Tuesday, September 23, 2014

What is a good age to die?

Ezekiel Emanuel has written a provocative essay explaining why he only wants to live to age 75. This is definitely some good clickbait bioethics, to be sure. But probing a little more into his position, it's actually a great example of a widely-held misconception about death.

Emanuel lists a bunch of reasons why 75 is good age to quit, ranging from physical, cognitive, and social. The subtext to his claim, however, is this: 'given the current state of various medical technologies and social norms regarding age, 75 is a good age to quit'. This is still a perfectly fine attitude to have, but its implications for policy and the social approach towards death are quite a bit different. Namely, these structural factors that determine Emmanuel's 'quit point' can change. And we have the power to change them.

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Emmanuel chose 75 and not 70 because his personal calculation about the opportunities for flourishing above that age don't outweigh his other concerns. But a few decades ago this number would probably have been lower, because the types of opportunities he sees as still available at age 65 would have already become inaccessible. Medicine and social norms have changed enough such that one's late-60s and early-70s can be pretty great, especially if you're rich and influential.

This brings me to the core point: across most cultures and institutions today, there exists a general lack of appreciation for our ability to change the two structural factors involved with ageing--medicine and norms. Let's put aside norms for the moment, as these tend to be very adaptable, and just focus on medicine. There's a huge consensus that age-related diseases like Alzheimer's and cancer are terrible and should be eliminated via technology and innovation. When you ask people if aging should be eliminated via technology and innovation, however, you get all sorts of confusing and bizarre arguments and rationalizations. Which is understandable given the horror of the topic. But here's the thing: aging and age-related diseases are the same thing.

Aging in the abstract is merely the accumulation of various age-related biological damage, and we're getting better and better at finding ways of repairing this damage. Which is great! But unfortunately the conceptual block between aging and age-related pathology prevents the issue from receiving the attention and funding it deserves (it kills lots of people every year). When a medical innovation comes along and makes being a 70-year old a little better, people cheer (if they notice at all). But they fail to place it into the wider context of history's incremental improvements in medical technology. And so we get powerful, influential people talking about how 75 is a good age to die instead of talking about how new technologies have the potential to make 75, 80--even 100--a great age to live.

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