[Ethical and social consequences of biomarkers that predict impending death in humans]. / Conséquences éthiques et sociales de biomarqueurs prédictifs de la mort chez l'homme - La vieillesse et la mort, problématiques comportementales et sociétales.

Fundamental research on ageing has taken an interesting turn in recent years with the rapid development of biomarkers predicting mortality in model organisms, particularly Drosophila, as well as in humans through improvements in approaches to the identification of circulating molecules in mass. These developments lead to a shift in our ability to predict the occurrence of death from the historically population level to the individual level. We question here the ethical, medical and social implications of this change of scale.

TITLE: Conséquences éthiques et sociales de biomarqueurs prédictifs de la mort chez l'homme - La vieillesse et la mort, problématiques comportementales et sociétales. ABSTRACT: La recherche fondamentale sur le vieillissement a pris un tour intéressant ces dernières années avec un développement rapide des biomarqueurs prédictifs de mortalité chez les organismes modèles, notamment la drosophile, ainsi que chez l'être humain à travers les améliorations des approches d'identification en masse de molécules circulantes. Ces développements conduisent à un déplacement de notre capacité de prédiction de survenue de la mort, du niveau historiquement populationnel au niveau individuel. Nous interrogeons ici les implications éthiques, médicales et sociales de ce changement d'échelle.

What if there's no such thing as "aging"?

Are diseases caused by aging? What are the mechanisms of aging? Do all species age? These hotly debated questions revolve around a unitary definition of aging. Because we use the word "aging" so frequently, both colloquially and scientifically, we rarely pause to consider whether this word maps to an underlying biological phenomenon, or whether it is simply a grab-bag of diverse phenomena linked more by our mental associations than by any underlying biology. Here, we consider how the presence of the colloquial word "aging" generates a cognitive bias towards supposing there is a unitary biological phenomenon. We ask what kind of evidence would support or refute that idea, and subsequently show clear evidence at multiple levels that aging is not a unitary phenomenon. In particular, the known aging pathways lead to heterogeneous outputs, not a single coordinated phenomenon. From levels ranging from cellular/molecular to clinical to demographic to evolutionary, we show how the supposition that aging is a unitary phenomenon can mislead and distract us from asking the best questions. For major sub-disciplines of aging biology, we show how going beyond the notion of unitary aging can hone the paradigm and help advance the pace of discovery.

Professional and personal attitudes of researchers in ageing towards life extension.

It is often assumed that there is broad public support for strong life extension research (i.e. research aimed at the dramatic extension of human life beyond the current maximum), and that there would be a near universal interest in using any life extending technologies that this research may produce. In this paper we report the opinions of researchers in ageing on the controversial promise of life extension, and compare these views. This paper describes the professional attitudes, personal interest and concerns expressed by Australian and international researchers in ageing (n = 14) as expressed during semi-structured, in-depth interviews. Researchers held varying opinions about the possibility of significantly extending human life. Some saw a limit to the extension of human life, while others did not. Some felt that research into the fundamental ageing process was a priority; others did not. Researchers tended to weigh up the potential risks and benefits of life extension with most expressing a personal interest in life extension that was contingent on the technology providing a good quality of life. Some participants were not interested in the prospect of life extension for personal reasons, because they felt the potential risks outweighed the potential benefits, or because life extension raised issues of justice and equity.

The fair innings argument and increasing life spans.

The fair innings argument maintains that for healthcare resources to be distributed fairly every person should receive sufficient healthcare to provide them with the opportunity to live in good health for a normal span of years. What constitutes a normal span of years is often defined as life expectancy at birth, but this criterion fails to provide adequate grounds for the equal distribution of healthcare across and between generations. A more suitable criterion for the normal life span is the idea that the human life span is biologically limited. Many current gerontological theories argue that the biological limit to human life spans is related to the ageing process. If technological advances in medicine can retard the ageing process by treating and preventing the diseases and disorders associated with it, human longevity will be limited only by the developments in and the successful application of medicine. In consequence, the fair innings argument will no longer be able to justify denying people healthcare resources because they have lived longer than the normal life span.

Ethical concerns in the community about technologies to extend human life span.

Debates about the ethical and social implications of research that aims to extend human longevity by intervening in the ageing process have paid little attention to the attitudes of members of the general public. In the absence of empirical evidence, conflicting assumptions have been made about likely public attitudes towards life-extension. In light of recent calls for greater public involvement in such discussions, this target article presents findings from focus groups and individual interviews which investigated whether members of the general public identify ethical issues surrounding life-extension, and if so, what these ethical issues are? In this study, while some participants were concerned primarily with the likely personal consequences of life-extension, for others the question of whether or not to pursue interventions to extend longevity, and how they should be implemented, clearly raised important ethical issues, many of which have been prominent in debates among bioethicists.

