EMPIRICAL ETHICS AND THE DUTY TO EXTEND THE "BIOLOGICAL WARRANTY PERIOD"

EMPIRICAL ETHICS AND THE DUTY TO EXTEND THE“BIOLOGICAL WARRANTY PERIOD”*

By Colin Farrelly

I. Introduction

The specific demands of morality are contingent upon the context of thesocieties and situations we find ourselves in. What we owe to each othercannot be deduced from a priori premises. “Empirical ethics” is a partic-ular methodology that empirically-minded moral philosophers adopt tohelp shed light on the complex ways empirical considerations shape andinfluence the demands of morality and justice. “The ultimate aim of allempirical ethics is to improve the context sensitivity of ethics.” 1 Propo-nents of such an interdisciplinary approach to ethics believe that “intel-lectually responsible philosophical ethics is one that continuously engagesthe relevant empirical literature.” 2 This paper focuses on an importantbut often neglected empirical reality of today’s world, a reality that hassignificant implications for the demands of morality. And this reality isglobal aging.

Human populations are aging. People are, on average, living muchlonger lives than they have in the past and they are having fewer chil-dren. Life expectancy at birth for the global population is 68 years and isexpected to rise to age 81 by the end of this century.3 “Globally, thenumber of persons aged 60 or over is expected to more than triple by2100, increasing from 784 million in 2011 to 2 billion in 2050 and 2.8 billionin 2100.” 4 The year 2050 will mark a truly unique time in human history,for it will be the first time that the number of persons age 60 or older willoutnumber the number of children (age 0–14 years) in the world. Theaging of the world’s populations brings novel health challenges as the

* I would like to thank the other contributors and the editors of this volume, as well as ananonymous referee, for their helpful feedback on an earlier version of the essay. I am alsograteful to Bruce Carnes for taking the time to help explain to me many of the biogerontologi-cal concepts I employ in the paper.

1 Albert Musschenga, “Empirical Ethics, Context-Sensitivity, and Contextualism,” Journalof Medicine and Philosophy 30, (2005): 467–90.

2 John Doris and Stephen Stich, “As a Matter of Fact: Empirical Perspectives on Ethics” inOxford Handbook of Contemporary Analytic Philosophy, ed. Frank Jackson and Michael Smith(Oxford: Oxford University Press, 2005) 114–52, 116.

3 United Nations, Department of Economic and Social Affairs, Population Division, WorldPopulation Prospects: The 2010 Revision, Highlights and Advance Tables (Working Paper No.ESA/P/WP.220, 2011), xviii.

4 Ibid., xvi.

doi:10.1017/S0265052513000228480 © 2013 Social Philosophy & Policy Foundation. Printed in the USA.

chronic diseases of late life have now replaced infectious diseases as theleading causes of death in the world. Age is a major risk factor for chronicpain, disability, and disease.

What impact does the phenomenon of global aging have on the demandsof morality? More specifically, what impact does global aging have on theduty to aid those at risk of disease, suffering, and premature death? Thislatter question is the focus of this paper.

Taking empirical considerations seriously thus means that ethical theo-rizing will often be provisional, as the circumstances that individuals andsocieties face will inevitably change over time, and so too will our under-standing of the relevant empirical considerations at play. The argumentdeveloped in this paper is an exercise in empirical ethics. It takes seri-ously the reality that the aging populations of today face novel healthchallenges (e.g., high prevalence of chronic disease and disability) neverexperienced before in human history. The moral landscape thus needs toadapt to reflect this novel empirical reality. I take for granted one basicmoral principle —a principle of preventing bad occurrences5, which I alsotake for granted entails a duty to aid (DA) —and explore the implicationsof empirical considerations from demography, evolutionary biology, andbiogerontology for the way we conceive of fulfilling this duty at theoperational level. These scientific fields of study provide key insights intothe limits on human health and longevity, insights that must inform theduty to aid in an aging world.

To improve the context sensitivity of the duty to aid, a variety of differentissues that arise at the operational level must be addressed. These include,beyond the severity of harm and cost of intervention, the probability thatnonintervention will result in the harm, the likelihood that intervention canprevent that harm, the magnitude of the benefits of preventing the harm, and theproximate and ultimate causes of suffering, disease, and death. After bringingthese general operational level considerations to the fore in Sections IIand III, I then make the case, in Sections IV–VII, for my central thesis thatthe aspiration to extend the biological warranty period (by retarding therate of biological aging)6 of humans is a pressing moral imperative for thetwenty-first century.

My argument employs some biogerontological concepts (e.g., essentiallifespan and potential lifespan) that explain the current constraints on theupper limits of human longevity as well as the available, and potential,

5 Peter Singer, “Famine, Affluence, and Morality,” Philosophy and Public Affairs 1, no. 3(1972): 229–43.

6 The proposal to pursue age retardation as a new model of health promotion is devel-oped by the first director of the National Institute for Aging, Robert Butler, and colleaguesin Robert Butler et al., “New Model of Health Promotion and Disease Prevention for the 21stCentury,” British Medical Journal 337 (2008): 149–50. I believe that there are many otherroutes, besides invoking the modified version of DA developed in this paper, to support thegoal of age retardation. See, for example, Colin Farrelly “Equality and the Duty to RetardAging,” Bioethics 24, no. 8 (2010): 384–94.

THE DUTY TO EXTEND THE “BIOLOGICAL WARRANTY PERIOD” 481

strategies for preventing disease and death. And in Section VIII I brieflyconsider some standard objections typically raised against life extension.The two objections I address are what I call the Too Many People in theWorld is Bad Objection and the Greater Inequality is Bad Objection. I arguethat, while both objections raise potential concerns worth taking seri-ously, neither is compelling enough to provide a rational basis for for-feiting the potential health and economic benefits that could be realizedby extending the biological warranty period.

The duty to extend the biological warranty period entails, among otherthings, that affluent individuals and societies support, through privateand public7 funding, the basic scientific research on the biology of agingthat could eventually lead to interventions which extend the biologicalwarranty period. Rather than focus on the specific details of which par-ticular actions and policies ought to be pursued in order to satisfy thisduty, I focus instead on the theoretical and empirical considerations thatprovide the basis for the contention that there is a moral duty to extendthe biological warranty period. The second stage, for another paper, wouldbe to detail what, specifically, is required, and of whom.

II. The Duty to Aid: An Operational Level Analysis

Peter Singer’s “Famine, Affluence, and Morality” helped bring appliedethics to the fore of moral philosophy by applying the duty to aid to theproblem of global poverty. Singer’s paper and argument is important tothe project in this paper for at least two reasons. First, like Singer, I believethat our moral conceptual scheme needs to be altered, and with it, theway of life that has come to be taken for granted in our society. Singeraspired to raise awareness about the plight of those living in poverty, andto provide a coherent and compelling moral argument as to why thoseliving in affluent countries should do more to aid the poor living indistant lands. In this paper, I aspire to raise awareness about the chal-lenges of global aging (for instance, the rapid rise in the prevalence ofchronic disease and disability), and to provide a coherent and compellingargument as to why those living in affluent countries should support thebasic scientific research which might help us decelerate the rate of molec-ular and cellular decline.

