on the development of human potential" (p. 40). If human beings could live to be 150 or 200 years old, what would that mean for our approach to education or careers or marriage? These "thought experiments" are worth undertaking because we face similar issues when we think about larger numbers of people now living to 90 or 100 years of age. If we are in favor of "more old age," as gerontologists might be expected to be, for what reason are we so eager to extend life?
As a philosopher, Overall is interested in digging deeper into our assumptions and to trace out implications of different positions. She believes, with good reason, that "an investigation of issues of human longevity inevitably raises issues about the meaning of human life" and her book is extraordinarily stimulating for that reason. She is insistent in rejecting cost-benefit arguments ("Old people are too expensive") but never simple-minded in thinking that adding years to life is simply a self-evident good thing. Again and again, she asks deeper questions and refuses to accept easy answers. Overall's book represents the very best we could ask for in a philosophical approach to gerontology.
Waiting for the Millennium
Philosophy, as a discipline, invites us to ask, again and again, the biggest questions of all. Toward the end of his life, Kant summarized the three basic questions of philosophy as these: (1) What do I know? (epistemology); (2) What ought we do? (ethics); and (3) What may I hope? (art and religion). Overall's treatment of prolongevity gives a powerful and persuasive answer to Kant's third question. Specifically, she has offered deep philosophical insight into the question of why longer lives might be better lives: This is the foundation for her qualified "affirmative prolongevity" position. What Overall has not done is to provide a basis for answering Kant's first two questions, which are actually the most pressing in practical and political terms: (1) How could we possibly know that putative prolongevity technologies actually work (and with what side-effects)?; and (2) What are the ethical issues that arise should societies begin to move, even incrementally, toward prolongevity technologies?
First, consider the epistemological problem. It is not at all obvious how scientists, philosophers, or citizens would know if we had a prolongevity technology at hand. The reason for uncertainty comes because we have no definitive biomarkers to measure the rate of aging in humans. Suppose we had, for the sake of argument, a safe and effective prolongevity intervention, a "magic pill" with results comparable to those achieved by dietary caloric restriction in lower organisms (approximately 30% gain in maximum life span, longer average life expectancy, and compression of morbidity). Such an intervention would mean that human beings would live not to a maximum of 120 years but 150 years, mainly in good health. It would be an extraordinary development in human history.
But how would we know that we had achieved this goal? Absent any biomarkers, we would know it the same way we prove the efficacy of caloric restriction in lower organisms: through a kind of actuarial process where we find out, empirically, how long the animals live. That is exactly the experiment underway right now, with NIA support, among chimpanzees, whose maximum life span is around 55 years. It's been more than a decade since these experiments began and it may be several more decades before we know that caloric restriction does works for chimpanzees. We will know it, if we do, only empirically and in actuarial terms, that is, by counting how long the chimps survive, how many survive to advanced age in good health, and so on.
What would a comparable experiment involve in human beings? Even with a large human sample (itself a practical and ethical problem), we would have to wait for many decades to find out how many humans survived beyond age 120. During that time, we would be monitoring our sample for unintended side effects of the prolongevity intervention, just as we do, say, for human growth hormone or any of the other purported anti-aging treatments (which often turn out to have serious side effects).
So the very first problem facing any prolongevity technology is epistemological: How we do actually know that it works? Absent reliable biomarkers, it will be a long time before we can answer this question—maybe even long enough time to come with answers to the philosophical problems of prolongevity. Claims that prolongevity remedies are at hand need to be greeted with great skepticism because it will take a long time to know whether any intervention actually works. As with the technology of interstellar space travel, the technology of prolongevity may one day prove itself, but time itself will be a challenge for us.
The problem gets worse when we move on to Kant's second question: What ought we to do? Should we allocate large new scientific resources right now in a heroic attempt to produce a prolongevity technology breakthrough? What other priorities will we overlook in such an attempt? And if we do succeed, how then will we decide how who will have access to it? Overall is not inclined to explore these questions in any detail. Instead, she prefers to stipulate (her term) that a successful prolongevity technology would be accessible to all, thus bypassing questions of distributive ethics.
Overall is certainly within her rights to make that stipulation. In fact, her argument becomes interesting when she does so because she is able to consider all sorts of fascinating consequences for a society of very long-lived humans. She is engaged in what philosophers call a "thought experiment," and this methodology serves her well, like laws of ideal gases in physics, which are useful for simulating hypothetical situations. Precisely because she engages in this imaginative construction of human immortality she is able to offer powerful insights into Kant's third question, causing us to be uncertain whether immortality, long dreamed of, would actually be a desirable thing at all. But she does not give us much practical guidance about what to do in the meantime until the millennium arrives.
My problem with three of these books—Overall's elegant philosophical argument, Stock's utopian biotechnology, and McKibben's ecological meditations—is that I find it difficult to make a translation from grand, first-order principles to second-order political judgments about what to do. For example, what answer do we give to the following questions, questions that ought to be of concern to gerontologists:
These second-order political questions are pressing. Congress will come up with answers, no matter what philosophers or futurologists may say. But it's not clear how, for instance, the environmentalist's Precautionary Principle (McKibben) or a qualified endorsement of prolongevity (Overall) will help us make the kind of political judgments we need to in particular near-term cases. Unfortunately, McKibben, Stock, and Overall do not give us much guidance in "translating" first-order philosophical ideas into second-order prudential judgments.
Perhaps here is exactly where gerontologists could help advance the dialogue. The appropriate contribution should not be a knee-jerk response (e.g., to denounce Dan Callahan or endorse therapeutic cloning) but a response that draws both on empirical research and on what we have learned about the changing meaning of age and aging. We need less shadow boxing and staking out rhetorical positions and more thoughtful consideration of how the intimations of prolongevity are already affecting our politics, our social arrangements, and our image of the future. The debate on these questions has barely begun.
References
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