In this chapter, I summarize the policy recommendations I’ve argued for here and there in various chapters and then list all the conclusions reached in chapters 2 through 12. The list of conclusions serves as a narrative index for the course of argument developed in this book.
I have addressed three policy issues: (1) whether developing life extension is a good or bad thing (that is, whether it should be promoted or inhibited), (2) how to handle the fact that not everyone can afford access to life extension, and (3) how to minimize the possibility of Malthusian population pressures.
Policy concerning the development of life extension
The first policy choice is whether to encourage or discourage the development of life extension. In chapter 1, I presented three possible public policies concerning the development of life extension:
- Inhibition: We can try to inhibit such research—prevent it from going forward or at least slow it down. We might refuse to spend public funds on it, or fund it only very conservatively, or try temporarily to prohibit it until we develop a complete regulatory framework or a strong social consensus about such research.
- Prohibition: We can try to prohibit anyone from using life extension once it has been developed.
- Promotion: We can fund life extension research aggressively in order to develop life extension methods as quickly as possible.
Throughout this book, I have argued for the policy of Promotion. In particular, I argued (in section 11.5) for Promotion with Immediate Access (Haves can get life extension as soon as it is developed rather than waiting until all the Have-nots can get it too) rather than Promotion with Delayed Access (no one can get life extension until everyone who wants it can have it). There are two reasons I favor Promotion with Immediate Access. First, Promotion with Delayed Access is a form of temporary Prohibition, and Prohibition is not feasible. Second, Promotion with Immediate Access will probably stimulate the development of life extension faster, making it available to earlier generations of Have-nots as well as earlier generations of Haves.
Promotion is presented as a policy concerning public funding for scientific research and whatever laws might further or inhibit life extension research, but the idea is more general than that. This is a way of saying that life extension is, on balance, a good thing, and we are better off getting it sooner rather than later. We could say that without reference to public funding for research, of course, but deciding how to spend our tax dollars is a natural place to raise the question. Even if Silicon Valley multibillionaires fund the research all by themselves and bring life extension about before anyone else has had time to mull it over, we should still ask whether that is a good thing. (We might, after all, want to think about whether to encourage or discourage them from doing so.) Deliberating about these three policies is a way of doing that.
Policy concerning access to life extension
The second policy choice concerns access to life extension once it has been developed. In chapter 8, I argued for two sets of policies:
Who gets access
- • No one should be denied access to life extension, nor should the development of life extension be inhibited. (Section 8.3)
- • Life extension should be subsidized for those Have-nots who want it to the extent possible, provided that the amount of wealth necessary to do this does not exceed the amount that justice requires to be transferred from those who are better off. (I leave open what that amount is, but I believe that once the technology matures, it won’t be too difficult to provide it to all of them, so I have not tried to address this.) (Section 8.5)
- • If the amount needed to subsidize it for all Have-nots is larger than what justice requires, then instead of subsidizing it for some Have-nots and not others (selected, for example, by lottery), justice requires equal compensation to all Have-nots in some form other than subsidized access to life extension. This might be done through cash transfers or other social benefits. (Section 8.6)
How to finance access for the Have-nots
- • To the extent that subsidizing life extension for the Have-nots requires an increase in the overall transfer of wealth that justice would require in the absence of life extension, that increased transfer should come solely from the Haves. This additional burden can be financed at least in part through a user fee or use tax on Haves or an increased income tax above an age past which people don’t live without life extension (such as age 115, or perhaps a graduated increase from 90 on up), perhaps coupled with a confiscation of much of their assets. (Section 8.5)
- • Will-nots should not be subject to greater transfers of wealth than justice would require in the absence of life extension. (Section 8.5)
Policy concerning the possibility of Malthusian consequences
The third policy choice concerns the threat of increased population pressures that will occur (in the absence of any limits on reproduction) if people live far longer than they do now. There is some room for debate over how much population increase constitutes a Malthusian crisis. I suggested in section 6.2 that an increase of one-third is tolerable. I might be wrong. The main point is that we can set a target fertility rate to keep population growth within whatever limit we decide upon.
In sections 6.3 through 6.7, I argued for a reproductive policy I call “Forced Choice,” which restricts the number of children people can have after they use life extension but does not apply to those who never use life extension. Because Forced Choice doesn’t apply to those who don’t use life extension, it doesn’t guarantee that we won’t exceed our target anyway. If we do, then we may have to impose reproductive limits on everyone, or set the limit for those who use life extension even lower, or some combination of the two.
Here are the elements of Forced Choice (for illustration, I’ll assume a limit of 0.5 children per woman for however long that is necessary):
The reproductive limit and who it applies to
- • Those who extend their lives can have (in our example) an average of only 0.5 children per woman at an average age of 25 at childbirth.