7 The claim that the moral duty advanced in this paper is stringent enough to entailpublic support, via taxation, of biogerontology requires a more detailed justification thanI have space to detail here. I believe a persuasive argument can be made for this point,one that requires science to be construed as part of what John Rawls calls the “basicstructure of society.” I cannot develop that argument in this paper. Instead, I will simplynote that those who believe that justice can mandate public support, via taxation, forbasic research on specific diseases of aging, like cancer, heart disease, and stroke, alsoought to accept age retardation as a legitimate aspiration of justice worthy of (state enforced)public support.

482 COLIN FARRELLY

Second, like Singer’s moral analysis, my argument will invoke a dutyto aid those in need. The duty to aid involves undertaking individual andcollective actions that I will refer to, following terminology employed byOlshansky, Carnes, and Grahn,8 as “manufacturing survival time.” Sav-ing drowning children, providing sanitation, antibiotics, seatbelts, andproviding food to the hungry are all actions that manufacture survivaltime. There are two general strategies for manufacturing the survival timeof an individual: (1) reclaiming survival time by reducing avoidable mor-tality (e.g., death from starvation, malaria, appendicitis, infection, acci-dent, violence, cancer, heart disease, stroke, and so forth), and (2) reclaimingsurvival time by extending the biological warranty period.9 The former focuseson reducing the proximate causes of suffering, disease and death. Thelatter adopts the lens of evolutionary biology, and as such expands theduty to aid to include tackling the ultimate causes of suffering, morbidityand mortality. And the reasons for doing so are simple: disease, sufferingand death are bad, and we should try to prevent such bad things fromoccurring to people at all stages (the pre-reproductive, reproductive andpost-reproductive) of life. Extending the biological warranty period requiresmodifying the rate of biological aging (or senescence), so that there is adeceleration of the rate of molecular and cellular decline. This results inextending the healthspan (and lifespan) rather than simply increasing “lifeexpectancy” by reducing mortality risks.

The strategy Singer employs to bring attention to the importance oftackling global poverty is to invoke the following moral principle, whichI will refer to as the Duty to Aid:

Duty to Aid (hereafter referred to simply as DA): if it is in our powerto prevent something bad from happening, without thereby sacrificing any-thing of comparable moral importance, we ought, morally, to do it.10

Singer’s moral principle is deficient because it only tracks two (of many)relevant variables —namely, (1) the magnitude of the harm that could beaverted, and (2) the cost of intervening (and it is debatable whetherSinger’s proviso “without thereby sacrificing anything of comparable moralimportance” is an adequate account of these costs, but I will put that issueaside here). There are, however, at least four other variables that are likelyto arise at the operational level of trying to prevent bad in the real world.These are:

8 S. Jay Olshansky, Bruce A. Carnes and Douglas Grahn, “Confronting the Boundaries ofHuman Longevity,” American Scientist 86, no. 1 (1998): 52–61.

9 The concept of a “biological warranty period” is developed by Bruce Carnes, JayOlshansky and Douglas Grahn in “Biological Evidence for Limits to the Duration of Life,”Biogerontology 4 (2003): 31–45.

10 Peter Singer, “Famine, Affluence, and Morality,” 231.


(3) the probability that significant harm will occur if one does notintervene.

(4) the probability that intervening to aid will be successful in pre-venting or redressing the bad or harm in question.

(5) the magnitude of the benefits of preventing the harm in question.

The sixth variable is one which the duty to aid should actually beinsensitive to, rather than track. And this variable is the cause of harmor badness, which is, in itself, irrelevant with respect to the stringencyof the duty to aid those who suffer, or are at risk of, serious harm.11

This sixth condition (which I shall focus on in Section V) can be statedas such:

(6) The fact that the cause of something bad stems from extrinsicfactors, intrinsic factors, or a combination of extrinsic and intrin-sic factors is not, in itself, relevant to the stringency of the duty toaid those at risk of suffering, disease, or premature death.

Singer’s moral principle must be analyzed and refined further, so thatmany ambiguities concerning how it is employed at the operational levelcan be rectified. These ambiguities stem from the fact that the appliedexamples Singer invokes, such as saving a drowning child, and the pro-vision of food and shelter to the poor, are examples that involve protect-ing humans from certain harms that arise from extrinsic factors which canbe prevented or mitigated with certainty (and without regard for themagnitude of the benefits of intervention).

In the real world there are pervasive forms of suffering, disease, andpremature death, the risks of which can range from possible to certain.And the likelihood that interventions can successfully prevent such harmscan also vary from low likelihood of success to certainty of success. Andfinally, the magnitude of the benefits of possible intervention can rangefrom short-term (prevent suffering and death for a few weeks or months)to long-term benefits (prevent suffering and death for the foreseeable

11 The duty is applicable, at least, to those harms that are not self-inflicted —that is, toharms that are not the result of the free and voluntary decisions of those who now requireaid. There is much debate concerning the role personal responsibility plays in determining thedemands of the duty to aid. I do not take a definite stance on this issue here, though I aminclined to take the view that the duty to aid still applies in those cases where those in needof aid are responsible for their own plight. Regardless of the view one takes on how sensitiveor insensitive the duty to aid ought to be to harms that are self-inflicted, the intrinsiclimitations of our biology, which are the result of the evolutionary and life history of ourspecies, are not things any person can be considered responsible for. So the duty to retardaging can be supported by an account of the duty to aid that is responsibility-sensitive (i.e., theduty to aid weakens when those in need are responsible for their own misfortune) orresponsibility-insensitive. Condition (6) could be refined further to be compatible with aresponsibility-sensitive or responsibility-insensitive stance. As (6) is currently stated, I haveopted for a responsibility-neutral position.

484 COLIN FARRELLY

future). The duty to aid must track these kinds of variables that arise atthe operational level.

III. Probable Harms, Prospects for Success, and theMagnitude of Benefits

In Singer’s original example he asks us to imagine a scenario inwhich we witness a child drowning in a pond. While the example issimple, it is effective because it helps draw attention to the moral sen-sibilities we have concerning the strength of the imperative to aid oth-ers in need and what we feel is the appropriate burden others shouldbe willing to shoulder to aid those in need. The first revision of Sing-er’s drowning example that I would like to make modifies the cer-tainty of the child drowning to a probability of the child drowning.Suppose the pond in question has a lifeguard on duty to rescue people.You see the child drowning and also notice an able lifeguard swim-ming quickly to aid the child. What do you do? If the pond is veryshallow, and the water very calm, it is reasonable to assume that thelifeguard will successfully rescue the child, and thus the duty to aid (asit applies to you) evaporates in this particular example because theprobability of the child suffering serious harm is close to zero.

But we could modify the example in different ways —e.g., making thewater more hazardous, the lifeguard inexperienced, and so on —that couldincrease the odds that the child would drown without your help. Thestringency of the duty to aid others ought to track the probability thatharm will be realized if you do not intervene. All else being equal (e.g.,the severity of harm and cost of intervening), the greater the probabilitythat nonintervention will result in serious harm, the more stringent theduty to aid.

Singer’s moral principle, as originally formulated by him, is very con-strained because it only applies in the limited cases where there is a100 percent certainty of harm being realized. But many real-world harms,such as risk of infectious disease, famine, cancer, climate change, etc., areprobable or even just possible problems. And the duty to aid should alsoprovide some guidance for action in those cases, otherwise all efforts toaid will be diverted solely to preventing certain harms while ignoringprobable, and potentially greater, harms.

