Pulse
3 July 2023
In January 2023, Channel News Asia reported that as the population in Asia ages, a race is underway to find various means to slow down the ageing process. Arrestingly entitled ‘Chipping away at the mystery of immortality: The race to cheat death as populations age in Asia’, the article announces that ‘research in longevity has advanced to the point of several potential interventions mostly in animal models that might work in humans.’
Research on how human ageing can be significantly slowed down (with some even aiming at its reversal) has been ongoing for many decades. Some of the impetus behind this can be attributed to a motley crew of futurists, scientists and technologists who describe themselves as trans-humanists, and who believe that the ageing process can be arrested through the use of biotechnology and pharmaceuticals.
The quest to control human ageing has in fact grown into what may be aptly described as a movement in many western countries. In the United States, anti-ageing medicine is big business, with an estimated worth of around US$50 billion.
The success of the anti-ageing movement can only be properly understood in relation to the current postmodern milieu from which it emerged. As Michael Flatt et al have argued, it must be ‘situated within the context of sociocultural changes associated with the “postmodern life course” of the late twentieth and early twenty-first century, changes that diminished the salience of age and generation in social life and organisation’.
They add that the success of the movement is due not least to its strong appeal ‘to longstanding American cultural ideals of personal autonomy and responsibility that suggest that the course of old age is not predestined, but rather a condition that can be modified and controlled by individual choices’.
This must be borne in mind as we reflect briefly on the theological questions that the quest to control human ageing raises as well as its ethical and social ramifications.
PRELIMINARY REMARKS
Before examining the theological and ethical issues related to the anti-ageing drive and its possible consequences in society, it might be helpful to offer a few preliminary remarks to clarify the aims of the movement and the current debates in the medical field concerning ageing.
The anti-ageing movement and the ideology that inspired it must be distinguished from the ‘successful ageing’ approach that preceded it.
The expression ‘successful ageing’ first appeared in an article by Robert Havighurst that was published in the inaugural issue of The Gerontologist in 1961, in which successful ageing is defined as ‘the conditions of individual and social life under which the individual person gets a maximum satisfaction and happiness’.
As the ‘successful ageing’ model was being developed in gerontology, a new approach which involves research in ‘anti-ageing medicine’ was fast gaining traction. Unlike the ‘successful ageing’ model which seeks to create a new kind of ageing, the anti-ageing movement believes that the ageing process can be delayed or even reversed, and sought ways to achieve this.
Although the anti-ageing movement has captured the imagination of the scientific community as well as the general public, numerous obstacles remain which scientists working in the field are attempting to surmount.
There is currently no scientifically grounded and commonly accepted clinical definition of degenerative ageing. As a result, ageing is currently not an official category in any official pharmacopeia or medical registry.
The effects of ageing must be evaluated on the basis of changes in specific biomarkers for ageing. However, as Ilia Stambler explains: ‘There is yet no common agreement on the most informative or valid biomarkers of ageing, and no consensus about the evaluation of multimorbidity and functional decline.’
In addition, scientists have pointed out that the phase ‘intervention into the ageing process’ is misleading because there is no single ageing process and not all aspects of ageing can be described as degenerative. As Stambler points out, the answer to the question ‘… which ageing processes can be considered truly “degenerative” (leading to degeneration) that would require “anti-ageing” intervention?’ is not as clear as it is often assumed.
These as yet unresolved issues surrounding ageing present a formidable challenge to the quest to develop anti-ageing medicine that aim to mitigate the degenerative effects of ageing. For example, in the absence of a formal or agreed clinical definition of ageing, it would be quite difficult if not impossible to ascertain the efficacy and safety of any anti-ageing or healthspan-improving interventions.
THEOLOGICAL AND ETHICAL ISSUES
A theological response to the anti-ageing movement should take seriously Michael Flatt’s observation cited earlier that it is fuelled by postmodern ideas of autonomy and choice, and by what may be described as the ‘colosalism’ of the human spirit which insists that human beings can be the masters of their destinies.
Seen in this light, the anti-ageing movement can very easily become a perverted attempt at self-determination which stubbornly refuses to accept human finitude. In other words, it can easily become an expression of the kind of human rebellion which the Bible calls sin.
According to the Bible and Christian tradition, it is precisely because the first humans refused to accept their creaturely limit and desired instead to usurp the place of God that they were punished with death (Romans 6:23).
As the Lutheran theologian, Wolfhart Pannenberg has so insightfully put it: ‘Precisely for this reason they are riveted to their finitude, and this takes place through death. The distinction between finitude and death may be seen here in the fact that it is precisely the sinner’s non-acceptance of their finitude that delivers them up to death’.
Thus, while the attempt to address the problem of degenerative ageing through the use of the medical, technological and scientific knowledge that God has made possible by his common grace should be applauded, a thin line separates this endeavour from the idolatrous desire to play God.
It is not difficult to find distorted views on life and death among proponents of the anti-ageing movement. For example, the biogerontologist and influential advocate of trans-humanism, Aubrey de Grey, frames the quest to extend the lifespan of humans as an opposition to ‘deathism’, adding that to reject this quest is akin to committing suicide.
(De Grey believes that human beings will one day live to be 1,000 years old, beating the biblical Methuselah who died when he was 969 years of age.)
Beyond these issues, theologians must devote more attention to developing a more comprehensive theology of ageing. Such a theology must of course be set within the framework of a robust Christian theological anthropology and soteriology. For a Christian understanding of ageing must be undergirded with what the Bible says about the human condition and about the human future beyond physical death.
Many bioethicists have pointed out that anti-ageing medicine raises a number of significant ethical issues which must be addressed. Space allows us to look at only some of them briefly.
Radical life extension programmes and technologies will most certainly exacerbate the already serious problem of inequality and social distribution that we currently face. As some theologians and bioethics have put it, advances in bio- medicine and technology do not only worsen the divide between the haves and have nots, they also create the never will haves.
Christine Overall highlights the political aspects of life extension technologies. Access to these technologies, she writes, ‘is also about power, about differences in privileges, rights, opportunities, and access, and about oppression and the ways in which oppression might be deepened or diminished’.
She suggests that policies surrounding anti-ageing medicine should privilege those with low life expectancy, and special attention should be given to disadvantaged groups. But given the high costs of such therapies, it is doubtful that such policies will ever see the light of day.
However, even if the problem of inequality is miraculous resolved, and even if we are all guided by the better angels of our nature and choose to give priority to the vulnerable, the question of whether the use of life extension is morally right or wrong still needs to be addressed.
As Arthur Caplan points out, equity arguments ‘tell us whether a pattern of inequality or a particular distribution of resources is right or wrong’. It does not address the question ‘what is inherently wrong with the desire to use biotechnology to improve ourselves and our children’.
There is also the ethical question about the responsible use of resources. ‘It has been a persistent fear’, writes Stambler, ‘that successful amelioration of ageing and the resulting extending longevity would lead to a shortage of resources for the global population as a whole due to unsustainable increase’.
Bioethicist Tobias Hainz thinks that those whose lifespans have been extended would ‘lose any sense of finitude and generational succession and proceed to waste immense quantities of resources’.
The advance of anti-ageing medicine appears to be unstoppable, given the optimism of the scientific community and the general public of its potential, as well as the media attention that it has received.
But the profound theological, philosophical and ethical issues and questions surrounding radical life extension strategies must be addressed not only by private and state actors but also by ordinary citizens because of their serious implications for society.
Dr Roland Chia is Chew Hock Hin Professor at Trinity Theological College (Singapore) and Theological and Research Advisor of the Ethos Institute for Public Christianity.