- • This policy is imposed on everyone, regardless of gender or sexual orientation.
- • It is applied on an individual basis, not on couples as units.
How we decide who gets to reproduce if the limit is low enough that not everyone can
- • To decide who gets the right to reproduce, those who wish to extend their lives must enter a reproductive lottery or be denied access to life extension.
- • If you’ve had no children yet and you enter the lottery, you have a 25 percent chance of winning the right to reproduce.
- • If you’ve already had one child and you then enter the lottery, the trade-off is reversed: you enter the lottery with a 25 percent chance of winning the right to extend your life. Thus, having one child reduces your chances of being allowed to extend your life from 100 percent to 25 percent, and if you win the lottery, you may not reproduce again.
- • If you’ve had two children already, then you’re forbidden to have life extension.
- • Delaying the average age of childbirth slows the population increase to some extent, so your odds of winning the right to reproduce are correspondingly higher the longer you wait to enter the lottery (linked to whatever higher rate of childbirth at that average age of childbirth will produce the same population increase).
- • If you lose the lottery when seeking to reproduce at a given age 25, you can subtract your odds at that age from your higher odds at some later age and enter the lottery again at that later age with a percentile chance of reproducing equivalent to the difference between the original odds and whatever higher odds you would have had if you had waited until that later age to enter the lottery the first time. This can be repeated indefinitely, with progressively lower odds of winning.
How you can use your right to reproduce
- • If you win the right to reproduce, anyone you reproduce with can do so as well even if they lost the lottery.
- • Those who extend their lives may have children with people who don’t extend their lives, but the reproductive limit still applies to the person who lives an extended life.
- • The reproductive limit does not apply to adoption.
- • If you’re living an extended life and your child dies, you can have another child to replace the one who died. The reproductive limit is based on the number of children, not the number of childbirths.
- • Someone who is biologically unable to reproduce still gets a 25 percent chance to reproduce. If that person wins the lottery, they can then use assisted reproductive technology and egg and/or sperm donors (or even cloning) to exercise that right and have a child.
- • People who win the lottery can sell or give the right to reproduce to someone else, somewhat like a carbon credit.
What if you extended your life and you then reproduce without the right to do so?
- • If you’ve already extended your life and you then have a child without having won the reproductive right to do so, your life-extending treatments are terminated and you resume aging at a normal pace. Your reproduction is now no longer limited (assuming your society has not imposed some other limit on reproduction that applies to everyone), but you will resume aging.
What if you extend your life and you later change your mind?
- • If you extend your life and you later wish you had reproduced instead (or wish you had more children than you were allowed to), you can reverse that decision and revert to normal aging, just as if you had never extended your life in the first place. You can then have more children.
- • If lots of people extend their lives and then, after many decades or centuries, they decide to discontinue their life-extending treatments and then have an extra child, the reproductive limit could be reimposed on that group so that they don’t increase the population too much (due to the lingering guest problem).
How to enforce Forced Choice
- • Governments must keep track of birth records to see who has had children and how many children each person has had.
- • Life extension clinics would be licensed and supervised, and each person who comes in would be identified (perhaps with a pinprick blood sample and a DNA chip) and their reproductive records called up to see how many children they have had.
- • Genetic testing (again, with a pinprick of blood and a DNA chip) would be used to read every child’s genome. The child’s genome would be compared with all others in the system so the child’s biological parents (or at least sperm or egg donors) can be identified. There would be no penalty for the child, but if a child is traced to parents who have exceeded their reproductive limit, then the parents are penalized.
- • Birth records would be checked every day; anyone above a certain age is obviously extending their life. We would take a pinprick blood sample from anyone above the age of 115 who isn’t already in the database of people permitted to use life extension and use a DNA chip to identify that person’s genome. That genome can then be compared with the genetic records for all children, and if any of the children turn out to be a match with that adult, we know that adult has reproduced and how often. We then check to see how many he or she has already had, and so on.
It’s easy to object that these methods of enforcement are not airtight, and of course, they are not. However, like most other laws and policies, Forced Choice need not be 100 percent effective in order to prevent a Malthusian crisis. Being enforced well enough is good enough. Besides, a Malthusian crisis would develop over a long period of time, with plenty of opportunity to fine-tune the policy and the methods of enforcement.
