The Holy Grail of enhancement is immortality.1 Increased longevity and its logical extension, some would say its reductio ad absurdum, immortality, have a long history. The human imagination is familiar with the idea of immortals and mortals living alongside one another and doing all sorts of things together, including of course having sex and fighting! The Iliad, the Odyssey, the Bible, the Qur’an, the Ramayama, and Shakespeare’s plays have all made such ideas familiar; and even modern classics have taken seriously the possibility of immortality. In his celebrated five-part trilogy The Hitchhiker’s Guide to the Galaxy, Douglas Adams imagines a man who had achieved immortality by accident:
To begin with it was fun, he had a ball, living dangerously, taking risks, cleaning up on high-yield long-term investments, and just generally outliving the hell out of everybody.
In the end it was the Sunday afternoons that he couldn’t cope with, and that terrible listlessness which starts to set in at about 2.55, when you know that you have had all the baths you can usefully have that day, that however hard you stare at any given paragraph in the newspapers you will never actually read it … and that as you stare at the clock the hands will move relentlessly on to four o’clock, and you will enter the long dark teatime of the soul.2
Despite the apparent pessimism of this passage many people would be prepared to endure “the long dark teatime of the soul” in exchange for immortality.3 Indeed, there is much evidence that suggests that many people are willing to trade off quality of life for longevity.4 From the pact of Faust, celebrated by writers from Marlowe to Goethe, Berlioz, Thomas Mann, and Mikhail Bulgakov to Bram Stoker and his vampires,5 to choices made by cancer patients with a terminal diagnosis,6 the evidence is strong that people want extra lifetime even at substantial costs in terms of pain, quality of life, and even when outcomes are highly uncertain.
Life-extending therapies and optimistic discussions of their promise and probable effect are an increasing dimension of serious scientific and philosophical discussion.7 If such therapies ever become reality,8 and if our bodies could repair damage due to disease and aging “from within,”9 the effects not only on personal health and survival but also on society and on our conceptions of ourselves and of the sorts of creatures we are would be profound.10 If we could switch off the aging process,11 we could then, in Lee Silver’s words, “write immortality into the genes of the human race.”12
I am not of course suggesting that we are on the verge of discovering the elixir of life, although, as noted in chapter 3, there is at least one living person who has studied these matters and who thinks that the first 1,000-year-old human is already alive. I am, however, interested in exploring the ethics of attempting to prolong life and even to create immortals if that should ever prove possible.
We should note that immortality is not the same as invulnerability, and even “immortals” could die or be killed. Accidents, infectious diseases, wars, and domestic violence would all take their toll; and although we might hope for progress in combating existing diseases, the development of new threats, as HIV/AIDS, resurgent avian flu, and the emergence of Creutzfeld–Jakob disease have demonstrated, may increase rather than reduce human vulnerability over time. If we add to this the diminishing effect of proven therapies such as antibiotics through the emergence of resistant strains of bacteria, it is difficult to predict the likely levels of “premature” deaths in a future in which increased life expectancy is developing and spreading through the human population. This is one reason why predictions about the connection between increasing life expectancy and overpopulation are often reckless.
When we save a life, by whatever means, we simply postpone death. Since lifesaving is just death-postponing with a positive spin, it follows that life-extending therapies are, and must always be, lifesaving therapies and must share whatever priority lifesaving has in our morality and in our social values. So long as the life is of acceptable quality (acceptable to the person whose life it is)13 we have a powerful—and many would claim overriding—moral imperative to save the life, because to fail to do so when we can would make us responsible for the resulting death.14
Five main sorts of philosophical or ethical objections have been leveled at life extension. The following claims have been made.
(i) Life extension would be unjust.
(ii) It would be pointless and ultimately unwanted because of the inevitable boredom of indefinite life.
(iii) It would in any event be nugatory or self-defeating because personal identity could not survive long periods of extended existence. I may wish to be immortal but in the end it wouldn’t be “me,” so the project fails.
