I now want to consider some philosophical concerns about increases in human longevity. My first task is to clarify different claims.
One philosophical issue involves increased longevity versus immortality. The late English philosopher Bernard Williams argued that immortal human lives would be tedious, worse than mortal lives, and meaningless.[1] Williams thinks that doing projects gives one’s life meaning and that unlimited years would allow completion of all projects. Moreover, the fact that our lives end was important to him: death orders our priorities and forces us to make choices. Moreover, heroes make the ultimate choice and give up their lives to save others. If no one died, this kind of courage would be impossible.
However, for such a good philosopher, Williams made (what are often called) “category mistakes” in his essay. First, it’s a jump of categories from extending life to obtaining immortality. Second, we should distinguish between involuntary immortality and voluntary immortality. With the latter, you can always choose—if life gets too boring—to end your life. Only the former is a sentence. Third, increased longevity involves different kinds of goals: curing aging-related diseases, increasing average life spans, curing aging itself, and obtaining voluntary immortality. We shouldn’t conflate these.
So let’s try to drill down to more basic philosophical claims. Let’s assume we won’t be immortal soon, that we won’t cure aging at the cellular level (because of the Hayflick limit), and that any increase in longevity would be voluntary, such that, if life got too tedious, it could always be ended.
If James Vaupel is correct, then the incremental enhancements that have been ongoing over the last decades have extended morbidity and mortality accordion-like by at least a decade for healthy people in developed countries. If so, Bismarck’s age of sixty-five for being old and retired may need to be extended to seventy-five—in other words, “seventy-five is the new sixty-five.”
Assuming the trend spotted by James Vaupel is correct, is it a good thing? To some impatient people, the question is stupid. Why wouldn’t anyone want to live more rather than less? Well, another view exists here, with some cogent objections, but we need to carefully separate its claims.
One claim is that extended life is a misguided use of resources. Bioethicist Daniel Callahan of the Hastings Institute, who was born in 1930, opposes research to extend life.[2] He thinks we should accept our present life span, not invest in research to extend old age. Or to be more precise, he argues that wise people should have better ways to spend their monies on research than extending human lives. Social conservative Leon Kass, born in 1939, also seems to claim that trying to extend human life foolishly wastes resources.
This objection now seems moot. As said, various enrichments have combined to allow healthy people to live longer, including ones not previously mentioned, such as fluoridated water, statins to reduce inflammation and the effects of cholesterol, assisted living in group homes, better nutrition, physical therapy after injuries, better dental care, good public transportation, and efficient departments of public health. These improvements both improved the quality of existing lives and thereby extended longevity. Extending longevity never was an either/or choice.
Another objection is that extending life is not natural. To rebut this claim, recall the figures about human longevity that began this chapter. Which expected human longevity is natural? Death in ancient Sparta by age thirty-five? Death in 1900 in America at age forty-seven? For those now living, death by age ninety-five? If the human life span peaks at 125, why is death at any point along the spectrum more natural than any other? Moreover, if fifty years of life is good, why isn’t one hundred?
If we could enter a time machine and switch lives with someone in 1900, few people would just want to live to the then-predicted life expectancy of forty-seven years. Parents would not understand what is wrong with living to eighty-four rather than to forty-seven. We don't believe, as anti-aging researchers such as Francis Fukuyama imply, that a newborn girl who lives an extra thirty-seven years might lose her humanity and become “post-human.”[3] What is natural is relative to what century one is born into.
Another objection might be that extending human life is foolish. Why, cynics ask, will people want to live so long? Won't people become sad? Suppose you outlive your parents, your siblings, and your good friends. Maybe you outlive your children. Wouldn’t it be sad to be alone and so old? Maybe you were foolish to want to live so long.
An associated view of Callahan and Kass, abetted lately by Yale surgeon-essayist Sherwin Nuland, is that society wastes a lot of money in the last year of life pursuing a lousy last few months of life. New York Times essayist David Brooks recently uncritically accepted this falsehood.[4]
But the great logical fallacy here is to only calculate the cost of the last year of life for those patients who actually died. What about the other 80 percent who recovered, went home to live another five years with their families, and who were quite glad to have had the money spent on them for their recoveries? If you want to do a fair study, take a group of one hundred eighty-five-year-olds in a hospital and calculate how much is spent on them for twelve months. Then compare the costs for those who died during that year with the costs of those who lived. Then, for those who lived, prorate the costs over their new years of living.