As originally formulated, Singer’s principle of preventing bad occur-rences is an impotent moral principle for guiding moral action in the realworld because it assumes that the relevant harms in question (i.e., suf-fering and death from poverty and lack of medicine) can be preventedwith 100 percent certainty and it provides insufficient details concerningthe relevant benefits of intervention; that is, it is unclear whether theprevention of suffering and death means extending life by two days,twenty years, indefintely, etc. In the drowning child scenario Singer


describes, there is a 100 percent certainty that intervention will result insuccess (i.e., saving the child from drowning). Furthermore, because it isa child drowning, it is also the case that “preventing the child fromdrowning” will likely result in “adding 60–70 years of additional life.”And these two factors thus make the intuitive force of the duty to aid thedrowning child very stringent.

However, when Singer moves to the example of helping the poor indistant lands, he insists that the probability of preventing suffering anddeath from lack of food, shelter, and medicine is also a certainty with littleregard for the magnitude of the benefits of intervention (beyond saying“it prevents suffering and death”). Here is a very telling passage thatillustrates this first point:

From the moral point of view, the development of the world into a“global village” has made an important, though still unrecognized,difference to our moral situation. Expert observers and supervisors,sent out by famine relief organizations or permanently stationed infamine-prone areas, can direct our aid to a refugee in Bengal almostas effectively as we could get it to someone in our own block. Therewould seem, therefore, to be no possible justification for discrimi-nating on geographical grounds.12

In the forty years since Singer wrote that statement it has become clearthat the story of humanitarian aid is, at best, a mixed story of both failuresand successes. Effectively combating global poverty has proved to bemuch more challenging and complex than Singer presupposed in 1972.13

The expert observers and famine relief organizations did not always pur-sue policies that helped (in the short- or long term) the poor. Indeed,sometimes these interventions made the situation even worse, despitegood intentions. Once we attend to the probability that intervention cansuccessfully prevent bad in the real world, a further guideline informs theduty to aid: all else being equal, the greater the chances are that we can preventserious harm, the more stringent the duty to aid.

In addition to ignoring the probability that intervention will be suc-cessful, Singer’s principle and examples obscure the details of the specificbenefits of intervention. By characterizing the goal of aiding as a generalduty to “prevent suffering and premature death” it is not clear if we areobligated to prevent harm only for the short term, the long term, orpermanently. One can plausibly presume that Singer means permanentlypreventing (i.e., eliminating) the suffering and death caused by lack of

12 Peter Singer, “Famine, Affluence, and Morality,” 232.13 See Leif Wenar, “Poverty is No Pond: Challenges for the Affluent,” in Giving Well: The

Ethics of Philanthropy, ed. P. Illingworth, T. Pogge, L. Wenar (New York: Oxford UniversityPress, 2010), 104–32.

486 COLIN FARRELLY

food, shelter, and medicine. But then his claim that it is just as easy to helpa refugee in Bengal as it is to help a poor neighbor down the street isclearly erroneous.

Assuming the neighbor down the street lives in a society that alreadyhas access to clean drinking water, security (e.g., effective police force), astrong economy, and so forth, the odds that providing some food to himwill, in the long run, prevent him from suffering and dying from povertyis much higher than the odds facing the person who lives in a less devel-oped country that is plagued by infectious disease, lacks basic sanitation,is prone to civil war and conflict, and so on. Providing the globally poorwith food and supplies for one month is not, itself, likely to redress theproblems of global poverty.

Singer deliberately limits his principle to refer only to the “preven-tion of something bad,” rather than suggest the duty requires us tobenefit others.14 He wants to avoid suggesting that others are morallyrequired to benefit people, as that would lead to a principle to maxi-mize utility that would enslave everyone to work for the greatest hap-piness of the greatest number. Singer’s principle only instructs us toprevent avoidable suffering and death. And in a world devoid of suchharms people are morally free to do as they wish. But by failing toprovide more details about the benefits of intervention, Singer’s prin-ciple becomes untenable, for very few harms can be permanently elim-inated. And this means that attention ought to be placed on the differentkinds of benefits that preventing harm can confer. All else being equal,the greater the benefits of preventing something bad from happening, the greaterthe duty to prevent the bad in question.

Bringing the various points together, we can now state our modifiedduty to aid (Modified DA) as follows:

Modified DA: The higher the probability that non-intervention will resultin something very bad, and the greater the likelihood that one can preventthat bad without thereby sacrificing anything of comparable moral impor-tance, the stronger the case for aiding. Furthermore, all else being equal, thegreater the benefits of preventing something very bad from happening, thestronger the case for aiding.

This modified principle, unlike Singer’s original formulation, can serveas a useful moral compass for guiding action to address the dilemmasthat arise in a world with limited resources and pervasive suffering,disease, and premature death. With this contextualized account of theduty to aid in hand, we can now begin to make the case for aspiring toextend the human biological warranty period.

14 Singer, “Famine, Affluence, and Morality,” 238.


IV. Saving Drowning Children and Drowning Grandparents

Return again to Singer’s example of the drowning child. Instead of theyoung child drowning in a pond, let us now imagine that it is sixty yearsinto the future from Singer’s imagined drowning example. The child isnow a sixty-five-year-old adult, in fact she is a grandmother, and hasreturned to the very same pond where she almost drowned sixty yearsearlier. She has brought her grandson with her, to enjoy a picnic lunchand explore the pond. While chasing tadpoles with her grandson in thepond, the grandmother slips on a rock and hits her head. She now laysunconscious at the bottom of the shallow pond that nearly took her lifesixty years earlier. You are walking by the pond and hear the grandson’spleas for someone to help his grandmother (he is not strong enough torescue her). What do you do?

I shall assume that most readers share my conviction that we shouldaid the drowning grandmother. Furthermore, I believe the stringency ofthe duty to aid in this example is very pressing, and of equal strength tothe imperative to help her when she was a child. The urgency to preventsuffering and death does not dissipate, or even severely diminish, simplybecause the grandmother is now older than she was sixty years earlier.She still deserves to be treated as a moral equal to other persons; herchronological age does not erode this status as an equal. She, like all of us,has interests, aspirations, and goals that are worthy of respect and con-sideration. Thus we ought, if it is within our power to prevent somethingbad from happening without sacrificing something of comparable moralimportance, to aid her.

This modified version of Singer’s drowning example illustrates thepoint that the age of the person in need of assistance by itself has noethical relevance in the drowning example. The person who saves drown-ing children, but is unmoved to aid drowning grandparents, acts uneth-ically. His or her actions are “ageist.” Robert Butler, the first director of theNational Institutes of Health’s National Institute on Aging, coined theterm “ageism” in 1969,15 which means a systematic stereotyping of, anddiscrimination against, people because they are old. Ageism violates thehumanist conviction that all persons’ interests matter, and they matterequally. The age of a person in need, just like the nationality of those inneed, has no ethical significance.

However, it is important to note that, at the operational level of imple-menting DA in practice, the age of those in need of assistance can berelevant as age often functions as a proxy for estimating the “expectedutility” (or benefits) of an intervention, and this can be a relevant con-sideration when the resources available to aid those in need are insuffi-cient to redress all preventable suffering and death in the world.

