Professional Documents
Culture Documents
Enhancement
Eric T. Juengst; Robert H. Binstock; Maxwell Mehlman; Stephen G. Post; Peter Whitehouse
The Hastings Center Report, Vol. 33, No. 4. (Jul. - Aug., 2003), pp. 21-30.
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Thu Jun 28 22:20:04 2007
i-aging M e
--
ne,"
and
the
Slowing the aging process would be one of the most dramatic and momentous ways of enhancing
human beings. It is also one that mainstream science is on the brink of pursuing. The state of the science,
together with its possible impact, make it an important example for how t o think about research into all
legitimate medical concerns to treat and prevent traditionally defined disease, disability, and suffering in
the sick. If they are understood as part of traditional
medicine, the problem of policing their proliferation
shifts from the laboratory to the street, where new
enhancement interventions will appear, fait accompli,
as "off-label" applications of existing medical tools
and their regulation becomes a significantly more
challenging social project.3
There is one biomedical field, however, which is
now teetering on the brink of enhancement research
at a fundamental level and can provide an instructive
illustration of the dynamics that surround the emergence of enhancement interventions from medical research. The field of biogerontology-the study of the
biology of aging processes-is already struggling with
the prospect that its findings might be applied to produce unprecedented human longevity.
Moreover, of
all biomedicine's potential capacities to re-engineer
the human, slowing the hitherto inexorable clock of
HASTINGS C E N T E R REPORT
21
aging would be one of the most dramatic and far-reaching. This makes
the field a bellwether for other domains in human biology, like neurobiology, muscle physiology, and genetics, that might also have "enhancement" applications as their science
matures. For policymakers, the proof a
file that b i o g e r ~ n t o l o gprovides
~
field in transition may. -prove useful in
attempting to develop early warning
systems for the emergence of "off
label" enhancements in those domains.
In this paper, we concentrate on
three lessons that biogerontologists
are already learning, long before the
arrival of any actual anti-aging interventions: (1) the dangers of premature commercial exploitation of scientific goals; (2) the challenge of philo-
have been willing- to evoke quite dramatic "anti-aging" rhetoric to describe the potential implications of
their research. Their own books, with
titles like The Quest for Immortality:
A,
22
HASTINGS C E N T E R R E P O R T
July-August 2003
23
Of
July-August 2003
Compressed Morbidity
ne outcome that does seem to provide some common ground for applied aging science is the prospect of
"compressing the morbidity" of the
aging process.37 The ideal envisioned in
this scenario is for all of us to lead long
lives free of chronic disease and disability, and then die rather quickly as we
reach the limits of the human life span,
"worn out" from the fundamental
processes of aging. Natural aging apologists frame this goal as attempts to hold
off the ailments of "premature" aging
limit of
and see it as the -proper
biogerontology's ambitions. Gerontologists and geriatricians seek to compensate for or cure the health problems associated with aging so that even the oldest old can live as "successllly" as possible. Basic biologists of aging go further,
to argue that "because aging is the greatest risk factor for the leading causes of
death and other age-related pathologies," intervening to decelerate the normal aging process would be the best
form of prevention for age-associated
pathology.38 O n this view, human life
expectancy (that is, the average age at
death in the population) can increase
even if the maximum fixed life span
does not.
Behind this united front on the matter of compressing the morbidity of
aging, however, lie two important philosophical questions, which will have
analogs in other areas. First, how far is it
appropriate to compress the morbidity
of senescence? At one end of the spectrum, some apologists for natural aging
H A S T I N G S CENTER REPORT
25
J u s t -as
the
free markst
does- met
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free
to forego their n~oralcoil-.- - "-hucksters
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$aking on t h e responsibility to
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111
H A S T I N G S C E N T E R REPORT
gizing aging will also convert antiaging products into health care needs,
expanding the markets for commercialization.
Ultimately, whether aging becomes pathologized or not in our society is not a matter about which the
science of aging itself will be definitive: too many other social voices are
involved. Biomedicine, however, does
have powerful standing in those negotiations, and has shown in the past
that a concerted effort by the biomedical community can effectively
shape public perceptions of health
and illness.
Decelerated Aging
professional irresponsibility for ignoring the potential impact of their overreaching claims on their customers'
lives and with social irresponsibility
for exploiting and exacerbating our
culture's "ageism," despite the fact
that they operate in a free market
with voluntary consumers. Should
basic scientists be held similarly accountable if they ignore the downstream consequences of their research
for individuals and society?
For "decelerating" biogerontologists, anticipating the implications of
success will mean supporting informed speculation on a number of
important social policy questions. We
are learning firsthand the social implications of a burgeoning population of
frail elderly, but we are only just beginning to anticipate the challenges of
increasing numbers of healthy active
elders.45 What would be the effect of
this prospect, for example, on the social place of those who, by choice or
circumstance, continued to age normally? If the interests of the slowly
aging align more with those of young
adults than with their aging peers, the
aging elderly could find themselves
increasingly marginalized. If "antiaging medicine" ultimately stigmatizes the aging process as pathological,
this political disadvantage could be
compounded even further by social
intolerance. O n the other hand, if
slower aging extended the years available for productive work, vigorous
and expert older workers may become
more desirable, making unfair discrimination against the less experienced young the bigger problem.
Of course, our society may never
have to face these issues: the real future will be contingent on many factors, one of the least of which may be
how the science in question pans out.
Nevertheless, just as the free market
does not free hucksters to forego their
moral conscience, predictive uncertainty about the future does not excuse responsible scientists from foregoing the use of their moral imaginati0n.~6Fortunately, basic science communities are increasingly taking on
the responsibility to help society ad-
27
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bion5edieins by b i ~ g @ ~ ~ ~ k ls$rg3n;gg%s
tdtp!~
t ~~i ~
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its
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~
for human
July-August 2003
their research program and the social attempt to "compress" as pathological outside as well as within the walls of
consequences of its achievement. The will be as much a social as a scientific the academy will ultimately be the
history of biomedical science shows process. But it is a process which the best way of foreseeing the significance
how unexpectedly progress can catch biogerontological community can of a real "anti-aging medicine," or any
the scientific community and society have a tremendous influence on, if it other human re-engineering project
unawares by accomplishing the "im- accepts a leadership role by initiating, of similar magnitude.
possible."
hosting, and engaging the broader
In fact, the virtue of anticipatory cultural conversation.
Acknowledgements
deliberation about such sequelae is
Third, those interested in slowing
Support for this paper comes from a
the dominant common thread that the aging process also have the re- research grant (1ROlAGHG209 16-01)
links the lessons raised for biomedi- sponsibility to contemplate the impli- from the National Institute on Aging
cine by biogerontology's struggle with cations of their success. This means and the National Human Genome Reits implications for human re-engi- participating in, supporting, and pay- search. Additional support provided
neering.
- Four different kinds of delib- ing attention to the interdisciplinary S.G. Post by the John Temleton Founerations emerge from the points social impact studies that can help illu- dation. We are indebted to the expert
above that seem particularly general- minate the possible roads ahead. A research assistance of Roselle Ponsaran.
izable to other biomedical domains.
fundamental tenet of engineering
First, the traditional polite silence ethics is the obligation to anticipate References
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July-August 2003
H A S T I N G S C E N T E R REPORT
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30
HASTINGS CENTER R E P O R T
M138-M145.
July-August 2003
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