But not everyone sees extra years of living, like Callahan-Kass-Nuland-Brooks, as years of misery. For starters, maybe everyone you know would also live a nice long life, including your children and friends. Michael Kinsley wrote in 2008 in the New Yorker about “the biggest competition of all.”
Ask yourself: what do you have now, and what do you covet, that you would not gladly trade for, say, five extra years? These would be good years, of cross-country skiing between fashionable Colorado resorts, or at least years when you could still walk and think and read and drive.[5]
As Kinsley points out, “Life would be pretty empty without your friends. But not as empty as death.” Sure, you may be lonely, but you can also make new friends.
Are these shallow personal values? Kinsley also ridicules the “shallow” idea that “he who dies with the most toys, wins,” noting that lust for longevity trumps because “what good are toys if you’re dead? ‘He Who Dies Last’— he’s the one who wins.”
One thing they could also mean is that it will be boring to live longer. Perhaps that will be true for some people.
However, a survey of life over the last fifty years reveals that various advances helped (what Tom Brokaw famously called) “the Greatest Generation” live twenty more years of high-quality life than their parents. For my parents (both of whom made it into their late eighties), their last two decades differed little in quality and functionality from their own parents' last two decades, but they had an additional twenty years of good living. The Study of Adult Development at Harvard University, the longest study over decades ever conducted, falsified the view that as they get older, men turn into curmudgeons. Instead, men got happier as they got older.[6] Another 2011 study, which followed two large groups of Boston-area men, found that men became happier in their sixties and seventies, not crabby and depressed.[7]
One member of this greatest generation, Corporal Frank Buckles, lied at age sixteen to enlist in the army and to see action in World War I.[8] He lived robustly for 110 years and until he died in 2011, he was our oldest living veteran. Each morning, he did fifty sit-ups, lifted two-pound weights, and stretched major groups of muscles. Buckles remained so mentally alert that, at age 106, he stated in 2007 that the United States should only go to war when it’s an emergency, and implied then that invading Iraq was not such an emergency.[9] Because of his nearly eleven decades, not despite them, Frank Buckles lived well and wisely.
“We’ve entered a new age of old age,” said James Firman, president and CEO of the National Council on Aging. “The possibility of experiencing positive, vital aging lasting into our tenth decade of life is one of the new realities of the 21st century.”[10]
But if you live an extra twenty years, isn’t that selfish? Think of all the resources you’re consuming! Well, not necessarily. The longer you live, the more you care about the future. It’s one thing to burn down the savannah to hunt game if you’re starving; it’s quite another if you plan to live to one hundred. Taking it one step further, people who expected to live two hundred years would care much more about environmental pollution and the integrity of the world’s financial system because they would have a greater stake in what happens.
Also, the longer we expect to live, the greater our motivation to save. This might revive the dying virtue of saving money, as compound interest would build up much more over a hundred years than seventy.
With an average life of 105 rather than 85, one might pursue not one, but three careers—perhaps one as a Navy medic, one as a bioethicist, and one as a travel guide. You would cultivate a different set of virtues in the extra thirty years, but not the present ones of old age that center on frailty, physicians, and hospitals.
Within a life, one way to view two extra decades (or even two extra centuries) is as a neutral tool, neither good nor bad in itself. Like any tool, different people may use it differently. A hammer can be used to build a house or to kill humans. Some people will use a new tool wisely, others foolishly. If someone has made bad choices, then the extra decades will make them worse, but others, who make good choices, can enjoy the benefits.
A third philosophical issue raised by two more decades of life concerns relationships to members of one’s family. This is a complex issue.
If the average woman lives a century, this will create what Wittgenstein called a different “form of life,” especially from her ancestors, where in 1900 the same woman would have only lived to fifty. It is as if a person gets to live twice, in two different worlds, while retaining the same self.
Many relationships within a family evolved from past practices. In developing countries without old age safety nets such as Social Security and Medicare in the United States, having children to care for you is essential. This is one reason why families in India and China have lots of children and value boys more, as males are obligated to care for their parents.
In developed countries, different gender obligations have prevailed. Females more often care for parents of their own and their husband’s. Such “sandwich” women may both raise their own children and care for aging parents and in-laws. The downside of living a century is that a caring woman could get burdened with caring for too many people: her children, her parents, and some grandparents too.
