aa PUBLIC HEALTH LIBRARY
_ NSF/RA 770123

   

| Extending -
the Human Life Span:
Social Policy

and Social Ethics,

S
e@

: Report Prepared for:
: .. National Science Foundation
RANN-Research Applications Directorate

Division of Advanced Productivity

Research & ae
U.S. DEPOSITCrY

OCT 13 1971

 
''(BERKELEY \

LIBRARY

UNIVERSITY OF
\Ccauironnia/

UBLIC HEALTH LIBRARY

This material is based upon research supported by the National
Science Foundation under Grant No. G1I39091.

Any opinions, findings, and conclusions or recommendations
expressed in this publication are those of the author(s) and do
not necessarily reflect the views of the National Science
Foundation.

 

For sale by the Superintendent of Documents, U.S. Government Printing Office
Washington, D.C. 20402 - Price $2.20
Stock No. 038-000-00337-2

 
''_ Extending

the Human Life Span:
Social Policy

and Social Ethics

Bernice L. Neugarten
Robert J. Havighurst
(Editors)

Committee on Human Development - University of Chicago
'' 
'' 

 

Table of Contents

PERSPECTIVES ON HUMAN LONGEVITY
Leonard Hayiick . «cota dencnim eee R285 AER REARS Rims Emi we «

PROSPECTS OF LENGTHENING LIFE AND VIGOR
Robert J. Havighurst and George A. Sacher..................000005

EXTENSION OF THE LIFESPAN: A NATIONAL GOAL?
James L. Goddard ...... 2... 0c

EXTENSION OF THE ACTIVE LIFE: ETHICAL ISSUES
James M. Gustafson. 0... cece ee

TREATING AGING: RESTRUCTURING THE HUMAN CONDITION
H. Tristram Engelhardt, Jr... 0.0... cee eee

THE AGING SOCIETY AND THE PROMISE OF HUMAN LIFE
Warner A. Wick... 0.0.0.0... 000 ccc cece eee e tent e nen neeas

DISCUSSION
Robert J. Havighurst . 2.0.0... cece eens
Appendix A: Future Numbers of Older People.....................-0.
Appendix B: Life Expectancy in the United States.....................
Appendix C: What is the Likelihood of Major Life Extension? ..........

FEB? 1979

 

13

27

33

41

47
59
63
65

 
'''' 

preface

A group of faculty members at the University of Chicago undertook in 1973 a 3-
year project on the future of aging and the aging society. With support from the Na-
tional Science Foundation (NSF Grant G1-39091), the project centered around an in-
terdisciplinary seminar of faculty and graduate students who attempted to assess the
state of knowledge concerning aging and the aged, and to identify the areas in which
new research is particularly needed if public policies are to be well informed over the
next decade.

Out of this project a special interest developed in the ethical aspects of policy deci-
sions. Members of the seminar drew up a plan for a conference that would bring
together social and biological scientists, policymakers, and social ethicists for an ex-
change of views regarding the policy decisions that lie ahead. So far as was known, this
would be a first attempt to establish a dialogue between persons from such very
different backgrounds.

The conference focused upon three topics: the economic welfare of older persons,
health services for older persons, and extension of the human life span. Background
papers were invited from present or former Federal Government officials, scientists,
and ethicists.

A few months prior to the conference, the persons preparing papers came together
for a preliminary exchange of ideas. The papers were then completed and circulated
among the authors, and copies were sent also to a small list of people who were invited
to participate as commentators. The latter were academicians or persons who occupy
major positions in private or public agencies. (The full list of participants is shown at
the opening of this volume.)

Because the participants had read the papers beforehand, the conference itself
consisted of discussion sessions, arranged to promote informal exchange. The discus-
sions proceeded in the presence of a limited number of observers who were also in-
vitees—graduate students, faculty members, local State and Federal Government
officials, and representatives of private foundations, all of them persons with special
interests or special responsibilities for programs in the field of aging.

The papers relating to the first two topics of the conference—the economic
welfare of older persons, and health services for older persons—along with selected
portions of the conference discussions, have been published under the title, SOCIAL
POLICY, SOCIAL ETHICS, AND THE AGING SOCIETY (Washington, D.C.,
U.S. Government Printing Office, 1976, Stock Number 038-000-00299-6). The
papers and the accompanying discussion relating to the third topic of the conference,
extension of the human lifespan, are presented in this volume, along with brief appen-
dix materials prepared by the editors.

In preparing the present papers, authors were asked to leave aside those issues, im-
portant as they are, that have to do with prolonging the life of the individual patient in
the terminal stage of illness, the issues that have come to be known as “the right to die”
or “death with dignity.” They were asked to focus, instead, upon the more general
question of basic biological research that might lead to extending the longevity of the
human species.

In this connection, it was pointed out that two general strategies for lengthening
the lifespan are now being pursued by biomedical and biological scientists. The first is

 
'' 
 
      
   
   
   
   
   
   
       
   
   
   
     
   
   
   
   
   
   
 
      
   
   
   
   
   
   
   
     
      
     
   
     
   
   
 
      

 
 

the continuing effort to conquer disease. The second is the attempt to identify the in-
trinsic biological processes that are thought to underlie aging and that proceed inde-
pendently from disease processes—that is, to discover the genetic and biochemical
secrets of aging, then to alter the biological clock that is presumably programed into
the human species. The second approach is directed at rate control, rather than disease
control. The authors were asked, What should be the primary objective of the science
of biogerontology—to improve the quality of life for older people, or to extend the life-
span of the human species? Can the latter be achieved without cost to the former? If
the human lifespan could be extended beyond the present maximum of 110 or 115
years, what would be the major deleterious and the major beneficial effects upon the
society? Is it likely than an increased lifespan can be achieved that will lengthen the
period of healthy, active life; or instead, would it mean a lengthened period of
deterioration at the end of life? If the numbers of very old people increase, must the
numbers also increase of those who are physically or psychologically impaired? Can
those risks be weighed against the benefits? How are social and ethical values to be
weighed against economic values? Can a new priority of social values be effected?

Other questions included, How much of our scientific resources should be allo-
cated to research addressed directly to the extension of the human lifespan? What
would be the social and ethical implications if biologists were to succeed in discover-
ing a “magic elixir” that would extend active life expectancy by 15 to 20 years? Should
there be new government controls on the directions of research?

Two of these papers have been written from the perspective of biological
researchers, the first by Professor Leonard Hayflick, describing the state of knowledge
regarding human longevity and the prospects for a major extension of the lifespan; the
second, by Professor Robert J. Havighurst and Mr. George Sacher, describing two
different approaches to life extension and the possible social consequences of each.
Another paper was prepared by Dr. James Goddard, former Commissioner of the U.S.
Food and Drug Administration, setting forth some of the social issues as seen by a
government official and some of the problems of government regulation. Three papers
were prepared on the ethical issues of life extension, one by Professor H. Tristram
Engelhardt, philosopher and physician, one by Professor James Gustafson, theologian
and ethicist; and the last by Professor Warner Wick, philosopher-ethicist, indicating
how the specific questions regarding life extension relate to the underlying philosophi-
cal questions about what constitutes a good life in a good society.

We are indebted to these authors for the thoughful ways in which they have dealt
with the questions originally put to them, and for the ways in which they all—whether
as scientist, government policymaker, or ethicist—have broadened and deepened the
issues before us.

We are indebted also to those who provided the financial support for the con-
ference at which these papers were discussed: to the National Science Foundation, and
in particular, to Dr. George Brosseau, then Program Manager, Office of Exploratory
Research and Problem Assessment, RANN (NSF); to the Edna McConnell Clark
Foundation; and to the Trinity Church of the City of New York.

Bernice L. Neugarten
Robert J. Havighurst

Chicago
1977

 

 
'' 

*Odin W. Anderson, Professor of Sociology and Direc-
tor, Center for Health Administration Studies,
University of Chicago

*Robert M. Ball, Senior Scholar, Institute of Medicine,
National Academy of Sciences (formerly Commis-
sioner, U.S. Social Security Administration)

D. J.R. Bruckner, Vice-President for Public Affairs and
Director, Center for Policy Study, University of
Chicago

*Richard V. Burkhauser, Department of Economics,
University of Chicago

*James C. Corman, Representative to the U.S. Con-
gress from the 22nd District of California, House of
Representatives, Washington, D.C.

Nelson H. Cruikshank, President, National Council of
Senior Citizens, Washington, D.C.

“B. J. Diggs, Professor of Philosophy, University of II-
linois at Urbana-Champaign.

Alan Donagan, Professor of Philosophy, University of
Chicago

**H. Tristram Engelhardt, Jr., Assistant Professor of
the Philosophy of Medicine, University of Texas
Medical Branch, Galveston

Richard A. Epstein, Professor of Law, University of
Chicago

Jane E. Fullarton, Director, Division of Health

Research, Office of Policy Development and Plan-

ning, Office of the Assistant Secretary for Health,
U.S. Department of Health, Education, and
Welfare

**James L. Goddard, formerly Commissioner, U.S.
Food and Drug Administration

*Byron Gold, Fellow, Center for Study of Welfare
Policy, University of Chicago and Special Assistant
to the Commissioner, Administration on Aging

*“*James M. Gustafson, University Professor of
Theological Ethics, University of Chicago

Robert Harris, Senior Vice-President, The Urban In-
stitute, Washington, D.C.

*Robert J. Havighurst, Professor Emeritus of Education
and Human Development, University of Chicago

**Leonard Hayflick, Professor of Medical
Microbiology, Stanford University School of
Medicine

James L. Hill, Office of Management and Budget, Ex-
ecutive Office of the President, Washington, D.C.

conference participants

“Albert R. Jonsen, S. J., Associate Professor of Medical
Ethics, Health Policy Program, University of
California, San Francisco

"Elizabeth Kutza, Lecturer, School of Social Service
Administration, University of Chicago

Arthur B. Laffer, Associate Professor, Graduate School
of Business, University of Chicago

*Theodore R. Marmor, Associate Professor, School of
Social Service Administration and Research
Associate, Center for Health Administration
Studies, University of Chicago

Edward J. Nell, Professor of Economics, New School
for Social Research, New York City

“Bernice L. Neugarten, Professor of Human Develop-
ment, Department of Behavioral Sciences, Univer-
sity of Chicago

John H. Noble, Jr., Director of Policy Research for
Social Services and Human Development, Office
of the Assistant Secretary for Planning and Evalua-
tion, U.S. Department of Health, Education, and
Welfare

William E. Oriol, Staff Director, U.S. Senate Special
Committee on Aging

Michael R. Pollard, Professional Associate, Institute of
Medicine, National Academy of Sciences

Richard N. Rosett, Dean and Professor, Graduate
School of Business, University of Chicago

**George A. Sacher, Senior Scientist, Division of
Biological and Medical Research, Argonne Na-
tional Laboratory

Sol Tax, Professor of Anthropology, University of
Chicago and Director, Smithsonian Institute
Center for the Study of Man

*George S. Tolley, Professor of Economics, University
of Chicago

**Warner A. Wick, Professor of Philosophy, Univer-
sity of Chicago and Editor, ETHICS

Rod Yarling (Conference Coordinator), Department of
Social Ethics, University of Chicago

“These persons prepared background papers which

appear in the first volume of proceedings, Social policy,
social ethics, and the aging society, 1976. Washington, D.C.:
U.S. Government Printing Office, Stock number 038-
000-00299-6.

**Papers prepared by these persons are reproduced
in this volume.

 
'''' 

Perspectives on Human Longevity*

If the future can be judged by the past, then the im-
pact of biomedical research on human longevity in the
next 25 years in this country should be to extend life ex-
pectancy considerably beyond the present 70 years. Yet
the likelihood of a net increase occurring by the year
2000 of the magnitude seen since 1900 is very doubtful.
Life expectancy at birth in 1900 was about 49 years and
in 1950 it was about 68 years—a net gain of 19 years.
Since 1950, however, the gain has been only 2.4 years.

Why has there been such a profound increase in life
expectation in the first half of this century and, in the
beginning of the second half, an equally profound level-
ing off? That this leveling off has occurred is even more
impressive if one accepts the common notion that the
extent of advances made in biomedical research in the
past 25 years has been greater than those made in all

Leonard Hayflick

previous years. The answer to this apparent dilemma
derives from a consideration of the important distinc-
tion between life expectancy and lifespan.

It is generally believed that the human lifespan, of
about 100 years, has not changed since recorded his-
tory, but what has changed is the larger number of peo-
ple surviving toward this apparent limit (figure 1).
Deaths in the early years are becoming increasingly less
frequent, resulting in life tables that are simply becom-
ing more rectangular as indicated by the direction of
the arrow in figure 2. In many privileged countries, one
can now reasonably expect to become old, which is a
very new phenomenon, indeed.

*Supported, in part, by Grant HD04004 from the National In-
stitute of Child Health and Human Development, National Institutes
of Health, Bethesda, Maryland.

Fig. 1.FromL. |. Dublin, A. J. Lotka and M. Spiegelman, Length of Life. The Ronald Press Co., New York,

1949,

AVERAGE LENGTH OF LIFE
FROM ANCIENT TO MODERN TIMES

About 2,000 Middle
Years Ago Ages
England
Russell

Early Iron &

Bronze Age
Greece Rome

Pearson

PERIOD

AREA

AUTHOR Angel

Before 1838-
1789 1854
Mass. & N.H. — Eng. & Wales

Wigglesworth Farr

United States _ United States
Glover Greville

 

 
'' 
 

  
 
  
 
 
  
 
    

 

 

New Zealand, 1934-1938

 

Japan
1926-1930

 

Number of survivors
oI
Ss
oe
Ss
T

 

Fig. 2. Adapted from Comfort, A. Aging: The Biology of Senescence, Holt Rinehart & Winston, Inc., New
York, 1964.

Ultimate curve

ROR Eee
"=.
.

United States, “se,
whites, 1939-1941 *,

United States,
whites, 1929-1931

Italy,
1930-1932

United States,
whites,
\ 1900-

  
   

 

    
 
 

In a Utopian world where the two leading current
causes of death would be resolved, the elimination of
cardiovascular diseases and cancer would yield a net in-
crease of about 20 years in life expectation at birth and
only slightly less at age 65 (table 1). This figure is
almost identical to the net increase in life expectation
achieved at birth in this country from 1900 to 1950. If
deaths from cardiovascular diseases and cancer were to
be eliminated in the next 25 or 50 years, then after that
spectacular accomplishment, the leading cause of death
would be accidents, which because of their statistical
nature are not likely to yield to total elimination. Thus
the social, psychological, political, and economic im-
pacts of resolving the two leading causes of death in the
next half-century can be reasonably assessed by study-
ing like changes that have occurred in the first half of
this century when a similar increase in life expectation
occurred.

Let us next consider a world in which all causes of
death resulting from disease and accidents are totally
eliminated (table 1). What would be the effect on
human longevity and the human lifespan? The effect
would be to realize the ultimate rectangular curve

  

Age (years)

 

Table 1

Gain in Expectation of Life at Birth and at Age 65 Due to
Elimination of Various Causes of Death

 

 

 

 

Gain in years in expectation
Cause of death of life if cause was eliminated
At birth At age 65
Major cardiovascular-renal
diseases 10.9 10.0
Heart diseases 5.9 4.9
Vascular diseases affecting
the central nervous system 1.3 1.2
Malignant neoplasms 2.3 1.2
Accidents excluding those
caused by motor vehicles 0.6 0.1
Motor vehicle accidents 0.6 0.1
Influenza and pneumonia 0.5 0.2
Infectious diseases (excluding
tuberculosis) 0.2 0.1
Diabetes mellitus 0.2 0.2
Tuberculosis 0.1 0.0

 

 

Source: Life tables published by the National Center of
Health Statistics, USPHS and U.S. Bureau of the Census,
“Some Demographic Aspects of Aging in the United States,”
February 1973.

 
'' 

(figure 2) in which citizens would live out their lives,
free of the fear of premature death, but with the certain
fate that on the eve of their 100th birthday, they would
drop dead.

Biomedical research has trained its heavy artillery
almost exclusively on the disease-associated causes of
death. Scant attention has been paid to the underlying
causes of biological aging that are not disease-associ-
ated but which, in clocklike fashion dictate for each
species a specific maximum life span. To be sure, the
physiological decrements that occur in advancing years
increase vulnerability to disease, but unless more atten-
tion is paid to the fundamental nondisease-related
biological causes of aging, the fate of all persons will be
death on or about their 100th birthday.

Prospects for Increasing
Human Longevity

As implied, there are two ways in which the efforts of
biomedical research can be expected to extend human
longevity in the next 25 years. The first is to reduce or
eliminate the major causes of death, in particular, car-
diovascular diseases and cancer. The results of
ameliorating minor diseases will be minimal. For ex-
ample, if tuberculosis were completely eliminated,
there would be a mere 0.1 year gain in life expectancy
at birth (table 1). Thus it could be argued that if an in-
crease in life expectation becomes the main goal of
biomedical research, all such research should be
directed toward the elimination of the two major causes
of death. This position, although less than humane, and
not likely to attract many adherents, is nonetheless the
most logical conclusion to be derived from life-table
studies and the projections dealt with in table 1.

The second way in which biomedical research can
deal with human longevity is to address itself
specifically to the underlying nondisease-related funda-
mental biological causes of age changes. These are not
diseases but are the basic biological changes that result
in those physiological decrements characteristic of
aging and upon which are superimposed an increasing
vulnerability to disease. The latter, in fact, defines the
science of gerontology. Such an approach then does not
directly concern itself with efforts to increase human
life expectancy but rather to extend what appears to be a
fixed lifespan that differs in its length for man and all
other animal species.