15 Robert Butler, “Age-ism: Another Form of Bigotry,” The Gerontologist 9 (1969): 243–46.

488 COLIN FARRELLY

Recall that modified DA has the stipulation that the greater the benefits ofpreventing something very bad from happening, all else being equal, the greaterthe moral duty to prevent the bad in question. But all else is not necessarilyequal, and this reality means that the duty to aid cannot be simply par-titioned into serially ordered duties, with the duty to save children havinglexical priority over the duty to prevent suffering, disease, and death latein life. We must attend to both kinds of harm, and the stringency of theduty to prevent the risks associated with premature death should dependupon the considerations that modified DA stipulates (e.g., the probabilitythat nonintervention will result in harm, the probability that interventionbe successful, the cost of intervention, and the magnitude of the benefitsof intervention).

In the following sections the duty to aid will be viewed through the lensof biogerontology. This will bring into sharper focus the constraints on theupper limits of human longevity as well as the available, and potential, strat-egies for preventing disease and death in the pre-reproductive, reproduc-tive, and post-reproductive stages of life. The primary focus is on the latter.In particular, I contrast the benefits likely to be realized by continuing downthe path of trying to reclaim potential survival time near the limits of aver-age maximum lifespan ( potential lifespan) with the benefits likely to be real-ized by extending the biological warranty period (extended lifespan).

V. Extrinsic and Intrinsic Causes of Harm

A further limitation of Singer’s original moral principle (DA), and hisexamples of saving drowning children and redressing global poverty, isthat the aspiration to manufacture survival time is understood as only entail-ing a duty to reclaim potential survival time when it ought to also entail aduty to extend lifespan (by extending the biological warranty period). Thelatter can also prevent suffering and premature death because it retardsthe rate of molecular and cellular decline. This oversight was perhaps areasonable one to make when Singer was writing in the early 1970s andour understanding of aging was much more limited. However, given theadvances that have been made over the past four decades in the field ofbiogerontology, the exclusive focus on reclaiming potential survival timeis no longer warranted. Viewing the duty to aid through the lens ofbiogerontology is useful for redressing this operational level deficiency ofDA. To set the stage for that discussion (in the following section), we mustfirst recognize the different causes of harms like suffering, disease, anddeath.

Broadly speaking, there are three different causes of the kinds of harmsDA seeks to mitigate. These are extrinsic factors, intrinsic factors, and acombination of extrinsic and intrinsic factors. Extrinsic factors are thosetypical of the world’s hostile environment. For example, infectious dis-


eases like smallpox and malaria, natural disasters (e.g., hurricanes), vio-lence, scarcity of resources, and unjust institutions. But there are alsointrinsic factors, such as our biological design, that make our bodies andminds less resistant to various kinds of stress over time. “Intrinsic causesof death are those that remain after the total elimination of extrinsiccauses of death.” 16

Most instances of disease and death are a combination of both intrinsicand extrinsic factors. Take, for example, poverty. It is easy to assume thatall the causes of malnutrition stem from extrinsic factors, like a lack offood or unsound or unjust public policies that cause food shortages. Aperson that does not have ample food will be malnourished, and thusvulnerable to disease and suffering and, eventually, death. However, thisexplanation is only part of the story of our vulnerability to starvation.There are also intrinsic factors at play. Not every mammal will die if itgoes days, weeks, even months, without food.

Bears, for example, can survive prolonged periods of time without foodwhen they hibernate. What determines the nourishment requirementshumans need to stay healthy and alive? Why is it that humans cannot besustained with less frequent access to food? The biology of Homo sapiensis thus implicated in the story of our vulnerability to starvation in theworld. If humans had the ability to slow down their metabolism, asanimals that hibernate can, they could reduce the expenditure of energywhen food is scarce. But humans do not have this biological capability.We have basic material needs that must be met frequently (i.e., almostdaily). And these nutritional demands mean that we risk malnourish-ment, even starvation, when the supply of food is not steady. The metab-olism we have today is a result of our species’ evolutionary and lifehistory.17

A complete picture of all the causes of disease and death would includeextrinsic and intrinsic factors, as well proximate and ultimate causation.One might wonder why I even bring up the intrinsic, evolutionary factorsat play in the story of malnourishment. Am I suggesting we could redesignthe human metabolism to combat global poverty? No. But actually con-sidering such a case can be instructive and help explain why it is impor-tant to aspire to decelerate the rate of aging.

To illustrate the significance of identifying the different causes of avoid-able suffering and disease, when it comes to the operational level of DA,consider the following purely hypothetical and fanciful scenario. Supposethat, while Singer was writing in 1972, a new drug had just been devel-

16 Bruce Carnes et al., “Mortality Partitions and Their Relevance to Research on Senes-cence,” Biogerontology 7 (2006): 183–98, 185.

17 Evolutionary theory “explains the origins and development of species through time,while life history theory provides an explanation of the evolution of important life eventssuch as growth and reproduction in a species” (Richard Bribiescas, Men: Evolutionary and LifeHistory [Cambridge, MA: Harvard University Press, 2006], 2).

490 COLIN FARRELLY

oped that safely and effectively reprogrammed the metabolism of thehuman body. By simply taking one (relatively inexpensive) pill a month,the daily food and drink a person consumed would automatically beconverted into the nutrients typical of a healthy, balanced diet regardlessof the quantity and quality of provisions consumed. Consuming even justa minimal amount of rice and water could, when taken in conjunctionwith this metabolic drug, be equivalent to consuming the nourishmentprovided by eating a balanced diet composed of fruits and vegetables,meat, and bread.

Furthermore, imagine also that the person taking this pill, in conjunc-tion with minimal amounts of food and water, would not feel any hungerpains after taking this pill. So the psychological, as well as physiological,effects of eating a balanced and healthy diet would also be realized.Suppose this scientific discovery occurred on the eve of Singer complet-ing his paper “Famine, Affluence and Morality.” Would he have reason toedit and revise his paper before sending it off for publication? I think hewould.

It would be odd to invoke DA and insist that those living in affluentcountries donate money only to charities which would ship food halfwayacross the world to impoverished nations if there was another, moreefficient and effective, way to prevent the bad of poverty. DA does notprejudge what constitutes the most effective way to prevent the bad ofavoidable suffering and death. It merely instructs us to prevent some-thing bad from happening when we can prevent this bad, without sacri-ficing something of comparable moral significance. Assuming the drug inquestion was truly safe and effective, the provision and distribution ofsuch a pill could be a more effective way of combating the harms ofpoverty than trying to redress all the extrinsic factors at play with foodprovision (e.g., drought, floods, war, agricultural infrastructure, and soforth). Such a pill would be viewed as “a medicine” which protects againstmalnourishment. And if we could prevent suffering and death by pro-viding this medicine to the world’s poor then we ought to do so.

When it comes to malnourishment we perhaps naturally think theprovision of food is the central strategy for combating poverty because itredresses one extrinsic factor (namely, the shortage of food). But elimi-nating poverty is vastly more complex and challenging than simply “mak-ing food available.” Forty years after the publication of Singer’s articlemillions of people still live in poverty, despite enormous humanitarianefforts to eradicate poverty. Could we do more? Yes. But poverty persistsnot only because of a lack of “political will,” but also because of a lack ofknowledge concerning the most effective ways of mitigating poverty in thelong term in diverse regions of the world. Our knowledge has improvedsince 1972, but there is still much work that needs to be done in order toimprove the likelihood that intervention will successfully redress the rootcauses of poverty.