I will finish by listing, once again, all the conclusions reached in each chapter, partly so that it is easier to see how we got to the policies discussed above, partly to sketch the overall argument in this book, and partly so that readers can locate particular issues more easily:
- A. Extended life could become very boring, but it probably doesn’t have to be. You might avoid boredom by acquiring new and repeatable interests and projects over time. (Section 2.3) You might also avoid boredom by taking a pill, much as we now use pills to avoid depression, anxiety, and other states we do not like. There’s nothing wrong with taking boredom pills. (Section 2.4)
- B. Even if you change so much over time that eventually you become a different person, either because you acquired new interests and values or because you just lived long enough, this is not a reason to turn down life extension. It’s rational to have an ongoing desire, a desire at any given time to continue existing a while longer. Moreover, evolving into a new person is at least no worse than descending into senility and moving closer to death, and probably better. (Section 2.5)
- C. Even if extended life is unavoidably boring, that’s not a good reason to refuse extended life. At most, it’s a reason to discontinue extended life after it has become unavoidably boring. (Section 2.6)
- D. There are reasons to believe that extended life would be just as good as life in a normal life span, all things considered. (Section 3.2)
- E. The bioconservative arguments tend to exhibit four mistakes: they use arguments that work only (if at all) for immortal life, they overlook counterintuitive implications that arise when we extend those argument to all forms of immortal life, they cannot be run backward without absurd results, and they look only at the possible downside to extended life. (Section 3.3)
- F. There is insufficient reason to believe that extending the human life span will make it harder to accept death, undermine our motivation and make us waste time, be less meaningful than life as we know it, or make it harder to develop virtues and care about things beyond our selves. (Sections 3.4 through 3.8)
- G. Extended life presents a new human condition, especially in radically extended lives. The new human condition has four features: (1) aging is elective, (2) life extension is reversible, (3) death will be unscheduled, (4) your life expectancy at any given age will always the be same, and death will deprive you of vastly more time no matter how old you are when you die. The new human condition might be better than the old one. (Section 3.10)
- H. To the extent that there are benefits to living a normal life span, refusing life extension but living in a world where life extension is available might reduce death benefits for the Will-nots to some degree. However, any harm of this kind is likely to be very minor. (Section 4.2)
- I. Refusing or discontinuing life extension is a kind of suicide, but not an immoral suicide. (Sections 4.3 and 4.4)
- J. Will-nots who live in a world where life extension is available and who believe that refusing or discontinuing life extension is an immoral suicide may feel that they’ve been forced to choose between an extended life they don’t want and a form of suicide that is morally wrong. Will-nots who believe this suffer a harm called “moral injury” (though not all Will-nots have that belief about life extension and suicide, so not all of them suffer a moral injury). (Section 4.4)
- K. Most of the concerns about undesirable social consequences, such as pension-funding concerns or worries about hierarchies becoming more entrenched, are not trivial but probably not insurmountable. Some of them may well turn out not to be problems at all. In any case, living in a world with these problems is not worse than death. Moreover, the human race has adapted to other, equally profound changes in its history. It’s time to do so again. (Section 5.2)
- L. There is reason to be optimistic that a world full of people living extended lives will be in many ways a much better world: more mature, more interesting, stabler, wiser, more concerned about the future and the environment, and more at peace. (Section 5.3)
- M. There is good reason to believe that making life extension widely available will pose a serious risk of a Malthusian crisis of overpopulation, pollution, and resource shortages. To avoid this, it is very likely that we will have to significantly limit the reproduction of those who extend their lives. (Section 6.2)
- N. A policy of Forced Choice, which requires people to choose between extending their lives and having as many children as they wish, is feasible and just. (Sections 6.3, 6.4, 6.5, 6.6, and 6.7)
- O. The distress suffered by Have-nots over the fact that others can get life extension and they can’t is a harm, even if they have nothing to be distressed about. We may have a duty to alleviate it to some extent. However, it should be discounted unless there is another harm they are distressed about. Their distress is a separate harm from that other harm. (Section 7.2)
- P. Making life extension available harms the Have-nots by increasing their death burden. The measure of the severity of death—of the death burden—is counterfactual C: How long you would have lived with life extension, discounted by the odds of getting life extension (in other words, if you would have lived another 1,000 years but your odds of getting life extension were only 10 percent, then your loss is equivalent to 100 years). (Section 7.3)
- Q. Inhibiting or prohibiting the development and distribution of life extension can reduce the death burden, but it can never eliminate it. (Section 7.4)
- R. A world where the Haves get life extension and the Have-nots don’t is unequal in ways that are unjust. (Section 8.2)
- S. Once life extension has been available to Haves for long enough, it may become reasonable for people to think that extended life is, so to speak, normal—that having enough in life includes having extended life and that a normal life span is no longer sufficient. (Section 8.2)