In this context, philosopher Jane English famously raised the question, “What Do Grown Children Owe their Parents?”[11] Here the “owe” means “what parents can claim from grown children as their right.” For English, children and parents over decades should become friends and children ideally should care for parents out of love. But if they are not friends and no love exists, grown children are not obligated to provide for their parents. Simply because their parents brought them into the world and raised them does not create such an obligation in part because children had no choice in the matter.
Although technically her arguments may be valid, the feelings that exist within families do not run along valid arguments. I expect that, as people live longer, families will need to negotiate new arrangements. Some senior citizens will fear being burdens and insure that they are not. Others won’t be so organized.
Tennessee philosopher John Hardwig famously argued that seniors in some circumstances should not ask their middle-aged children to sacrifice for them.[12] English’s and Hardwig’s pieces should be considered opening salvos in a new intergenerational war about resources owed to those over age seventy.
Another issue to consider is work. Vaupel wonders whether the nature of work may need restructuring to accommodate so many people living so long. Using the example of Germany, he speculates that this country, if more people work longer, may need to reduce the average workweek so that more people can work.
Japan seems to be facing this problem now, with much of advanced Europe close behind.[13] Japan has too many people over eighty and too many financially secure people aged fifty to seventy. The latter stay so long in their careers that they hog all the good jobs in education, business, and professions. Most twenty- to thirty-year-old Japanese believe they face a closed future and that they must leave Japan to find real opportunities to advance.
Consider also tenure in teaching in K–12 education and in universities. It is one thing to tenure a teacher for twenty-five years, but another for forty or fifty. How many teachers can retain their enthusiasm for such a period? How many professors? As education downsizes and tenured spots become a scarce resource, can an efficient society bestow sinecures that might last for five decades?
A fourth philosophical issue involves justice. Some might object that, unless we increase longevity for everyone, extra life in developed countries would create global resentment, so none should have it until all can have it. Can we really justify, critics ask, a medical world where rich people in Europe and North America live three times longer on average than the poorest people in Botswana?
First, there’s little that short-lived people can do about others living longer because it’s not as if the years are transferable. Second, longevity will be a symptom of inequality, not a cause of it. Finally, the masses of the world are unlikely to rise up against citizens of developed countries merely because the latter live longer. Already, although the average life span in Botswana is thirty-four and eighty-four in Japan, you don’t see dying Botswanans protesting the long lives of Japanese.
It is also true that not everyone will live longer. Until we find a cure for cancer, coronary artery disease, and stroke, these three diseases will be the cause of death for most people before age eighty. If they don’t succumb to these three, aging at the cellular level will weaken the immune system, making those over eighty vulnerable to other diseases. Even if we cured these major diseases, we’re not safe yet. Of the 2.4 million Americans who died in 2001, about 13,000 died from bites and poisons, another 13,000 died from falls, about 44,000 died in automobile crashes, and firearms figured in another 30,000 deaths.[14] If none of these get you, doctors and hospitals may: according to the Institute of Medicine, mistakes by medical personnel kill nearly one hundred thousand Americans each year.[15]
Despite all these dangers waiting to kill us, more and more of us will live until our eighties and nineties. More and more will become centenarians, especially those born today in middle-class families with good medical and dental coverage. By 1990, about 37,000 Americans lived to be over one hundred years old, yet by 2050, according to the National Institute on Aging, four million will live to become centenarians.[16]
But can an advanced society afford for us to live these extra years? The philosophical issue here is not about global, but rather, domestic justice. If senior Americans live too long, won’t they consume too many resources, resources that might otherwise be given to young Americans? This argument stings: “Die early, so younger people can get your money.” Will intergenerational war soon divide young against old? Has it already started?
Past projections about Medicare, social security, life insurance, long-term care insurance, annuities, mortgages, and savings assume a normal human life span. Already citizens in developed countries live far longer than the life envisioned by the founders of our old-age systems.
In Bismarck’s time, most people did not make it to fifty, much less sixty-five, so few resources were needed to fund his pension. When Social Security began in 1935, only about half of men and about two thirds of women lived to age sixty-five, and for them, at retirement they could expect to live eleven more years. Today, about three-fourths of men and nearly 85 percent of women live to that age and can expect to live another sixteen years.