Singer’s appeal to DA in the context of global poverty is effectivebecause the link between “lack of food” and “harm or badness” is self-evident. One does not need to invest a great deal of attention or insightto the relevant context to know that not having enough nourishment willresult in something bad. So for many extrinsic risk factors, the imperativeto aid will have intuitive traction. And for such cases an appeal to a generalprinciple like DA could be useful in motivating individuals and govern-ments to act to prevent harm (which was Singer’s central goal). Unfor-tunately this is not the case for many intrinsic factors, especially thosecaused over the long period of our evolutionary and life history. Manypeople will conceive of these risk factors as simply “natural” and/or“inevitable,” when in fact they are, in an important sense, unnatural and,most importantly, they are malleable (even though they are, ultimately,inevitable).

A contextual empirical analysis can thus be of great service if it canbring to the fore a more comprehensive understanding of the health risksfacing aging populations. And this is why the story of the intrinsic factorsthat influence the health prospects for humans in the post-reproductivestage of life is important.

VI. Essential versus Potential Lifespan

The duty to aid must take seriously the biological determinates of, andconstraints upon, longevity given the reality that all deaths can be clas-sified as “premature.” “Living a perfect life in a perpetually perfect envi-ronment and avoiding all avoidable mortality risks is impossible.” 18 Inthis section, I detail the difference between “essential lifespan” and “poten-tial lifespan.” The former determines the biological warranty period of humansand the latter is the focus of interventions that seek to reclaim our survivaltime by preventing specific mortality risks. Reclaiming survival time canbe achieved by interventions which reduce extrinsic risk actors (like infec-tion, poverty, and poor diet) and by interventions “that suppress (but donot cure) mortality risks arising from the intrinsic biology of the organism(e.g., some forms of cancer and heart disease).” 19

The “essential lifespan” of a species is defined as “the time required tofulfill the Darwinian purpose of life, that is, successful reproduction andcontinuation of generations.” 20 If it takes a particular species, like Homosapiens, thirteen to fifteen years for offspring to reach sexual maturity,then the mortality risks facing such a species at both the pre-reproductive

18 Bruce Carnes, David Staats, and William Sonntag, “Does Senescence Give Rise toDisease?” Mechanisms of Ageing and Development 129 (2008): 693–99, 697.

19 Bruce Carnes, “What is Lifespan Regulation and Why Does it Exist?” Biogerontology 12(2011): 367–74, 370.

20 Suresh Rattan, “Biogerontology: the Next Step,” Annals of the New York Academy ofSciences 908 (2000): 282–90, 282–83.

492 COLIN FARRELLY

and reproductive stages of life had to be significantly lower than thosethat face a short-lived species like mice. Offspring that are dependentupon others (for example, dependent on parents or grandparents) forfood and protection for years while they develop can only survive if thosecaring for them are also able to survive long enough to care for and raiseoffspring. This is not the case for small mammals like mice. Mice reachsexual maturity in a matter of weeks, not years. This reflects the empiricalreality that mice face very high mortality risks from predators. Thus, micecould not afford to take the same route Homo sapiens have taken to winthe race against death. A faster rate of development is the winning strat-egy when the external pressures are so great that it is unlikely any parentcould survive for very long in such a hostile environment.

The essential lifespan of a species thus shapes and determines the “bio-logical warranty period” of that species and of individuals. This is the periodof time when intrinsic failures of our biology are not expected. The war-ranty period itself is not selected for; rather, it is an “inadvertent byprod-uct of evolutionary neglect, and genetic programs for growth, developmentand reproduction.” 21

In their extensive cross-cultural examination of longevity in hunter-gatherers, Michael Gurven and Hillard Kaplan conclude that “humanbodies are designed to function well for about seven decades in the envi-ronment in which our species evolved.” 22 Within this seven-decade periodof time humans could, if they escaped the extrinsic threats to their lives,reach sexual maturity, produce, and nurture their offspring. And, for atleast one-fourth of the adult population living in such conditions (forexample, with no sanitation, no immunizations or medicine, no predict-able food supply, and so on), they likely lived fifteen to twenty years asgrandparents.23

This seven-decade estimate for the warranty period also matches upwith morbidity rates in aging populations. After this period of time mostpeople will have multiple chronic conditions and mortality rates riseconsiderably. Multiple chronic conditions are evident in 62 percent ofAmericans over age sixty-five.24 And it is the management of those con-ditions that permits mortality rates to decline to a level at which lifeexpectancy can reach a number near the upper limits (approximatelyeighty-five years) of average potential lifespan.

The prolonged survival of a species beyond the expiration of the bio-logical warranty period is thus “unnatural” in the sense that it would not

21 Carnes, Olshansky, and Grahn, “Biological Evidence for Limits to the Duration of Life,”43.

22 Michael Gurven and Hillard Kaplan, “Longevity Among Hunter-Gatherers: A Cross-Cultural Examination,” Population and Development Review 33, no. 2 (2007): 321–65, 322.

23 Ibid., 331.24 Christine Vogeli et al., “Multiple Chronic Conditions: Prevalence, Health Conse-

quences, and Implications for Quality, Care Management, and Costs,” Journal of GeneralInternal Medicine 22, no. 3 (2007): 391–95, 392.


occur without human intervention. In 1953, Peter Medawar describedsenescence as something “revealed and made manifest by the most unnat-ural experiment of prolonging human life by sheltering it from the haz-ards of its natural existence.” 25 “Humans, and the animals we choose toprotect, are the only species in which large numbers experience age-ing.” 26 Without the benefits of the knowledge of hygiene and biomedi-cine, only a small percentage of people would live long enough toexperience what occurs when the biological warranty period expires (e.g.,survival time procured by managing multimoribidity).

Unlike the essential lifespan of a species, which is the length of time itsmembers must survive to successfully reproduce at the rate sufficientlyhigh to win the race against death, the “potential lifespan” is how long aperson or population could live if all avoidable mortality risks could beeliminated. Suppose, for example, it were possible to eliminate all pre-mature deaths caused by the extrinsic factors of poverty, infectious dis-ease, accidents, war, and so forth. Furthermore, assume that all populationsin the world had the medical knowledge and resources that the UnitedStates possesses today to suppress some of the mortality risks intrinsic toour biology, such as some forms of cancer, heart disease, etc. In such anidealized scenario the life expectancy of humans on the planet would beclose to approaching the average potential lifespan of our species, whichis estimated to be approximately eight-five years. Such an estimate isbased on insights from demography,27 as well as comparative biology,28

which compares interspecies mortality. Jeffrey Fries explains how esti-mates of the human lifespan are arrived at:

There are several methods of estimating the human life span. Onemay use the anthropological formulas, reconstruct an ideal survivalcurve from the tail of the present curve using the assumption thatthese individuals have been essentially free of disease, make extrap-olations from the rectangularizing survival curve, or use estimatesbased on observed decline in organ reserve. All suggest an averagelife span of approximately 85 years, with a distribution which includes99 percent of individuals between the ages of 70 and 100.29

It is of course impossible to eliminate all extrinsic risks of prematuredeath. There will always be accidents, for example, that result in people

25 Peter B. Medawar, An Unsolved Problem of Biology (London: Lewis, 1952), 13.26 Leonard Hayflick, “The Future of Ageing,” Nature 408, (2000): 267–69, 269.27 Jay Olshansky, Bruce Carnes, Christine Cassel, “In Search of Methuselah: Estimating

The Upper Limits To Human Longevity,” Science 250 (1990): 634–40.28 Carnes, Olshansky, and Grahn in “Biological Evidence for Limits to the Duration of

Life,” Biogerontology.29 James Fries, “The Compression of Morbidity,” The Milbank Quarterly 83, no. 4 (2005):

801–23, 808.

