Many people say they aren’t interested in having an extended life. They are potential Will-nots. (They would be actual Will-nots if life extension existed and they could afford it but turned it down anyway.) For various reasons, they think extended life is not a good life. I discussed some of those reasons in the last two chapters. I now want to discuss another reason they might have for thinking that life extension is bad for them. I am not talking about Malthusian pressures or other consequences that are bad for everyone, including the Will-nots; I’ll get to those issues in the next two chapters. I am talking about possible harms that affect only Will-nots. Moreover, these harms—if they exist—affect Will-nots even if they never use life extension. In short, I will discuss possible reasons for thinking that merely living in a world where life extension is available is bad for Will-nots, even though they never extend their own lives. That kind of harm is important, for we can’t answer it by saying, “Fine, maybe extended life is not good for you, but that’s no reason to stop anyone else from getting it.” If living in a world where life extension exists is bad for Will-nots even though their lives are not extended, then we have some reasons against developing life extension even though it’s optional and reversible.
Do such reasons exist? This concern has an obscure provenance. I confess that I can’t offer any quotes or citations for it, and I’ve never seen it explicitly mentioned in any publication (though I feel I sense it somewhere between the lines in certain bioconservative passages). However, when I talk to people who don’t want life extension, I sometimes have the sense that some of them don’t merely want to avoid living an extended life. They seem to feel distaste or apprehension at the very idea of living in a world where life extension exists at all. There is something about living in such a world that feels uncomfortable to them—and not just because they’re worried about overpopulation or social injustice or because such radical change may seem threatening. In this chapter, I’ll try to articulate and explain two reasons why they might legitimately feel that way.
First, they might think that the mere fact that life extension is available reduces the advantages of living a normal life span, at least for them. To put this another way, it might reduce the death benefits of their normal life spans. (I didn’t argue in chapter 3 that there are no such benefits, only that they’re not as numerous or significant as some thinkers believe.) Second, they may think that refusing life extension or discontinuing it after they started it is a kind of immoral suicide so that creating life extension puts them in the position of having to choose between living an extended life they don’t want and doing something immoral.1
By the way, the suicide question is not an issue only for Will-nots. It is also an issue when I claim that we should not worry about whether extended life is good to have, for we can always go off our life extension meds and resume aging (in effect, transferring from the Haves to the Will-nots). If doing that is an immoral suicide, then my arguments in favor of developing life extension are undermined in a more general way.
I will argue that neither of these reasons is very strong.
As we saw in the last two chapters, some people believe that aging and a normal life span have advantages. These advantages, which I call “death benefits,” might include greater ease in accepting death, using our time better, having a certain kind of meaning in life, developing virtues, learning to transcend our own narrow concerns by developing concern for posterity and other things beyond ourselves, and avoiding the risk of intolerable boredom. (The concern that you may eventually change enough to become a new person, and thereby cease to exist in the long run even if your body survives, is not an objection to extended life so much as a reason to think you cannot extend your life forever.) These are offered as reasons not to extend your life: extend it, and you’ll lose these benefits. Now, imagine that you can afford life extension, but you turn it down to avoid reducing those benefits. You are a Will-not. You expect to die in your 80s or 90s, and you want to enjoy your death benefits in their full measure. If life extension is available to you, then you might feel that your death benefits have been reduced somehow even if you refuse it, choosing to age and die on schedule.
Here is why you might feel that way. Without life extension, death is a hard limit—you can avoid it for a while, but you will run up against it in roughly a century or less. However, as I argued in section 3.10, if life extension is available to you, then for you, death is no longer a hard limit. It is a soft limit in the sense that it’s a limit you can postpone if you choose to take advantage of life extension. This is true not only if you extend your life but also if you don’t, for if you refuse life extension when it’s available to you, you can later change your mind and extend your life, thereby postponing death after all. You have this choice during much of your life, or at least until you’re too elderly to make use of life extension (and perhaps even then, if we learn to reverse aging). The significance of this is that the death benefits depend partly on death being a hard limit. Thus, the fact that you can change your mind and start extending your life—even if you never do—might seem to reduce some of your death benefits.
