-Caveat Lector- <A HREF="http://www.ctrl.org/"> </A> -Cui Bono?- Health Care Ethics March 17, 2000 Should we cure dying? by MARK MEANEY RELATED LINKS * Bioethics.net * Extended Life, Eternal Life * Meta List on Science and Religion * Philadelphia Center for Religion and Science * More articles by Mark Meaney What could be better than to age without aging ... or dying? That was the question under consideration at a public debate sponsored March 5, 2000, by the University of Pennsylvania College of Arts and Sciences and by the Philadelphia Center for Religion and Science. Entitled "Should Biomedicine Treat Dying as a Disease -- and try to Cure It? Its Scientific Basis, Future Prospects, and Ethical and Theological Significance," the debate was broadcast live over the World Wide Web from the university's Museum of Archeology and Anthropology. It was moderated by Art Kaplan, Ph.D., director of the university's Center for Bioethics, and followed by an open discussion. Princeton's Lee Silver, Ph.D., began the debate with a defense of the biotechnological imperative and the free market. He first described how genetic mechanisms gradually block cell regeneration until cells can no longer reproduce and the organism dies. He then argued that these genetic inhibitors no longer serve an evolutionary purpose. Gene therapy would merely act to remove what prevents cell regeneration. The removal of such inhibitors, in turn, would simply promote health. Thus, the goal of gene therapy is not different from the goal of medicine generally. Health is the end of medicine. The application of biotechnology to alter genetic structure promotes health and indirectly extends life. Silver bolstered his defense of the biotechnological imperative with an appeal to the value of free market mechanisms. Individuals can best determine for themselves whether to alter their gene structure to extend their own lives. Moreover, the market place is the best arbiter of individual choice. If individuals do not want this form of technology, then it will disappear, much as genetically modified food disappeared from the shelves of British supermarkets. In his counterargument, Leon Kass, M.D., Ph.D., a professor of social thought at the University of Chicago, made the paradoxical claim that mortality is good; the finitude of life is, in fact, a blessing. Kass established his claim by providing the answers to three questions: What are the virtues of mortality? Why do humans seek immortality? What is the purpose of reproduction? In brief, there are four virtues of mortality: knowledge of the purpose of human life, knowledge of means to ends, love, and courage. Human beings seek not for deathlessness, but wholeness, wisdom, love and integrity. Aging and mortality are mechanisms for the reproduction and regeneration of sociality and culture. Kass first argued based on the quality/quantity distinction. The extension of life indefinitely (deathlessness) is no assurance of a life lived well. Drawing on existentialism, Kass argued that quite the opposite is closer to the truth: The quality of human life is intimately related to death. The most important aspect of death is its psychological dimension. Anxiety is the key to death. As a cognitive emotion, anxiety can reveal the truth about the human condition and provide answers to the meaning of existence. It takes courage to face and explore our anxieties over death. A person gains knowledge of freedom, when she faces the ultimate existential crisis. Knowledge of freedom, in turn, produces character and hope, power and effectiveness. We grow to cherish the fullness of life only by confronting our own death. Thus, deathlessness would lead to ignorance of the meaning and purpose of human life. Could a deathless person truly love? Relationships deepen with age, as lovers become aware of their finitude. When it dawns on us that someday we will lose the other to death, we love wisely. Kass argued that the horizon of death compels us to go beyond mere appearances to grasp at the true meaning of relationships. Deathlessness might rob us of our chances of attaining what we really want in life, the well being of our souls and not just bare existence with other people. Fundamental human longings cannot be satisfied by deathlessness. In an interesting twist, Kass used evolution and reproduction as the basis of his last counterclaim. Human beings are built for more than biological reproduction. We are social by nature and depend on culture for survival. Aging and mortality are in fact biological mechanisms "chosen" for the sake of the success of sociality and culture. Kass argued that the longer we live, the more conservative, apathetic and jaded we become. The regeneration of society depends upon a struggle for justice and equality; the regeneration of culture depends upon new forms of art and literature. In short, aging and death cull the old to make way for the new. They are mechanisms for the regeneration of society and culture. Consequently, agelessness would result in a steady decline of civilization. An alteration of gene structure to cure dying would ultimately violate the dictums of prosperity and cheat children out of their chance to improve the lot of society. In support of a cure for dying, Ronald Cole-Turner, Ph.D., M.Div., a professor at Pittsburgh Theological Seminary, attacked Kass' conception of aging. Where Kass conceived of aging in terms of a beginning, middle and a nursing home, Cole-Turner offered a "new narrative" of life. He proposed this new narrative as an alternative to the antiquated, tripartite division of aging. We ought not to conceive of aging in quantitative terms. The richness of life is not a function of