- T. Equality doesn’t require leveling-down, so the fact that life extension will not be available to everyone is not a justification for retarding the development of life extension (Inhibition) or preventing people from having it (Prohibition). (Section 8.3)
- U. We should not postpone or prohibit life extension until other, more pressing needs are met first. For example, the fact that some people lack basic healthcare is not a good reason to prevent life extension from being developed or distributed. (Section 8.4)
- V. Even if society should redistribute resources from wealthier members to poorer members, the advent of life extension does not increase the size of transfer that justice requires from Will-nots, though it may require reallocating that transfer. However, it does require increasing the size of transfer required from the Haves, perhaps by imposing a user fee or increased tax on those who extend their lives. (Section 8.5)
- W. If it’s not possible to provide life extension to all Have-nots who want it, justice is not served by providing it to some Have-nots but not others. Instead, justice requires that Have-nots should be compensated in some way that can be distributed equally among them, such as a redistribution of wealth or increased social spending that benefits all of them. (Section 8.6)
- X. Even if we can be sure that many Haves will evade their duty to subsidize or otherwise compensate Have-nots, Prohibition and Inhibition are not justified. (Section 8.7)
- Y. The best way to decide which life extension funding policy is morally most justified is to apply a set of midlevel moral principles that call for maximizing welfare whenever doing so either does not violate a right or violates a right but the amount of welfare is very, very large compared to the importance of whatever interest the right protects without violating any rights. (Section 9.2)
- Z. In the long run—and quite possibly in the short run too—a world with life extension will almost certainly have greater welfare than a world without it. (Sections 9.3 through 9.6)
- AA. It’s very likely that a world with life extension will have a larger population than a world without it and have greater welfare than the world without it. (Section 9.7)
- BB. The right to equality does not weigh in favor of either Inhibition or Promotion, even if we have good reason to believe it will be violated under Promotion. (Section 10.3)
- CC. The right to self-determination does not weigh in favor of either Inhibition or Promotion, for neither policy violates the right to self-determination of any of the three groups: Haves, Have-nots, or Will-nots. (Section 10.4)
- DD. Promotion will harm the Have-nots and Will-nots, but Inhibition will not harm the Haves. Inhibition prevents the Haves from becoming better off, but that’s not a harm. The only right that’s relevant to deciding whether to make life extension available is the right of Will-nots and Have-nots against harm. (Section 10.5)
- EE. Usually, we shouldn’t maximize welfare at the expense of rights, but welfare can outweigh rights when the conditions of the gambling test are met. The gambling test says that a gain in welfare is big enough to outweigh rights violations when we would be willing to risk that harm on a chance of getting that benefit if we were making that choice for ourselves and we didn’t know our identity or position in society. (Section 11.2)
- FF. The gambling test tells us that if we take all future generations into account, the welfare gained by Haves outweighs the rights violations of Have-nots. (Section 11.3)
- GG. Even if the development of life extension is inevitable, it matters morally which policy we follow. Promotion is more just than Inhibition even if life extension will eventually be developed under Inhibition too. (Section 11.3)
- HH. It’s likely that there will be so few Will-nots that the welfare gained by Haves outweighs the rights violations of Will-nots. (Section 11.4)
- II. There are two versions of Promotion: Promotion with Delayed Access, where no one gets life extension until it can be made available to everyone, and Promotion with Immediate Access, where the Haves can get it as soon as it is developed. However, even if Promotion with Delayed Access is more just than Promotion with Immediate Access, Promotion with Delayed Access is the morally preferable policy. (Section 11.5)
- JJ. Life extension is an enhancement. (Section 12.1)
- KK. There is nothing wrong with enhancement per se, and no one thinks there is. (Section 12.1 and Sections 12.3 through 12.8)
- LL. The precautionary principle may or may not be appropriate for the environmental context, but it’s not appropriate for all new technologies. It overlooks the possible benefits of new technologies and fails to consider the possibility that not intervening might be more risky. Normal aging poses a greater risk of harm than extended life. (Section 12.2)
- MM. The maximin principle does not apply to the choice between normal aging and extended life, for the odds are not completely unknown and it’s not the case that we attach far more value to avoiding the potential harm life extension might bring than we do to gaining its potential benefits. (Section 12.2)
- NN. When we apply the precautionary principle or the maximin principle to the choice between the funding policies of Promotion and Inhibition (not the choice between normal aging and extended life), we’re no longer dealing with a decision about risk. We are dealing with questions of justice. (Section 12.2)
- OO. Objections to enhancements on the grounds that they undermine authenticity, that they involve failing to appreciate giftedness, that enhancements are not natural, that we should defer to evolution as a designer, that they involve playing God, or that they undermine the basis for human rights are either not good objections to begin with or don’t apply to life extension. (Sections 12.3 through 12.8)
- PP. Aging is a disease, and life extension is a kind of medicine. (Section 12.9)