Two papers by Partridge et al [1, 2], both published in 2009, provide the somewhat rare opportunity to examine some concerns about life extension as formulated by actual people, rather than their general, more abstract forms.

As highlighted in the studies, research on the public’s perception of life extension science has been very much neglected; this, in turn, has made it harder to identify the misconceptions and incorrect information fueling some common concerns about life extension and made it even harder to address those very concerns. Needless to say, the more that the public views life extension negatively, the less supportive that it will probably be, which is bad news for researchers.

The papers present the results of several interviews, conducted either in person or on the phone, aimed at understanding what ethical concerns the interviewees had about life extension and what implications they thought extended human lifespans would have for themselves and for society. The research was conducted on a sample of the Australian population only, but the issues they raised were entirely representative of a typical discussion about life extension. In both studies, the interviewees were presented with the general premise of possibly slowing down aging and the onset of age-related diseases in order to greatly extend human healthy lifespan.

We’ll be taking a look at specific claims made or sentiments expressed by different interviewees in both studies.

Nature (doesn’t) know best

A common assumption is that nature knows best and interventions to slow down or reverse aging equal tampering with it, which is bad in its own right and therefore shouldn’t be done. This position is apparent in the following quotes from the studies:

“It seems totally unnatural. It seems to be upsetting the natural sequence of things. […] But I think doubling life would be… I don’t like it at all.” “[…] it’s just not natural to live to 150.”

Quite frankly, this is the kind of teaching you would expect to find in an episode of “The Smurfs”, in which Mother Nature is a sweet old lady with a magic wand and has designed the world to work in a certain way for everyone’s good. However, nature is really just a label used to indicate many things — the interactions between fundamental particles, animal behavior, the intricacies of biochemistry, green foliage, and black holes. No one sat down and decided how long each species should live, and most definitely not for anyone’s good.

Counterexamples of natural things that are bad for you and “unnatural” things that are good for you are plentiful, but we’re not going into counterarguments and confutations; what is interesting to note is that the naturalness argument is presented without further justification: it’s unnatural, hence it’s bad. The interviewees themselves don’t seem to know why it’s bad. It’s rather dangerous to assume that nature knows best when, in fact, it knows nothing at all. Nature does all it does rather well — who wouldn’t, after billions of years of practice — but that’s not necessarily what is best for you.

Another interesting claim is that extending our lifespans would make us less human — as if living around 80 or 90 were a defining quality of humanity:

“To change lifespan that much just seems like, I don’t know, we’re not human anymore… Think of all the intervention we’d need… we’d be counteracting everything about us to make us live longer.” “[…] it’s kind of inhuman to live a long time, as we are not made that way […]”

It’s honestly difficult to imagine why a lifespan change from around 80 to around 150 would make us any less human than the one from about 40 to about 80 did. However, the covert assumption here might be that extending lifespan would necessarily require radical alterations that would turn us into something we don’t like — a rather stale teaching that has been reiterated, unproven and unchallenged time and again in all manner of fiction, so it wouldn’t be surprising if it had made its way into people’s most deeply held beliefs.

Some interviewees expressed the conviction that curing disease and extending lifespan are fundamentally different:

“There’s a difference between just treating an injury or an illness compared to ‘I’m going to break natural bounds and extend my life’.” “I don’t think life extension, in the sense of strong life extension, is a necessary thing. Whereas a lot of other aspects of medicine involve fixing things to enable people to live a normal life in a regular lifespan.”

The misconception that might be behind this is that there’s a “right” kind of death — death by old age — whereas other kinds of “early” death, however they may happen, are “bad” kinds of death in that they’re not the way things are supposed to go. It’s almost as if there were a belief that death is scheduled to happen to us irrespective of our health at some point around age 80 or so; death “ahead of schedule” is considered a tragedy, and postponing your “scheduled death” is considered “breaking natural bounds”.