As a measure of the current effort put forth toward
these two approaches, funds spent on cardiovascular
disease and cancer research are one hundred times

greater than the funds spent in gerontology. It is also
probable that the number of researchers, and conse-
quently the amount of effort, in both these areas also
differs by a hundredfold. Consequently, the likelihood
that any significant increase in human longevity will oc-
cur in the next 25 years depends upon (1) significantly
better cure rates for cardiovascular diseases and/or
cancer, and/or (2) significant advances in our under-
standing and ability to manipulate the biological clocks
that set for each species a mean maximum lifespan.

If potential success in either of these endeavors can
be measured by the current attitudes and priorities of
the biomedical research establishment, then it is clear
that the search for cardiovascular disease and cancer
cures are much more likely to effect human longevity
than is gerontological research. The further conclusion
is that by curing these two diseases a maximum of 20
years of additional life expectancy could be attained,
but with successful efforts to increase the lifespan itself
no fixed end point is ruled out. Furthermore the resolu-
tion of the two leading killers will in no way reverse or
half the decline in physiological decrements charac-
teristics of age changes, whereas efforts to increase the
lifespan could lead to such a reversal. Clearly research
in cardiovascular diseases and cancer should not be
stopped, but if our goal is to maximize opportunities to
effectively increase human longevity, then our current
priorities are seriously out of balance. If this imbalance
continues unchanged the likelihood is very small in-
deed that the research accomplishments of a handful of
underfunded gerontologists_ will affect the human
lifespan.

Some Immediate Possibilities

In spite of this pessimistic view there is, in the judg-
ment of many gerontologists, at least one comparatively
innocuous way in which the human lifespan can un-
doubtedly be extended significantly. The method is
based on classic studies made in the 1930’s and con-
firmed in many laboratories for a number of animal
species, including the rat in which it was first
described.!2 The method is to simply reduce the caloric
intake to such a level that undernutrition but not
malnutrition occurs. This is done by providing an

' McCay, C. M., Maynard, L. A., Sperling, G., & Barnes L. L.
Retarded growth, lifespan, ultimate body size and age changes in the
albino rat after feeding diets restricted in calories. Journal of Nutrition,
1939, /8, 1.

2McCay, C. M., Pope, F.,
prolongation of the lifespan. Bulletin of New York Academy of Medicine,
1956, 32, 91-101.

& Lunsford, W. Experimental

 

 
'' 

animal with a diet sufficient in all necessary nutrients
but very low in calories. Longevity can then be in-
creased by as much as 50 percent. The effects are most
pronounced if caloric restriction diets are initiated
when animals are very young. This results in a
stretchingout of the developmental stages such that in-
fancy, puberty, maturity, adulthood, and aging simply
occur at later than usual points in time so that the total
lifespan is increased.

On the assumption that undernutrition in man
would yield similar results, it is of interest to observe
that in the 40 years since this has been known, no
human has consciously chosen to undertake it, even the
biologists who know the data best. Considering the
number of nostrums and treatments that have been
foisted on a gullible public as antiaging regimens, the
lack of interest in underfeeding is, upon superficial con-
sideration, truly remarkable. On the supposition that
the method is widely known, that it works, and that it is
not dangerous, the main conclusion that can be drawn
from the notable lack of interest is that for most people
the quality of life is more important than its quantity.

If this is so, then an important lesson can be learned.
Any method that might increase human longevity is
unacceptable even if it minimally affects the enjoyment
of life. It might be amusing to consider the reciprocal
question: Will many people opt for a treatment that
would accelerate aging and presumably give twice the
pleasure (and twice the grief) in half the time?

Another aspect of this question bears on whether any
method shown to increase human longevity will, in fact,
be used. The notion that any method guaranteed to
reduce illness or extend life would not be used may at
first seem to be naive, but we are, nonetheless, sur-
rounded by that reality. Consider poliomyelitis and its
tragic consequence. Even with the availability of a
highly effective prophylaxis in what surely must be con-
sidered to be the most painless form of administration
(one drop of a sweet-tasting solution on the tongue),
fully 40 percent of preschool age children in this coun-
try are not immunized. When the vaccine first became
available, long lines of people waited for treatment. The
current apathy is due largely to the fact that, unlike the
older generation, young adults have never seen a polio
victim. Consequently, a strong motivation to voluntarily
immunize their children is lacking, and were it not for
the legal requirement that immunization is necessary
for school admission, the likelihood is that immuniza-
tion against polio would fade to zero in a few years. In
order to maintain a proper level of motivation to im-
munize, the best method probably would be to allow a
sufficient number of crippled polio victims to hobble

around the streets as constant reminders of the threat.
Perhaps it would be more humane to secretly employ
paid actors for this purpose.

It would be my guess that like the one example cited
of the many that could be given, any regimen designed
to increase longevity, even one as simple as a drop of
sweet-tasting fluid on the tip of the tongue, would fail
one generation after its initial use. Quite obviously if no
one ever saw an aged individual the likelihood is nil
that he could be persuaded that for lack of treatment he
might age.

To Sleep, Perchance To Dream...

There remains yet another method for increasing life
expectancy that bears consideration. Although it will
not result in an extension of life on an absolute time
scale it is interesting to consider a form of increased
longevity based on the self-evident proposition that life
can be lived only when individuals are both physically
and mentally active. Since, for most individuals, sleep
consumes nearly one-third of our lives, any method that
reduces the time spent sleeping should result in an in-
crease in productive occupation and the enjoyment of
life—that is, if sleep itself is not considered to be either
productive or enjoyable. Sleep researchers tell us that
no detectable effect on health has been observed in
those individuals who have learned how to make a
modest reduction in the length of time usually spent
asleep. The impact of this change would be profound,
for if we were to reduce by one-half hour the average of
8 hours spent sleeping, the net effect on “‘life-exten-
sion” would be an increase of more than 2 years. This
“increase in life expectancy” is equivalent to living in a
society where deaths from cancer do not occur at all.

Other Alternatives

The patchwork method of resolving individual dis-
eases, together with other public health prophylactic
measures, is of predictably limited value if our goal is to
increase human longevity by more than 20 years. The
results of such measures, although certainly desirable,
will not further increase the length of vigorous life since
most cardiovascular diseases and cancers are associated
with advancing years. To resolve diseases occurring late
in life means that those who are saved merely would
continue to suffer those physiological decrements to
which the aged are all prone. Taken together, the
characteristics of these decrements, their predictable
occurrence at specific periods of time in the life of each
individual, and the uniform lifespan for all animal

 

 
'' 

species strongly suggest the presence of a clocklike
mechanism that dictates the occurrence of age changes.

What is the likelihood that we will be able to under-
stand the workings of this clock and to tamper with it?
In my judgement the likelihood that a full understand-
ing of the mechanism and the capability of tampering
with it is unattainable in the next 25 years. The basis for
this speculation is simply the observation that the rate
of gain in our understanding and ability to intervene in
similarly complex biological processes, e.g., biological
development, cancer, and genetics, has been so slow
that, if extrapolated to gerontotogical inquiry, it will not
yield dramatic results in as short a time as 25 years.
Superimposed on this consideration is the observation
that by sheer weight of numbers of investigators and
dollars available, the likelihood is small that a handful
of underfunded but dedicated gerontologists will soon
understand the mechanism of aging sufficient to deal
with it.

Short of this, however, is the distinct possibility that
a complete understanding of the fundamental mecha-
nism of aging is unnecessary in order to permit us to
alter the process. Many human illnesses are currently
dealt with adequately without a full understanding of
the mechanism and, in several cases, even without
proof of etiology. Based on this argument it may not be
premature even today to initiate studies on the age-
decelerating effects of a variety of potentially useful
treatments. It has been suggested that one reason for not
testing such innocuous means as calorie restriction is
that the human lifespan affects not only the investigated
but also the investigator. Consequently, it is argued,
gerontologists are unwilling to undertake experiments
whose outcome may only become known to their
children.

Nevertheless, some believe that a battery of short-
term tests for rate-of-age-changes that could be
measured over a decade or less might adequately
substitute for measurements made over a lifetime.34
Models for this approach have, in fact, been developed
to assess the possible age accelerating effects of irradia-
tion on Hiroshima survivors. One could simply assess
the rate of change in a number of unrelated physiologi-
cal decrements over a 5- or 10-year period in treated
and untreated human subjects, with the expectation
that, if most of these variables were affected, the effects
could be extrapolated to effect longevity.34 Studies of

3 Comfort, A. Measuring the human aging rate. Mechanisms of
Aging and Development, 1972, /, 101-110.

* Comfort, A. Test battery to measure aging rate in man. Lancet,
1969, II, 1411-1415.

similar design and magnitude are now underway to test,
for example, the effects of diet on heart disease.

An approach such as this has a great deal of appeal,
not the least of which is the fact that it is currently feasi-
ble, and we know of several possible age-decelerating
treatments that would probably be morally and
ethically acceptable if a sufficient number of volunteers
could be found. In particular, caloric restriction and the
effect of antioxidants could be studied immediately.
Caloric restriction is inherently safe since it is both
voluntarily and involuntarily practiced by many people,
and antioxidants, existing as they do as food preserva-
tives, have already gained acceptance by the Food and
Drug Administration for human ingestion.

Thus the arguments in favor of this kind of ap-
proach, rather than the control of specific diseases, can
be summarized as follows:

1. Disease elimination will not retard the processes
of aging, but approaches designed to specifically
affect the rate of age changes will do so.

. The approach is currently feasible from the
standpoint of several practical considerations in-
cluding cost, ethics, logistics, and time.

. It is easier to affect a biological rate than it would
be to prevent its occurrence. It should be easier,
for example, to postpone the occurrence of cancer
or atheroma than to cure these conditions.3

Demographic Projections

It is well known that the proportion of individuals in
our society over the age of 65 has been steadily increas-
ing. In the last 100 years their proportions of the total
population have increased from 3 to 10 percent (figure
3), and the aged have become a larger proportion of the
nonworking component of the population which in-
cludes the nonworking youth. This nonworking
population component is largely supported by the work
force itself, and if current population trends continue it
will be the elderly who will command increasingly
more support.

Within 50 years it is expected that those over 65 will
number nearly 40 million (figure 4). This prediction
does not take into account any major resolution within
50 years of the two leading causes of death—car-
diovascular disease and cancer. If some significant cure
rate were to occur, however, we might have as many
people over 65 as under 15 in the year 2025.

If zero population growth were achieved and main-
tained, the family size of old people would obviously be

 

 
'' 

Fig. 3. From L. |. Dublin, A. J. Lotka and M. Spiegelman, Length of Life, The Ronald Press Co., New York,
1949.

PERCENT DISTRIBUTION OF TOTAL POPULATION BY AGE;
UNITED STATES 1850 TO 2000*

unver 5 G5-19 (7) 2004 «(a 5-61 «| I) eS ANDOVER
2.6 27 3.0 3.4
ces | Ee Bcd 6 boaae Le | 4.1 | 4.3 | 4.) } | 5.4 | 6.8 | 77 91 | 10.2

ee) [aut

 

   

Al fs

ig

 

) tat
pa

1850 1860 1870 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

*1850 to 1940 from United States census enumerations; 1950 to 2000 from estimates by the Bureau of the Census, 1947.

Fig. 4. From U.S. Bureau of the Census, Current Population Reports, Series P-23, No. 43. Some
Demographic Aspects of Aging in the United States. U.S. Government Printing Office, Washington,
D.C., 1973.

Growth of the Population 65 Years and Over: 1900 to 2020

MILLIONS
20

 

    
 

65 and over

75 and over

 

24

2b FEMALE

65 and over

75 and over

 

 

 

 

0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020

Fig. 4. From U.S. Bureau of the Census, Current Population Reports, Series P-23, No. 43. Some Demographic Aspects of Aging in the
United States. U.S. Government Printing Office, Washington, D.C., 1973.

6

 

 
'' 

reduced and there would occur along with this a
diminution in the economic, social, and psychological
benefits that now accrue from adult children. The in-
evitable consequence would be a further acceleration of
current trends in which the government would be pro-
viding more health care, food, housing, recreation, and
income to the elderly. Since it could safely be assumed
that the proportion of those in government over 65
would also increase, the closest thing to a gerontocracy
could prevail in 2025.

Since zero population growth might be achieved by
the year 2025, it is interesting to speculate on the conse-
quences of another extreme condition—that is, a
population in which no one dies at all. The immediate
effect on the growth rate of the total population would
be significant since the growth rate would be increased
by the death rate. In the long run, however, the increase
would not be dramatic.5 The increase in growth rate
would be somewhat less than one-half million persons
per year in a population of 250 million—over and
above, that is, the number of births presently being add-
ed to the population each year. (In 1974, the number of
births was approximately three million. If there were no
mortality, the number of births would be an additional
one-half million, based on the projection that those
females who now die in childhood would survive and
would bear children. )

Consequently, even the stupendous achievement of
attaining biological immortality would not greatly in-
crease the total population—that is, if those achieving
biological immortality did not concomitantly gain in fe-
cundity. However, even a steady-state annual increase
of one-half million persons over the present annual in-
crease of three million would make a significant impact
after several years.

After the initial large impact of a shift to zero mor-
tality, the rate of increase of the elderly would change
slowly. Since with the current life expectancy of 70
years any large reductions in death rates would be
limited to persons over 60, the elimination of all deaths
would increase the proportion of older people. If the
birthdate were to decline to zero—the most unlikely
event of all—then quite obviously the population would
eventually consist entirely of centenarians and then of
supercentenarians.

Aging Russian Style

No discussion of the prospects for increasing human
longevity would be complete without considering the

 

5 U.S. Bureau of the Census, Current Population Reports, 1973, Series
P-23, No. 43. Some Demographic Aspects of Aging in the United States.
Washington, D.C.: U.S. Government Printing Office.

claims of superlongevity attributed to three
geographically disparate peoples—for if these claims
were true, it would be reasonable to conclude that there
is, indeed, a factor or factors that lead to increased
human longevity and, more importantly, if these factors
were known, they could be manipulated to apply
equally to other people as well.

One of the three groups is found in the Andean
village of Vilcabamba in Ecuador, the second is found
in Hunza in the Karakoram Range of the Pakistani
region of Kashmir, and the third is found predomi-
nantly in the Abkhazia and Osetia regions in the
Caucasus of the Georgian Republic of the U.S.S.R.

In order to appreciate the magnitude of the claims
made by these groups it is important to realize that in
other parts of the world the number of centenarians in
the population is normally about two or three per
100,000.6 Only one person in a million reaches the age
of 105, and only one in 40 million will live to be 110.
Yet in the three regions mentioned, not only are there
claims of higher proportions of centenarians, but many
individuals claim ages of 120, 130, and even 150 and
160 years.

In addition to the Georgian Republic, the whole
Caucasus area, with a population of 21,290,400 (in
1959), was reported to have 8,890 centenarians (45 per
100,000) and about 500 people claiming to be between
120 and 170 years of age. In certain areas of Azerbaijan
claims of 300-400 centenarians per 100,000 have been
made! In the census of 1971 the village of Vilcabamba
in Ecuador, which had a population of 819, claimed
nine centenarians with one individual purportedly 123
years of age. This extrapolates to an incredible rate of
1,100 centenarians per 100,000 people.

Unhappily, however, none of these claims, which
have enjoyed widespread popularity in the news media,
can be authenticated.

In Hunza, very few statistical data are available and
the Hunzukuts, who have no written language, cannot
even point to falsified birth records. The Vilcabambans
are very isolated and their birth records are either non-
existent or totally unreliable. One gerontologist who re-
cently returned from his second trip to this village after
a lapse of 5 years was told by several supercentenarians

 

6 Ed’s. note: The 1960 Census for the USA gave 10,369 aged 100
or over compared with 4,475 in 1950. The 1970 Census gave an ob-
viously much too large number, caused by a widespread misin-
terpretation of the Census taker’s question. Therefore, we may esti-
mate the probable number aged 100 or over in 1970 as an increase
over 1960 in the same ratio as the age group 95-99 increased between
1960-70. This gives us an estimate of 20,000 people aged 100 or over
in 1970.
''that during his absence their ages had increased by 7 to
10 years!

In the three areas of Hunza, Vilcabamba, and Soviet
Georgia, it was long suspected that some common
geographical, climatological, dietary, genetic, or life-
style situation could account for the claims, yet no com-
mon denominator has been found. More important,
however, is that the claims of superlongevity themselves
cannot be substantiated in any of these regions. The
best studied situation is that found in the U.S.S.R.
where the evidence is a curious admixture of social
mores, pseudoscience, and politics, sadly reminiscent of
the Lysenko Affair.

First and foremost is the complete lack of valid docu-
mentation for these claims since all census information
is based on verbal replies unsubstantiated by documen-
tation. Curiously, census data in the U.S.S.R. reveal
that the number of centenarians outside of the
Caucasus area dropped from 1926 to 1970 but in-
creased within this area. Dr. Zhores Medvedev, the
Russian gerontologist, now a London resident, specu-
lates that this imbalance is most probably connected
with an improvement in the cultural and educational
levels outside of the Caucasus and where, therefore, the
likelihood of collecting spurious information is
reduced.? (Medvedev draws an analogy with similar
claims for large numbers of centenarians among black
Americans, and he suggests that the claims are at-
tributable to the same cause.)