494 COLIN FARRELLY

dying before they would from intrinsic factors. Nor is it likely that all theintrinsic risks of our biology, like cancer and heart disease, will be elim-inated. But this does not prevent us from aspiring to do so. In 1971,President Richard Nixon declared a “War on Cancer” and signed theNational Cancer Act. More than forty years later not a single cancer hasbeen eliminated and yet billions is spent each year on cancer research inthe United States. The National Institute of Health’s estimated invest-ment, for the year 2013, in cancer research is 5.4 billion dollars.30 Thecurrent approach of the medical sciences in the United States is to aggres-sively pursue reclaiming potential survival time near the upper limits oflongevity by investing billions of dollars annually in the development ofdrugs and treatments to reduce the risk of death by specific diseases. Thisapproach does not extend the human “healthspan,” as such interventionsmostly apply to persons past or near the expiration of the biologicalwarranty period. As such they help people survive for longer by managingmultiple maladies. Viewing the duty to aid through the lens of biogerontol-ogy can open up an alternative strategy for tackling the health challengesof late life.

VII. The Duty to Aid Viewed through theLens of Biogerontology

The duty to aid would look very different if our biology were such thatthe only things that could cause suffering, disease, and premature deathwere extrinsic factors like infectious disease, poverty, and unhealthy diets.But these extrinsic factors are only part of the story of the cause of bad-ness in the world. To fixate only on the duty to redress extrinsic harms isto subscribe to the mistaken view of what one might call “environmentaldeterminism.” Like “genetic determinism,” which mistakenly assumesthat a person’s genes determine a host of complex phenotypes (such aspersonality and health), “environmental determinism” subscribes to themistaken view that a person’s health prospects are determined solely byenvironmental factors, such as socioeconomic prosperity, access to edu-cation, diet and exercise, and so forth. Such a perspective thus ignores thegenetic endowments a person is born with and the evolutionary and lifehistory of our species that influences that genetic heritage.

Why do individuals have any intrinsic constraints upon their healthand longevity? Why is it the case that we are not designed for permanentmaintenance? The disposable soma theory provides the answer.31 This accountof aging maintains that biological aging occurs because natural selection

30 National Institutes of Health, Estimates of Funding for Various Research, Condition,and Disease Categories (RCDC). http://report.nih.gov/rcdc/categories.

31 See Thomas Kirkwood, “Evolution of Aging,” Nature 270 (1977): 301–4; and ThomasKirkwood and Robin Holliday, “The Evolution of Ageing and Longevity,” Proceedings of theRoyal Society of London: Biology 205 (1979): 531–46.


favors a strategy in which reproduction is made a higher biological pri-ority (in terms of the utilization of resources) than the somatic mainte-nance needed for indefinite survival. The story of the intrinsic constraintsof our biology thus begins with the story of the world’s extrinsic risks.The world is a dangerous place. Death is, for all living things on thisplanet, inevitable.32 In order for any species’ existence to persist over timea solution to death must be found. And that solution, for us and for othersexually reproducing species, is reproduction. There is thus a real racebetween reproduction and death, and all the species alive today are, atleast for the moment, winning this race. But for all the species that arenow extinct, like the Mammoth and Neanderthal, the race was lost.

Adopting this organismal perspective is important because it brings tothe fore the fact that a biological trade-off must be, and has been, madebetween the physiological resources we invest into reproduction and thoseinvested in the maintenance of the soma. Reproduction is given a higherbiological priority, which means that, while our bodies and minds are notdesigned to fail, a consequence of their being designed for reproductionis that there are inevitable health problems as the “biological warrantyperiod” expires (typically by the seventh decade of life).

Surviving long enough to experience the co-morbidity of late life is an“unnatural” state of affairs made possible by modern techniques of man-ufacturing survival time near the limits of the average maximal lifespan.Stents can be inserted into coronary arteries to help treat coronary heartdisease. Diuretics can help manage hypertension. Chemotherapy can killfast growing cells in the human body. Artificial hips, knees, and shoulderjoints can restore some of the range of motion and mobility compromisedby the wear and tear of life on our bones and joints.

We have not, at least yet, cured any chronic disease of late life. But byspending enormous sums of money developing drugs and interventionsto reclaim potential survival time in late life (by reducing avoidable mor-tality, like cancer), the developed world has been able to permit individ-uals to survive beyond the expiration of their biological warranty periods.This is done by funding the expensive project of managing multiple mor-bidities. Such an approach to health extension is unlikely to be sustainable,either for developing33 or developed countries, as populations continueto age this century.

As the number of people over the age of sixty-five increases, espe-cially those above age eighty, the current approach of tackling specific

32 This is a summary of the account of the disposal soma theory provided by BruceCarnes. See Carnes, “Senescence Viewed through the Lens of Comparative Biology,” Annalsof the New York Academy of Sciences 1114, (2007): 14–22.

33 “Since in poorer countries most health-care costs must be paid by patients out-of-pocket, the cost of health care for NCDs [non-communicable diseases] creates significantstrain on household budgets, particularly for lower-income families” World Health Orga-nization, Global Status Report on Noncommunicable Disease 2010 (Geneva: WHO Press), 3.

496 COLIN FARRELLY

diseases of aging becomes more and more strained. The costs associ-ated with care for those managing multiple diseases increases, and thehealth dividend yielded by reclaiming survival time near the upperlimits of average lifespan diminishes the closer that limit is reached.This is so because of co-morbidity, which means that staving off onedisease, like one type of cancer, does nothing to impact the risks ofdeveloping another type of cancer, stroke, Alzheimer’s disease, heartdisease, and so forth.

Some, admittedly rare, individuals naturally possess the “longevitygenes” required for an extended biological warranty period. And theseindividuals are centenarians (age � 100) and supercentenarians (age �110). In the United States and other industrialized nations, centenariansoccur at a prevalence rate of about one per six thousand. And supercen-tenarians occur at a rate of about one per seven million.34 Centenariansmarkedly delay or even escape age-associated diseases.35 The develop-ment of a novel medical intervention that would permit us to replicate thebiology of those who age in this exceptionally healthy way would beamong this century’s greatest medical breakthroughs. Extending the bio-logical warranty period offers the promise of adding years of healthy lifeto older ages.

Extending lifespan, in contrast to reclaiming potential survival time,involves developing interventions that delay the onset of disease anddisability by directly modifying our biology. This might sound like acompletely implausible prospect, but scientists have extended the biolog-ical warranty period in a variety of species, including worms, mice, andmonkeys via caloric restriction (CR) and genetic intervention. These inter-ventions demonstrate that novel interventions can, in principle, extendthe biological warranty period. At this stage there is still uncertaintyabout the impact similar interventions would have on human health andlongevity.