The Haves, the Have-nots, and the Will-nots.

What if science enabled us to live an extended lifespan? Well, not us, but people in the future, and perhaps not everybody in the future, at least not at first. Should we allow and encourage science to develop this capability, or should we try to prevent or inhibit it? John Davis's book New Methuselahs: The Ethics of Life Extension is a thorough exploration of these questions. He presents the arguments for and against developing this capacity, and he considers three perspectives: those of individuals who will be able to extend their lives (the Haves), individuals who will not because they can't afford to (the Have-nots), and individuals who will not extend their lives because they are opposed to doing so (the Will-nots). Davis is a philosopher, and the bulk of this book is for the cognoscenti.

How Long a Life Is Enough Life?

Humans have long been troubled by the prospect of old age and its culmination in death. Whether to rebel against or accept this fate have been wrestled with down through the centuries. But new medical technologies and the growing science of aging have sided with rebellion. We know that aging can be pushed back and improved in its quality. That progress is well under way, but now intensified by many scientists and Silicon Valley entrepreneurs. In 2016, Mark Zuckerberg and Priscilla Chan pledged three billion dollars toward eventually "preventing, curing or managing all diseases." And some visionaries have made the elimination of death or its indefinite postponement a goal. To put those aspirations in a broader context, it is helpful to keep in mind where population growth and aging trends stand. Apart from any success in the explicit efforts to increase longevity, there will be a steady increase in the number of elderly worldwide-and a much higher percentage of the elderly as part of the overall population. Most of the largest changes will be in developing countries. They will be overburdened by the death of the elderly from expensive chronic diseases-already a vexing problem for affluent countries.

Articulating the Case for the Longevity Dividend.

The survival of large segments of human populations to advanced ages is a crowning achievement of improvements in public health and medicine. But, in the 21st century, our continued desire to extend life brings forth a unique dilemma. The risk of death from cardiovascular diseases and many forms of cancer have declined, but even if they continue to do so in the future, the resulting health benefits and enhanced longevities are likely to diminish. It is even possible that healthy life expectancy could decline in the future as major fatal diseases wane. The reason is that the longer we live, the greater is the influence of biological aging on the expression of fatal and disabling diseases. As long as the rates of aging of our bodies continues without amelioration, the progress we make on all major disease fronts must eventually face a point of diminishing returns. Research in the scientific study of aging has already showed that the aging of our bodies is inherently modifiable, and that a therapeutic intervention that slows aging in people is a plausible target for science and public health. Given the speed with which population aging is progressing and chronic fatal and disabling conditions are challenging health care costs across the globe, the case is now being made in the scientific literature that delayed aging could be one of the most efficient and promising ways to combat disease, extend healthy life, compress morbidity, and reduce health care costs. A consortium of scientists and nonprofit organizations has devised a plan to initiate an accelerated program of scientific research to develop, test for safety and efficacy, and then disseminate a therapeutic intervention to delay aging if proven to be safe and effective; this is referred to as the Longevity Dividend Initiative Consortium (LDIC). In this review, I articulate the case for the LDIC.

Would doubling the human lifespan be a net positive or negative for us, either as individuals or as a society? Point-counterpoint.

There is a significant possibility that over the next few decades science will make discoveries of a kind that might allow the doubling of the average human life span, from roughly 76 years now to 150. This development would, for many, represent the realization of a dream: that of enabling people to live much longer lives than at present, holding back death, which has often been seen as an ancient, unbeatable enemy. It would also raise a large number of unprecedented individual and social problems: Would we really want to live to 150? Is such a goal ethical? What would this putative longevity do to our present social structures and arrangements? Would we get a better society or a worse one?

Facing immortality.

This study is primarily a call to philosophers to attend the concerns raised by the increasing possibility of indefinitely extended human life. While these concerns are largely moral and socio-political, questions arising from this possibility are seen to involve other philosophical areas, including epistemology. Starting with the age-old desire for extended, enjoyable life, possible strategies for realizing such life are considered. Such realization is shown to conflict with the desire for children. Various reasons for choice between the alternatives of indefinitely extended life and what is currently understood to be a normal life, including the possibility of offspring, are examined. Competing social visions are sketched for the purpose of resolving this dilemma. It is argued that humanity's likely choice from among the competing social sketches favors the decision for extended life against that for limited lifespan with the possibility of children. Assuming that the extended life will be a life of learning leads to epistemological considerations regarding what is to be learned.