As for birth records, internal identity cards only
came into use in the U.S.S.R. in 1932 for urban areas
only, and dates of birth were recorded only from oral
information. Furthermore, in the Moslem areas of the
Caucasus where the centenarian claims are most exag-
gerated, there is no birth registration at all. It has been
suggested that the Moslem year, which spans a 10-
month period, caused some misunderstandings when
census takers arrived. In Christian areas birth records
were kept prior to 1917 in special church registers, but
because 90 percent of all churches were destroyed be-
tween 1922 and 1940, these records are almost com-
pletely lost. Not one of 500 supercentenarians ques-
tioned in the Caucasus could produce a valid document
in support of his claim.

General census statistics in the U.S.S.R. clearly
show that females 90 to 99 years of age exist in a ratio of
3:1 to males, yet in the group of Georgian centenarians
the ratio after the age of 100 clearly favors the males. Is

 

7 Medvedev, Z.A. Caucasus and Altay longevity: A biological or
social problem? Gerontologist, 1974, /4, No. 5, Pt. 1, 381-387.

it more likely for centenarian men to exaggerate their
age than women? A further curiosity is that tendencies
to exaggerate age in most industrialized countries occur
more frequently in the very young and very old age
groups. Persons in their middle years are more apt to
reduce their real ages.

Medvedev, in further investigations on the super-
longevous people of the Georgian Republic, offers some
interesting notions on why these claims persist. Very
old people in these regions enjoy the highest levels of
social authority and the older a person is, the more
respect and honor he receives. “The most elderly peo-
ple are almost regarded as saints.” These traditions
create a stimulus for age exaggeration, especially when
documentation does not exist and when no living wit-
nesses can contradict the claims. Furthermore, the na-
tional and international publicity surrounding the
superlongevous, such as images on postage stamps, fre-
quent news media photographs and_ stories, and
establishment of centenarian bands, chorale and dance
groups, have made these areas profitable tourist attrac-
tions. The Novosti Press Agency itself derives income
from the sale of stories and photographs of the super-
centenarians to the gullible Western news media.

The villages compete to have the oldest resident in
the U.S.S.R.; the competition is fueled by this circus at-
mosphere; and longevity records are pushed upwards
annually. Associated with these claims, and providing
further impetus to the exaggerations, is the political
propaganda which refers to these people unabashedly
as a special social achievement of the Soviet Union. Ar-
ticles in central newspapers and magazines with such
titles as “The U.S.S.R.—State of Longevity” promote
the legend. Dr. Medvedev cites statements such as the
following, appearing in what are purported to be
scholarly academic publications, ‘““The Soviet Union is
the country with the record longevity of human beings.
The number of centenarians is increasing, parallel with
our approach to the creation of a Communist Society.”

The fact that Joseph Stalin was a Georgian must also
be taken into account in the legend of the Soviet cen-
tenarians. Stalin himself was very much interested in
the phenomenon, and because of that interest, local
Georgian authorities were anxious to provide more and
more cases of longevous people. But perhaps the most
reasonable explanation for the appearance of this
phenomenon in the Soviet Union is the likelihood that
hundreds of thousands of known deserters and draft
dodgers of the First World War and the Russian
Revolution (most of whom were from the Caucasus)
used their fathers’ documents to falsify their ages. In
order to maintain the fiction, they have had to continue

 

 
'' 

the masquerade, and have exaggerated it even further
when the several benefits cited here were likely to ac-
crue.

Who Is Old?

The aged as they are presently defined are culturally
anomalous. This is largely because the concept of old
age has become absolutely tied to a birthdate on the
calendar. This definition of age is entirely removed
from the biological reality that the rate of aging is
different for different people. There are many who are
“old” at 50 and others who are not “‘old” at 90. The ma-
jor social dislocations created by assiging old age at a
fixed time for all persons is best exemplified by the
spurious assignment of a fixed age for retirement—now
generally enforced at age 65. This numerology takes no
account of differences in rates of aging in individuals, as
also is the case for fixed calendar ages in determining
adulthood, ability to drive a car, or alcohol consump-
tion.

Old Is Not Beautiful

In America today normal aging is more often than
not a process of disengagement in which there occurs a
mutual withdrawal of the aged person from society and
society from the aged person. It is tacitly assumed that
both parties are better off after disengagement has oc-
curred. Yet psychologists and sociologists have
demonstrated that life satisfaction of the aged is more
highly correlated with the same kinds of social activities
that are characteristics of middle age.

In modern industrialized societies there is little
doubt that sickness is more frequently found among the
old as a group than it is among the young as a group.
Disease has come to be regarded as an almost invaria-
ble accompaniment to aging, even though the
physiological decrements of normal aging may, in fact,
be reversible. Such age-related changes as sensory loss,
learning deficits, incontinence, confusion, and memory
loss may indeed be reversible or controllable.

Gerontologists are beginning to look at some of the
societal expectations or the self-fulfilling prophesies
that lead so many old people to regard themselves as
“patients.” Professor Otto von Mering of the University
of Florida has described a pattern he has observed in a
large university hospital as “growing old the out-patient
way.” Professor M. Margaret Clark of the University of
California in San Francisco has recently described
cultural patterns that identify the aged as dependent
and which allow them to play one of the only socially

sanctioned roles for old people, that of being sick.
Professor Clark also suggests that the major fact leading
to the identification of the aged as a social problem is
concern over their real and potential dependence on the
rest of society. The prospect of dependency in old age is
frightening to individuals in most industrial countries,
but no more so than in the United States where only by
being independent can the ‘American Ideal” be
reached. Professor Clark goes on to observe that this
cultural imperative forces many elderly people in this
country to make an unhappy choice between denial of
need for help, on the one hand, and self-recrimination,
on the other. Although the degree to which this obser-
vation holds may vary from culture to culture, it is prob-
ably more prevalent in this country than elsewhere.
Professor von Mering concludes that “We have, in
effect, traded mortality for morbidity, and morbidity for
disability and medicated survival.”

Old, Poor, and Sick in America

A sizable proportion of the aged in most in-
dustrialized countries are poor. This may be largely at-
tributed to the replacement of an agrarian economy by
one based on wage labor. Over 16 percent of older peo-
ple in the United States had incomes below the poverty
threshold in 1973. Almost 60 percent of these poor were
living alone or with nonrelatives; of these, the large ma-
jority were women, mostly widows.

It is doubtless true that to be old in America is
unpleasant, to be old and poor in America is a tragedy,
but to be old, poor, and a member of an ethnic minority
in America is devastating. Compounding this situation
further are factors of marital status and health. Most
older men are married, whereas most older women are
widows. About 85 percent of older persons not in in-
stitutions have one or more chronic diseases, and older
people have a one in four chance of being hospitalized
during any year, which is twice as great as for people
under 65. Once in the hospital, older people stay twice
as long as do younger people (17.5 vs. 8.7 days).

What To Do

What is to be done about this situation? Short of ex-
tending life expectancy or the lifespan itself, a revamp-
ing of society’s attitudes toward the aged must take
place if we are to halt and hopefully reverse the current
situation.

People should not be removed from the work force
at a specified retirement age, but only with due regard
for the differences in rates of physiological decrements
''peculiar to each individual. There are many elderly
people who have continued to be productive in-
dividuals despite what society has come to expect of the
elderly. How have they succeeded where so many of
their peers have failed? This is an area of sociological
and psychological investigation that could define the
sets of conditions that are necessary to increase the
numbers of productive elderly.

In the past few years several strong advocacy groups
for the elderly and retired have appeared. Such large
groups in the public sector as the American Association
of Retired Persons, the National Retired Teachers
Association, the National Council of Senior Citizens,
and the National Association of Retired Federal
Employees have assumed leadership roles in articulat-
ing the needs of retirees and the elderly. At the Federal
level, the Administration on Aging, the Social Security
Administration, and the Veterans Administration have
been the main organizations concerned with the affairs
of the elderly. All these groups deal with the social and
economic status of the aged, but do not concern them-
selves with the fundamental causes of age changes and
their possible resolution. The social support system for
the aged in this country has now reached a staggering
level and still more must be done. It is not too difficult
to imagine a society in which the major efforts of most
of those under 65 will be directed toward the care of
those over 65. We are fast approaching a time when
very important decisions must be made in regard to the
future of an increasingly greater population of the aged
in this country. Our present policies are simply
designed to offer symptomatic relief, with very little
effort directed toward the fundamental causes of the
problem.

The current situation is roughly analogous to policy
decisions facing, for example, the National Foundation
for Infantile Paralysis in the 1940’s and 1950’s. Had
that Foundation decided at that time to invest all or
most of its resources in the perfection of better iron
lungs, we would probably have today the best designed,
best automated, and exquisitely comfortable iron lungs
for tens of thousands of current polio victims. Instead,
the Foundation made the decision that a substantial
portion of its resources should be invested in the basic
research necessary to understand and control the dis-
ease. The outcome, of course, is familiar to us all.

Basic research is often a high risk speculative ven-
ture, but like high risk speculative stocks, it can result in
huge payoffs. It can and often does result in no payoff at
all, yet can we afford to neglect it? The development of

the polio vaccine has led to complete control of the dis-
ease, something that more efficient iron lungs would

 

 

never have done. In a similar fashion, improvements in
the social, economic, and medical support system for
the elderly will not result in a better understanding of
the fundamental causes of aging but will merely pro-
vide that kind of symptomatic relief analogous to the
use of iron lungs for polio victims.

Tampering With Our Biological Clocks

If the control of aging is dependent upon under-
standing the basic biological processes, one profoundly
important question arises: How desirable is it to be able
to manipulate our bilogical clocks? The answer to this
question is not simple. The fact that it must be asked is
further evidence of the distinction that must be made
between disease-oriented biomedical research and
gerontological research. Who would ask: What are the
goals of cancer research or what are the goals of car-
diovascular research? The answers are so obvious as to
preclude asking the question. But the goals of geron-
tological research are quite a different matter, because
we are not certain whether the “resolution” of the
physiological decrements of old age will indeed benefit
the individual or the society as a whole.

Many different biological resolutions of age changes
are possible, and each has an important potential side
effect. Take, for example, the possibility that research
into the biology of aging might result in the total
elimination of all age-related physiological decrements.
As already said, if this were achieved, and no control
existed on the biological clock itself, the result would be
a society whose members would live full, physically
vigorous, youthful lives until the stroke of midnight on
their 100th birthday—at which time they would die. If,
on the other hand, we were to learn how to tamper with
our biological clocks, with what goal in mind would
one choose to reset his clock? Surely one wouldn’t
choose to spend an additional 10 years suffering from
the infirmities of old age—yet that might, initially, be
the only way to intervene. Is society prepared to cope
with individuals whose only choice might be between
naturally occurring death and 10 or more years spent
with the vicissitudes of old age? We can hardly deal
with a mean maximum lifespan of, say, 80 years, to say
nothing of the further social, economic, and political
dislocations that might occur if we add another 10
years.

Aside from this possibility, it is also worth consider-
ing the prospect of clock tampering in which the choice
would be to spend more years at a particular stage of
our lives than we now do. The clock might be stalled for
10 years at, for example, a chronological age of 20. Is

  

10

 

 

 
'' 

 

this desirable? Each of us, after pondering this provoca-
tive question, would likely agree that the time at which
we would like our biological clocks arrested should cor-

respond to those years in which maximum life-satisfac-
tion and productivity occurred. Yet if we were forced to
make such a decision it would probably have to be
made prospectively. Even more complex is the question
of when in the human lifespan individuals are most
productive. An interesting and exhaustive study of this
question was made by Dr. Harvey C. Lehman in 1953.8
The conclusion to be reached from his data is that, de-
pending upon the particular area of human endeavor,
the time of maximum productivity can occur at any
time in adulthood. Thus clock tampering becomes a
game that very few of us are capable of playing.

Goals for the Old

Having presented here only a few of the possible
goals of biological research in aging it should be clear
that a simple answer cannot be given to the question,
What should the goal be? Although simple to state and
conceptually easy to understand, I have purposely
avoided the notion of biological immortality. I have
done this for one principal reason—that to attain it is so
far beyond any practical realization that any discussion
would be science fiction.

The most serious effects of even a modest success by
biological gerontologists in increasing human life ex-
pectancy would be the societal consequences. Most
gerontological sociologists are persuaded that even as
little as a 5-year increase in life expectancy would be so
profound as to rupture our present economic, medical,
and welfare institutions.

In spite of the apparent dilemma in stating goals for
gerontological research, one goal appears to be wholly
desirable and even attainable as a short-range objective.
That is simply to reduce the physiological decrements
associated with biological aging so that vigorous, pro-
ductive, nondependent lives would be led up until the
mean maximum lifespan of, say, 100 years. Implicit in
this notion is that the quality of life is more important
than its quantity.

Of what value is immortality, if by achieving it, one
extends the infirmities? Two modern versions of this
theme exist in Aldous Huxley’s “After Many a Summer
Dies the Swan” and Oscar Wilde’s “The Picture of
Dorian Gray.” In fact the Gerontological Society itself
has as its motto: “To Add Life to Years, Not Just Years
to Life.”

 

8 Lehman, H. C. Age and achievement. Princeton, N. J.: Princeton
University Press, 1953.

If longevity is to be increased merely by extending
the years of our infirmities, then the goal is not worth
seeking. This indeed is the modern dilemma faced by
many physicians who are torn between using every
means for prolonging the terminal stages of disease in
the name of prolonging life, but at the expense of con-
tinuing the agony of certain death. The goal that is not
only more desirable, but indeed more attainable, is not
the extension of longevity per se, but the extension of
our most vigorous and productive years. If tampering
with our biological clocks ever becomes a reality, it
would be tragic if such clock tampering would result
only in the extension of those years spent in declining
physical and mental health. Having said this, what are
the prospects of achieving the goal? I believe that the
prospects are beginning to brighten.

Changing Attitudes

It is sometimes observed that there are no geron-
tologists, just biochemists, cell biologists, and im-
munologists working in gerontology. Many serious
biologists with an interest in aging still hold at arm’s
length the appellation “gerontologist,” either because of
the attitude that the problem is simply too complex to
yield to experimentation, or because the many pseudo-
scientific fringe groups in search of biological immor-
tality have had such a pervasive influence that to for-
mally associate oneself with the field is to suffer an un-
seemly stigma.

Happily in the past few years a significant change in
attitude has occurred toward the science of gerontology.
There is now the realization that biological aging is no
more complex than are problems in embryology,
development, neurobiology, cancer research, or
genetics. The attitude is untenable that efforts by geron-
tologists to reverse the aging process are akin to
medieval alchemy, for all successful biomedical
research has the net effect of prolonging life. Thus there
is no rational reason to discourage research on the fun-
damental causes of age changes. Established investiga-
tors are no longer apologetically explaining their in-
terest in aging, and young scientists are beginning to ap-
preciate that the fundamental problems are less intrac-
table than their predecessors thought. Public awareness
of this neglected field has led, for one thing, to the crea-
tion of an Institute on Aging in the National Institutes
of Health.

For the first time the discipline of gerontology has
been given a degree of national recognition at the
biomedical level, to make real meaningful efforts to un-
derstand the biology of aging. The field has now been

 
''given a level of national visibility that is almost com-
patible with the magnitude of the problem. Even more
important is the implication that something can and
should be done about biological age changes. The
period of utter disregard of the question has now
passed.

Prognostications

In any attempt at futurology it is wisest to base pre-
dictions on similar events that have happened in the
past. To the question, What will be the impact of
achieving a 5-, 10-, or even 20- year increase in human
life expectancy, we have only to look back at the same
question asked in 1900, for it is only during the period
1900-50 that increases in human longevity of these
magnitudes did, indeed, occur. It is therefore safe to
conclude that any further increase in human life
expectancy is likely to incur the same sets of problems
and solutions to those problems that occurred in the
first half of this century. The question then is: To pre-
pare for a potential increase in human longevity, what
should we now do that is different from what was or was
not done in 1900? The chief medical problem during
the first half of the 20th century was infectious diseases,
and the chief biomedical accomplishment during that
time was their virtual elimination. As a result society
now finds itself burdened with unprecedented numbers
of disabled and indigent old people who have survived
infectious diseases but who will not survive old age. We
do not wish to prolong old age by keeping people alive
well beyond their years of vigor. What we want to do is
what the science of gerontology is all about.

As to making predictions about the likelihood of in-
creasing human longevity, some consideration should
be given to two recent efforts in which such prog-
nostications have been made. In both these studies, the
opinions of scientists were elicited. Polls are a poor way
to conduct scientific research, but for what it might be
worth, the results were as follows: In the Rand Study
scientific prognosticators concluded that an increase in
longevity of 50 years will occur by the year 2020.9 In the
study by Bender, Strack, Ebright, and von Haunalter a
major increase in longevity was considered attainable
by the early 1990's. 10-11

ee

9 Gordon, T. J., & Helmer, D. Report on a long-range forecasting study,
1964. (No. P-2982) Santa Monica, Cal.: Rand Corporation.

10 Bender, A. D., Strack, A. E., Ebright, G. W., & von Haunalter,
G. Futures, 1969, /, 289.

11 Ed’s. note: These predictions are not accepted by any except a
very few gerontologists. As reported in appendix C of this volume, a
sample of Fellows of the Section on Biological Sciences of the Geron-
tological Society were asked in 1974 what they expected to happen by
the year 2000 with respect to life expectancy at age 65. Their average
prediction was a gain of 5 to 10 years.

12

Since life expectancy has increased so dramatically
in the last half century anyone can foresee the
possibility of some small degree of further extension.
All that needs to be done is to better the hygienic, health
care, and nutritional deficiencies of the substantial pro-
portion of Americans who are now denied these basic
human needs. Thus there is no requirement for new in-
tellectual bases of understanding the biology of aging to
materially increase the longevity of a substantial portion
of our society. All that it takes is motivation and money.
This achievement would increase life expectation but,
of course, would not affect the lifespan or the rate of
aging. Nevertheless, it is something that could be done
now without requiring any new scientific innovations.