Some have estimated that, if the effects of the magnitude of the benefitsof CR on mice were replicated in humans, this would mean it would takeindividuals 112 years to have the abilities and risks of today’s seventy-eight-year-old adult.36 This would mean extending the biological war-ranty period of the average person from seven decades to over ten decades.This is very different from merely keeping someone alive for three moredecades by helping her manage multiple diseases and disorders. Theapproach of “reclaiming” potential survival time near the upper limits ofaverage lifespan runs the risk of extending the period of frailty at the end

34 Boston University’s New England Centenarian Study at: http://www.bumc.bu.edu/centenarian/overview.

35 Thomas Perls, Louis Kunkel, Annibale Puca, “The Genetics of Exceptional Longevity,”Journal of America Geriatrics Society 50, no. 2 (2002): 359–68, 360.

36 Richard Miller, “Extending Life: Scientific Prospects and Political Obstacles,” MilbankQuarterly 80 (2002): 155–74, 165.


of life. That is the downside of applying the duty to aid to mitigate everyproximate cause of disease and death. Extending the biological warrantyperiod offers a very different outcome in terms of the quality of lifepersons could enjoy in the post-reproductive stage of life.

In contrast to the scenario of “adding more years to life,” tackling agingitself promises to “add life to years.” An intervention that extends thebiological warranty period would extend the healthspan, thus delayingthe onset of the disease, frailty and disability of late life. And even if themagnitude of the benefits of such an intervention were a small fraction ofthose realized in CR experiments with mice, slowing aging by just sevenyears is estimated to reduce the age-specific risk of death, frailty, anddisability by approximately half at every age.37 This is why, when Mod-ified DA is applied to the dilemmas posed by global aging, it is importantto distinguish between the benefits of reclaiming survival time near theupper limits of average maximum lifespan and those expected from extend-ing the lifespan via extending the biological warranty period. Benefitsmatter. And, all else being equal, it is more important to add more life toyears than years to life. A consequence of extending the biological war-ranty period is that people would live longer lives. But the purpose ofextending the warranty period is to prevent disease, suffering, frailty, anddisability (as prescribed by the principle of preventing bad occurrences).

Would extending the biological warranty period compress morbidityat the end of life? There is reason to think this could be an additionalbenefit of retarding aging. It has been observed that supercentenar-ians38 and centenarians39 have a compression of morbidity at the endof life. Exceptionally long-lived individuals perhaps hold the key to thegoal of delaying disease and frailty, as well as compressing the periodof time persons must experience these maladies at the end of life. Theexceptionally long-lived share “longevity genes” 40 that extend the bio-logical warranty period.

The health prospects of the exceptionally long lived (age > 100) shouldbe the baseline the duty to aid adopts for determining what constitutes“premature death” in today’s aging world. This would permit the duty tobetter track both intrinsic and extrinsic factors that cause disease, suffer-ing and disability and thus expand the potential strategies to be exploredfor increasing the opportunities for health.

37 Jay Olshansky, Daniel Perry, Richard Miller, and Robert Butler, “In Pursuit of theLongevity Dividend,” The Scientist 20 (2006): 28–36.

38 Stacy Andersen et al., “Health Span Approximates Life Span Among Many Super-centenarians: Compression of Morbidity at the Approximate Limit of Life Span,” Journal ofGerontology: Medical Sciences 67A, no. 4 (2012): 395–405.

39 Thomas Perls, “Centenarians Prove the Compression of Morbidity Hypothesis, ButWhat About the Rest of Us Who Are Genetically Less Fortunate?” Medical Hypotheses 49(1997): 405–7.

40 See, for example, Paola Sebastiani et al., “Genetic Signatures of Exceptional Longevityin Humans,” PLoS ONE 7(1): e29848. doi:10.1371/journal.pone.0029848.

498 COLIN FARRELLY

VIII. Two Objections

The operational-level considerations Modified DA emphasizes makes,I have argued, a strong case in favor of adding age retardation to the listof strategies to pursue in order to manufacture survival time. Recall thatModified DA draws attention to the probability that nonintervention willresult in something very bad, the likelihood that these harms can beprevented, and the magnitude of the benefits of intervening. The harmsof aging are certain; nonintervention in the aging process will result inmuch more suffering, disease, and disability in the world than there needbe. Furthermore, given what science has unravelled about aging, espe-cially “exceptionally healthy aging,” there is now a sound empirical basisfor believing that intervening in the aging process could extend the bio-logical warranty period of humans. And the magnitude of the benefits ofdoing so, given the number of persons projected to be over age sixty bythe middle of this century, helps solidify the case for taking urgent andcommitted action to retard the rate of biological aging.

Many objections are often raised against life extension, and thus byextension, to the suggestion that we are obligated to extend the humanbiological warranty period. I will briefly address two standard objectionsthat one commonly encounters. These concerns are the potential harms ofoverpopulation41 and a worry that new technologies that intervene directlyin our biology to extend life will only serve to further exacerbate thehealth inequalities that exist between the developed and developing world.I shall call the first objection the Too Many People in the World is BadObjection, and the second objection the Greater Inequality is Bad Objection.

While I think both objections express potential concerns42 about extend-ing healthspan, I am sceptical that these concerns would support theconclusion that the health and economic benefits of age retardation should,all things considered, be forfeited for the benefit of population reductionand/or less health inequality.

With respect to global population, perhaps the natural question to askis how many people are too many for this planet? But this general ques-tion might not be the most useful one to ask. The world is a diverse place.

41 Peter Singer himself raises this objection and argues that we should not favor thedevelopment of an anti-aging drug. See “Research into Aging: Should it be Guided by theInterests of Present Individuals, Future Individuals, or the Species?” in Life Span Extension:Consequences and Open Questions, ed. Frédéric C. Ludwig (New York: Springer, 1991), 132–45.

42 Allen Buchanan (See Beyond Humanity [Oxford: Oxford University Press, 2011], 71)makes a useful distinction between a concern about an enhancement and an objection to theenhancement. The former is merely a “con,” a reason against it. But an objection to anenhancement is a much stronger claim. An objection is an “all-things-considered” judgmentthat an enhancement is undesirable because the cons outweigh any pros. As Buchanannotes, “all objections are concerns, but not all concerns are objections” (71). While I do notdispute the point that age retardation would raise concerns pertaining to population growth,I do not think these are likely to provide a decisive objection to the case in favor of pre-venting chronic disease.


The size of the population living in different countries varies, as do fer-tility rates and the amount of land and resources available to the peopleliving in different geographical territories. The situation of Canada, forexample, a country with a relatively small population considering its sizeand low fertility rate, is very different from a country that is more denselypopulated and has a higher fertility rate, like Bangladesh.

The population of many developed countries will actually decline overthis century, and these countries see increasing the number of healthy,productive workers contributing to their economies as a vital necessity.That is why most countries pursue immigration. Keeping people healthyand productive would confer significant individual and societal benefits,and these benefits must be considered when weighing up the pros andcons of age retardation.