Does it? Of course, that depends partly on whether there are any death benefits. The death benefits are the flip side of drawbacks to extended life. Having a normal life span is beneficial because you avoid the drawbacks. I argued that these drawbacks are either minor, nonexistent, or avoidable—or, at very least, we lack evidence that they are serious and unavoidable. I also noted that the advantages and drawbacks of extended life may vary from person to person. However, in this section I’ll assume, just for discussion, that extended life has some drawbacks for at least some people. With that in mind, let’s consider how living in a world where life extension is available might reduce some death benefits for some Will-nots.
First, you may not come to terms with the inevitability of death if death is not a hard limit. If you can always change your mind and start using life extension, then death may not feel inevitable, and it may be more difficult to accept death. Thus, living in a world where life extension is available to you may undermine the first death benefit even if you never use life extension at all. Second, if you can get life extension when you want it, then you might procrastinate and use your time poorly even if you never extend your life. After all, you can always take the cure and buy more years if you feel the press of time. Just having that option might induce you to waste time. Third, if the virtues we develop by facing mortal danger, such as courage, are harder to acquire in an extended life, they may also be harder to acquire if you think you could still delay death substantially if you changed your mind and used life extension. Presumably the same is true of death’s power to drive us to transcend our narrow, selfish concerns and invest ourselves in posterity and other things that are bigger than we are. As for avoiding the boredom of extended life, that’s one drawback the Will-nots will completely avoid, provided they never change their mind and join the Haves.
So the advent of life extension might reduce some death benefits for some Will-nots. (The advent of life extension would not, of course, have this effect on Have-nots who don’t want life extension, for the fact that they can’t afford life extension makes it effectively impossible for them. For them, death is still a hard limit.) How serious a harm could this be? We have no data and no algorithm for calculating that harm, so all anyone can do is use their judgment and hazard a guess. My guess is that it’s trivial, but perhaps the magnitude of this harm varies from person to person.
In any case, there is a second way in which the advent of life extension might affect the Will-nots: it might force them to choose between (a) an extended life they don’t want and (b) committing what they consider an immoral kind of suicide. Does introducing life extension into the world put such people in a position where they are damned with extended life if they take the cure and damned for committing suicide if they don’t?
First we must ask whether declining or discontinuing life extension is a kind of suicide. We can approach that question by drawing an analogy between forgoing life extension and forgoing life support, such as respirators, feeding tubes, or intensive care. No one has foregone life extension yet, but people forgo life support in hospitals all the time. There are two further questions here:
If the answer to both questions is yes, then foregoing life extension is a kind of suicide. If the answer to either question is no, then foregoing life extension is not a kind of suicide. (My discussion treats never starting life support the same as stopping life support after it has started.2) I ask the reader to be patient while we take a short detour and consider life support.
Suicide consists of intentionally bringing about your own death. The US Centers for Disease Control and Prevention define suicide as “death caused by self-directed injurious behavior with any intent to die as a result of the behavior,”3 and the Oxford Dictionary of American English defines it as “the action of killing oneself intentionally,” noting that the word comes from the Latin words sui (“of oneself”) and caedere (“kill”).4 These definitions are a bit terse; here is a similar but better one from Michael Cholbi:
Suicide is intentional self-killing: a person’s act is suicidal if and only if the person believed that the act, or some causal consequence of that act, would make her death likely and she engaged in the behavior to intentionally bring about her death.5
Cholbi says “intentional self-killing” occurs only when “the individual rationally endorses her own death as the chosen means or a foreseeable effect of pursuing her ends.”6 The agent need not endorse death as such; it is enough that she endorses dying when that’s the only way to achieve some end she values more than staying alive.
Note that all three definitions are purely descriptive. They leave it open whether suicide is always immoral, never immoral, or sometimes immoral—and when. This is as it should be; we need a concept for intentionally bringing about your own death, and we should not assume that doing so is always wrong. Even if it is always wrong, this does not follow from the concept of suicide but must be argued from other premises.
