ageing, disease, treatment, therapy
Ageing need not be the excruciating process it is starting to be

The Moral Responsibility for Treating Ageing and Age-related Disease

Written by Charles Dublow

The quest for eternal youth has been pursued by many throughout human history and has up until now been considered outside of mankind’s reach. Yet in recent studies scientists have successfully discovered treatments that slow the ageing process in mice. Researchers are already planning to start human trials to see if such treatments could benefit elderly patients. With these recent developments in medical research comes a question – would it be ethical to intervene in the ageing process?

Longer Life Requires a Better Quality of Life

The fear of exchanging wellbeing for longevity has always been considered a fate worse than death. Indeed the representation of this fear extends back to the ancient Greeks in the mythology of Tithonus. In this ancient story the Goddess Eos falls in love with the mortal prince Tithonus. Eos pleas to her father Zeus to grant Tithonus immortality, however she forgets to ask for eternal youth. Unfortunately for Tithonus this meant he continued to age even when he was old, growing weaker and more decrepit with every passing year. Ultimately to end his suffering Eos turned Tithonus into a cricket.

The significance of the myth of Tithonus is that the average lifespan has slowly increased across first world countries over the last few decades. With this rise in life expectancy has come a rise in the global elderly population. Since 1950 the global population of aged 60 or over has tripled to over 700 million. It has been predicted that by 2050 this population will triple again reaching 2.1 billion. The primary concern that this raises is to the extent to which the elderly are vulnerable to a range of age related diseases and so, if more people are living longer, would they suffer like Tithonus?

Contrary to the myth of Tithonus, however, a more positive approach to tackling late-life limiting dysfunctions may require tackling ageing itself. In lifespan experiments, it has been observed that animals that live longer tend to have a reduced risk of developing age related diseases. To find out whether this effect could be extrapolated in human beings as well, a study was conducted on centenarians (100 to 104 years), semisupercentenarians (105–109 years), and supercentenarians (110–119 years) to find out how morbidity and disability developed as people got older. Interestingly the groups least affected by disease, cognitive and functional decline were the supercentenarians. It was observed that the older the age group, the more delayed the onset of age related diseases was in addition to morbidity and disability. The observations gleaned from studying the supercentenarian indicated that the longer someone is healthy the longer that person lives – as a corollary, they would have longer health spans. The conclusions drawn from this experiment indicates that the process of ageing cannot be disentangled from the processes that drive age related dysfunction. This may explain why supercentenarians are more resistant to the onset of age related diseases. Hence the only practical approach for preserving wellbeing and independence in 60 year olds or over, it appears, is to tackle the ageing process itself (Andersen, Sebastiani,. 2012).

Why Ageing is Indistinguishable from Disease

A continued study of ageing and age related diseases has motivated Bioethicists such as Arthur Caplan to argue that ageing is itself a disease. Caplan points out that ageing, like that of other diseases is a process that is primarily caused by macromolecular damage. To illustrate his point, he describes the progression of the disease known as Progeria – a condition that rapidly ages young children, through an acceleration of molecular damage that in turn causes age related pathology. The only difference between the ageing process and Progeria is that with ageing, its effects occur 80 years later. One response to Caplan is to argue that ageing is a natural process that is inevitable and occurs universally unlike Progeria, which is an accelerated process. However, this argument finds itself unable to account  for the fact that infections, cancers and coronary atherosclerosis are also universal occurrences that are practically inevitable, and is therefore a weak one. The fact that such incidences are natural does not, and has never, prevented them from being categorised as diseases worthy of treatment by human society. Hence, Caplan argues that as characteristics of the ageing process mirror characteristics of disease, it would seem unreasonable to not include ageing within the categorisation of disease.

Why Longer Life may Lower Population Growth

The ethics of this research is challenged by another profound question related to the global good – what influence would such an increase in lifespan really have on population size? The statistician Hans Roslin monitored global population growth over the last century to answer that question.  His work revealed that fertility rates had significantly lowered in the countries that developed and became wealthier over this period. Roslin suggests that birth rates in poorer countries  are high because children are more vulnerable to disease meaning families need to be larger. People are also less educated and do not have much access to contraceptives. The reason that population growth slows therefore, is because in developed countries, women have easier access to education and information about contraceptives, and that families are much wealthier. As a consequence, there is an incentive to have fewer children in order to invest more time into nurturing each child.

It is unsurprising that when countries become wealthier the average lifespans of the citizens increase. Fortunately, therefore this means that when life expectancy increases within a country it doesn’t necessarily cause an increase in population size. A more radical prediction from statisticians is that developed countries won’t just stabilise the populace but will actually start having a decline in population size. Already many countries have started to see such a decline – the most noticeable being Japan. What is particularly significant is that out of all the countries in the world Japan has the highest average lifespan for its citizens. Considering this, the population decline seen in Japan and in other countries with high life expectancies strongly suggest that longer life won’t be a negative force that will lead to overpopulation.

With the proportion of the elderly population set to increase radically over the coming decades, effective treatments will be required to help protect this demographic from a spectrum of age-related diseases. As ageing is what drives these age-related diseases, it becomes pointedly necessary to research this process of ageing itself in order to develop effective treatments.

Thus the primary aim for research into ageing would be to provide therapies so that elders maintain a good standard of living and can maintain their independence. Protecting the elderly from these late life pathologies is a moral obligation that must not be neglected. To disregard the challenges that older citizens’ face would only allow unnecessary suffering to take root in society.

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