One Hundred Candles…Or More

Our guest blogger is Alex Kravitt, intern at the University of Pennsylvania Center for Bioethics.

Aside from raising her children, your grandmother’s greatest feat in life could be her centenarian celebration. According to the Census Bureau, there were 90,422 American centenarians in June 2008, a dramatic increase from the 50,454 in 2000. Thanks to drastic improvements in medicine, nutrition, and the understanding of healthy living over the past century, some Americans have seen their grandparents live to a ripe age of 100 or even beyond.

Part of the rapid increase in the number of people in the United States who are living not just longer, but a very long time stems from the steady development of life-extending medical developments. But the pace of medical advances is in fact so rapid that we are barely able to consider both the ethical dimensions of certain life-extending procedures and the social responsibilities that come with caring for an old population.

Consider the case of Dr. Michael DeBakey, the astounding heart surgeon who recently passed away at age 99. Two years ago, an ethics committee of physicians convened in Houston to discuss whether an aortic dissection repair, an advanced surgical procedure to correct a tear in the lining of the aorta, would be appropriate for the 97-year-old man—before deciding to perform the procedure on DeBakey. The operation was risky for a man at such an age and in such a grave condition, so the anesthesiologists declined at first to administer the anesthesia to put him out for the procedure. DeBakey’s wife convinced the ethics committee to go ahead with her husband’s operation.

The elderly are susceptible to a wide range of diseases: from cancer to Alzheimer’s to heart disease. Yet with modern medical procedures, health care providers can combat these ailments. Doctors can use hip and knee replacements, heart valve replacements, biventricular defibrillators, pacemaker implantations, and bypass surgery to prolong life. Consider biventricular defibrillators, which go beyond the capabilities of more common pacemakers in regulating heart rate. The device synchronizes heartbeat, and if the heart rate drops below the set threshold programmed by the doctor, the device fires small electrical pulses that pass through leads and into the heart muscle, shocking the individual and saving him or her from a potentially fatal arrhythmia.

But does the defibrillator go too far? Wouldn’t it be ideal to peacefully pass away in your sleep when your heart stops at age 100? Why would you want the defibrillator to prevent a peaceful death after a long, fruitful life? Some who live to 100 refuse to see their age as a barrier, and many who survive to such an age still pursue extremely satisfying lifestyles.

Transhumanists, who advocate the expansion of human capabilities through enhancement technologies, take this reasoning even further, arguing that life extension should be pursued to its fullest, perhaps to 500 years or more. Why not live forever? Their opponents argue that a very long life is not worthwhile. Immortality would get tiresome, and even worse, lack meaning. Yet who’s to say that a long life would be meaningless? People who live in a democratic society are free to choose whatever lifestyle they wish, provided that one’s choices aren’t harmful to others. Since we are free to make such choices, is it wrong to prevent those who wish to radically extend their lifespan from doing so?

While our ability to live to 500 is not a prospect for the near future, a practical objection to boundless life extension is that keeping the elderly alive could lead to overpopulation and continue to strain limited resources. Moreover, the elderly will stay insured for longer, placing an increasing financial strain on our already overwhelmed health care system. The field of geriatrics is currently in great need of more doctors and nurses, and the children and grandchildren who care for elderly relatives will need to care for their loved ones even longer. Nobody wants to see their parents or grandparents age, suffer, and pass away. But perhaps we need to come to terms with the simple fact that aging is a part of life.

Not only have we developed procedures that extend life by repairing and rejuvenating damages to tissue, researchers are working on anti-aging drugs. The most recent anti-aging drugs showing positive results are known as sirtuin activators. The theory behind sirtuin activators derives from experiments demonstrating that a healthy diet with 30 percent fewer calories than usual triggers a reaction in mice that increases their lifespan. Most people have a hard time cutting their caloric intake down by 30 percent, so medications that could activate the “famine reflex” (allowing an individual to function on a less caloric diet) may actually be desirable. Living on such a reflex would reduce food intake and could decrease the chance of developing type 2 diabetes, a disease that greatly decreases lifespan. Dr. Leonard Guarente, an MIT biologist, has found that the famine reflex is mediated through sirtuin enzymes, and Dr. David Sinclair, his former student, found that sirtuins can be activated by resveratrol, a natural substance found in red wine. The new resveratrol drug, known as SRT501, has passed safety tests and has been found to reduce patients’ glucose levels. The hope of SRT501 is that by activating sirtuins, degenerative diseases such as diabetes, heart disease, cancer, and Alzheimer’s could be prevented, possibly expanding lifespan by 5 or 10 percent. In experiments, mice on SRT501 remain relatively healthy right until the end of their lives, when they simply drop dead without showing any signs of diminishing health.

What could be better? Decreasing the effects of aging, along with the risk of heart disease and diabetes, while allowing the elderly to suffer less in old age—these are immense benefits. Elderly citizens would require less care from family members and the rest of society, because aging would not keep them from being self-sufficient. Younger generations are often in the dark when they consider what they may do to care for their parents and the elderly population in the future. Could an anti-aging drug be the answer? We can marvel at the number of grandmothers celebrating their 100th birthdays, and hope that some will even make it to their 120th, but with this marveling comes questions of whether the medical developments that allow for such longevity are morally permissible, and obligatory—or if they require a vigilant eye and restraint.

Tags: bioethics

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