However, this is at odds with everything we know about the functioning of the human body. Medicine is not meant to fix things so that you live a normal life in a regular lifespan; medicine is meant to fix things so that you retain your health and thus continue living. That’s all there is to it. Nowhere is it said that medicine works or should work only within the boundaries of a “regular lifespan”; the only reason why the current “regular” lifespan is of about 80 years is that, thus far, we haven’t been able to cure the ailments that manifest at that age, in pretty much the same way that 300 years ago, we didn’t know how to cure infectious diseases. This interviewee summed it up rather well:

“I don’t know how to separate the rate of aging though from a disease. I don’t know what the difference would be if you took away all of the diseases, if you took away all of the things that could cause heart failure, cancer and all of those sorts of things. I see them the same as aging.”

The authors of the papers reiterated many times how interviewees were favorable to what they perceived as therapies to cure diseases and against all that they perceived as an enhancement; for some reason, extending lifespan was perceived as the latter, rather than merely the obvious consequence of curing the diseases of old age. In this sense, rejuvenation therapies are no more an “enhancement” than any therapy that prevents or cures life-threatening diseases earlier on in life. This point can never be stressed enough.

Discriminations and impositions

Another extremely common concern is the ill-famed spectre of unequal access to rejuvenation biotechnology, summed up by these two quotes from the studies:

“I don’t think any good will come out of it. It would be beneficial to only one class, supporting only one social class. In a way, we will unbalance the powers.” “We end up with this society where the poor live their brief little lives and then you know… The rich live forever and have time to accumulate vast resources and there is never any way to cross the divide.”

If you are interested in more detailed counterarguments, you will find them here and here; what is most interesting to note in this venue is the fatalistic attitude of this stance. Not only did interviewees — along with many more people — assume that the dystopian scenario they presented will certainly occur; they didn’t seem to think that measures could be taken to prevent it or even just mitigate its effects or shorten its duration. They didn’t seem to think that the benefits of an aging-free world — which several interviewees acknowledged and which you can read about here, here, and here — might be worth the effort of looking into ways to prevent or mitigate any potential problems, such as inequality of access.

The same can be said of two more common concerns: overpopulation and lack of resources. The answers of the interviewees betrayed the assumption that the problem is inevitable and impossible to even alleviate, as if our technological development had already reached a peak and further innovation in terms of resource production and management were utterly out of the question, neglecting the obvious precedents in this regard — the Malthusian catastrophe has been predicted time and again and always failed to materialize; supporting a world population of even just a billion would have seemed impossible with the technology of 300 years ago, yet present-day technology allows us to cope with seven billion people — not perfectly, but we’re on our way there.

Worse still, interviewees didn’t seem to realize the even more obvious fact that, assuming that rejuvenation would be only for the rich, banning it, as some suggested, would do exactly nothing to narrow the rich-poor divide; at best, it would prevent it from getting larger. However, nobody benefits from a technology not existing, let alone the poor. Imagine if, back in the day when sewers to separate waste from water were first invented, someone suggested that we don’t build sewers anywhere at all because some areas could end up being unjustly left out. Making sure that sewers reach everywhere, even if it takes a long while before they actually do, is a much better idea than having water mixed with waste everywhere forever.

Whether or not the rich live forever is rather inconsequential for the poor, especially as long as they don’t even have the basics covered — even though some people think that the poor somehow find comfort in thinking that one day the rich will die of aging if nothing else gets them first. The idea of relishing someone else’s death, regardless of the circumstances, is so appalling that it’s paradoxical how this whole argument is often called one of “ethics”.

Another interesting concern related to financial possibilities is that if you live longer, you need to support yourself for longer; some interviewees were afraid that the quality of their extended life wouldn’t be good, because their finances might not be good either. This is another scenario where utter pessimism somehow managed to take the place of common sense. It’s very sensible to be afraid of a life of poverty, but if you found yourself so poor at age 30 that your quality of life suffered significantly, the odds are that you’d do your best to try to lift yourself out of poverty well before even contemplating death as a liberation. If you found yourself poor at, say, age 120, and assuming that you were perfectly healthy because of the very life-extension technologies that allowed you to reach that age, why should this case be any different?