(iv) It would lead to overpopulation and
perhaps the end of reproduction.
(v) Finally, it is claimed that life extension would be prohibitively expensive in terms of increased health care costs.
We will be examining each of these objections in due course.
One thing we do know is that the technology required to produce dramatic increases in life expectancy will be expensive. For existing people, with multiple interventions probably required, the costs will be substantial. To make modifications to the embryo or even to the gametes prior to conception, people will have to be determinedly circumspect about procreation and will probably need to use reproductive technologies to have their immortal children. Even in technologically advanced countries therefore, “immortality” or increased life expectancy is likely to be confined to a minority of the population. In global terms, the divide between high-income and low-income countries will be increased, with low-income countries effectively denied access to the technology that might make some of their citizens immortal. The issue of the citizens of rich countries gaining further advantages over the poor will rightly disturb many. How are we to understand the demands of justice here?
A feature of life-extending treatments which has seldom been thought through is the fact that as treatments become available we will face the prospect of parallel populations, of “mortals” and of “immortals” existing alongside one another.15 Thus, the problems of global justice will be repeated in those societies able to implement life-extending therapies. Just as there will exist parallel societies, some able to provide immortalizing therapies and some not, so, within those societies that have the technology and the resources required, there would exist parallel populations of mortals and immortals. This of course is precisely the destiny for which the poetic imagination has prepared us, literally from “time immemorial.”
While the creation of such parallel populations seems inherently undesirable and even unfair, it is not clear that we could, or even that we should, do anything about such a prospect for reasons of justice. If immortality or increased life expectancy is a good, it is doubtful ethics to deny palpable goods to some people because we cannot provide them for all. And this unfairness is not simply contingent, a function of a regrettable, but in principle removable, lack of resources.
There will always be circumstances in which we cannot prevent harm or do good to everyone, but no one surely thinks that this affords us a reason to decline to prevent harm to anyone in particular. As I pointed out earlier, if twins suffer from cancer and one is incurable and the other not, we do not conclude that we should not treat the curable cancer because this would in some sense be unjust to the incurable twin. We don’t refuse kidney transplants to some patients unless and until we can provide them for all with renal failure. We do, however, have a clear ethical responsibility to maximize benefits and in cases of scarcity to ensure that the question of which of those who could benefit receives the treatments should be decided according to some morally defensible principle of distribution.
The introduction of any new complex and/or expensive technology raises these problems. The impact on global justice or on justice within societies is important and must be addressed; it is a principled objection, but not an objection in principle to the introduction of life-extending therapies. The principle requires that strenuous and realistic efforts be made to provide the benefits of the technology justly and as widely as possible, not that the benefits be denied because of the impossibility of ensuring adequate justice of provision.
We should also note that we live in a world, and indeed in most cases also in a country, that already has such parallel populations. We know, for example, that people in the southeast of the United Kingdom live longer than those in the northwest and that people in industrial cities have shorter life expectancy than those in leafy suburbs. Life expectancy in 2001–2003 for males in Manchester (where I live) was eight years less than that for a fashionable part of London, Kensington and Chelsea (from a life expectancy of 71.8 years in Manchester to 79.8 in Kensington and Chelsea).16 On the world scale it is even more dramatic, the A–Z of life expectancy extending from Andorra at the top with 83.5 in 2002 to Zambia at the bottom with 37.2.17
Speaking personally of our terrible situation in Manchester, eight years’ difference may not sound a lot, but in stepwise improvement in treatment for advanced solid tumors in colorectal cancer, for example, increases in survival of between five and twelve months are regarded as dramatic improvements.
As someone who wants to live forever and who happens to live in central Manchester, I feel this injustice keenly! However, the solution, as with transplants, is surely not to level down nor yet to put improvements in some places on hold until they can be provided for all.
