The Choosy Reaper: From the myth of eternal youth to the reality of unequal death

1. The Choosy Reaper: From the myth of eternal youth to the reality of unequal death Heidelberg Nov 5-6, 2004 Prof. Alex Mauron Bioethics Research and Teaching Unit

2. From the announcement of the 2004 Wright colloquium, Geneva

3. Anti-aging medicine • Many aspects of current medical research (stem cells, neuroscience, etc.) are currently united under the label: « regenerative medicine ». • This fuels legitimate hopes for innovative treatments of degenerative diseases. • This also fuels futuristic speculations about massive increases in human life-span or even the abolition of mortality.

4. Arguing for death • These speculations have raised many criticisms, often on ethical grounds.

5. 1. Disturbing the workings of nature (or « Playing God ») Example: mortality is needed for the frictionless motion of evolution to occur. Answer: who needs evolution? Not we, the current humans! Who wants to be superseded by a « new and improved » species (unless we do the superseding, of course)!

6. 2. Upsetting the moral confines of the human condition. Many high-powered conservative intellectuals want to persuade us that mortality is part and parcel of what we understand to be humanity. Answer: This argument is based on the assumption that content-full, naturalistic statements about mortality and disease are morally binding. Difficult to sustain outside of special ethical or religious communities.

7. 3. Breaking the “laws of the species” (Habermas) Answer: The notion of species that operates in these arguments is far removed from current biological concepts (Robert, Baylis). Still, there are arguments invoking the cultural significance of species characteristics that are more sophisticated than the « playing God » kind.¶ But at the end of the day, they amount to a kind of philosophical anthropology that has little normative force by itself. ¶American Journal of Bioethics. Issue dedicated to “Crossing Species Boundaries”. 2003, vol 3.

8. The various organised reactions against high-tech interventions in human nature, such as: • « yuk-reaction » à la Leon Kass • Culture wars against « scientism » • Religions and/or philosophical wars against « anti-humanism » … are basically « symbolic crusades ».

9. The sociology of « symbolic crusades » Classical example (Gusfield, 1963): The temperance crusade in early 20th century America was basically a « status conflict ». It was a political move to assert the power of Protestant, rural, small-town America against the Southern immigrants as well as against the urban elites (does that ring a bell?…).

10. « Symbolic crusades » and pharmacology • Symbolic crusades create moral panics as a tool to gain, or maintain, social influence (Howard Becker, 1963). The panic about « designer drugs », « lifestyle drugs », « genetic enhancement »… points to a genealogy of moral crusades that all involve: • Unusual, articifial, tamperings with the natural order • « moral entrepreneurs » (Becker) that have an intellectual, but also political, stake in the issue

11. Example: the politics of indignation in current German debates 1- Habermas vs. Sloterdijk The issue was often framed to be about who will be the official « court philosopher » in the reunited Germany. 2- The influence of the churches and of academic theology (which is rather strong in Central Europe, as opposed to France or Italy, for instance) may relate to their ability to be efficient « moral entrepreneurs ».

12. Traditional moral entrepreneurs… … Tend to be conservative in outlook, and to instigate moral panics about « eugenics », « de-humanization », « the complete instrumentalisation of human life ». This explains for instance the Mitteleuropean attitude to futuristic technologies, but also to more current issues such as: • preimplantation genetic diagnosis • embryonic stem cells.

13. Non-traditional moral entrepreneurs - Proponents of high-tech intervention into human nature are also organized in militant, ideologically-charged movements. example: • World Transhumanist Association • Extropianism - Transhumanism is touted as an all-encompassily philosophy, medicine, aesthetics, culture, etc.

14. From the website of Natasha Vita-More

15. A symbolic crusade for hypercapitalism? Transhumanism embodies the mix of futuristic optimism, individual assertiveness, libertarian denial of limits and techno-enthusiasm that has become the hallmark of the current entrepreneurial culture. Transhumanism is the « optimistic » version of a symbolic crusade

16. Radical anti-ageing medicine • It is difficult to argue cogently against it. • Still, one ought to ask what its effects would be if it became a workable proposition in the current demographic, social and ideological context. • An essential feature of this context is that life expectancy is an important marker of inequality.

17. Life expectancy at birth (WHO, 2002) male female Japan 78.4 85.3 Switzerland 77.7 83.3 Greece 75.8 81.1 Cuba 75.0 79.3 Costa Rica 74.8 79.5 USA 74.6 79.8 Brazil 65.7 72,3 Bhutan 60.2 62.4 Russia 58.4 72.1 Uganda 47.9 50.8 Mali 43.9 45.7 Zimbabwe 37.7 38.0 We are not yet a genetically engineered species, but do we still belongto the same species?

18. Universal inequality • Marmot, Wilkinson, the Whitehall studies: Inequality in life expectancy is not (just) an “us vs. them” issue. It cuts across all societies and all social strata.

19. The pecking order • Disease and premature death are more prevalent on the lower rungs of the social ladder • It is not just a matter of material circumstances and access to medical care. • Life entails a series of more or less stressful transitions and the lower you are on the social ladder, the harder you are hit at each of these steps. This is the case even in affluent societies.

20. From: Social Determinants of Health: The Solid Facts. WHO 2003

21. Social inequality is bad for you… • …especially if you experience relative deprivation from an early age onwards.

22. From: Social Determinants of Health: The Solid Facts. WHO 2003

23. Insecurity kills • Precarious jobs are chronic stressors that exert profound effects on health

24. From: Social Determinants of Health: The Solid Facts. WHO 2003

25. Social support is good for you… ..but in turn depends on a social context that values social cohesion and equality. • Although social hierarchies exist everywhere, the associated « health gradient » can be steeper or shallower.

26. From: Social Determinants of Health: The Solid Facts. WHO 2003

27. All this is not inevitable… Michael Marmot (University College, London):   • « If you want to hang around, get ahead. Higher status is a prescription for a longer life » • « You might say the whole thing is inevitable: let us just give up and go home. Let’s start worrying about obesity again. My argument is it is not inevitable. Hierarchies are inevitable. But how hierarchies translate into differences in health is the crucial question. » • The Guardian, June 8, 2004

28. …but the prevailing mood does not lead to optimism • « Liberté, égalité, fraternité » : only the first and the last seem to have a future. • « Liberté » is what everyone argues for, you cannot have enough of it. • « Fraternité » is nice, chummy and sentimental. • « Egalité »: try to argue for it (and I mean the real thing, not the bland « equality of opportunity »), and you stand accused of bringing back the Gulag.

29. Yet if we do not take equality on board as a central value in social ethics, we must remain blind to an essential aspect of the life perspective of today’s humankind… …namely that even as the basics of life are secured, at least in the developed world, longevity remains an important marker of social stratification. Will radical anti-ageing medicine make it worse?

30. Conclusions • The more flamboyant claims of anti-aging medicine, just as the moral panic about them, are two sides of the same coin: a culture war about status. • The conservatives defend their status as moral entrepreneurs for the frightened, disconcerted, « back-to-good-ol’-morality » crowd. • The techno-progressives defend their status as trend-setters for the libertarian, entrepreneurial crowd.

31. Conclusions • Equality is a central value of the Enlightenment. • But nowadays, equality is unfashionable as a source of social-ethical guidance. • Since longevity is an important indicator of global inequality as it is, our culture may have little moral resources when it comes to implementing radical anti-ageing medicine in a way that wouldn’t aggravate inequalities further.