Given our concept of suicide, it turns out that declining or terminating life support can count as suicide. Suppose, for example, that you’re dying slowly from a very painful, incurable, and untreatable cancer and that your life support includes a ventilator. You act by telling your doctor to turn off your ventilator, believing that this will make your death likely, and you do this in order to bring about your death and thereby avoid unbearable pain and what you consider a meaningless life. This fits all the elements of the definition: you acted in a way that made your death more likely because you wanted to bring about your death, which you rationally endorsed as a means of avoiding pain and a meaningless existence. The same analysis should work for many ways of declining or discontinuing some treatment that would keep you alive, such as declining cancer treatment knowing this will shorten your life by six months, provided you did so in order to bring about your death and believed that doing so would make your death more likely. (This is why merely neglecting your health to the degree that you foreseeably shorten your life is usually not suicide: people who neglect their health typically don’t do so in order to hasten their death.)
Cholbi has argued this way.7 So have Franklin G. Miller, Robert G. Truog, and Dan W. Brock, who define suicide as aiming at and causing one’s own death, and contend that this happens when, for example, patients request to be taken off a ventilator to avoid life as a quadriplegic.8 David Shaw argues that the body is a kind of life support for the person (or at least the brain), and thus euthanasia is a way of taking someone off life support—and hence morally permissible. Shaw does not discuss suicide, but it’s easy to extend his argument to suicide. Euthanasia involves killing someone else, while suicide involves killing yourself.9
One might resist the claim that foregoing life support is suicide by appealing to the killing/letting-die distinction: suicide involves killing, while foregoing life support is a form of letting-die; therefore, forgoing life support is not suicide. This is not because death happens more slowly when you let yourself die and more quickly when you kill yourself; you can kill yourself by ingesting a poison that takes months to kill you. Rather, the objection is that suicide requires killing and not merely letting-die.
One possible argument behind this objection is that suicide is necessarily immoral, and letting-die is not immoral, so letting-die is not suicide. However, that can’t be right. Aside from doubts about whether the killing/letting-die distinction is morally relevant at all, it should be uncontroversial that some instances of letting-die are clearly immoral too, such as removing your competent grandmother from her respirator in order to speed up your inheritance. It should also be uncontroversial that some instances of killing are not immoral, such as killing in self-defense.
Another possible argument for this objection appeals to how we use the concept of suicide. Here the claim is that we use the concept of suicide only in cases of killing one’s self, and never in cases of letting one’s self die, so that killing is simply part of the concept of suicide, whether or not the killing/letting-die concept makes any moral difference here. Now, it is true that we rarely use the term suicide to refer to cases of letting-die. However, there are two possible reasons why we do this, and neither one is a good reason to say that letting-die can never be suicide.
One possible reason is that in most cases of letting-die, the decision is made by a surrogate decision-maker and not by the patient himself, who is usually incompetent in such cases; this is not suicide because suicide requires action by the one who dies. However, that doesn’t preclude applying the concept of suicide to cases of letting-die where the decision to let the patient die is made by the patient. Another possible reason is that there are laws prohibiting helping someone commit suicide, yet in most cases of letting-die, the medical staff help, at least by terminating the treatment that sustains life. Medical professionals don’t want to call this suicide, partly to avoid upsetting the patient or family and partly to avoid attracting attention from prosecutors. However, these are pragmatic concerns and not good reasons to limit the concept of suicide to cases of killing.
Moreover, not all cases of bringing about death fall clearly on either side of the killing/letting-die distinction. Consider some cases.
Am I letting myself die, or am I killing myself? Does it matter that I refrain from ingesting the antidote?
If that’s suicide, then why isn’t refraining from taking an antidote just as much a case of suicide?
Taking someone off a respirator is usually considered a case of letting-die, but if I did this to someone else, would I not be killing him? If so, then I’m killing myself when I do it to myself.