quantity, but of self-transcendence both in relation to others and to God. Not length, but wholeness defines human life. The new narrative, age without aging, entails indefinite growth toward wholeness and interconnectedness. In this new perspective, people will envision life extension as an extended adventure toward new levels of spirituality and mystical awareness. Thus, deathlessness will only help us individually and collectively address the true meaning of life; it will provide new opportunities for religious insight. Daniel Callahan, Ph.D., director of International Programs for the Hastings Center, made three points: There is no correlation between length and quality, a cure for dying offers no known social benefit, and the issue is far too important to leave to individual choice. Bioscience is schizophrenic about death. We develop and deploy extremely expensive technologies to combat death in the final weeks of life; or, we deposit the elderly in a nursing home or in hospice care. Callahan's point seems to have been that, while bioscience spends enormous sums of money combating death to extend life, there has been precious little done in the way of improving the quality of the end of life. Instead, Callahan argued, we should not spend the majority of our healthcare dollars to research high tech in order to prolong life. The aged have had a chance to live. Eighty years or so of life is enough. We should rather allocate scarce healthcare dollars to enhance the quality of the lives of those who have not yet had a chance to live a full life. Focus dollars on quality, not quantity. Rather than fund research to find a cure for dying, we should find a cure for breast cancer. Moreover, who will pay for the maintenance of those ageless people who will not want to work after retirement? What will happen if people change their minds? Would we then kill them, or help them to commit suicide? The world is faced with enormous social, political and economic pressures -- problems of homelessness, poverty, crime, famine, disease, adequate health care, world peace, etc. While research into aging may benefit the few corporations that depend on capitalization, longer life fails to contribute anything to solving these morally pressing problems. The burden of proof falls on those who are for it to show how agelessness will contribute to happiness. Callahan's last counterclaim addressed the argument from individual autonomy. Silver had argued that the individual could best decide to alter gene structure. Callahan counterargued that once researchers introduce technologies into society, use eventually becomes mandatory. People have little choice to escape the options. In effect, the options are forced upon them. Callahan took as an example word processors and email. Though it might be possible to work, an academic cannot function today without the Internet. If we find a cure for dying, eventually everyone will have to accept the "benefits." Before we all have deathlessness foisted upon us, we ought to reflect on the consequences. In the follow up, Silver argued that the burden of proof is on Kass and Callahan to define an appropriate life span. Kass countered by arguing that there is a natural norm of life expectancy, and Silver wants radically to change that norm. A genetic alteration of the aging process represents a wholesale transformation of the character of biomedicine. Moreover, deathlessness would amount to a massive change in human nature. The burden of proof is therefore on Silver to show why we ought to change the existing norm. Who appointed the "immortality people" to create the choice and then inflict it on us? Why should scientists enjoy unfettered options without showing us why we ought to do what they propose? Kass went on to conclude that agelessness is too important and too irreversible to have it left up to individual choice and market forces. In their concluding remarks, Cole-Turner and Callahan debated the merits of federal regulation. Cole-Turner questioned the wisdom of placing the future of research in the hands of an "advisory group" that would be made up largely of bioethicists. Callahan too seemed opposed to oversight. He suggested instead that we should make the very idea of a cure for dying morally repugnant. In the end, serious ethical discourse ought to focus on what counts as a good choice, and what counts as a bad choice. Cole-Turner countered that the market is the best means to determine what society deems repugnant. Kaplan brought the exhilarating program to a close by suggesting that the debate seemed less about deathlessness and more about when we will die. The research raises a question about how far we can and ought to extend life. He also observed that it is paternalistic in the extreme to offer people a choice about their own death, with the proviso that if they really do not want the gene therapy, they could just go off and die. Many thanks go to the sponsors, but especially to the webmaster for delivering a seamless broadcast. <A HREF="http://www.ctrl.org/">www.ctrl.org</A> DECLARATION & DISCLAIMER ========== CTRL is a discussion & informational exchange list. Proselytizing propagandic screeds are not allowed. Substance—not soap-boxing! These are sordid matters and 'conspiracy theory'—with its many half-truths, misdirections and outright frauds—is used politically by different groups with major and minor effects spread throughout the spectrum of time and thought. That being said, CTRL gives no endorsement to the validity of posts, and always suggests to readers; be wary of what you read. CTRL gives no credence to Holocaust denial and nazi's need not apply. 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