At least for some interviewees, the difference might be that they found the prospect of having to work for longer as a “significant downside to taking life-extension pills”. To put it bluntly, they’d consider dying as an alternative to working for longer, which hints that the problem might lie in the jobs they do rather than in how long their lives are.

More concerns related to access to the therapy, rather the opposite of each other, were expressed by interviewees afraid that they might be coerced into using life extension or that life extension users might end up having to watch as their friends and relatives who refuse these treatments slowly wither and die.

For the first concern, this might betray a lack of understanding of what life extension is, because it’s hard to imagine how anyone could worry about being coerced into being healthy; as for the second one, it’s surprising how these interviewees didn’t notice that their fears are already taking place here and now. The old people of today need to get used to the fact that their lifelong friends and companions keep dying around them, and to add insult to injury, their own health is also going critical. Granted, if you yourself die of old age at some point, you won’t have to continue witnessing the death of your loved ones; however, this is pretty much equivalent to curing the disease by killing the patient.

The Real Problems™ are others

The argument that there are higher-priority problems than aging was also among those touched upon by the interviewees:

“I don’t see the point in developing something else at great expense that may not be available to everybody, when money could be channeled towards getting the basics of what people would have a right to them now so that they’re not starving and dying.” “What’s the point of me living to 150 if six-year-olds are going blind and needing kidney transplants because they’ve got diabetes?”

Appeal to worse problems is very much the fallacy being committed here; once more, the truly important thing is assumed to be something else. For some reason, the interviewees appeared blind to the possibility that the pursuit of rejuvenation might not necessarily be incompatible with that of alleviating poverty, etc; their unproven assumption seems to be that, with the resources available, it is absolutely impossible to achieve both. Also, interviewees didn’t seem to value the life of elderly people as much as that of people who are in danger of death from other causes, such as starvation or health problems at a younger age. In both cases, somebody’s life is at stake, and yet it appears that the life of someone who has already been around for several decades is less worth saving — even though, given the premise of the study, this life wouldn’t end in a handful of years spent in ill health but rather in a far longer period spent in good health.

For some other interviewees, “medicine” was ironically a more important priority than life extension — as if there were any difference between the two. In their minds, the risk is sometimes that research funds could be diverted away from more pressing medical needs. The fact that some of them failed to realize the connection between aging and disease is apparent from this quote:

“They’ve got to look at this [life extension] one hundred years in the future when they’ve got all the diseases sorted out.”

It appears this interviewee expected that, in a hundred years, when all diseases will have been sorted out, people in their 80s will still drop dead for no apparent reason; only then should we start looking into how to extend life. This betrays a serious lack of understanding of the deep connection between healthspan and lifespan, and it is something that advocates of life extension need to make extremely clear. Indeed, the idea that being old equals being sick is (rightfully) so ingrained in our minds that, even though the researchers had clearly stated that life extension means being healthy for longer, some interviewees still struggled to comprehend this and were concerned about how physically and mentally healthy they could be nearing 150 years of age.

Yet some others understood all too well how life extension implies retaining your health during old age, and this was their very concern:

“You’d miss out on that aspect of what it is to be an older person… I think that there’s natural progressions [sic] in growth and that’s why I don’t think you can do it without aging in some ways because you’re not actually physically or whatever in that situation. Intellectually it’s not the same as experience of it. So it’s a whole barraging process that could actually stunt our development; the depth of who we are as human beings.”

This is by far the weirdest concern you’re likely to run into — it’s like saying you shouldn’t cure cancer if you get it, lest missing out on what it is to be an oncological patient. Not all experiences are worth having; from my middle school days, I recall how being hit by a basketball kicked straight into my groin at point-blank range was something I would gladly have done without, and the lack of this experience would hardly have stunted my development — if anything, my early teenage development risked being arrested altogether because of this very experience.