For significant increases in longevity to take place,
spectacular scientific achievements will be necessary.

The consensus of scientific opinion is that the funda-
mental causes of age changes, like developmental
changes, are somehow programed within the genetic
apparatus. It is there that the clock is undoubtedly lo-
cated. A fruit fly is old in 30 days, a mouse in 3 years,
and a man in 90 years. The genetic control of these
differences is more or less self-evident. The rate of
aging per gram of mouse tissue is 30 times faster than
per gram of human tissue. Further clues that genetic
processes control age changes can be seen from the sex
differences in human and animal life expectation.
Perhaps the best examples are actuarial data which
clearly show that the children of long-lived parents are
themselves long-lived. Demographic data lead to the
amusing conclusion that the best possible circum-
stances for achieving maximum longevity are to be a
white, highly educated, wealthy, Swedish female with
centenarian parents and grandparents. (One wonders
what such a women would have to say to her poor old,
black, sick counterpart living in an American ghetto. )

The conclusion to be reached, then, is that if, in the
next 25 years, biomedical research were to triumph to
the extent that deaths caused by cardiovascular disease
and cancer would be preventable, a net increase in life
expectancy of about 20 years would occur. Advances
made in preventing deaths caused by other diseases
would not have much impact on human longevity. The
greatest potential impact on human longevity would be
research directed toward reducing the rate of the funda-
mental nondisease-related biological causes of age
changes, causes which are undoubtedly genetically
determined.

If our social, political, and economic institutions are
likely to be severely dislocated by these achievements,
what right do we have to encourage this kind of
research?

 

 
'' 

Prospects of Lengthening

At present the average remaining years of life for
Americans aged 65 is about 15 years for men, 19 for
women. It is rare for people to live beyond the age of 90,
but there are known cases of Americans living to be
110, which seems to be a kind of upper limit. (As
pointed out in Mr. Hayflick’s paper,* none of the claims
of superlongevity—of persons who claim to be 120 or
130 or 150—is scientifically valid.)

The concept of a “human lifespan” of about 100
years is a concept that most biogerontologists find
useful. It is not the maximum lifespan, which remains to
be determined empirically; nor is it the mean lifespan, or
average life expectancy, which is now about age 70 for
Americans. The mean lifespan is an established datum
for various populations. It has increased greatly during
the present century in developed countries of the world,
and it will probably increase slowly for another quarter
century.

So far as is known, the “Shuman lifespan,” in contrast
to the mean lifespan, has remained the same over the
centuries. A major question is whether the human
lifespan can be increased by methods that some
biogerontologists are presently pursuing. One group of
biogerontologists believes that the human lifespan of
about 100 years can be increased substantially through
methods of treatment that slow down the “rate of
aging” of the cells of the body. Another group, includ-

*This essay draws upon more technical papers by George A.
Sacher.!:2:3

**Mr. Sacher’s work was supported by the U.S. Energy Research
& Development Administration.

'Sacher, G. A. The future of biological gerontology: A proposal
for evaluation and action. Working paper for the Salk Institute
Workshop on Aging, La Jolla, California, July 6-8, 1974. Un-
published.

2Sacher, G. A. Life table modification: Ends and means. Working
paper for the Conference on Social Policy, Social Ethics, and the
Aging Society, University of Chicago, 1975.

3Sacher, G. A. Life table modification and life prolongation.
Chapter 24, the Handbook of the biology of aging, J. E. Birren, L.
Hayflick, and C. W. Finch (Eds.). New York: Van Nostrand
Reinhold, 1977.

+ Hayflick, L. Perspectives on human longevity. Paper appears in
present volume.

13

Life and Vigor***:

Robert J. Havighurst and George A. Sacher

ing Hayflick* and Sacher, believes that certain forms of
treatment and certain improved health habits will con-
tinue to lengthen the mean lifespan, and will perhaps in-
crease the human lifespan slightly, but that these ap-
proaches will not change the “rate of aging.”

Life Expectancy

Before examining this issue of the extension of the
human lifespan, and what is meant by the “rate of
aging,” we should consider the changes that have oc-
curred during the 20th century in the mean lifespan, or
average life expectancy. Obviously, the mean lifespan
has already been substantially increased in this country
by the prevention and cure of the diseases that formerly
led to deaths at relatively early ages. First, the major
causes of infant mortality came under control, im-
mediately producing a big gain in life expectancy. Then
around 1940 antibiotics came into use against infec-
tious diseases, especially against pneumonia, which had
been a major killer of people aged 40 and over. This
produced another major increase in mean lifespan.

Since 1950 there has been only about 2 years gain in
life expectation in the United States for people who
reach age 65. The principal cause of death for
American adults is cardiovascular disease, and the next
in importance Is cancer. It has been calculated that an
absolute cure or preventive agent for cardiovascular dis-
ease would increase the average length of life for people
who reach age 65 by about 10 years, and a similar cure
or preventive of cancer would increase life expectancy
at age 65 by | to 2 years.5 It is not likely that we will dis-
cover a complete cure or preventive, but a 50-percent
reduction in the death rate from these two diseases
would produce a considerable increase in life expectan-
cy and would greatly increase the size of the elderly
population compared to the total population.

 

5National Center for Health Statistics, U.S. Public Health Service,
“U.S. Life Tables by Causes of Death: 1969-71,” by T. N. E. Greville,
U.S. Decennial Life Tables for 1969-71, Vol. I, No. 5, 1976
(forthcoming).
''It has been estimated, for instance, that if all people
would quit inhaling tobacco smoke, and would eat less
of certain foods, and if air pollution was markedly
reduced in the big cities, the death rate due to car-
diovascular disease would be cut in half, producing a
gain of 3 to 5 years in mean lifespan. Whether or not
that estimate is accurate, any improvement in the pre-
vention or cure of certain chronic diseases—the dis-
eases that most frequently attack elderly people—would
increase life expectancy.

The Rate of Aging

There is another conceivable way of prolonging life
which is now being discussed by specialists in the study
of aging. This is to slow down the process of aging with-
in the body. Biological researchers have found that as
people grow older, their bodies become more suscepti-
ble to the major diseases which lead to death. There
must be something going on within the body, an aging
process, which is not the disease process itself but which
makes the body less resistant to disease. If this aging
process could be understood, it might be treated so as to
delay the process, and therefore give people more years
of health and vigor before they become vulnerable to
the common diseases of old age.

The possibility of slowing the rate of aging is a topic
of disagreement among biological researchers. Some
say that the postponement of the process of biological
aging is very unlikely; others predict a breakthrough
within the next 20 years. Among the optimists is Dr.
Alex Comfort, the British biologist, who believes that
intervention to postpone or slow down aging is practical
and ready to be tested on human subjects. He said, in
1969,

Direct experiment on the delaying of age
changes in man is virtually certain to be in hand
by 1975. If the techniques used in rodents prove
directly applicable, or we are lucky, even allowing
for normal research delays, some agent
demonstrably reducing the rate of mature human
aging is likely to be known within 15 years.

The net result will be a 10-year extension in
health and the productive years of life. At age 70,
for example, the average individual will enjoy
about the same physical and mental vigor he had
at age 60. Most if not all degenerative changes
and disabilities will be postposed roughly across
the board; cancer, heart disease, arteriosclerosis,
etc., generally will occur at a much later age than
they do now.5

 

6Comfort, A. Longer Life by 1990? New Scientist, 1969, 44,
549-551.

14

Comfort belongs to a minority of biologists who
believe that we can add 10 to 20 years of vigorous health
to the average lifespan by slowing the rate of aging; but
even most members of that minority believe such an
achievement is far in the future, surely much farther
away than the next 15 years.*

Most of the relevant research has been carried out on
mammals with short lifespans, such as rats and mice.
This research on animals is necessary in order to find
out what treatments make a difference in lifespan.

“Rate of Aging” Versus the Factor of “Vigor”

Sacher has analyzed lifespan data for a number of
organisms including man, and has formulated a
mathematical description of the life table.!2 To explain
his description with a minimum of mathematics, we
can look at a set of model survivorship curves as pre-
sented in figure 1. The curve a approximates the sur-
vivorship curve for the adult U.S. population in 1970.
(The model does not take account of infantile and
juvenile mortality, which for the most part are not re-
lated to the aging process.) The proportion of the
population surviving to the age of 40 is about 95 per-
cent. After that age, the death rate increases, and the
numbers of survivors begin to fall off more and more
rapidly. The proportion still living at age 70 is 60 per-
cent. If this part of the curve, from age 40 to age 70,
could be kept from falling so rapidly—that is, if there
were fewer deaths—then, by definition, the mean life-
span would be substantially increased.

Sacher’s mathematical analysis showed that the sur-
vival curve is characterized by two parameters or vari-
ables, which can be designated as alpha and q,.

The first parameter, alpha, is the slope of the straight
line that results when the logarithm of the age-specific
death rate is plotted on a graph. This tells how rapidly
the death rate increases with age, and it can be called
the rate of aging. It is an empirical fact that for man, after
about the age of 40, the death rate doubles about every 8
years. The death rate doubling time is characteristic of
the particular species. It is about 200 days in experi-
mental populations of mice, for example, while it is
about 3,000 days (or 8 years) in man after man reaches
adulthood, a 15-fold difference.

The second parameter, q, is needed together with
alpha to give a full mathematical description of the sur-
vival curve. This second parameter can be called the
vulnerability of the vigor factor. It represents the vigor or

*Editor’s note: See appendix.

 

 
'' 

the stability of constitution in the species being studied;
or in somewhat different words, the susceptibility to in-
Jury, disease, and death that is present in the animal at
birth and all through life. This second factor can be
measured, for instance, by the initial death rate, or the
death rate that theoretically occurs at birth, before the
rate of aging comes into effect. On this measure, the
difference between mouse and man is about 500-fold.

The two factors together create the life table. Both
these factors vary from one species to another. Both are
constitutional characteristics of the body. They are cor-
related, but the degree of correlation differs from one
species to another and is related to body size and to
facts about the reproduction of the species. The two fac-
tors are partly independent, then, although both have
an inborn or genetic basis. Both of these factors can be
changed, at least theoretically, by some kinds of treat-
ment that biologists are attempting to discover.

Two Ways of Extending the Mean Lifespan

There are two conceivable ways to increase the mean
lifespan, depending on which of the two factors is in-
volved:

(1) Slowing the rate of aging: Turning again to figure 1,
the survivorship curve ¢ results from a change in the
rate of aging or in the alpha factor. This curve was

drawn on the assumption that the time taken to double
the mortality rate after age 40 would be lengthened
from the present 8 years to 16 years, i.e., that the rate of
aging would be slowed down. This might conceivably
result from a breakthrough in aging research of the type
referred to by Comfort. One or more substances or
methods of treatment might be used by people
systematically from age 40 onward so as to increase
their life expectancy at age 65 by as much as 15 or 20
years.

Thus far no pharmacological method has been
demonstrated that slows down the rate of aging, even in
smaller animals. Several “antiaging” drugs or chemi-
cals that have been used with mice and other small
animals have prolonged the lives of these animals ac-
cording to the 6 curve of figure 1 but not according to
the c curve. That is, the “antiaging” substances extend
lives by helping the animals resist the ordinary diseases
which cause death, but these antiaging substances do
not greatly extend the maximum lifespan of the animal.

There are two kinds of regimes that do extend life for
experimental animals by decreasing the rate of aging
and that do therefore extend their maximum lifespans.
The first is by restricting the food of rats and mice to the
point of slowing down the animals’ activity; the second
is by reducing the body temperature of coldblooded
species, insects, and fish.

Fig. 1. Survivorship Curves Based on Various Patterns of Mortality

NUMBER LIVING

 

bss bs

Soe

 

a. Adult U.S. population, 1970
b. If ‘vigor’ were improved

130 140

100 Il0 120

AGE, years

c. If the “rate of aging” were slowed

15

 
'' 

How might these methods be applied to humans? It
is generally supposed that most people in affluent
societies eat too much, and would be healthier if they
ate less. But this assumption is based on the facts about
the dangers to health of excess fat. Just following a
“reasonable” diet will keep a person’s weight down to a
healthy normal, but it will not slow the rate of aging of
the cells in the body. To actually reduce the rate of
aging of the cells, it would probably be necessary to
reduce the intake of food drastically, or if not the intake
itself, at least the body’s absorption of nutrients. (The
latter might be accomplished by taking pharmacologi-
cal substances which would prevent the body from ab-
sorbing nutrients, even though the person eats all he
wants.) The body would not get the nutrition, and
would therefore enter a state of slow starvation. This
might slow down the rate of aging of body cells, but it
would also slow down the body’s activity, for the availa-
ble energy from food would be reduced, and the person
would become listless. The question would then
become, Would people want to pay this price for an ex-
tra 10 years of existence?

The second method of slowing the rate of aging,
reducing body temperature, can be carried out with
coldblooded animals like fishes, but can hardly be done
with humans. When the human body temperature
drops a degree or two below normal, the body starts to
shiver, which is a way of making the body exercise itself
and thus raise its temperature back to normal. Still,
biochemists might discover chemicals that would
reduce the temperature of the human body by, say, five
degrees, and thereby slow down all body processes, in-
cluding the processes of aging of cells. But this would
make the body less active, and reduce what Sacher
refers to as productive energy output. The body would slow
down, all mental and physical body processes would
slow down. Again, would people want to extend their
lives by this method?

(2) Improving “vigor”. The survivorship curve 6 is
based on the assumption of a change in the vigor or
vulnerability factor. This change can be brought about
in two general ways: One way is by improved health
practices and health services. Increased vigor and
decreased susceptibility to disease have, of course, been
going on at all age levels, although very slowly among
persons 65+. As mentioned earlier, the use of anti-
biotics has been one of the ways in which mortality has
been greatly reduced; and various public health
measures have had the same effect. For present pur-
poses, however, we are speaking of health practices that
might begin at age 40, when, for example, reduction of
cigarette smoking, maintenance of low cholesterol

16

diets, and improved medical services might produce

new reductions in susceptibility to disease or new in-
creases in the vigor factor.

Another method of increasing the vigor factor might
be use of drugs or pharmacological agents which are
not specific treatments for specific diseases, as anti-
biotics are, but which have more generalized effects on
bodily vigor. Sacher3 has reviewed the experimental
work with such drug treatments on mice and other
small animals, and finds that they do increase the vigor
factor, thus lengthening the average lifespan of these
animals. However, such treatments have not yet been
shown to affect the mean lifespan in man, although
several substances are now being used experimentally
with humans in pursuing this goal.

The survivorship curve 6 in figure 1 is based on the
assumption that death rates will be reduced to one-fifth
of their present values after age 40, whether the reduc-
tions come about by changed health practices or by the
use of pharmacological agents. To increase the vigor
factor to the extent shown by curve 6 would increase the
mean lifespan, or average life expectancy, at age 65 by
about 18 years. This hypothetical reduction is much
greater than we can realistically expect, but it serves to
make clear the possible effects of reducing the
vulnerability factor.

Comparing the Two Methods

Comparison of the two hypothetical survivorship
curves 6 and c shows some important differences. A
change in the rate of aging (curve c) would not reduce
mortality very much in the period from age 40 to 65, or
in other words, for the first 25 years after people of 40
would begin the treatment. After age 65, however, and
especially after age 80 the effect would become more
pronounced. This method of reducing mortality would
extend the mean lifespan, and it would also extend the
“human lifespan” from the present 100 years to some-
thing like 130 years.

A change in the vigor factor (curve b), on the other
hand, would save lives from the time it started at age 40,
and it would save more lives than the method of rate
control up to age 90, where the two curves cross each
other. It would then save fewer lives from age 90 on-
ward.

Thus curve 6 saves more lives between ages 40 and
90, while curve ¢ saves more lives between ages 90 and
110. Curve 6 would extend the mean lifespan from about
70 to about 90, as already mentioned, and it would also
extend the “human lifespan” from the present 100
years to about 115 years.

 

 
'' 

Curve 6 is more nearly rectangular, with a higher
shoulder at the ages from 50 to 90. This type of sur-
vivorship curve would probably be more satisfactory
than curve c, from the standpoint of the community and
the individual, for the period of low mortality and low
morbidity would be extended, while the declining
period of life, the period of high morbidity after 90,
would be shorter. With curve 6, there would be a
bunching of deaths in the last 10 or 15 years of the life-
span. Curve b is also more “‘determinate” in the sense
that persons could more often predict the approximate
age of their deaths.

The Problem of Disability and Life Extension

A question of enormous social significance is, What
will happen to the amount of physical disability in the
elderly population if an extension of life is achieved?
Will there be increased need for medical care, in-
creased need for long-term care, increased years of
physical or mental disability?

From the survivorship curve a of figure 1 we see that,
by age 50, the mortality rate is substantial and doubles
every 8 years. From this age on, there are increasing
amounts or lengthening periods of physical disability,
due mainly to increased morbidity from chronic dis-
eases. The following diseases show increased incidence,
and they tend to cause more and more disability: car-
diovascular disease, cancer, cerebral accidents (stroke),
arthritis, rheumatism, and failing eyesight.

In addition, there are two other major causes of dis-
ability: senility and the kinds of accidents that result in
broken hips and other conditions that reduce physical
mobility. Senility perhaps should be regarded as a dis-
ease entity—some form of deterioration of the brain oc-
curs, and it may progress to a point where the person
can no longer care for himself.