Disruptive visions.

Numerous advanced technologies, both medical and nonmedical, are emerging faster than their social, behavioral, political, moral, and ethical implications can be understood. Some of these technologies will fundamentally challenge the practice of surgery: human cloning, genetic engineering, tissue engineering, intelligent robotics, nanotechnology, suspended animation, regeneration, and species prolongation. Because of the rapidity of change, the current status of these emerging technologies with their specific moral and ethical issues must be addressed at this time by the new generation of surgeons, or we must all face the consequences of an uncontrolled and unprepared future.

The prolongevists speak up: the life-extension ethics session at the 10th annual Congress of the International Association of Biomedical Gerontology.

Life-extension was the focus for the 10th annual Congress of the International Association of Biomedical Gerontology, held last September at Cambridge University. This scientific convention included a panel of several bioethicists, including Art Caplan, John Harris, and others. The presentations on the ethics of life-extension are reviewed here.

A linguagem acadêmica e o estigma na longevidade / Academic terminologies and stigma in later life

It is common to find stigmatising terms being used to describe older people with dementia and / or living in care homes in the Brazilian literature, such as 'demented person', 'patient in asylum', or 'institutionalised elderly'. Historically, both mental illnesses and long-term care settings for older people have had negative connotations in society. The use of terms that historically refer to social segregation, institutionalization, or that reduce the individual to their disease can therefore contribute to the perpetuation of the stigma, prejudice, depersonalization and discrimination experienced by these people. This opinion paper aims to stimulate discussions about the use of such terms by the Brazilian scientific community and the media, as well as to foster reflections on the impact of the use of such language as part of current academic and clinical environments. The author mentions examples of stigmatizing phrases and words that are commonly found in the literature and mentions some of the consequences of stigma for people with dementia and those living in care homes. The author also refers to international documents which can be used as references for more inclusive and ethical writing.

É comum encontrarmos na literatura científica brasileira termos potencialmente estigmatizantes sendo utilizados para descrever pessoas com demência e pessoas vivendo em residenciais de cuidado, tais como os termos pessoa demenciada, paciente asilado ou idoso institucionalizado. Historicamente, transtornos mentais e residenciais de cuidado de longa duração para idosos detêm conotações negativas na sociedade. O uso de termos que historicamente remetem à segregação social, à institucionalização ou que reduzam o indivíduo à sua doença pode, portanto, contribuir para a perpetuação do estigma, do preconceito, da despersonalização e da discriminação frequentemente vividos por essas pessoas. Este artigo de opinião tem por objetivo fomentar discussões sobre o uso de tais termos pela comunidade científica brasileira e pela mídia, bem como refletir sobre o impacto do uso de tal linguagem como parte das culturas acadêmica e clínica atuais. A autora cita exemplos de frases e palavras estigmatizantes que são comumente encontradas em publicações brasileiras e aponta algumas das consequências do estigma para as pessoas com demência e aquelas que vivem em residenciais de cuidados. A autora também menciona documentos internacionais que podem ser utilizados como referência para uma escrita mais inclusiva e ética.

The pursuit of longevity - the bringer of peace to the middle East.

Despite the common apprehensions regarding the aging population, this work aims to argue, on both deontological and utilitarian moral grounds, that any increase in general life-expectancy will be beneficial for the Middle East, countering the common fears associated with this increase. A set of ethical arguments concerning increasing longevity is presented, from both the deontological and utilitarian perspective. A wide selection of economic, psychological, demographic and epidemiological literature and databases is analyzed to determine common correlates of extended longevity. On the deontological grounds, the value of extended longevity is derived from the value of life preservation, regardless of its term. On the utilitarian grounds, the value of extended longevity is demonstrated by its correlation with further human values, such as education level and intellectual activity, economic prosperity, equality, solidarity and peacefulness. With the common apprehensions of stagnation and scarcity due to life extension found wanting, the pursuit of longevity by the population can be seen as a cross-cultural and cross-generational good. Though the current study mainly refers to sources and data relevant to the Middle East, a similar pro-longevity argument can be also made for other cultural contexts. In view of its numerous benefits, normatively, the goal of longevity should be set clearly and openly by the society, and actively pursued, or at least discussed, in academia, the political system and broader public.