Further progress in the life sciences seems guaranteed because the evident health benefits will assure unstinting public support. Yet the dark side of this research is now impossible to ignore. Advanced biological weapons are now seen as a major threat, and rightly so. But two emerging problems of the life sciences also deserve more scrutiny. One is the outsized cost and ethical dilemmas of the longevity expansion. We can already discern the outlines of a cramped new world in which scores of millions in developed countries are in varying stages of senescence, but could be kept alive with indefinite life-prolonging interventions that would bankrupt national budgets.
The other threatening phenomenon is harder to define with precision, though potentially far more revolutionary. It arises from the accelerating pace of research in both neuroscience and computer science, and the gradually expanding joint projects of those disciplines. Slowly coming into focus is a merger of the two versions of “intelligence”—the human brain’s unique thinking ability and the computer’s vast search-memory-and-computation powers. Superhuman intelligence looms on the horizon.
The Deconstruction of Death
From antiquity until yesterday, old age was not thought of as a curable affliction. Senectus insanabilis morbus est—old age is an incurable disease—wrote the Roman philosopher Seneca. The outer bounds of old age were understood to be the seventies and eighties, and we learn from biographies of famous people that a fair number lived that long. The Roman consul and orator Cato died at 86 in 149 B.C.; Saint Augustine died at 75, shortly after he finished writing The City of God; Michelangelo was creative almost until his death, a few months shy of 89; Voltaire lived to the age of 83; Benjamin Franklin lived to 84. What is new today is that a far larger proportion of people live to their eighties and often continue to participate actively in society. During the last three hundred years, most countries have experienced dramatic reductions in mortality rates. The average length of life almost everywhere has more than doubled, and in the developed world has tripled, rising from a norm of twenty to thirty years which had prevailed through most of recorded history.
Beyond this genuine progress lie more audacious goals. Competent experts in biotechnology now propose to transform old age into a curable disease. The “cure” they have in mind would both extend the life span and improve the quality of life in the later years. Scientists have predicted that it will become possible to extend people’s active life-span by twenty years or more, probably long before the end of this century. Less clear is how many of those living longer will spend decades in senility. But even with massive uncertainties about this critical aspect, demand for the new life-prolonging treatments will be irresistible, and will confront democratic governance with agonizing choices.
A threshold question is how will decisions be made about prolonging individual lives? Physicians and hospitals play a key role in any such decisions, and medical ethics assigns a high priority to prolonging life. Even when terminally ill patients convey a preference for ending life-support measures, their wishes are often overridden. Litigation over responding to surmised wishes of comatose patients can drag on for years, in the United States as well as in many European countries. Recent disputes offer a warning of things to come. Consider the case of Terri Shiavo, a comatose woman in Florida kept alive on a feeding tube for fifteen years, until the final court decision in 2005 gave her husband permission to have the feeding tube removed. This closure was preceded by three years of court decisions and appeals, as well as legislative interventions culminating in a special bill passed hurriedly by the U.S. Congress.
Some jurisdictions have sought to clear a path through this thicket. The Netherlands legalized doctor-assisted suicide. So has the State of Oregon, but with more restrictive rules. Such laws tend to meet with strong religious opposition, although most religions make allowance for countervailing considerations. In a letter rich in beautiful passages about aging and death, Pope John Paul II reaffirmed that “the moral law allows the rejection of ‘aggressive’ medical treatment.’”1 But under what conditions is a specific medical treatment “aggressive”? In the Terri Shiavo case, Catholic theologians cited a more recent statement by Pope John Paul II, asserting that providing food and water was “morally obligatory.” For those guided by this precept, most of the future life-prolonging treatments might be considered “morally obligatory,” especially if they turn out to be less onerous than the currently used stomach tubes and other invasive techniques.
Such treatments could also find warm support among doctors and might be eagerly requested by elderly patients. Before long, budgetary pressures would then force policymakers to limit the exploding expense of life-prolongation. It is not hard to imagine the ensuing debates. Well-intentioned theologians and ethicists would fiercely oppose any such limitations, seeing them as a “slippery slope” that leads to government-imposed euthanasia. And in case of deaths in hospitals that are now attributed simply to old age, family members supported by ethicists would accuse these hospitals of euthanasia and start innumerable lawsuits. Others will try to argue that the billions spent on life extension for centenarians ought to be used elsewhere, say to protect the lives of children who are killed in crime-ridden neighborhoods by cross-fire among drug dealers (at least one child per day in U.S. cities), or to reduce the deaths from automobile accidents (more than a hundred per day in the United States).
Still others will point to a different slippery slope. If death could be indefinitely forestalled by ever more sophisticated interventions, humanity would lose all sense