What’s absolutely puzzling about this quote is the kind of development we’re even talking about. A person in his or her 80s has been developing for quite some time already, and intellectually, his or her experience of life is hardly going to be improved by cancer, diabetes, or Alzheimer’s. Besides, whatever experience you might gain by going through the ordeal of age-related diseases, you’re not going to take it with you for very long, so it’s unclear how it would benefit you in the first place. Possibly, the point this person was trying to make might be that you need to experience bad things to learn that they’re bad, but this is true only to an extent. After a certain point in your development, you can extrapolate how good or bad something is without actually experiencing it — believe me, I didn’t need to be hit by that basketball to know that it would have hurt very much.

Old inside

Some interviewees were worried that, rejuvenation or not, an old person always stays old mentally; they feared that they might end up being “an old person in a young person’s world”. This suggests that some people may have internalized the stereotype of old people as being out of touch with the world simply by virtue of being old when, in fact, their health plays a central role in how able they are to stay connected with the rest of us. Old people in today’s collective imagination are confused by computers and technology, less educated than young people, and less open to change and novelty. This depiction is partly correct due to the exceptionally large generational gap between our generation and our grandparents’ — in some cases, even our parents’. It is conceivable that, having been exposed to this representation of the elderly our whole lives, some of us conclude that we, too, will be like this in our old age, as if this way of being were a product of the age itself rather than the sociocultural context in which we spent our lives.

Gerontocratic scenarios

Some interviewees showed another typical concern — that the older, rejuvenated people might just keep consolidating their wealth and power, shutting out younger people from opportunities. The long-lived elderly, they feared, might also hinder generational turnover and the emergence of new ideas.

An important factor that interviewees didn’t seem to think about is that being part of a new generation doesn’t automatically make you able to have new or better ideas. However young or smart you may be, you will have a hard time being much of an innovator if you don’t have access to adequate education and aren’t encouraged to engage in open, creative thought. Creativity and new ideas need these elements to thrive; they don’t just magically appear with the turn of every generation. Naturally, the gradual loss of brain plasticity as we age may make it harder for older people to be innovative, but if this problem can be fixed by sufficiently comprehensive rejuvenation therapies, then there’s no reason to assume that long-lived elderly will be a drag on progress.

As for the concern of a gerontocratic elite taking over as a consequence of rejuvenation, one should notice above all that it is typically expressed in such a vague fashion that it is impossible to falsify. Nothing absolutely prevents any dystopia from ever coming into being; in order to be able to tell whether rejuvenation will lead to a gerontocracy in 300 years, we would need information on the socioeconomic and technological context of the coming three centuries. Without it, this concern is pure fear-driven speculation. Its profound appeal to people’s sense of justice is probably what allows it to bypass rational scrutiny and appear as a valid objection despite the lack of evidence.

Ethics

According to the study’s authors, some participants defined “being ethical” as “thinking beyond one’s own life”; in their view, life extension didn’t fulfill this criterion and was an unethical, selfish pursuit:

“Ultimately, I don’t know if everyone should be doing it, but you know how you have those selfish desires?”

Life extension is about eliminating useless suffering just as much as the rest of medicine. Doctors saving people from deadly diseases are thinking well beyond their own lives, and it’s unclear why this wouldn’t be the case if they saved lives by administering rejuvenation treatments.

Other interviewees were instead clear that life extension is perfectly ethical:

“I can’t see an ethical issue. There’s no more an ethical issue than medicine being able to cope with disease. Is there an ethical issue in that? They’re prolonging life now with immunization and even heart transplants. People have come to accept this now.”

Others suggested that opposing life extension is unethical, because

“[…] you’re killing people. If you have the world where you can take an action where you do make someone live longer, or you can take the action that you can say ‘live shorter’, which is a take no action at all, that’s still an action. Then you’re killing them, you caused their death. Your action of not doing anything causes their death. So it’s unethical to not do this.”

