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John K. Davis, J.D., Ph.D. Department of Medical Humanities The Brody School of Medicine

Collective Suttee: Is it unjust to develop life-extension if it will not be possible to provide it to everyone?. John K. Davis, J.D., Ph.D. Department of Medical Humanities The Brody School of Medicine.

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John K. Davis, J.D., Ph.D. Department of Medical Humanities The Brody School of Medicine

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  1. Collective Suttee: Is it unjust to develop life-extension if it will not be possible to provide it to everyone? John K. Davis, J.D., Ph.D. Department of Medical Humanities The Brody School of Medicine

  2. “[T]hose involved in the discovery and the rich and powerful will have earliest access or, depending on availability, even the only access.” - Leonard Hayflick “[It] would be the ultimate injustice if… the world were divided not only into rich and poor but into mortal and immortal.” - Leon Kass

  3. “We can make [life-extension] socially despicable. Just like nuclear testing, we can decide we don’t want it.” - Daniel Callahan (citing limited access and other concerns)

  4. “Of course, we could allow people to pay for life-extending technology. But this would be unfair to those who could not afford to pay because it would preclude them from having the same choice as those who are better off. [This provides] moral grounds for not allowing people to extend their lives beyond the present norm.” - Walter Glannon

  5. Prohibition: outlaw access to life-extension - Very hard to implement Inhibition: hinder, delay, and do not adequately fund life-extension R&D - Inhibition is temporary Prohibition Free Choice: no prohibition or inhibition

  6. Consensus View on equality and justice: Taking from the Haves is justified only if doing so makes the Have-nots better off • Even if doing so decreases total utility (?) • But not when it makes the Have-nots no better off, or only marginally better off

  7. Taxes spent on life-extension R&D No taxation without elongation! • Harder to catch-up with the Haves • Distress and envy • Malthusian consequences

  8. 3 comparisons • Person by person, 1 year • Person by person, entire life • Population of Haves and population of Have-nots

  9. To compare populations of Haves and Have-nots, we need some speculative assumptions • Without life-extension, average lifespan of 100 years • With life-extension, an extra 500 years (aging halted; accident rate unchanged) • 22% of human race are Haves; can subsidize another 8% • Typical Have-not indifferent between 19 years of normal life and 20 years of burdened life (.95 QALY; 5% discount per life-year)

  10. Distribution of benefits and burdens under Free Choice for population of 100 30 Haves x 500 LY each = +15,000 LY 70 Have-nots x 5 LY (equiv.) each = -350 LY (equiv.) (100 LY each x .05 discount)

  11. How much worse life-extension makes your death is a matter of degree • Compare: • Death at 97 1,000 years ago • Death at 97 as a Have-not (now or in 2053) • Death at 97 as a Have in 2053 • Measure how bad a death is not only by comparison with length and quality of life one would otherwise have had, but also by the odds of living a given time longer – the better the odds, the worse the death

  12. How bad is a Have-not’s death if life-extension is available to others? • With life-extension, Have-not would live 500 more years • To get access to life-extension: • Start a successful business, receive a bequest, etc. • Technological breakthrough makes it affordable • Odds of one of these things happening: 10%? • 500 LY x .1 = 50 LY (equivalent)

  13. Distribution of benefits and burdens under Free Choice, with death burden included 30 Haves x 500 LY = +15,000 LY 70 Have-nots x 55 LY (equiv.) = -3850 (equiv.) (5 LY (equiv.) burden + .1 x 500 LY)

  14. Distribution of benefits and burdens under Inhibition, with death burden included 30 Haves x 500 LY = +15,000 LY 70 Have-nots x 30 LY (equiv.) = - 2,100 LY (equiv.) (.5 x 500 LY + 5 LY (equiv.)) • Under Inhibition, each Have-not bears a burden lighter by the equivalent of 25 LY -- compared to 500 LY per Have • Under Inhibition, total burdens of 70 Have-nots are lighter by equivalent of 1,750 LY -- compared to 15,000 LYs

  15. Different assumptions: fewer years, fewer Haves 6 Haves x 50 LY = +300 LY 94 Have-nots x 1 LY = -94 LY (1% of 50 LY, plus equiv. non-death burdens of .5 LY per Have-not)

  16. How to argue for Collective Suttee • Claim that justice requires leveling-down (equality with a guillotine), or • Claim that the burdens (other than badness of one’s death) are much worse than .95 QALY (ex: indifferent between 10 normal years and 20 burdened years), or • Claim that a Have-not’s odds of access under Inhibition are far, far worse than under Free Choice, or • Claim that the appropriate comparison is between populations, AND that the tradeoff will be more like 300 LYs for 6 Haves versus –94 (equiv.) LYs for 94 Have-nots, AND that, on the Consensus View, this justifies Collective Suttee

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