The point of these three cases is that there are clear cases of suicide that do not fit easily on either side of the killing/letting-die distinction. It therefore makes sense to characterize suicide more neutrally as “bringing about death.” Therefore, both forgoing and terminating life support can be suicide.
The detour is over. Back to life extension.
Yes: they are morally equivalent. If it is suicide to decline or terminate chemotherapy and die from cancer, thereby giving up six months of life, then it is even more clearly suicidal to decline more radical kinds of life extension that may confer centuries of life. The fact that the potential life is longer and better does not make this less a case of suicide; if anything, the reverse. I’m not saying that life extension is a kind of life support, only that there’s no morally relevant distinction, so far as suicide is concerned, between life support and life extension—if terminating one counts as suicide, so does the other. Both of them require help from medical professionals, both are beyond the natural capacity of the body to heal itself, both will make your life longer, both can be declined, and both can be discontinued.
Here is an objection: the definition of suicide refers to bringing about one’s death, but “death” here refers to death at the end of our natural, biological life span, not to death after an unnaturally long, artificially extended life span. In other words, “bringing about your own death” means “bringing about your own death before the natural end of your life,” not “bringing about your own death when it is possible to live longer than we naturally do.” Once you reach, say, age 100, you have a free pass to check out any time you like without being labeled a suicide for doing so.
What could be the argument for this claim? I suspect that those who find it appealing are drawing upon a concept of suicide as something bad and further drawing upon a sense that what is contrary to nature is bad. If aging and dying in a more natural way is right and suicide is wrong, then turning down life extension must not be suicide. Once again, this kind of argument relies on a normative definition of suicide as something necessarily wrong or bad, and for the reasons given earlier, we should use a purely descriptive definition of suicide rather than building a normative view of suicide into the definition. Claims that suicide is wrong must be argued for, not assumed in the definition. Moreover, the claim that what is natural is presumptively right and what is unnatural is presumptively wrong is subject to too many counterexamples to have much weight as a moral rule of thumb: vaccination, eyeglasses, and literacy, among many others. (We’ll discuss the significance of what is natural at greater length in sections 12.5 and 12.6.)
I have argued that declining or terminating life extension is a kind of suicide. Now let’s consider whether this kind of suicide is immoral. Of course, this question is too broad; except for absolutists who believe all suicides are always wrong, the morality of suicide depends on various factors. Let’s ask a narrower question instead: Is the fact that one commits suicide by refusing life extension relevant to whether or not that suicide is morally permissible? In other words, does the fact that life extension is involved ever make a difference to the morality of suicide, or is it, like the difference between using a gun and using poison, morally irrelevant? I think it’s morally irrelevant. This is not to say that suicide by refusing life extension is always morally permissible, and certainly not that it is never permissible—only that the morality of suicide by turning down or discontinuing life extension turns on arguments about the morality of suicide in general.
To see why, consider the main arguments against suicide:10
None of these characterizations do justice to these arguments, but they provide enough detail to see whether and how life extension might be relevant to arguments that suicide is immoral.
The fact of discontinuing or refusing life extension seems to make no difference to the natural law argument. Life extension is artificial and therefore unnatural, in a sense, but that artificiality seems irrelevant to whether there is a natural law mandating survival. Indeed, the survival instinct is one of the main impulses behind life extension research, though few researchers will say so openly. If it’s immoral to refuse life support for this reason, then it’s also immoral to refuse life extension. However, it’s neither more nor less immoral simply because life extension is involved. The fact that this occurs by turning down life extension is morally irrelevant.
Turning down life extension also makes no difference to arguments that you are God’s property or owe him a debt of gratitude. If being his property or in his debt makes suicide wrong, it makes suicide wrong however you commit it. The fact that life extension is involved is morally irrelevant here.