Remember that immortality is not unconnected with preventing or curing a whole range of serious diseases. It is one thing to ask the question, should we make people immortal? and answer in the negative, and quite another to ask whether we should make people immune to particular diseases or to treat heart disease, cancer, dementia, and many other diseases and decide that we shouldn’t, because a “side effect” of the treatment would be an increase in life expectancy. We are, then, unlikely ever to face the question, should we make people immortal—yes or no? We may rather be called upon to decide whether we should treat a particular disease when we know an effective treatment will extend life span.
It might then be appropriate to think of immortality as the side effect of treating or preventing a whole range of diseases. Could we really say to people, “you must die at the age of thirty or forty or fifty, because the only way we can cure you is to do something which will also extend your life span”? Faced with such a choice an individual might well say, “let me have my three score and ten and then kill me if you must.” Whether, given the quite pervasive and irrational hostility to euthanasia, societies would be willing to allow such bargains to be made is doubtful.
Given that people want life and fear death it is difficult not to see longevity, and perhaps immortality, as a palpable good. Many have taken issue with this claim on two main grounds: either that indefinite life would eventually become terminally boring, or that over long periods of survival personal identity could not be maintained and so the survival of a particular individual would prove illusory. Elsewhere18 I have criticized, and I believe decisively refuted, both these objections.
Suffice it to say that only the terminally boring are in danger of being terminally bored, and perhaps they do not deserve indefinite life. Those who are bored can, thanks to their vulnerability, opt out at any time. But those of us who do not have terminal failure of the imagination should be left to create new ways of enjoying life and doing good.
Hans Jonas and Walter Glannon have suggested19 that over the very long life of a Methuselah personal identity must fail, giving place to successive selves, and that it follows that prudential or self-interested motivation for continued existence must also therefore fail. However that may be, and for my own part I am utterly unconvinced that personal identity would fail in the circumstances suggested, it is easy to see that personal identity is not required for a coherent desire for indefinite survival. Suppose “Methuselah” has three identities, A, B, and C, descending vertically into the future and that C can remember nothing of A’s life. But suppose the following is also true: A will want to be B, who will remember being A; B will want to become C, who will remember being B but possibly not remember being A. It is not irrational for A to want to be B and not irrational for A to want to be B partly because he or she knows that B will be able to look forward to being C, even though by the time she is C she won’t remember being A. Thus, even if personal identity in some strict sense fails over time because of loss in continuity of memory, it is not clear that a sufficiently powerful motivation for physical longevity fails with personal identity. This would remain true however many selves “Methuselah” turns out to be. For myself I am skeptical as to whether failure of memory is nearly enough to cause failure of personal identity but here is not the place to argue the point.
A B C
B
C
The point remains good for what we might term “horizontal” identity failure, although again I am skeptical as to whether cognitive enhancements or indeed other sorts of enhancement that might impact on personality or life history would lead to failure of personal identity. Suppose chemical cognitive enhancers either involved dramatic personality changes as a side effect of their enhancing properties or that the enhancements were so marked that someone with such dramatic improvements in memory, intelligence, or concentration would predictably live a very different life to their former self to the extent that, in either case, the question of whether or not they would remain the same person was a real issue. Again the question of whether or not B or C, after successive enhancements or the time and buildup of decisions and choices that only the cognitively enhanced person would have made, would be enough like the unenhanced A to count as the same person would not destroy the rationality of A’s enterprise. Here again A would have decided to create C, a different but closely related individual, and would have enough continuity with C to want to create C and to welcome and embrace the required personality changes that might raise issues of personal identity.