The savings of past workers do not fund Social Security and Medicare, but taxes from current workers. It’s a revolving-door system of financing, where current workers pay for benefits of existing senior citizens. Decades ago, about two workers paid for every beneficiary receiving Social Security or Medicare. As Baby Boomers retire, things could get bad, with two people benefiting for every worker taxed. Obviously, the amount of taxes has to rise, the number of beneficiaries has to shrink, or the amount of benefits has to fall.
Worse, many states have made commitments to retirees, both for pensions and medical coverage, that they have not funded; these commitments depend on the trust and goodwill of future taxpayers of that state, but such taxpayers may have never voted for such payments. Is a generational war brewing? In 2050, will workers under age seventy be taxed at 60 percent of earnings to pay for entitlements of long-living, retired Americans?
We could mitigate this problem. Although the United States pays for Social Security and Medicare by taxing working citizens, adjustments can keep the system operating. The age when one can first withdraw Social Security can be raised. This is like a tax on current workers, so if they must feel pain, so must others. Benefits to current retirees can be reduced, while taxes on the youngest and healthiest can be increased. To make the system just and functional, everybody should sacrifice something.[17]
More radically, illegal working immigrants could legally be allowed to stay in the country on the condition that they pay twice as much as other Americans into FICA and the Medicare Trust Fund (it’s only “unfair” if they refuse the bargain and for most, legal entry on these terms would be better than not being able to enter or remaining illegal immigrants).
Third, more immigrants want to enter the United States, thereby growing the work force and increasing the number of taxpayers. Fourth, the U.S. population itself is expanding. Just a few decades ago it was at 200 million; in 2007, it topped 300 million. That’s a lot of extra tax-paying workers.
In the debate over reforming Medicare in 2011, one Republican senator claimed that the average beneficiary of Medicare paid in $150,000 and gets $350,000 in benefits. If we allow millions of Americans to draw an extra twenty years of Medicare benefits, younger workers will be financially crushed.
From the point of view of the tragedy of the commons and intergenerational justice, it is obviously unfair that one generation might be able to use up so many resources at the expense of another. Whether that last phrase is true is the big question, i.e., whether the Baby Boomers living longer and better will be at the expense of Generation X living shorter and worse.
For me, it is going to be hard not to use up expensive medical resources, especially for the abstract goal of helping younger workers. But I hate to think my living longer is an injustice to my students and their generation. To avoid this, we should plan for what is coming.
Bernard Williams, “The Makropoulos Case: Reflections on the Tedium of Immortality,” in his Problems of the Self (Cambridge: Cambridge University Press, 1973).
Daniel Callahan, What Kind of Life? The Limits of Medical Progress (New York, Simon & Schuster, 1990).
Fukuyama, Francis, Our Posthuman Future: Consequences of the Biotechnology Revolution (New York: Farrar, Straus & Giroux, 2002).
David Brooks, “Death and Budgets,” New York Times, July 14, 2011.
Michael Kinsley, “Mine is Longer than Yours,” New Yorker, April 7, 2008, 38ff.
Laboratory of Adult Development, Harvard University, http://adultdev.bwh.harvard.edu/research-SAD.html
Christine Stapleton, “Study: Men Get Happier as They Age,” Cincinnati Enquirer and Cox News Service, March 3, 2011, E2.
“106-year-old WWI Veteran Speaks on Iraq War,” Washington Post, November 12, 2007.
“106-year-old WWI Veteran Speaks on Iraq War.”
Jane English, “What Do Grown Children Owe Their Parents?” Philosophical and Legal Reflections on Parenthood, Onora O'Neill and William Ruddick, eds. (New York: Oxford, 1979).
John Hardwig, “Is There A Duty to Die?” Hastings Center Report, 27, no. 2 (1997): 34–42.
Martin Flackler, New York Times, January 27, 2011, “In Japan, Young Face Generational Roadblocks.”
National Vital Statistics Report, Vol. 15, September 16, 2002.
Institute of Medicine, To Err is Human: Building a Safer Health System, (eds) Linda T. Kohn, et al., Committee on Quality of Health Care in America (Washington, D.C.: National Academy Press, 2000).
Jesse Green, “What Do a Bunch of Old Jews Know about Living Forever?” New York Magazine, November 14, 2011, 31.
This was what the UAB Ethics Bowl Team argued in winning its case in the 2011 regional competition in Tampa about precisely this kind of case.