The life prospects of people living in disparate parts of the world areinterconnected in different and complex ways. No continent or country isan island. Population growth in one region of the world can strain resourceselsewhere, and increase problems like pollution and climate change. Andyet it seems odd, if not perverse, to suggest that these problems beaddressed by forfeiting health innovations that could reduce the preva-lence of chronic diseases like cancer, heart disease, and stroke. Why doesthe critic of biogerontology select just this one potential health interven-tion as the one to forfeit? Why not propose forfeiting the benefits ofexercise, smoking cessation, sanitation, or antibiotics? Or, taking theirlogic even further, why not propose increasing the mortality rates fromaccidents, war, or infectious disease? Such measures could be very effec-tive in constraining global population growth. And they could be morehumane and cheaper than the slow, expensive, and painful death bychronic disease.

Proposing to decrease global population by increasing the mortality ofwar, accidents, or lung cancer no doubt strikes us as grossly unjust and,well, just plain silly. Why? Because the duty to aid entails we preventwars, accidents, and lung cancer unless the sacrifice involves somethingof comparable moral importance. Are the overall harmful effects of popula-tion growth so severe and large that we should forfeit the health andeconomic benefits of any health innovation (including an anti-aging inter-vention)? If they are, then we would need to rethink our attitude on allpublic health measures and not just an applied gerontological interven-tion. To object only to modes of manufacturing survival time that extendlifespan is ageist because it assumes the interest people have in remaininghealthy during the post-reproductive period of life is not worthy of thesame respect and value that we place on those interests in the reproduc-tive and pre-reproductive stages of life.

The burden of proof is thus on the critic of age retardation to demon-strate that a more pressing moral demand (one more specific than a vaguereference to “overpopulation”) of the duty to aid trumps the duty to

500 COLIN FARRELLY

promote the health of the two billion people who will be over age sixty bythe middle of this century. This means that something of comparablemoral importance to reducing chronic disease for billions of people mustbe at risk, and this risk must be as certain as the harms of senescence.

The rational response to the problems of population growth is to sup-port the fair and empirically demonstrated measures that have been suc-cessful in curtailing population growth. The tried and tested solutionsinclude education (especially of women), access to birth control, eco-nomic development, alterations in social attitudes toward the family andgender, and so on. My response to the Too Many People in the World is BadObjection against retarding aging is the same response I would invoke todefend any other measure that manufactures survival time —curbing fer-tility, rather than forfeiting health innovations, is likely to be the more fairand viable solution to these problems.

The Greater Inequality is Bad Objection raises different types of concerns,many of which take place against the background of debates about thealleged intrinsic and/or instrumental value of distributive equality. I donot have the space needed to address these larger philosophical pointshere. But the critic who raises the Greater Inequality is Bad Objection againstextending the biological warranty period is most likely worried about thefair diffusion of an anti-aging intervention. If such a technology is (at leastinitially) quite expensive, they worry, then it is only likely to be enjoyedby people living in the richest countries. And these people already enjoythe longest lives. So this would further exacerbate the injustice of existinghealth inequalities.

To assess their concerns it is perhaps best to reflect upon our attitudesto other, existing interventions, which manufacture survival time to seewhat the appropriate response to this potential objection to an agingintervention might be. The benefits of sanitation, for example, are unequallyaccessible to the global population. And I believe this is unjust. However,saying this does not entail that we have compelling grounds for forfeitingthe benefits of the sanitation revolution. It would be perverse to say:“Well, two billion people do not enjoy the benefits of the sanitation rev-olution, therefore, the other five billion people in the world should notenjoy them either. I would prefer everyone to be equally vulnerable thanto permit some to enjoy lower risks of morbidity and mortality.” Thereason we do not take such a position is that, even if we take the view thatequality has intrinsic and/or instrumental value, the benefits of levellingdown with respect to health are not weighty enough to override what welose in utility from higher rates of morbidity and mortality.

What would be preferable, the egalitarian might argue, is a situation of“levelling up.” Everyone in the world should enjoy the benefits of thesanitation revolution. I agree with this sentiment. But what prevents thisfrom being the case? Concerns about equitable access to health interven-tions must take seriously the different obstacles that face the fair diffusion


of health innovations. The reasons why health innovations are not equallyaccessible to all are often varied and complex. The obstacles to universalis-ing the benefits of smoke cessation, for example, are different from theobstacles that arise with sanitation, immunizations, chemotherapy, andtriple bypass heart surgery.

The intervention I have described in this paper, namely an “anti-aging”pill that mimics the effects of caloric restriction or the “longevity genes”of centenarians, does not require the expertise of surgeons to operate onhumans, nor does it require the complex infrastructure required to tapclean drinking into the homes of millions of people living in dense andpolluted urban settings. So the obstacles facing the development anddiffusion of a pharmaceutical that retards aging is very different frommany of the obstacles that face interventions that reclaim potential sur-vival time.

The biggest hurdle facing the development of an intervention thatextends the biological warranty period is most likely research and devel-opment. Once such a pill is developed, and approved for safety andefficacy, then the dispersion of it should be relatively straightforward. Theobstacles to diffusing such a pill would probably be more comparable tothose facing the provision of micronutrient supplements (to combat vita-min A and iron deficiencies, for example) or the birth control pill than tosanitation or major surgery. So I believe there is some basis for beingoptimistic that an aging intervention would be more accessible to theworld’s poor than the expensive medical interventions that reclaim poten-tial lifespan.

Those committed to promoting the health and economic prospects ofthe world’s poor ought to also be committed to extending the biologicalwarranty period. The poorest aging populations in the world cannot relyon Social Security and the health care that many enjoy in the developedworld. Remaining healthy and productive is even more vital for the world’spoor. Thus biogerontology could help, rather than hinder, the goal ofeliminating global poverty. Countries with a healthy population are muchmore likely to escape poverty than they are if citizens with a lifetime ofexperience and knowledge are more vulnerable to disability, disease anddeath.

IX. Conclusion

I have argued that the duty to aid requires that we aspire to extend thehuman biological warranty period. If my argument has been successful,then the field of biogerontology ought to be considered an integral part of“well-ordered” science43 for the twenty-first century. The aspiration to

43 James Flory and Philip Kitcher, “Global Health and the Scientific Research Agenda,”Philosophy and Public Affairs 4, no. 32 (2004): 36–65.

502 COLIN FARRELLY

manufacture survival time must thus extend beyond the goals of reduc-ing extrinsic risks and preventing avoidable mortality. We must also aspireto modulate the trade-off that evolution through natural selection hasmade between reproduction and longevity. To do so we must also shiftthe current moral landscape, so that the duty to aid transcends the aspi-rations of reclaiming potential survival time and also applies to the goalof age retardation. While natural selection cares little about keeping humanshealthy during the post-reproductive stage of life, we should not showthe same indifference.

The duty to prevent suffering, disease and disability requires that wesupport the science which could extend the biological warranty period ofthose living this century, and for all future generations. The aging of theworld’s population is a novel and monumental development. And, bar-ring the catastrophe of a large-scale outbreak of infectious disease or war,it is likely that the most prevalent forms of disease and suffering for theforeseeable future will be those that afflict people in late life. Our under-standing of the demands of morality ought to reflect this basic reality.And I hope the empirical ethical analysis advanced in this essay helpsfacilitate such an understanding.

Political Studies, Queen’s University


EMPIRICAL ETHICS AND THE DUTY TO EXTEND THE "BIOLOGICAL WARRANTY PERIOD"

Documents

Transcript of EMPIRICAL ETHICS AND THE DUTY TO EXTEND THE "BIOLOGICAL WARRANTY PERIOD"