Interestingly, if Jonas, Glannon, and others are right and extreme longevity does raise issues of successive selves, successive different persons inhabiting the same body so to speak, then two prominent objections to longevity and other identity altering enhancements fail. For if the long-lived person is in fact a succession of only averagely old individuals, then claims that making people live longer is giving them an unfair advantage over those who do not benefit from life extension also fails. After all, there is no one who has this advantage, just a succession of different people who have long but not excessively long lives. Moreover, it is hardly harmful to any of them, let alone anyone else, that one full life gives way to another using the same body. Indeed, from the perspective of resources and overpopulation this multiplication of people without any multiplication of resources used by the extra numbers must surely be advantageous, as will the fact that these extra persons add not at all to the total population of the world, presumably have a good start in life, and don’t require long periods of expensive education and equally costly dependence on parents, etc. Here, however, the successive new persons inhabiting the same body are no more responsible for any increases in population than are the successive new persons born in different bodies from those of their “parents.”
Again for the horizontal case, even if the cognitive enhancement of A involves her eventual disappearance to be replaced by B or C, this would at worst involve the creation of extra individuals without the necessity of creating the extra bodies and the extra resources those bodies would consume or the extra opportunities or space those extra bodies would require.
Indeed, multiplication of selves in the same body is so ecologically sound, environmentally friendly, and population efficient that it might well become the preferred method of procreation for all except the most unregenerated eco-wastrels or sex-obsessed chauvinists.
Prominent among recent denigrators of the idea of life extension has been Leon Kass, who identifies the core question as the following: is it really true that longer life for individuals is an unqualified good? Kass has many arguments against life extension, all of which fail disastrously.20 We have time to consider only his main objection:
For to argue that human life would be better without death is, I submit, to argue that human life would be better being something other than human.… The new immortals, in the decisive sense, would not be like us at all. If this is true, a human choice for bodily immortality would suffer from the deep confusion of choosing to have some great good only on condition of turning into someone else.21
Insofar as this claim of Kass’s relies on claims about psychological continuity over time, it has the problems we have already considered. However, Kass’s argument seems to be suggesting a more simple objection: that since the (current) essence of being human is to be mortal, immortals would necessarily be a different type of being and therefore have a different identity. There is a sense in which this is true, but not I think in any sense in which it would be irrational to want to change identity to the specified extent. Someone who had been profoundly disabled from birth (blind, say, or crippled) and for whom a cure became available in his or her mid-forties would become in a sense a different person. They would lead a different type of life in many decisive ways. It does not follow that the blind or crippled individual has no rational motive to be cured. It would be both odd and cruel to say to them, as Kass presumably would have us do, “it is deeply confused to want to cease to be disabled because then you will no longer exist.” We will return to the theme of disability in chapter 6.22
Many people addressing the question of life extension have assumed that such a possibility will have a disastrous effect on the world’s population with the present generation living indefinitely and a procession of subsequent generations adding to the congestion.23 However, this is by no means either a likely or even the most likely scenario. We have already noted some advantages to longevity and personality change in terms of fears of overpopulation. Even without these somewhat fanciful advantages, the effect of life extension on population will be a function of a number of different factors, the outcomes of which are all difficult to predict. The first is the degree of uptake, which itself will be heavily dependent on cost and availability of the therapies. Granting, as we have, that life-extending therapies will gradually become available, cost, risk, and uncertainty will mean that for a very long time the numbers of people availing themselves of such therapies will be a tiny proportion of the world’s population. We have already noted a possibly increasing human vulnerability due to new infectious diseases or antibiotic resistant strains of bacteria. Again it is difficult to predict the continuing effect of these on population or how the advent of some immortals would affect the equation. Disease may well continue to be an effective leveler, improving its own technology as we improve ours. And of course immortal but vulnerable people will continue to die in accidents and from injuries received.