As for the argument that human life has intrinsic value, if a natural life span has sufficient intrinsic value to make suicide wrong, then an extended life span will too. Some may say that extended life is less valuable to the person living it the longer it continues. This is a version of the boredom, personal identity, and death benefits arguments. However, that’s a claim about the value of your life for you, not a claim about the intrinsic value of your life. Again, even if suicide is wrong for this reason, the fact that life extension is involved does not make the suicide more or less wrong.
Now consider the arguments based on your relationships and obligations to society and others. The fact that life extension is involved is irrelevant to those arguments too. Your relationships, obligations, and value to society do not go away just because you live a lot longer, so if those things make suicide immoral in a normal life span, they should do so in an extended life span too. The same seems true of using yourself as a mere means, for halting aging doesn’t mean you are no longer an autonomous person.
In general, the fact that you’re turning down life extension seems irrelevant to whether suicide is wrong. If any of these arguments establishes that at least some suicides are morally wrong, then at least some cases of declining life extension are morally wrong too.
The fact that life extension is involved might, however, be relevant to the degree of wrongness (if any). This depends on the argument. Many of these arguments make some reference to the value of your life to others (society, your children, God) or its intrinsic value. If suicide is wrong for one of these reasons, then it may be more wrong the more potential years of life you are avoiding, for life extension makes so much more of that valuable life span available. However, the fact of life extension probably makes no difference to the degree of wrongness when it comes to arguments that suicide is wrong because it violates natural law or that you are God’s property. If it violates natural law, that violation does not seem more serious the longer the span of time one fails to survive. The fact of life extension is also probably irrelevant for the Kantian argument that committing suicide is a case of using yourself as a mere means, for it is not clear how the number of years involved is relevant, unless the Kantian wants to say that you are using yourself as a mere means for a longer period of time the longer your potential life span was.
So the fact that it’s irrelevant that suicide occurs by refusing life extension does not tell us whether refusing life extension is morally wrong, but it might be wrong for some other reason. As I said, whether or not suicide is morally permissible depends on the case, so it’s hard to generalize, but we can try to identify what might make it wrong and the odds that it would ever be wrong. If the odds are low, then we have one fewer reason to think that some Will-nots may suffer harm by being forced to choose between extended life and what they regard as suicide.
To evaluate this, I want to divide the arguments against suicide into two groups. Some of the arguments appear to imply that suicide is always wrong. These arguments—that it violates natural law, or that we are God’s property and life is a gift from God, or that human life is intrinsically valuable, or that we should not use ourselves as a mere means—don’t seem to be limited to particular cases. When people say life came from God, they mean we all got it that way, not just those who are on particularly good terms with God. When people say human life has intrinsic moral value, they typically mean that all human life has this. When we’re taught that it’s wrong to use other people, we are not told that it’s wrong under certain circumstances but perfectly all right under other circumstances. We are told that it’s wrong, period. These arguments appear to be absolutist; they seem to say that suicide is always wrong. I want to set aside the question whether those views are correct and ask what they imply about refusing life extension. They might seem to imply that refusing life extension is always wrong.
Then again, they might not imply this. It may be that suicide is always wrong but that sometimes there are reasons for doing something that happens to be suicide that are so strong, they outweigh the wrongness of suicide. We think this way in many situations. For example, many of us would say that it’s not wrong to lie to a murderer about the location of his potential victim. It’s still lying, of course, but even if lying is always wrong, telling a lie might, for countervailing reasons that are more important—like preventing a murder—be the right thing to do. We might say something similar about refusing or discontinuing life extension. For example, we might say that when you have strong reasons to prefer not to continue living, refusing or discontinuing life extension is still suicide, but the moral reasons against doing so are outweighed by other moral considerations. For example, if you find that the drawbacks of extended life are pretty bad and you’re bored beyond toleration and longing for death, then you might have moral justification for committing suicide by refusing life extension despite the fact that doing so is wrong.