As a result of these various diseases and disabilities,
a sizable number of persons over 75 are placed in in-
stitutions where they receive such physical and medical
care and such general supervision as they need. This
has been an increasing number, although the number
may be stabilizing at a relatively constant proportion of
the over-65 population. This group includes practically
all residents of nursing homes who are over 65, and a
portion (but not all) of residents of homes for the aged.
It also includes a portion of the residents of State and
private mental institutions.

The total number of elderly people in need of physi-
cal care and general supervision—both in and out of in-

17

stitutions—is estimated at between 10 to 15 percent of
the over-65 population, or 2.6 to 3.3 million in 1975.7

The proponents of both methods of lengthening
life—changing the vigor factor, and changing the rate of
aging—say that they will lengthen the active and
vigorous part of life. That is, they say that by appropri-
ate methods of treatment it is possible to stretch out the
active and useful life without increasing the period of
physical disability. But the evidence for this proposition
is scanty, whether it be related to one method or the
other.

It seems reasonable to suppose that with more effec-
tive methods of preventing or curing chronic diseases,
older people will retain their physical activity and vigor
longer. For example, if hypertension and other forms of
cardiovascular disease are reduced, the physical dis-
abilities connected with these diseases will be reduced,
and people will live longer without any net increase in
the amount of disability. On the other hand the dis-
abilities attached to arthritis, rheumatism, and failing
eyesight may increase as people live longer, and new
treatments will be needed to reduce their incidence.

The proponents of the rate control method of ex-
tending life say that if all the living cells of the body age
more slowly, the body will stay fit for a longer period.
Thus a person who is 90 years old but who has under-
gone treatment to slow down the rate of aging will be as
vigorous at 90 as he would otherwise be at age 75. His
eyesight will not deteriorate as fast as it would under
present-day conditions, his teeth will hold out longer,
and his arthritis will not be as painful. Yet the 90-year-
old will be subject to the “‘accidental” causes of dis-
ability, such as infections and accidents, and these will
require health care and medical treatment.

Sacher argues that there is nothing in the theory of
action of antiaging drugs to indicate that a reduced rate
of aging will be accompanied by a reduction in mor-
bidity, or in the average duration of time a person stays
alive with a terminal disease.?.3 It seems reasonable to
believe that the amount of medical care and health
service needed by a particular elderly subgroup is
bound to increase with the age of that subgroup, no
matter what kind of antiaging treatment or preventive
health care it has received. The amount of disability
and dependence upon care by others is sure to be high-
er for the oldest 10 percent of the population than for

 

7 U.S. Congress Senate Special Committee on Aging. Report on
Nursing Home Care in the United States, December 17, 1974. Supporting paper
# /. Washington, D.C.: Government Printing Office.
''younger age cohorts, and if the last survivors live more
years, as they clearly do for the ¢ group in figure 1 (com-
pare the shaded areas under the three curves), they will
in all probability require a greater total amount of
health care and service.

It is difficult to believe that the average length of life
after age 65 could be extended by either of these
methods without a substantial increase in the number
of visits to the doctor or dentist, the number of days in
the hospital, and the number of nursing home beds.

From these considerations it appears that, above all,

18

we need more studies of the physical vigor and the
health care of the population beyond age 80 or 85.
Among other things, we need to examine the kinds of
preventive health care and treatment persons receive
after age 40 or 50.

We may be fairly sure that the average lifespan
beyond age 65 will be increased by the year 2000,
whether it be by 2 years or 5 years or 15 years. Many
more people will live into their 80’s and 90’s, and their
health and happiness will be influenced by research in
biogerontology.

 

 
'' 

Extension of the LifeSpan:

In the United States today there are several thousand
individuals who are over 100 years of age.! The pro-
bability of any of us joining that select group is very
slight in spite of the astonishing advances made in the
medical sciences in recent decades. Most of us will, in
fact, have to be content with the traditional three score
and ten as evidenced by today’s average age of death for
men at 69!/2 years, and for women, 752/s years. There
are those, however, who believe that these averages can
be substantially increased in the not too distant future
through the development of methods to slow the rate of
aging. If so, becoming a centenarian could become the
norm rather than the exception. What lies behind this
belief? What would be involved in accomplishing such
a change? What ethical and social issues would con-
front society if such a development were to occur?

The belief that it might be possible for man to ex-
tend his lifespan seems to be age-old. Its roots are in the
myths and religions of early societies and in the early
era of modern man, when it was observed that some in-
dividuals lived many decades beyond their contempo-
raries. Such observations led alchemists during
medieval times to seek a magical formula, led explorers
such as Ponce de Leon to search for the “fountain of
youth,” and in the late 19th and early 20th centuries en-
ticed scientists to undertake investigation of the
phenomena associated with aging in the hopes of dis-
covering a method to prolong life. Metchnikov, of the
Pasteur Institute in Paris, published in 1903 a treatise
called “The Nature of Man” in which he set forth the
hypothesis that autointoxication caused by bacterial
pathogens in the digestive tract was the major factor in
the mechanism of aging.2 He was wrong, but his work
was an early landmark in the study of the processes in-

'Ed’s. note: The number of centenarians in the United States has
probably been overstated in recent censuses. Various methods of
estimating their number are discussed in a recent paper by J. S. Siegel
and J. S. Passel, New estimates of the number of centenarians in the
United States. Journal of American Statistical Association, 1976, 71, No.
355, 559-566. Their preferred estimate is 4,800 centenarians for 1970,
3,300 for 1960, and 2,300 for 1950.

2Metchnikov, E. The nature of man. New York and London: G. P.
Putnam’s Sons, 1903.

 

19

A National Goal?

James L. Goddard

volved in aging (more commonly called gerontology, as
opposed to geriatrics which is a study of the diseases of
the aged). Since then the scientific community and the
public at large have periodically been exposed to new
“discoveries” which held forth the hope that man’s
cherished dream of postponement of death was indeed
at hand. In turn we have witnessed the rise and fall of
the yogurt diet fad, the era of glandular transplants,
cytotoxic serum, and the current rages of cell therapy
and Gerovital.3 Over this same period of time less spec-
tacular but more important developments have oc-
curred which must be appreciated in order to under-
stand why many scientists feel we are in a position to
tackle the job of extending man’s lifespan.

New Research Directions

First of all, scientists have been conducting labora-
tory experiments on a variety of nonhuman species
throughout most of this century in an attempt to under-
stand the aging process and how to alter it. These ex-
periments have resulted in a substantial body of
knowledge which suggests that life processes can be ex-
tended beyond their normal range. Some of the more
significant experiments and their implications are
these:

(1) Cooling experiments, reported as early as 1917,
indicate that lowering the internal temperature of an
organism will result in longer life. One such study
showed that a common pond organism, the rotifer, if
kept in water 10°C below its normal environment will
almost double its lifespan. Currently there is considera-
ble interest in determining if alteration of the tem-
perature-regulating mechanisms of subhuman primates
to achieve a lower internal temperature will produce in-
creased longevity. Results to date indicate that the inter-
nal temperature of monkeys can be lowered by 7°F.

The potential of this approach is that scientists esti-
mate that a 3°F decrease in internal body temperature

 

3Cherry, R., & Cherry L. Slowing the clock of age. New York
Times, May 12, 1974, 20.

 
'' 

of humans could extend life by as much as 30 years.
How long the lower temperature can be maintained in
monkeys is yet to be determined, and whether the
change will indeed enhance their longevity.

(2) Changing the ability of animals to resist infec-
tions has been tested through manipulation of their im-
mune systems in order to prolong life. Old mice when
injected with virulent bacteria die off very quickly; but
when protected by the injection of selected cells from
young mice, the same dosage levels of virulent orga-
nisms are not lethal and the mice live on for several
more months with this “acquired immunity.” Similarly
in experiments in which the thymus gland of a young
mouse is transplanted to an older mouse, along with
bone marrow cells and the spleen, the recipient’s ability
to combat infections and live longer is enhanced. A
comparable effect has been produced by extracting a
hormone, Thymosin, from the thymus glands of young
mice and injecting it into older mice. The importance
of this hormone in man is as yet unknown, but it has
been reported that the level of Thymosin decreases sig-
nificantly during the middle years of life and thus may
set the stage for the initiation of the aging process.

(3) Experiments with rats and mice have demon-
strated that sharply reducing their caloric intake
throughout their early life will enable them to live as
much as 30 to 50 percent longer. The implications of
such findings for humans is uncertain. It has been
noted that persons surviving to very old age are usually
lean and have generally been moderate throughout life
in their dietary intake, but extrapolation from such
meager data is not sound.

(4) Dietary experiments have also been carried out
involving the use of additives of varying types. The ad-
dition of antioxidants in order to combat “free radicals”
within the body cells is a method that has been used by
a number of researchers. The “‘free radicals” are frag-
ments of molecules which are thought to combine in
deleterious ways with other intracellular elements and
thus cause cell aging. The addition of an antioxidant
such as vitamin E has been tried in an experiment in-
volving mice, but it had no effect on lifespan. Other an-
tioxidants have been tested in a similar fashion and
several have resulted in extending life. One of these
tested, dimethylaminoethanol, prolonged life by as
much as 40 percent when fed to young mice. None of
the chemicals tested in this fashion have as yet been
used for trials in humans, although it is not unlikely
that such a trial could be carried out in the near future.

(5) Scientists have developed new techniques to
study aging which permit greater insight into the proc-

20

esses involved. The most significant of the new tech-
niques involved that of studying cell behaviour in the
laboratory. With the ability to grow generation after
generation of cells derived from human or animal
tissues, scientists can undertake a wide variety of ex-
periments which had previously been impractical or
impossible. Without presenting a comprehensive
review of the field of molecular biology it is difficult to
appreciate the substantial accomplishments which have
followed. Two brief statements will hopefully provide
some insight into this area:

(5a) The discovery by Dr. Leonard Hayflick in 1961
was a milestone; namely, that normal cells grown in
laboratory culture systems have a finite capacity for
reproduction before they deteriorate, show changes
characteristic of aging, and die. Prior to his now classic
experiments it was assumed that cell lines could be
maintained indefinitely in the laboratory, provided the
proper nutrients were supplied and provided that the
environment was carefully controlled. Dr. Hayflick not
only demonstrated the fallibility of this assumption, but
also showed, along with other experimenters, that the
capacity for cell division varies with the species in-
volved and is related to the longevity of the species.
Thus the longer the species lifespan, the greater the
number of cell divisions before death occurs.

The underlying implications of Hayflick’s findings
are indeed substantial. We may well possess within our
body cells a “biological clock,” genetically preset,
which determines maximum age. If so, it may be possi-
ble, using normal human cell systems, to discover ways
to safely alter the rate of aging within the cell without
having to understand the basic cause(s) of the changes
which occur with aging. This could greatly facilitate the
discovery of an antiaging agent or technique.

(5b) The technology has been developed to study in
exquisite detail the inner workings of the cell, including
its genetic material. Just how complex the processes are
can be appreciated by contemplating Dr. Samuel
Goldstein’s description of the role of genetic factors
within the cell. ‘““Every cellular component, whether it
is the surface of cytoplasmic receptor for a drug, hor-
mone, or nutrient, an enzyme, or a structural compo-
nent, is coded for by genes. The same applies to other
gene factors exported from cells, including hormones
and interstitial factors such as collagen and related
ground substances that heretofore had been regarded as

 

4Hayflick, L., & Moorhead! P. S. The serial cultivation of human
diploid cell strains. Experimental Cell Research, 1961, 25, 585-621.

 
'' 

informationally inert.”5 These new techniques involv-
ing normal cell culture lines, microanalysis, electron

microscopy, and genetic manipulation have fostered the

development of a new area of gerontological research
which Dr. Hayflick has termed ‘“‘cytogerontology,”
meaning the study of the aging processes in cultured
cells. The cell is, according to Hayflick, “. .. where the
gerontological action lies.”

Theories of Aging

From the expanded research permitted by the
development of these approaches over the past several
decades, a host of clues to aging have emerged which
have led to the development of several theories as to
cause(s). The major theories now being tested include
Hayflick’s concept that lifespan is limited by a “biologi-
cal clock” within the cell which permits a finite number
of cell divisions before deterioration sets in and cell
death occurs; a genetic program within the cells which
“runs out” and ceases to provide information to the
cellular components, thus causing disorganization and
malfunction; and an “error” theory which says that
mistakes occur at a low rate throughout the life of a cell
and their accumulation reaches a lethal threshold.

Which theory will prove to be correct is, at this stage,
relatively unimportant. What is of significance is that
the field of gerontology has advanced to a stage where a
theoretical framework has been formulated for its
future research efforts. With a theoretical framework,
based on a substantial body of experimental data, and
with a highly sophisticated technology, we seem to be in
a position to move rapidly towards fulfilling man’s age-
old dream of extending life.

The Low Priority of Aging Research

When one examines the resources being allotted to
the field today, it is quickly apparent that aging research
is a relatively low priority at the national level.6 We will
have spent, depending on how one defines the field,
between $15 and $25 million during fiscal year 1975 on
gerontological research. It has been estimated that we
spend 2 dollars in cancer research for every 3 cents
spent in research on aging. This disparity is due in part
to the relative newness of gerontology as a special field
of interest. It is due also to the absence of major public
support groups, such as the National Cancer Society or

5Goldstein, S. Biological aging: An essentially normal process.
Journal of the American Medical Association, 1974, 230, No. 12, 1651.

6Hayflick, L. The strategy of senescence. Gerontologist, 1974, 1/4,
No. 1, 39.

the American Heart Association, who, along with
leaders from the professional organizations within these
fields, lobby effectively for the limited funds available
from both public and private sources.

Another factor is that aging characteristically has
been viewed as an inevitable consequence of living and
not subject to attack in the same fashion that enabled us
to eliminate polio and other communicable diseases.
Only within the past 5 years have we begun to hear ex-
perts voice the opinion that aging, although a normal
physiological process, can someday in the not too dis-
tant future be deferred or even perhaps eliminated.
Some of these statements are noteworthy because they
constitute unique appraisals of the field of aging, or
they express expert views of what our goals should be,
how successful we may be in our endeavors, and when
a significant breakthrough may occur

For example, Dr. Nathan Shock, Director of
the Gerontology Research Center of the National
Institute on Aging, recently stated “We are not in-
terested in our laboratory in increasing the life-
span. I don’t buy that as a legitimate goal. I’d
rather make the years that we have into good
years.”’7

Dr. Leonard Hayflick has said ‘“The goal that
appears to be not only more desirable, but indeed
more attainable, is not the extension of longevity
per se, but the extension of our most vigorous and
productive years.’’8

Dr. Alexander Comfort, former director of the
Research Group in Aging of University College
of London, has commented “The aging process
can be slowed down,’’? seeming to suggest that
not only would the middle vigorous years of life
be extended but also that the lifespan would be
increased in the process.

Dr. Ivan Asimov suggests that by understand-
ing the biochemical and biophysical process, we
may by the year 2000 “. . . face a future society in
which men and women will routinely live to be
over 100, perhaps far beyond 100.”!9 Others in
this field are even more optimistic as to what can
be accomplished.

7Reported in a column by Victor Cohn, Washington Post, March
16, 1975, p. C-2.

8Hayflick, L. 1974, op cit.

9Comfort A. We know the aging process can be slowed down. The
Center Eclectics, No. 11, 1974. Center for the Study of Democratic In-
stitutions, Santa Barbara.

10Cohn, V., 1975, op cit.

 
'' 

Pierre Auer of France has said, ‘““Death may be
a manipulable genetic characteristic.”!!

Dr. Bernard Strehler of the University of
Southern California has been quoted as saying
“Someday we may live indefinitely.”!2 It is ob-
vious that Dr. Strehler does not hold the view ex-
pressed by one skeptic Dr. Sobel, who said “Man
will, if present research trends continue, be able
to live for 300 years, 50 years of virility and 250
years of senility’’!3 for Strehler says “. . . there is
no way to appreciably increase the lifespan except
by improving the body’s physical state.”

As to the probability of success, there is sub-
stantial agreement among the experts. Dr.
Hayflick has said “The notion that the biology of
senescence is too vastly complex to yield to ex-
perimentation is, I believe, a myth.” !4

Dr. Alexander Comfort has predicted the
probability of a breakthrough as being “. . . one
hundred percent, given the time and resources,”
and “...
altering the rate of aging before we get the theo-
ry.” On the timing of the breakthrough, he said

we shall probably get the method of

that by 1990 “. .. we will know of an experimen-
tal way of slowing down age changes in man that
offers an increase of 20% in lifespan.”!5

Given these perspectives, it seems that at this
juncture we should seriously consider altering our na-
tional priorities to provide the funding necessary to en-
sure a reasonable chance of fulfilling man’s age-old
dream. How can this best be done? Should we, as has
been suggested, establish the extension of the lifespan
as a national goal for the year 2000?

Adopting a National Goal

The process of establishing a national goal is much
more complex than generally recognized. It usually re-
quires a coalition of outstanding leadership, strong
political support, the presence of strong vested interests,
a constellation of pressures which combine to cause
substantial public support, the economic wherewithal,
and in those few instances which have involved science,
the existence of a capability which can reasonably be
expected to lead to a successful outcome. Thus in the

'1Cohn, V., 1975, op cit.
'2Cohn, V., 1975, op cit.

13Sobel, H. In E. Palmore & F. Jeffers (Eds.). Prediction of life span:

Recent Findings. Lexington, Mass.: D.C. Heath, 1971, p. 275.
\4Hayflick, L. 1974, op cit.
'5Comfort, A., 1974, op cit.

instance of the space program we had the leadership of
President Kennedy, the public appreciation which had
been heightened by desire to outdo the Russians, the
political support stimulated by the vested interest
groups, and the underlying scientific capability.

