ECAP7 - Christopher Wareham

ECAP7 UniversitĂ Vita-Salute San Raffaele

Ethics, Human Enhancement and Genetics Workshop – Sunday, September 4th 2011

Christopher Wareham POLICY IMPLICATIONS OF AN EXISTING MEANS OF SUBSTANTIAL LIFE EXTENSION: IS IT AN ENHANCEMENT, AND DOES IT MATTER IF IT IS?

Christopher is engaged in an interdisciplinary PhD programme in the foundations and ethics of the life sciences conducted by the European School of Molecular Medicine, in conjunction with the University of Milan. His research interests include philosophy of science, political theory, and normative and applied ethics, particularly the ethics of emerging biotechnologies. He is currently working on the ethical implications of life extension by caloric restriction (CR) and CR mimetics such as rapamycin and resveratrol.

abstract Calorie restriction (CR) has been shown to increase the lifespan in a wide variety of animal subjects. This has led biologists such as Richard Miller (2002) and David Gems (2003) to predict that calorie restriction, or drugs that mimic the effects of CR may greatly increase the maximum human lifespan.

Moreover, caloric restriction mimetics such as the drug rapamycin have recently been used in humans for purposes other than life extension (Kenyon, 2010). This raises the possibility that interventions that substantially extend lifespan may have arrived largely unheralded.

These developments increase the need to examine the ethical and policy implications of life extension. Typically, life extension is treated in a coarse-grained way, and categorised alongside other enhancements (eg Bostrom and Roache, 2007). Further, discussions of life extension tend to focus on empirically unlikely possibilities like immortality (eg Williams, 1973).

I resist these more general and speculative approaches and concentrate on the most plausible consequences of life extension, given what we know about a particular life extension intervention: the use of CR and CR mimetics. This is made possible by the aforementioned studies on animals, as well as a number of recent studies on calorically restricted humans, such as the CALERIE project (Rochon et al, 2010). Such research allows us to examine ethical issues in a more fine-grained way than has previously been possible.

Amongst the ethical issues raised by this research, there is a question about whether interventions that extend lifespan should be allocated healthcare resources. In this paper I argue that, based on what we know about CR, there are good reasons to think that a fair society should allocate resources to CR-related interventions.

Many tools involved in resource allocation, such as the quality adjusted life year (QALY), assign funds to health interventions on the basis of the additional years a person would live, adjusted for the quality of life likely to be experienced in those years. Preliminary findings suggest that CR-related interventions may increase both the number and quality of years lived. If so, there is a strong presumption in favour of allocating resources to these interventions.

One of the major obstacles to this possibility, however, is that life extension is, as mentioned, usually regarded as an enhancement, while existing health regulations assign resources primarily to treatments. This means that interventions like CR mimetics would not be allocated resources by national health services on the basis of their life extending properties.

In response to this difficulty, I provide a three tiered argument for the allocation of resources to CR-related life extension interventions. The first tier outlines and questions the policy role of the treatment-enhancement distinction. I argue that it provides at best an equivocal basis for, and may be ethically irrelevant to, the allocation of resources (compare Buchanan et al, 2000). If so, there are reasons to reconfigure policy along more ethical lines. I claim that on the basis of at least one promising alternative criterion, which I call the welfarist criterion, resources should be allocated to CR-related life extension.

Nevertheless, I argue that despite the appeal of the welfarist criterion, it is unlikely to be accepted soon enough to deal with emerging life extension technologies. As a result, the second tier of my argument accepts the existing treatment-enhancement distinction, but suggests that there are grounds for treating ageing as a degenerative disease. If so, CRrelated interventions that slow ageing should be regarded as treatments and not enhancements. They should thus be allocated resources in accordance with existing policy guidelines.

Finally, in case the above arguments fail to convince, the third tier accepts both the policy role of the treatment-enhancement distinction, as well as the claim that ageing is not a disease, but holds that CR-related interventions should nonetheless be provided. This is because there are good empirical reasons to think that a CR drug would affect other diseases closely related to ageing, such as cancer, cardiovascular disease and Alzheimer’s disease. There are thus grounds for allocating resources to CR-related interventions in spite of, rather than because of their enhancing effects.

On the basis of these arguments, as well as findings about the quality of life of calorically restricted subjects, I claim that there are grounds to allocate resources to life extension technologies that mimic CR. This is true whether or not we regard life extension as an enhancement.

References Bostrom, N. and Roache, R. 2007. Ethical Issues in Human Enhancement. In J. Ryberg, T. Petersen & C. Wolf (eds.) New Waves in Applied Ethics. Palgrave Macmillan.

Buchanan, A., Brock, D.W., Daniels, N. and Wikler, D. 2000. From chance to choice. New York: Cambridge University Press.

Gems, D. 2003. Is more life always better? The new biology of aging and the meaning of life. Hastings Center Report. July-Aug: 31-39.

Kenyon, C. 2010. The genetics of ageing. Nature. 464: 504-512.

Miller R.A. 2002. Extending life: scientific prospects and political obstacles. Milbank Quarterly. 80:155–174.

Rochon et al. 2010. Design and conduct of the CALERIE study: comprehensive assessment of the long-term effects of reducing intake of energy. J Gerontol A Biol Sci Med Sci. Williams, B. 1973. The Makropulos case: reflections on the tedium of immortality. In his Problems of the self. Cambridge: Cambridge University Press. pp. 82–100.