The belief that life extension is a selfish pursuit was further stressed in other interviews:

“But then you’ve got all the societal impacts like cost and population growth. There are so many different things that nobody really thinks about when they’re thinking ‘Oh, I could live to 200, that sounds great.’” “They [people who want life extension for themselves] are not thinking about anyone else.”

Once more, interviewees took the dire consequences they imagined for granted. As the study authors themselves pointed out, to some interviewees, the potential downsides of life extension appeared to be such inescapable certainties that they were not interested in the possibility at all. This might explain the belief that life extensionists don’t think about anyone else; seeing the “selfish” benefit of prolonging your healthy lifespan is easy, but it’s far harder to see that the alleged societal costs of it are not as set in stone as one might think.

One last, interesting position on the selfishness of life extension was expressed by the following interviewee:

“I don’t think there’d be any great social benefits in me living to 300… It’s all about greed and selfish purposes I suppose for why you would try to prolong your life. Ultimately, I don’t think it would impact the world in a positive way. It’s fair to say I wouldn’t be doing it for social reasons.”

It is again apparent that what really matters is not individual people’s lives — only what is good for society matters. However, society has no point if not that of serving the individuals of which it is comprised; if society asks its members to die for society’s sake, it is not doing them a very good service.

In reality, human society doesn’t have much to gain from shorter lifespans for its members, and its functioning is unlikely to be hindered by life extension. Aspects of it will certainly require rethinking, but it is indeed constant rethinking of how society works that allows us to improve it.

Fear of death

To some interviewees, fear of death wasn’t a good enough reason to justify life extension:

“Yes, it’s selfish… but it depends on what reasons you want to do it… they shouldn’t be able to extend their life just because they’re afraid of dying. It should be for a greater cause.”

The idea that only a “greater cause” than fearing for your own life legitimizes use of life extension is reminiscent of the old ideal that your life only matters as long as it serves the rest of society in some way. (The “greater cause” can’t be much else than serving others, if life extension for your own sake is not allowed.)

The ancient idea that death must not be feared — in part to exorcise the fear, very strong indeed, that it instills, and in part because a fearless army was in the best interest of the rulers of the past — has made its way into our modern time and is still alive and well. Being afraid of death is still mostly seen as a shameful thing, and many people still proudly proclaim that they don’t fear it; they’re much more afraid of the horrors that, allegedly, are an inevitable consequence of longer, healthier lives. Among the study participants who acknowledged the benefits of life extension, very few mentioned allaying the fear of death as a good reason; it wouldn’t be surprising in the least if they didn’t because they thought that it would be shameful to do otherwise.

Still, if we really weren’t afraid of death, our languages wouldn’t be full of all manner of euphemisms, edulcorations, and embellishments for it; religions wouldn’t all be hinging on overcoming death through resurrection, reincarnation, and the like; we wouldn’t have come up with any of the technologies that allow us to save lives in the most desperate cases; and we wouldn’t consider it heroic to save other people’s lives even at the cost of endangering our own.

Conclusion

Some of the most common concerns involving life extension are often taken to be inevitable consequences of it; from what can be seen in the two studies, interviewees never doubted that their fears would materialize if life extension were ever achieved. It would be interesting, as well as useful for more effective advocacy, to establish whether this happens because of a lack of relevant knowledge, the psychological effects of our perception of aging, or a combination of both.

Literature

[1] Partridge, B., Underwood, M., Lucke, J., Bartlett, H., & Hall, W. (2009). Ethical concerns in the community about technologies to extend human life span. The American Journal of Bioethics, 9(12), 68–76.

[2] Partridge, B., Lucke, J., Bartlett, H., & Hall, W. (2009). Ethical, social, and personal implications of extended human lifespan identified by members of the public. Rejuvenation research, 12(5), 351–357.