Obviously not every element is required before a
goal can be adopted, as witnessed by the Manhattan
project initiated just prior to the outbreak of World War
II. National Health Insurance is an example of a
seemingly desirable national goal which we have con-
sistently failed to adopt, in spite of substantial public
support, economic wherewithal, and technical
capability. The lack of outstanding leadership, the lack
of strong political support, and the presence of powerful
vested interest opposition have been more than enough
to preclude its adoption.

What then would be involved in adopting the exten-
sion of the lifespan as a goal for the year 2000? A prime
requisite would be the presence of outstanding national
leadership. Without it sufficient public support will be
lacking. The leadership may come from an individual,
such as a national political figure, or from an organiza-
tion. (The National Polio Foundation comes to mind as
an example of organizational leadership, although the
conquest of polio had the added advantage of President
Roosevelt’s personal interest and support.) A more
remote possibility is that the “leadership” would come
from industry.

A second prerequisite would be creation of substan-
tial public support. How easy this would be to obtain is
difficult to assess. My own experience in discussing this
issue with groups of scientists and academicians during
the past 3 years leads me to believe that widespread
public acceptance can be obtained. There are, however,
ethical and social issues to be considered.

Ethical Issues

One of the ethical issues certain to be raised is
whether it is right for man to alter life processes in such
a profound fashion. It can be anticipated that
philosophers will present a range of opinions on this
issue. Yet it would seem for the most part that our
society, and Western societies in general, have accepted
medical intervention for the improvement of health and
the preservation of life as a part of their ethos. Paradox-

ically, this view is so widely accepted that we are now,

because of technical innovations, confronted with the
ethical issue in dealing with terminally ill patients of
their “right to die.” An extension of that ethical issue
would no doubt arise in the future if the life-extending
process were to involve an irreversible change such as a

 

 
'' 

 

  

surgical procedure in early adulthood, or an alteration
of the genetic coding instructions within the cells.
Would euthanasia be available in later life, if desired?
To whom, and under what circumstances? This issue
would not arise if the life-extending process were to be
not only voluntary but controllable by the individual,
such as would be the case if one were to take pills each
day.

A somewhat different ethical issue would present it-
self initially. Are we justified in adopting extension of
the lifespan as a national goal in view of our current
domestic and international problems? It seems certain
that arguments will be advanced that adoption of such a
goal would be unethical—because of the potential im-
pact on world population; because of the need to
enhance the quality of life for today’s elderly before
reaching for a new goal involving aging; because of the
serious disruption to health care services in the future;
and so on. The reasoning would be that a society must
solve its existing ills before taking an action which
could produce new problems.

But societies, as we know, do not operate in this
fashion, and it would be no more unethical to adopt life

extension as a national goal than one calling for a per-
manent Earth colony to be located on the Moon. More
appropriate would be such concerns as, How much of
our resources should we commit? What changes would
these resource commitments generate? What types of
changes would be expected in the future with respect to
the individual, the family, and society?

Changes in Biomedical Research Programs

If life extension were to be adopted as a national
goal, the most immediate changes would involve our
current biomedical programs with respect to research
and training programs. We have in recent years sub-
stantially increased the funding for research and train-
ing related to the first three causes of death—diseases of
the heart, malignant neoplasms, and cerebrovascular
accidents. Our funding in these three areas accounts for
almost 50 percent of our current total health research
investment, but in terms of what is spent on health care
services (as estimated $94 billion in 1973), it is a fairly
modest amount. To have a reasonable chance of reach-
ing the goal by the year 2000, it may be necessary to ex-
pend as much as $25 billion in total, or slightly less than
the amount spent by the space agency in its program to
put man on the Moon.

Could we expend funds at this level and not adverse-
ly effect the efforts to discover causes of heart disease,
cancer, and stroke? It seems doubtful that both efforts

 

could be sustained at such high levels, especially during
the early years—not from the point of view of impact on
the national budget, but because we are limited largely
by the availability of qualified persons to conduct the
necessary research. Many of the persons now involved
in cancer and cardiovascular research would be the
very ones most needed in the new effort. It would
therefore be essential in the early phases to underwrite a
very substantial training program, beginning at the col-
lege level and extending through pre- and postdoctoral
levels. Only through substantial investment, perhaps as
much as $5 billion over the next 10 to 20 years, could
enough personnel become available to implement the
research program at an optimal level.

To minimize the disruption in both research and
training, an assessment of our resource allocation
would be required which would permit a redefinition of
priorities in light of the new goal; the identification of
current programs and projects which fit within the new
scheme of priorities; the exposition of areas requiring
research effort; the definition of short- and long-range
manpower requirements; the matching up of
capabilities and interests of organizations and _in-
dividuals with the tasks to be performed; and the in-
stitution of a management system which would couple
an appropriate degree of monitoring sensitivity with the
capability for periodic reassessment and redefinition of
tasks.

Human Trials and Ethical Problems

 

One special aspect of the experimental phase is wor-
thy of note. It seems almost certain, as the research
programs expand and the efforts to determine cause(s)
of aging intensify, that one or more developments will
occur which will suggest the feasibility of human trials
even though the basic cause(s) of aging has not been
determined. As a result of cell culture studies, and of
trials in one or more short-lived species of animals, an
agent or technique (relatively nontoxic) will be
demonstrated to prolong life. Are there any ethical
issues to be resolved before undertaking long-term
clinical trials in a selected population of humans?

No matter how many tissue cell lines are used, no
matter how many mice, rats, guinea pigs, dogs, and
chimpanzees will have been used in testing efficacy and
safety, we will be confronted with not knowing how safe
or how effective the approach will be when applied to
humans. The same, of course, is true today with regard
to all new drugs, but here we are generally dealing with
pathological conditions, and usually ones which will not
require long-term administration, or we are dealing
with conditions where the drug used will not produce

 
''an effect which may last for the remainder of the per-
son’s life. But in extending the lifespan we will be at-
tempting to alter a normal physiological process, either
by a one-time irreversible process or by administration
of an agent over a prolonged period of time, perhaps the
remainder of the person’s life.

How will we select persons to be included in the in-
itial trials?’ Much will depend on the nature of the data
derived from tissue studies and animal trials. If the data
show that the method extends life even when first used
late in the lifespan, we would be able to minimize the
risk in human studies. We would first test the method
in persons age 75 or more, and as experience war-
ranted, we would gradually reduce the age of entry into
the test group in a stepwise fashion. Each new age
group would then be followed carefully to determine
that the only significant change was a decrease in the
rate of aging. All other physiological processes, includ-
ing those involved in reproduction, should remain nor-
mal and there should be no unusual incidence of
tumors or other pathological processes.

If, however, animal data suggested that benefits
could only be obtained if treatment were instituted in
early adulthood, a different approach would need to be
used. Then indeed there would be some thorny issues.
Could we ethically recruit volunteers when the risks
would be so poorly defined and the benefits so long
deferred? This would be quite unlike the trial, say, of
oral contraceptives, where long-term risk was un-
defined, but where the short-term benefits were highly
desirable to the participants.

Even if we could recruit sufficient volunteers, we
might be faced with the difficult problem of maintain-
ing their interest in participation over the long period
required. Especially difficult would be to ensure com-
pliance if daily medication were to be involved. Could
we ethically in this instance offer any additional incen-
tives without beclouding the risk issues? Would we be
justified in encouraging the use of special groups such
as prisoners, to overcome some of the methodological
problems? Would we be forced to again start testing
with the 75-year-old persons and gradually work down
to the age groups most apt to benefit, in order that safety
could be assured? If so, how could we justify exposure
of participants to unknown risks when there would be
no reasonable expectation of benefits for the in-
dividual?

In the event a surgical procedure were involved,
such as the implantation of crystals into the tem-
perature regulating center of the body, no social con-
trols exist today comparable to the controls developed

24

in the field of drugs. No institutional review programs
exist in hospitals, medical schools, or large clinics to
review in advance whether the new procedure to be
tested is appropriate, or whether adequate safeguards
for protecting the rights of the individual have been
provided for. This is also an issue which would have to
be resolved.

If the agent proposed for trial were a chemical, then
the approval of the U.S. Food and Drug Adminstration
would be required before any clinical trials could take
place. FDA requirements call for proof of safety and
efficacy through animal experimentation. Once these
minimal requirements are met, an exemption from the
new drug regulations is issued (Investigational New
Drug Approval, or IND) which permits the trial to be
started on humans. In the normal course of events, with
successful completion of the trial, an approval from
FDA could be obtained by a private firm, without
awareness of this fact on the part of the scientific com-
munity or the general public. A handful of overbur-
dened medical officers, pharmacologists, and chemists
in FDA could make a decision which would have in-
estimable effects upon future societies.

Is this FDA process any longer adequate? Must we
not be concerned with more than safety and efficacy?
Should we not at an early point involve a broader
spectrum of the scientific community? If an effective
method is perceived as being probable, should there not
be provision for consideration by social scientists,
politicians, ethicists, and theologians? It has been my
concern for almost a decade that our present system is
inadequate to appropriately assess the highly sophisti-
cated drugs and devices being developed by the scien-
tific community. The existence today of a valid In-
vestigational New Drug Exemption to permit assess-
ment of an agent with potential for life extension adds
considerably to my concern for the adequacy of the
system. Should this not be the occasion for a reappraisal
of the FDA’s role?

One final note of caution concerning the human
trials needed to demonstrate safety—the numbers of
participants needed would be very substantial. This is
related to the need to detect changes in the rate of oc-
currence of rare events, such as malignant tumors or
diabetes, in order to properly assess safety. It would be
even more important that all foreseeable precautions
were taken at the outset, and that the utmost efforts
were made to ensure proper followup throughout the
trial. Finally, we would need to accept at the outset the
possibility that some of the participants would be ad-
versely affected. Should we not be prepared to provide

 

 
'' 

  

appropriate compensatory benefits? How this could be
done without unduly influencing the judgments of po-
tential volunteers is another unresearched issue.

The Aftermath

Successful conclusion of the research phase, and
validation of a method to defer aging, will create a new
problem and many important social issues will arise. If
one assumes usage by those age 40 and over, and if one
assumes that optimum benefits, in terms of number of
years by which life will be expanded, would decline ac-
cording to the age at which use is initiated, then it is ap-
parent there will be a lag period between introduction
of an agent or technique and the time of maximum im-
pact as measured by survivors in the population. The
precise period of time will be a function of the rate
change generated by the agent and extent to which it is
utilized. However, it would not be unreasonable to
assume that the minimum time available for adjust-
ment would be roughly 40 years. At first blush this
would seem to be more than adequate for even signifi-
cant social change to occur, but when one begins to
assess the nature and magnitude of changes that an age-
retarding agent would induce, 40 years may indeed be
grossly inadequate. What types of changes could
reasonably be expected to occur, and what social issues
would they generate?

The most obvious change would be the impact on
the population group over 65 years of age. The change
in lifespan by 20 to 25 percent (or 15 years on the
average) would markedly increase the proportion of
persons over 75 years of age, and it would noticeably
affect the numbers in the 65-74 age group. (Even with-
out any such antiaging treatment, the over-65 age group
in this country is expected to constitute approximately
15 percent of the population by the year 2040—this
assumes no improvements in death rates due to better
health habits or improved health services, and it
assumes a birth rate equal to that of 1972.)

With the increase in the over-65 age group, there
would be an increased demand for health and social
services. The magnitudes of these increases cannot be
specified with great precision, but they would be sub-
stantial. When we realize that today, in spite of our cur-
rent emphasis on acute rather than chronic health care,
some 27 percent of all health expenditures are made for
care of the elderly (now 10 percent of our population),
we can easily visualize what would be involved if there
were to be any significant lengthening of the lifespan. If
we are successful in the intervening years in developing
means of coping with chronic illnesses, in providing

adequate home health and social services, and in
developing a modicum of preventive services, it is not
unreasonable to assume that the health care industry
would become the major industry in our society if life
were to be extended by 20 to 25 percent. (This, despite
the desideratum advanced which stipulates that any
method of extending life is not worth developing unless
it extends the useful vigorous years, and not merely the
years of senility. )

The increased lifespan would require substantial ad-
Justments in retirement income programs of all types, if
adequate income levels are to be maintained. An in-
creased demand for housing of all types would occur as
the population expands; and if present trends towards
separate housing for the elderly continue, there would
be a substantial requirement for new construction after
the year 2040.

Less obvious are changes that might occur with
respect to family structure, life styles, especially with
respect to leisure time, educational patterns, work pat-
terns, and political processes. One could speculate that
with greater longevity assured, divorce might increase
and new partnerships might be formed after the end of
the child-rearing years. Multigenerational families, of
five generations would become more common. This
would pose new problems: What kinds of relationships
would exist between generations so greatly separated,
not only by years, but by life experiences? Life styles
would be expected to change markedly in response to
changes in work patterns and educational patterns. If,
as postulated, work weeks would be truncated, and two
or perhaps three careers would become the norm, then
education and leisure activities would assume greater
importance throughout life than they do today. With a
greater proportion of the population over 55 years of
age, one could reasonably expect that political proc-
esses would be biased towards the elderly. Beyond
these potential changes lie many others which would be
even more taxing upon our society.

The social issues which such changes would create
are even less predictable. What type of income distribu-
tion system would be necessary to accommodate the
varying needs and demands of the expanded society?
Could enough employment opportunities be generated
to permit the labor market to operate in essentially the
same fashion as it does today, or would we be forced to
some new system of job allocation with built-in require-
ments for periods of community service and reeduca-
tion, in. order to preserve some semblance of equity?
What could be done on an international basis to pre-
vent excessive population growth as usage of the anti-

 

 
'' 

agent agent? What could be done to foster a reallocation
of resources to minimize the possibility of nuclear
blackmail by the have-not nations? How could we alter
the “Protestant work ethic” to stimulate the intelligent
use of the increased amounts of leisure time available?
Would we adopt a permissive attitude towards
euthanasia for those who find the quality of life during
the extended years not worthwhile? Would use of the
life-extending technique be restricted, or available to
all? If restricted, how would we select those to benefit?
Would we consider it a privilege, as we do voting rights,
and deny it to any who commit felonies?

Others, more perceptive than I am with respect to
the social sciences, can enlarge upon the partial listing
of changes which might occur and the issues which
could arise. It is apparent even with this incomplete list-
ing that the disruptions to our society would be serious
unless appropriate measures were to be initiated at the

26

earliest signs of success derived from the limited human
trials.

How concerned should we be that the scientific en-
deavor now underway will be successful? When are we
likely to have our first trial of an agent or method on
humans, and when would we be likely to have the
method available for all? In my opinion, there is a high
probability of success. The indications are now that one
chemical currently under study could be tested within
the next 2 to 3 years if funds become available. Others
will certainly follow. The early efforts may fail, but if
we expand our research base and adopt the extension of
useful life as a national goal, it seems likely that by the
year 2000 we will have completed the initial trials in
humans and be on the threshold of accomplishing
man’s cherished dream. As for today, perhaps it is ap-
propriate to remember the advice given by Carlyle, who
said, ‘Our main business is not to see what lies dimly at
a distance, but to do what lies clearly at hand.”

 
'' 

Extension of the Active Life:
Ethical Issues

In order to write a fully satisfactory assessment of the
issues of ethics and human values that emerge from the
prospects for the extension of active life, some condi-
tions are necessary that cannot be met at this time. First,
insofar as a critical assessment is to be made of the
benefits and the deleterious consequences of the exten-
sion of active life, certain data needed for evaluation are
not readily available. One would need to know what
would be the actual consequences for individuals, for
particular societies, and for the human species. If such
information could be developed, there would be a bet-
ter factual basis in which to raise the more particular
ethical questions of what consequences are to be judged
to be of value, or of value to whom and for what. My
limited study of the literature available, and the hy-
pothetical character of much of that literature both
militate against accurate and precise analysis.

Second, while there is literature that makes evalua-
tive judgments about the consequences of life extension
and raises consciousness about the need for evaluative
studies of the consequences, neither moral philosophers
nor moral theologians have given much attention to this
arena. If one compares the amount of literature on
clinical medical problems as moral issues, for example,
with literature on social policy with reference to aging,
it is clear that both in its amount and in its degree of
sophistication the medical field is far ahead. Thus there
is little literature in relation to which these exploratory
efforts can be developed or assessed.

These limitations dictate that the present effort be
more formal and procedural than is desirable. Its basic
content is a clarification of questions and a develop-
ment of hypothetical arguments in favor of or against
proposals that are in themselves somewhat hypotheti-
cal. Some illustrative material will indicate how the
more formal issues could be developed with reference
to the extension of active life. Hopefully the reader will
find sufficient clarity to be able to engage in his or her
own revisions of the questions, criticisms of the argu-
ments proposed, and extension of the procedures to
other matters in the field of social gerontology.

James M. Gustafson

Ethical analysis is primarily concerned to explore
what reasons are given for choices, and particularly the
reasons that are moral in tone and character. It is con-
cerned to explore why someone might say, for example,
that to deter the rate of biological aging in humans is
the “right” thing to do, or is a “good” thing to do. What
would count as warrants for supporting the rightness or
the goodness of such activity? In a discussion of the ex-
tension of active life, it is quite apparent that a valuation
is already implied in the stipulation of the topic, namely
that “active” connotes something that is worthy,
whereas “inactive” suggests something that is not of
value. Thus the qualifier “active” seems to imply that
there would be reasons for not considering the
prolongation simply of human biological life itself as a
worthy purpose. “Active” suggests certain human
capacities that are either of value in themselves, or are
the conditions (and thus of instrumental value) for
realizing or achieving other values. Thus the principal
question of this paper can be stated as follows: What
reasons can be given to justify the extension of life in
conditions which make possible human “activity”?
That “active” and “activity” are susceptible to more
refined analysis in terms of their value-laden but am-
biguous weight I hope I have suggested. We will simply
presume that there is sufficient clarity about the con-
notations to proceed to develop three different types of
reasons that might be given in favor of life extension.