I said that the arguments against suicide divide into two groups and that the first group is a set of arguments that, by their terms, seem to apply to all cases of suicide. The second group of arguments do not, by their terms, apply to all cases of suicide. They apply to certain cases and not others. One of these arguments says that suicide denies society the benefits of your continued existence and that society will be worse off if you take yourself out of society by killing yourself. This argument is conditioned on the idea that society will suffer harm if you disappear, but not everyone is that essential to those around them, so this argument does not seem to apply to all cases of suicide. Another argument says that you have a debt to society, for society made your life possible and conferred various benefits on you. You therefore have an obligation to stick around and repay society. This too depends on circumstances. The argument probably doesn’t apply in cases where you long since repaid the value of whatever society gave you. Similarly, arguments against suicide on the grounds that you have responsibilities to children, other family members, or friends are only as strong as those responsibilities. If your friends and family are already well situated and no longer need your help, such arguments lose force.
You can see where this is going. Suppose you’re elderly and the available life extension methods can actually reverse aging, so it’s still not too late for you. Nonetheless, you refuse life extension. This could be wrong if you still have responsibilities to people around you or debts to repay. I’m not saying that elderly people never have such responsibilities or debts. I do claim, however, that by the time you’re elderly, you may well have done all you’re required to do for your children, relatives, or society at large. At some point, those responsibilities come to an end.
So is it morally permissible to refuse or discontinue life extension in most cases? I am inclined to say yes, if only because a normal life span is usually long enough to fulfill responsibilities and pay debts. (If it were not, we would also think that refusing life support is always wrong, but we tend not to think that.)
However, even if I’m right that refusing life extension is rarely an immoral suicide, Will-nots who think it’s an immoral suicide may suffer a harm anyway. I’m talking about “moral injury,” defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”11 The concept of moral injury was developed by psychiatrists working with war veterans who had participated in actions that violated their moral ideals. Victims of moral injury suffer guilt, shame, self-condemnation, demoralization, and self-harming behaviors. The injury is that you suffered such feelings because you were led to behave in ways that conflict with your moral beliefs.12
Some Will-nots may believe that refusing or discontinuing life support is a kind of immoral suicide. To suffer a moral injury, it’s not necessary that your moral belief is true, only that you sincerely believe it and you are led to act contrary to that belief. The harm lies in the guilt, shame, and so forth, not in the supposed wrongness of what you are doing. Therefore, Will-nots can suffer a moral injury even if they’re mistaken about whether declining life extension is suicide or about whether such suicide is immoral. Because introducing life extension into the world and making it available forces that choice on the Will-nots, developing life extension imposes a kind of moral injury on those Will-nots.
Let me add four qualifications. First, not all Will-nots suffer this moral injury—just the ones who believe that turning down life extension is an immoral suicide but turn it down anyway. The percentage of Will-nots in this group may turn out to be fairly small.
Second, I have defined Will-not as someone who has access to life extension but turns it down. Of course, there may well be many Have-nots who don’t want life extension and would turn it down if they had access to it. Those Have-nots are similar to Will-nots, but I leave them out of the Will-not category because they have no choice when it comes to using life extension (it’s not available to them), so they’re not forced to make a choice that’s contrary to their moral beliefs.
Third, it’s possible that some people who have access to life extension don’t want it but accept it anyway, for they believe that doing otherwise is an immoral kind of suicide. I doubt that very many people will fall into this category, so I have not set aside a separate subcategory for them. However, anyone who falls into this category suffers a kind of injury too, for although they haven’t committed suicide by turning down life extension, they are living a life they don’t want and presumably don’t like. That may not be a moral injury, but it is an injury.
Fourth, I have repeatedly pointed out that life extension is a reversible decision, so if it turns out to be boring or otherwise undesirable, a Have can always reverse that decision by going off her life extension meds, as it were, and resume aging until she dies in a few years or decades. My argument that this is not an immoral suicide is therefore an important element in my moral arguments for life extension in general, for the option of discontinuing extended life is a sort of escape clause for those who find they do not like life extension. However, Haves who do that are effectively becoming Will-nots, so if they believe that discontinuing life extension is an immoral suicide, then what I’ve said about the morality of committing suicide by discontinuing life extension applies to them too.