Steve Austad24 has calculated the death rate of immortals in the United States due to such factors. Austad bases his calculation on the death rate of twelve-year-olds. Kids of twelve have stopped dying of childhood diseases and have not yet started dying of the diseases of old age. If you work out their death rate, you can extrapolate a probable death rate for immortals. Austad originally suggested this might indicate an average life-span of 1,200 years. He now writes:
[H]ealth has improved in the U.S. since then. I recalculated this for the 2002 census data, and if we were now preserved in the health of a 12-year-old, life expectancy would be 4,986 years. Not bad, living from the age of the early Pharaohs to the age of Mars landings.25
Should we assume the necessity for, or desirability of, the creation of future generations? Is there a moral difference between a future that will contain x billion people succeeded by another x billion different people and so on indefinitely, or x billion people living indefinitely and replacing themselves on the (rare?) occasions when they are killed? Although, as we have noted, this is an unlikely scenario, posing the question in this stark form enables us to ask an important question: whether or not what matters morally is that life years of reasonable quality exist or that different people with lives of reasonable quality exist. Put in this way the problem assumes a familiar form—should we maximize life years or individuals’ lives?26 From the life-years perspective it ought not to matter how many new people the world will contain but simply how many life years of acceptable quality it will contain. Those who, like me, find the life-years approach unsatisfactory will be inclined to think that individual lives matter. But even so, it could consistently be held that it is the individual lives of existing people that matter, not how many new individual lives there will be.
However, the argument for making sure that there will be new generations is not settled by the outcome of the debate between those who think that future lives count equally with existing lives and those who do not. One group of such reasons has to do with the desire to procreate and the pleasures of having and rearing children.27
The second set of reasons has to do with the advantages of fresh people, fresh ideas, and the possibility of continued human development. If these reasons are powerful, and I believe they are, and if the generational turnover proved too slow for regeneration of youth and ideas and for the satisfactions of parenting, we might face a future in which the fairest and the most ethical course might seem to be to contemplate a sort of “generational cleansing.”28 This would involve deciding collectively how long it is reasonable for people to live in each generation and trying to ensure that as many as possible live healthy lives of that length. We would then have to ensure that, having lived a “fair innings,” they died at the appropriate time in order to make way for future generations. Achieving this result by voluntary or ethical means might be difficult; attitudes to suicide and euthanasia might change, but probably not overnight. Although it might appear to offer a solution, I believe no nonconsensual form of generational cleansing would be defensible.29 However, since the numbers of immortals would remain small for the foreseeable future, this is a problem that may never arise.
Søren Holm30 has suggested that immortality, far from increasing health costs per individual, might actually dramatically reduce them; there might in short be an economic discounting argument for the public funding of “immortality” interventions. We should note that, although immortality or at least longevity is expected to eliminate many of the diseases of old age, there will still be terminal conditions to treat (at least for those who do die) and hence always some postponed health care costs for the dying.
If we assume that
• for both mortals and immortals there is the same period of old age with increased health care costs (say ten years, but the length does not matter for the argument) and the same costs of treatment during those years (let’s say £10,000 on average),
• the mortals will reach this period in 70 years and the immortals in 1,000 years,
• there is a 1% per year rate of real economic growth,
then the present-day discounted costs of treating a person in 70 years’ time will be £4,948, whereas the present-day cost of treating the same person in 1,000 years’ time will be 43 pence! It thus makes economic good sense to invest now and postpone health care costs from 70 years into the future to 1,000 years into the future and, as is evident from the figures, it makes sense even if immortals were to have a much longer and more costly old age (because of the discounting, even a ten times increase in costs would not matter).31 Add to this the probability that a greater number of immortals would die as the result of accidents rather than long drawn-out illnesses and the economic arguments grow stronger still.
For the first time in human history we face the prospect of a truly open future, involving perhaps infinite sequential as well as simultaneous opportunities, and stretching, open-ended, before the individual in a an unprecedented but truly liberating pathway. We should be slow to reject cures for terrible diseases even if the price we have to pay for those cures is increasing life expectancy and even the creation of immortals. Better surely to accompany the scientific race to achieve immortality with commensurate work in ethics and social policy to ensure that we know how to cope with the transition to parallel populations of mortals and immortals as envisaged in literature and mythology.