The three types of reasons are as follows:

1. Individual persons desire to live as long as it is
possible for them to be active.

. Society would benefit from having a larger num-
ber of individuals live longer active lives.

. Individuals have a moral right to live as long as
possible in conditions that insure activity.

In the course of the elaboration of these reasons I shall
note difficulties involved in each, and also the sorts of
arguments that might counter them.

 

 
'' 

A delineation of limits or perimeters to the expectan-
cy of life that is assumed in the following parts of the
paper is necessary. For purposes of this paper we will
assume what are reasonable expectations with
reference to the coming decades, and not speculate
upon more imaginative prospects. The assumption is
that persons will be able to live actively for 3 to 5 years
more than has been the case in the immediate past, and
with the same extent and severity of disabilities in the
last few years of life that now occur. Stated differently,
we are working on the assumption that persons at the
ages of 78 or 80 will have the same level of vigor and
function of capacities as is normal for persons at the age
of 75 at the present time. As noted, this assumption
seems to be a reasonable one with reference to the next
decades on the basis of projections by demographers.

|. Life Extension Is Desirable to
Individuals.

This reason for extending active life, like the other
two reasons that will be analyzed, has imbedded in it
certain ethical and practical difficulties when it is
spelled out in terms of a social policy. We begin with
what will be presumed to be a generally valid empirical
statement: Individual persons desire to live as long as it
is possible for them to be active. This empirical state-
ment becomes one premise for a social policy. Because
individuals desire to live longer, research, social policy,
and relevant resources ought to be developed to extend
the period of active life. Briefly, what is involved can be

seen in the following form:

a. Individuals desire to extend their active lives.
b. The desires of individuals are the basis for what is
good or valuable.
c. Therefore it is good or valuable to have active life
extended.
. Therefore research, policies, and resources ought
to be developed to extend active life.

One important assumption to be noted is that the
basis for determining both what is “good” to do, and
what ought to be done, is the desires of individuals.
What is desirable for individuals is good or valuable.
Here we confront two complications worthy of note.
First, persons in the history of Western ethics who have
thought in these terms have had to find ways to dis-
tinguish between an “apparent” good for an individual,
and a “real” good. For example, an aging person might
desire to eat all the rich foods that he or she can, or
might desire to engage in as much strenuous exercise as
possible. To do so, however, might be only apparently

28

good, for each of these activities might create grave
threats to health. Health would be judged to be a “real”
good; at least it would have a more fundamental posi-
tion in an ordering of values than the pleasures of rich
food or strenuous exercise. The general point to be
noted is that to ground values in desires requires a proc-
ess of determining which desires are more worthy of
fulfillment than others, or even which are “essential” to
active life, and which are optional.

The second complication is readily noted when ac-
count is taken of the social and even natural context in
which desires are to be fulfilled. The words “good” or
“valuable” invite the questions, “Good for whom?” and
“Good for what?” Good, or value, it can be argued, is
always in relation to some person, or some community,
or even in relation to the natural world. What is good
(fulfills the desires) of one individual might be in con-
flict with what is good for another individual. Prolonga-
tion of active life of a person might not be beneficial to
members of that person’s family, or to a community in
which there are limited resources available for the
fulfillment of the desires of all individuals. Indeed,
prolongation might not be good for the human species
as a biological class. To introduce this complication is
to force recognition of the necessity of a distributive prin-
ciple in reasoning about policy. When the desires of all
cannot be fulfilled, some principles and procedures
need to be introduced that help to determine how the
resources available can be distributed justly or fairly
among all whose desires make claims upon them.

From these two complications we see the need for
more generalized principles to sort out, if not to resolve,
the ambiguities that are confronted. With reference to
the need to order desires, or goods, or values, some
might argue that the crucial factor is power, or capacity
to purchase or in other ways secure what fulfills desires.
Thus, for example, an individual who desires health
and has the economic means to secure health care is the
person who properly has access to it, while the person
without those means has no right to it. While this of-
fends the moral sensibilities of many persons, desire
plus power has usually been crucial in determining
whose desires are fulfilled.

Others might argue that social custom determines
not only whose desires are to be fulfilled, but what
desires have priority. For example, if one lives in a
society that is generally “‘youth oriented,” advanced age
itself becomes a disqualifying factor in determining
whose desires shall be met. Or, if one lives in a society
that has determined that high quality health care for all
citizens takes priority over the desire of some to enjoy

 
'' 

winter vacations in Spain, ramifications for public
policy follow. Others might argue that the ordering of
desires, or of values, must be grounded in the ontologi-
cal structure of the human. Thus on the basis of
philosophical reflection about what constitutes the
“truly” human, the “really” human, one can come to
some ordering of values to be realized for persons. One
would, in effect, determine what “goods” are really
good and therefore necessary; what “goods” are not
necessary, but nonetheless worthy of pursuit if
resources are available; and what desires are only “‘ap-
parently” good.

With reference to the need for a distributive princi-
ple (and the two complications overlap, as has already
become apparent), various delineations of the concept
of distributive justice would be invoked. Some would
argue that justice requires that each individual has a
right to fulfill his or her desires until the fulfillment in-
fringes upon the right of others to fulfill their desires.
Since, in social experience, this comes quickly, the
practical task of justice is to determine the proper limits
to free pursuit of individual desires. Others would
argue that equals shall be treated equally, and that those
who are equal to each other are those who have the
same needs. “The same needs” requires further
specification in the reality of social experience; some
would then argue that a judgment has to be made about
which human needs are more basic. Those that are
basic ought to be fulfilled for all individuals. Thus, for
example, what constitutes proper health care ought to
be provided to all aging persons, but what constitutes
desirable recreational opportunities might be second-
ary, or at least might be optional with reference to the
desires for recreation that different individuals have.
Further permutations on distributive justice can be left
to the reflections of the reader.

A further difficulty in working out this first reason is
seen in the multivalent or multidimensional character
of certain crucial terms that are used to simplify the
basic thrust. Aristotle, for example, judged that what all
persons desire as an end in itself, and not as a means to
any other end, is happiness. Others have used the no-
tion of fulfillment. The extension of active life, as I have
indicated, already suggests that extension of biological
life is not an end in itself; it provides a necessary condi-
tion for the realization of other desires or values.
Presumably happiness would be one of these. Both hap-
piness and fulfillment are multivalent or multidimen-
sional concepts when they are carefully formulated. In
order to provide more specific justification for extend-
ing life in order to pursue happiness, these complica-
tions need to be taken into account. Clearly the condi-

29

tions that make one individual happy are not
necessarily the same as those which make another per-
son happy. I take it that social policy is directed to pro-
viding those conditions. If the final end of a policy is to
prolong the pursuit or the realization of a state of happi-
ness, the proximate ends must be plural. Some persons
will be happy if they can live their aging years in the
company of the younger generations of their families;
others desire greater solitude and greater distance from
families. Some persons will be fulfilled if they can con-
tinue in their vocations or professions as long as they
have the capacities to do so; others find happiness in the
opportunity to engage in activities deferred by their
preoccupation with work during their earlier lives. For
some persons the extension of physical pleasures is a
major element in their happiness; for others a richness
of cultural life is more important.

Proposals for social policy necessarily are based
upon generalizations about what significant numbers of
persons desire. The limitations of resources dictate that
variations in provision of conditions deemed necessary
for happiness be limited. It is not unreasonable to note
that a principle of utility frequently is invoked at this
juncture. The social policies that ought to be pursued
are those that will provide the conditions for the greatest
amount of happiness for the greatest number of per-
sons. The difficulties frequently pointed to with
reference to utilitarian ethics pertain here quite aptly.
The major one is that a quantification of an elusive
quality—happiness—is required to provide more ac-
ceptable reasons for particular choices.

It is not my intention to make an overall judgment
about the adequacy or inadequacy of the first reason for
the prolongation of active life. In our culture, which has
cherished as central the value of individuals, and has
organized both law and social life along the principle
that persons ought to have the maximum possibilities to
pursue their individual desires, this reason for life ex-
tension comes almost “naturally” to mind. The com-
plications I have suggested are in no sense novel, but
the delineation of them might be of practical signifi-
cance to persons who choose to develop policy pri-
marily on the basis of this reason.

ll. Society Would Benefit

The second reason noted for the extension of life is
as follows: Society would benefit from having a larger
number of individuals live longer, active lives. Note the
predictive aspect of this: society would benefit. The em-
pirical generalization involved in the first reason is no
doubt more valid than is the predictive generalization
'' 

involved in this second, for its validity is more suscepti-
ble to empirical verification. This second reason is
based upon prediction of social consequences, and
therefore has greater uncertainty. Both reasons involve
judgments about the value of certain consequences.
One could at least turn the first reason into a statement
that the prolongation of active life is likely to lead to
greater, for example, happiness. The consequences of
happiness function to support the proposal to prolong
life. In the second reason judgments of the conse-
quences are made with reference to what is good, or of
value, for society. The first had its grounding in the
desires of individuals; the second is grounded in what is
“desirable’’ for society.

Briefly, what is involved can be seen in the following
form:

a. Society would benefit from having a larger num-
ber of individuals live longer, active lives.

b. The benefits to society are the basis for what
ought to be done with reference to individuals.

c. Therefore it is good to have active life of in-
dividuals extended.

d. Therefore research, policies, and resources ought
to be developed to extend active life.

One important assumption to be noted is that the
utility or instrumental value of individuals to society
determines what ought to be done with reference to
them. The “collective” good, or the “common” good,
or the good of society is of prior value to the good of in-
dividuals. Taken in its starkest form, this reason runs
counter to the maxim that persons are to be treated as
ends in themselves, and not as means to other ends. To
deprive the society or community of potential benefits
to itself by not extending active life would be wrong.

Two complications of this second reason have been
briefly noted, and now require more development. The
first is that the prediction has not been established
by sufficient evidence to permit it to
carry the weight that it must. Consensus could be
established that the extension of the active lives of cer-
tain individuals might benefit society—the care of a
vigorous genius whose research or ideas contribute to
the cause of health or justice in a society in some im-
mediate or direct way would raise no question. One
could with greater ease than in the case of a person of
less social significance make a rough “cost/benefit”
calculation that would come out on the affirmative side
of the equation. The quality and quantity of benefits
could be roughly adduced, because relative to the or-
dinary person they would be palpably greater. It is not

30

so clear that the same sort of argument could be made
for the majority of aging persons.

Another aspect of the prediction problem pertains to
what society or what community a policy has in mind
when it judges benefits. If one were to suggest that the
most universal human group, the species homo sapiens, is
the proper object of concern, one would have to justify
the policy in terms of contributions to the survival of the
species, as well as the biologically qualitative charac-
teristics of the species that survives. To establish this
would require a considerable amount of biological
research, extrapolating from the known to the predicta-
ble, and then turning back from the predictable to its
implications for policy.

If one were to suggest that a particular nation/state is
the proper object of concern, a large number of conse-
quences would have to be brought into consideration.
The good of a nation is multidimensional or
multivalent. Consequences for economic growth and
stability would have to be calculated; consequences for
allocation of resources, and particularly allocation be-
tween distinguishable age groups would have to be pre-
dicted. Some judgments about the social dislocations
and the political effects would have to be made.
(Further suggestions are unnecessary to indicate what
would be involved for a nation/state.) Pari passu, the
same process pertains to judgments about ethnic
groups, families, neighborhoods, professions, friends,
and so forth. The best possible factual evidences for po-
tential consequences would have to be adduced in
order to make the strongest possible case.

The second difficulty can be stated in the form of a
question. What constitutes benefits for society? A
historic and knotty issue comes to mind immediately.
Does one think of benefits for society in terms of a con-
cept of the common good which in effect claims that the
common good is the sum of the beneficial effects of in-
dividuals pursuing their own goods and desires? Or
does one think of the common good as the good of the
community as a whole, in such a way that the common
good requires an ordered distribution of the goods of in-
dividuals, and in some instances the elimination of cer-
tain individuals for the sake of the common good? It
makes a difference whether an affirmative answer is
given to the first or the second of these questions about
the meaning of the common good. If one affirms that
the common good is the sum of individual contribu-
tions, then whatever the extension of active life that
would permit the continuation of benefits by in-
dividuals would contribute to the good of society. If,
however, one affirms that the common good is the good
of the whole and that it must be determined whether

 
'' 

that common good is being enhanced by the extension
of active life, it is likely that the extension of the active
life of all members of the society would not be justified.

There is a further difficulty in judging what con-
stitutes benefits to society. In contemporary technologi-
cal societies it is easy to slip into the assumption that
benefits are to be judged in terms of contributions to
productivity and other aspects of the economy. Persons
contribute to society by their capacities to produce. Lit-
tle reflection is required, however, to grasp the limita-
tions of this notion of social benefits. Society benefits
from the capacities of persons to render social services
that might not make significant contributions to
economic growth or economic stability. Society benefits
from contributions to its cultural life, to the quality of
interpersonal relationships that exist, to the richness of
its symbolic and “spiritual” life. Specification of the
kinds of activities that would be beneficial to society
would be required if a strong argument were to be sus-
tained. Since the benefits are not likely to be easily
comparable or commensurable, the calculations and
the assessments of their significance will be rather loose
and more inconclusive than is desirable.

In comparing the first and second reasons for life ex-
tension the decisive significance of a basic moral choice
becomes clear. The choice is between the domination
of the valuation of individuals, their desires, and their
freedom, on the one hand, and the domination of the
valuation of societies or communities, their “common
good” and their requisite restraints upon individual
desires and freedom, on the other hand. An illustration
of this will make the point clearer. Physicians engaged
in the treatment of aging persons have what Paul
Ramsey calls a ‘“‘covenant relationship” with individual
patients. Their discerned obligation is to enable the pa-
tient to survive in the best possible health for the longest
possible time. Medical care locates the dominant value
in individuals. One would be surprised to find a physi-
cian refusing to treat an aging person because his or her
continuation of life would be detrimental to the survival
of the species. Population geneticists and other
biologists, in contrast, think of benefits in terms of sur-
vival of the species. They are more prone to consider
the survival of individuals in the context of the conse-
quences for the species as a whole. While it is possible
in theory to overcome the tensions between these two
primacies of valuation, in practical policy formation the
tensions are not resolvable.

Practical policy proposals in the area of aging as in
other areas are frequently buttressed by mixed argu-
ments; persons will argue that both extreme positions
can be properly defended and that each carries some

“grain of truth.” In effect, then, as the argument for a
policy is developed one finds tolerable compromises, or
“trade-offs” which take into account both poles. (Ab-
sence of consciousness of the use of mixed arguments,
however, sometimes leads to “rationalizations” in the
worst sense for impulsive or intuitive moral responses.
Persons, to justify their policy preferences, occasionally
argue from whichever starting point seems to give them
the greatest support in particular circumstances. )

As in the discussion of the first reason, I have in-
troduced no novel ethical considerations, but have at-
tempted to indicate the soft points in this second reason
for extending the active life.

lll. Individuals Have a Right To Live as
Long as Possible

The third reason for life extension invokes a very
different language and a different basic concept. In-
dividuals have a moral right to live as long as possible in
conditions that insure activity. The ground reason is not
the desires of individuals, nor the benefits for society. It
is stated as a right. While there was an “empirical”
premise in the argument that developed from the first
reason, and a predictive empirical premise in the sec-
ond, the statement of a right is not subject to the same
tests of validity; it is not verifiable in the same way. The
reason for life extension is not conditioned by conse-
quences either to individuals or to society. Indeed, it is
awkward on the face of it to introduce the language of
instrumental values. Individuals are, in this reason, in-
herently valuable; simply because they are human
beings they ought be treated as ends rather than as
means to other ends. The major premise is clear and
forthright:

a. Inherent in being a member of the human species
is the right to life, which includes the right to live
as long as possible.

. Aging persons are members of the human
species.

. Therefore the conditions which permit them to
extend their lives ought to be developed.

Similar arguments are made with reference to clini-
cal decisions in medical care. For example, there are
those who argue that a terminally ill patient ought to
receive whatever therapy medical science and tech-
nology can provide, even if it requires “heroic” pro-
cedures, on the grounds that humans have a right to
have their lives preserved. (It should be noted that no
significant moral philosophers or moral theologians

 

 
'' 

argue in this way; even the most conservative Roman
Catholic theologians distinguish between ordinary and
extraordinary means for the prolongation of life. Some
physicians, however, act as if there was an inherent
right to prolongation regardless of the consequences for
the “quality” of life of the patient.) There are those who
argue that radically defective newborns have a right to
every possible medical intervention to preserve their
lives, regardless of the incapacities with which they are
destined to live, simply because they are human in
biological parentage.

Clearly, if the grounds for the assertion of a right can
be defended, this argument is the strongest possible
argument for extending the active life. The grounds for
the assertion might be secular: (“There are natural
rights”); or they might be religious (“Rights are God-
given”). They might also be prudential: if one did not
assert that individuals have a right to the extension of
life, one would have grounded the value of life in the
quagmire of desires or social consequences or social
utility. Apart from the assertion of rights, the values of
individuals or of classes of individuals like the aging,
are instrumental or conditional. If they are instrumen-
tal or conditional, one is on an exceptionally slippery
slope. Rights are then conferred by others who deter-
mine the value of persons or age groups, and it is more
difficult to avoid great moral harm because of the va-
garies of those who have power to determine who has
rights.

To argue for the extension of active life from a
doctrine of rights, of course, does not avoid the problem
of conflicting rights, or of conflicts in the allocation of
resources when persons with equal rights compete for
scarce resources. Classic “triage” situations occur, for
example, in which persons with equal basic human
rights to life are competing for seriously limited
resources for survival. To use an expression found fre-

32

“

quently in Jewish literature on these situations, “one
man’s blood is not redder than another’s.” In the sight
of God each is of equal value. It is not important to
rehearse classic resolutions of such extreme situations,
and the reasons for alternative ones. The most frequent
resolution is that in extreme situations it is morally licit
to deny resources to some in order to save others, and
the others chosen to be saved are usually those who
would have greatest prospects for survival or greatest
utility value to the community, or both.

To extend life from 3 to 5 years does not place the
human race at the present time in a “lifeboat ethic”
situation, or in a triage situation. If, however, one sets
the claims of various groups within the context of
limited resources, and if age classifications are used to
group persons, the distributive question again emerges.
Those who have special interest in the rights of the
aging would need to make clear their grounds for either
equal treatment with other age groups, or for special
preference to the aging. If all age groups in society have
equal rights to resources for health and other benefits, is
there a good reason why the rights of the aging should
take any priority over the rights of other age groups?
Those who would argue this third reason, and whose
arguments would lead to preferential treatment for the
aging, would have to provide persuasive answers to the
question just posed.

Epilogue

Clearly my intention has not been to state and de-
fend a position with reference to the extension of active
life. I have attempted to make a relatively simple and
modest clarification of the issues that must be faced in
defending policies in favor of life extension. I hope this
paper is quickly superseded by work that is both more
learned in the literature about social gerontology and by
more sophisticated ethical analysis and arguments.

 
'' 

 

Treating Aging: Restructuring the

We all grow older in the sense of acquiring a longer
personal history. We are temporal beings extended
through time. Some of us are aging also in the sense of
losing vigor and capabilities as a result of diseases and
injuries, as well as a result of an internal loss of power.
There are, as Mr. Hayflick indicates in his paper, two
important basic distinctions to be made: (1) between
being old (having existed a good number of years), and
being aged (being compromised in vigor and ability by
having existed a good number of years), and (2) be-
tween increasing life expectancy and increasing the
span of useful, vigorous life.

In considering the implications of postponing aging,
of increasing life expectancy, and of increasing the life-
span it should be remembered that humans are mortal
by essence: humans are contingent beings. We exist,
but we could possibly not exist; and because our exist-
ence is dependent upon an indefinite number of con-
tingencies, we will eventually die. As we consider
postponing aging and postponing death, we are con-
sidering the proportions and measures for a finite life.
We are balancing values and determining what values
can be achieved, given human lifespans of different
characters and of different scopes. To talk as if we stand
on the giddy brink of immortality is to commit the sin of
hubris, and is to be punished by missing the answer to
the properly human question: How can the good life in
its richest sense be achieved by us who are finite, mortal
beings ?2

The possibility of altering the character of aging and
the prospect of postponing aging open new domains of
human responsibility. In the past, the onset of aging was

'I am grateful for the discussion concerning the issues in this
paper, as well as the criticism of this paper, by George Agich, Daniel
Callahan, Alex Capron, Joan and Eric Cassell, Maurice Kaplan,
Robert Lifton, William May, Laurence McCullough, Robert Mor-
rison, Robert Stevenson, and Robert Veatch. I am sure that they will
recognize the many places where I failed to take their good advice.

21 have treated this point elsewhere: see The counsels of finitude,
Hastings Center Report, 1975, 5, 29-36.

33

Human Condition‘

H. Tristram Engelhardt, Jr.

“natural” in the sense that it occurred without the com-
mission or omission of human artifice. In this con-
ference, the concern with aging indicates a new scope of
human abilities and, therefore, a new scope of human
responsibility. For example, large portions of the
population of developed countries are now aged
populations because death, although not yet aging, can
be postponed. Even if the human lifespan cannot yet be
increased, human life expectancy has been increased.
Both the upper limit for a lifetime and the point in life
when infirmity occurs have become conditions now
determined (or potentially determinable) by human ac-
tion. This makes us responsible for the consequences of
such action.

In reflecting on the possibility of postponing aging
and death, I will touch on four points: (1) the sense of
the normality of aging and the concept of a “pre-
mature” death; (2) the sense in which aging can be con-
sidered a disease, or the sense in which an aged person
can be healthy; (3) the ethical claims of others to have
their needs addressed before investment is made in
changing the character of aging; (4) the implications for
the scope of human responsibility concerning the
length and condition of our lives. I will attempt to sort
out ways we can talk about aging, the rights of the aged,
and the character of the human condition, given the po-
tentiality, at least theoretically, for altering the condi-
tion.

|. Of Being Aged and of Dying a
Premature Death

It may seem strange even to consider whether being
aged is a natural state of affairs. It appears obviously to
be natural; the individual simply loses vigor and
abilities in the usual course of time. But the aged now
constitute a proportionately larger segment of the
population than ever before. This change in what had
been the usual state of affairs is due in large measure to
the efforts of medicine: in particular, to public hygiene

 
'' 

and its impact on the mortality rates of younger age
groups.3 As a result, the aged have become a substantial
segment of the population of developed countries.+ The
increase in the proportion of the aged has occurred
while the extended family which supported the aged in
the past has been weakened, leaving many aged persons
to fend for themselves financially or to be sustained by
the state.5 The question of the aged has, as a conse-
quence, become a political one, structured by political
considerations and policies.6 One need only consider
contemporary concerns over the financial state of the
Social Security system to see the impact of having large
numbers of elderly in the population.” Again, this state
of affairs is due to the contrivance of humans who
labored so that life could be extended, with the result
that now persons for the most part die of chronic dis-
eases when they are old rather than dying of acute, in-
fectious diseases when they are young. Society now
finds itself burdened with unprecedented numbers of
disabled and indigent old people.

The general expectation that one will survive to be
aged provides a rationale for distributions of wealth
from the young to the old. For example, the Social
Security system rests on an expectation by the young
contributor that he or she will live to be an old recip-
ient.8 Old age has become an everyday expectation
rather than a mere hope. The talk about retirement
years is phrased in terms of this expectation of growing
old. Ours is a lifeworld in which new things have come
to be taken for granted—living until one becomes aged,
living to benefit from public programs for the aged, and
so on. These expectations form the basis for a fabric of
duties which bind together the young and the aged. The
aged constitute a class of the once-young who con-
tributed to a system so that when old they could be
secure. The now-young benefit from the general con-
tributions to society made earlier by the now-aged.

 

3Dubos, R. Man adapting. New Haven: Yale University Press, 1965,
pp. 229-230.

4Freedman, R., & Berelson, B. The human population, Scientific
American, 1974, 231, 31-29; Westfoff, C. F. The populations of the
developed countries. Scientific American, 1974, 231, 109-112.

5Riley, M. W., Johnson, M., & Foner, A. Aging and society, Vol. 3, A
sociology of age stratification. New York: Russell Sage, 1972, p. 176.

6Phelps, H.A., & Henderson, D. Population in it’s human aspects.
New York: Appleton-Century-Crofts, 1958, p. 221; Tibbitts, C, &
Donahue, W. (Eds.), Social and psychological aspects of aging, Vol. I, p.
55. Proceedings of the Fifth Congress of the International Association of Geron-
tology: Aging Around the World, (4 Vols.) New York: Columbia Univer-
sity Press, 1962.

7Will the Social Security bubble burst? Nation’s Business, 1974, 62,
28-32.

8Dale, E.L., Jr. The young pay for the old. New York Times
Magazine, January 14, 1973, 8, 40.

There is a fabric, in short, of implicit obligations and
expectations binding the young and the aged, one that is
still working itself out into public policies with respect
to the care and the position of the aged.

Such policies concerning the aged have developed in
the context of a general acceptance of public health and
other medical programs and policies that have them-
selves led to the presence of a large class of aged per-
sons. The aged are perceived to be alive as the result of
generally unproblematic policies of preventing “pre-
mature” death.? The implicit choice for the individual
is an obvious one, as exemplified by a conversation I
once overheard between two elderly men. The first
remarked: “It is hell to be old,” and the second re-
joined, “It sure is; my father told me when I was a kid,
‘Don’t ever get old.’ But when you consider the alterna-
tive—what the hell!” Even the compromised existence
of old age appears preferable to no existence—that is, to
an early death.

This very understandable attitude has caused major
demographic changes. There has been a population ex-
plosion, not simply because reproductive rates have
been unchecked, but because fewer children now die
“prematurely.” There are now, in a sense, too many
children: there is inadequate food available for a large
number of the children born each year, to say nothing
of the inadequate resources to afford them what most
persons in developed countries would consider a full
life. Because we have come to value having each person
live longer and live a fuller life, we have come to value
having fewer children. Fecundity has thus ceased to be
an unqualified natural virtue and has become some-
thing akin to a vice.

The changes that have taken place in the patterns of
dying have already had striking consequences—
namely, the population explosion. In fact, problems
concerning the further extension of life expectancy are
tied to widely pursued programs to decrease infant and
childhood mortality rates. Persons are starving in un-
derdeveloped countries because, inter alia, those coun-
tries are pursuing incompatible policies: insufficiently
limited reproduction and increased life expectancy
(especially increasing the life expectancy of children so
they can live to reproductive age), at the same time that
resources remain limited. Such policies lead to in-
creased length of life without increased quality of life
insofar as that quality depends upon available resources
(e.g., food). On the other hand, once one has decided to

 

9Phelps and Henderson, op cit., p. 207; Coale, A.J. The history of
the human population. Scientific American, 1974, 231, 41-51.

34

 

 
'' 

decrease reproduction and to increase life expectancy,
one has implicitly committed oneself to the problem of
providing a meaningful life for the aged. One has
decided that a greater quality of life—living longer and
consuming more resources per person—is preferable to
a greater quantity of human lives.

There are special problems of defining the quality of
life: of increasing enjoyable life, not life that is a burden
to the persons living it. In particular, one is forced to ex-
amine the prudent limits to which life should be ex-
tended; and what sense it makes to talk about “‘pre-
mature” death, “premature” aging, or death too long
delayed, for such questions concern the scope and
bounds of human life. There is, of course, an obvious
sense in which aging or death can be premature—
namely, getting old or dying before other members of
one’s cohort. In this sense, the statistical average is nor-
mative: one decides there is no complaint if one’s lot is
similar to the common lot. Thus, one perceives aging
due, say, to Alzheimer’s disease, presenile dementia, as
premature.

The sense that aging or death is premature also
derives from the truncation of projects one expects to
complete. A premature death is one that comes before
one has done the things he wanted to do. Of course, the
usually expected time of death may come after persons
have done the things that make their lives worth living,
making those deaths too late. This last point under-
scores the issues of the quality and significance of the
life gained by postponing death. To say that X died pre-
maturely, or aged prematurely, implies that aging or
death was premature with respect to certain expecta-
tions—a blend of the usually expected scope of life and
the scope of one’s projects.

These comments are not meant to suggest that death
is usually welcomed or should be welcomed, even if it
comes at an expected age and after one’s projects are
completed. Instead, I am suggesting that such a death
cannot be termed premature. Of course, this is some-
what circular—one is less likely to engage in projects
that one knows will not be completed, given the usual
scope of life. One measures projects by the length of
one’s life, and measures the scope of one’s life by the
scope of One’s projects. As a result, the question of the
meaning of free time or leisure time of the aged
becomes central to extending the scope of human proj-
ects. If one merely extends the scope of human life
without extending the scope of human projects, death
may be perceived by the aged as coming too late. Or, to
put it another way, death and old age are not premature
if old age offers only a taedium vitae. Postponing death
will, in short, be a contribution to the human condition

35

only if the longer lifespan will allow for the realization
of new projects, or the completion of more ambitious or
extended life projects, and only if those whose life is in-
creased believe that a shorter life would have entailed
premature aging and premature death.

This brings me back to Hayflick’s distinction be-
tween being old and being aged: the focus of research
aimed at postponing aging should have the goal of help-
ing us get older without becoming aged. But there is a
second point: such research inadvertently turns aging
into a disease process, a process to be treated and con-
trolled by medicine. From this perspective, aging is not
a process to be accepted passively as an unalterable
given of human existence, as is our eventual death.
Aging becomes a process open to medical explanation,
prediction, and control: that is, it becomes the subject of
diagnosis, prognosis, and therapy.

ll. Aging as a Disease

To call aging a disease may seem to compound the
confusion, for the concept of disease is itself am-
biguous. Yet aging is a disease because it shares essen-
tial characteristics with other conditions that are termed
diseases. Consider, for example, Talcott Parsons’
description of the four essential aspects of the sick
role:!0 First, being sick exempts persons from normal
social responsibilities—and aging does this. Second, the
sick person is not immediately responsible for his state,
that is, he cannot just will it away—and that is surely
the case with aging. Third, and more important, the
sick person is supposed to get well—and aging research
is focused on finding means for postponing and pre-
venting aging, and rehabilitating the aged. Fourth, and
for our purposes most important, the person who is sick
is to seek the help of physicians and others in the health
care establishment. Here is precisely where the shift in
responsibility is very striking—the possibility of
postponing aging makes unpostponed aging a state of il-
Iness to be treated by medicine. Unpostponed but
postponing aging makes unpostponed aging a state of
illness to be treated by medicine. Unpostponed but

 

!0Parsons, T. Definitions of health and illness in the light of
American values and social structure. In E.G. Jaco (Ed.) Patients,
physicians and illness, Glencoe, IIl.: Free Press, 1958, pp. 165-187; IIl-
ness, therapy and the modern urban American family, pp. 234-245;
The mental hospital as a type of organization, in M. Greenblatt, DJ.
Levinson, & R.H. Williams (Eds.), The patient and the mental hospital,
Glencoe, IIl.: Free Press, 1957, pp. 108-129; and The social system, New
York: Free Press, 1951, pp. 428-479. For a summary see M. Siegler
and H. Osmond, The “sick role” revisited, Hastings Center Report,
1973, 1, No. 3, 41.

 
'' 

The term, unpostponed but postponable aging, indi-
cates that although aging is inevitable, some postponing
of aging is possible; and that aging which we decide to
postpone and are able to postpone will constitute the
disease of being aged. Such aging will be a disagreeable
state or condition recognizable within the sick role; that
is, among other things, it will be assigned to the prov-
ince of medicine. As expectations of longer life ex-
pands and as the compass of human projects for life ex-
pands, unpostponed aging becomes a condition that
should be pushed back indefinitely. But aging can only
be postponed, not prevented, because at some time,
given our contingent nature, aging and death will oc-
cur. This is to say, again, that forever is a long time, and
in the long run we will all die.

The distinction between unpostponed and un-
postponable aging is important in saying that an aged
person is in good health, as when one might say, “He is
in good health for a man of ninety.” The expectations
for activity are adjusted to meet the physical limitations
we take to be beyond our control. Thus, the dyspnea
that a 90-year-old experiences after climbing five flights
of stairs might be termed normal, and that 90-year-old
person is said to be in good health—even if the dyspnea
would be abnormal and a sign of illness in a 20-year-
old. Norms of health and disease are therefore age de-
pendent, and one element is the expectation that the
person can carry out projects and activities we come to
associate with a particular age.

These norms are not purely statistical, for they also
depend upon what we think should be the case and what
we can do to alter the state of affairs. If a cure or preven-
tive were discovered for presybopia, presybopia would
become an abnormal condition, a disease, even though
it is a generally occurring phenomenon. In short, dis-
eases, even if they are the rule, are to be treated. That is,
we sort out various phenomena as syndromes to be
treated and controlled by medicine, whether or not they
are imposed by physiological or psychological
regularities. They become syndromes if (1) they thwart
the goals we usually assign to persons, or (2) they cause
pain that is not part of the process leading to an accep-
table goal (e.g., “normal” pain after “normal” exercise
is not pathological, for it is seen as part of the process of
keeping physically fit), or (3) they constitute a deform-
ity (an esthetic criterion—certain changes associated
with aging can be regarded as ugly and are therefore to
be treated by medicine even if all aged persons are so
afflicted).

Whether or not the pains and disabilities of aging are
considered diseases depends upon our judgments and
our expectations concerning the human condition.

36

Consider, for example, the argument that menopause is
a disease: “We believe the menopause and_ the
menopausal state to be a disease so insidiously blended
with chronologic aging that there is a tendency for it to
be overlooked and neglected.”!! This assertion is com-
plex. First, it is held that “a menopausal woman is...
not normal; she suffers from a deficiency disease with
serious sequelae and needs treatment.” Second, there is
an implication that aging is normal and therefore not a
disease. Third, there is the implication that we can and
should treat this state of affairs. It is exactly with regard
to the second judgment that aging research is likely to
expand our concept of “disease” to include the general
disabilities and pains of old age. We are likely to see the
events of aging, such as menopause, placed under the
rubric of disease as we come to be able to control
them. !2

In short, there are no definitive answers: norms for
what will count as nonpremature aging, and norms
regarding the meaning of health for the aged will de-
pend on our ability to alter the processes of aging and
on our decisions concerning the life projects that should
be open to humans.

ill. Claims and Counterclaims

Since resources are limited, there is the problem of
choice between preventing diseases of the young or
postponing aging, or between feeding the hungry of
other countries or supporting our desire to give longer
life to our own people. Such questions obviously have
no easy answers. Moreover, the questions multiply.
What projects should receive research investment—
childhood leukemia or aging? Such questions concern
fairness or justice within a particular society, and they
can be translated like this: Should not everyone be
given a fairly equal life expectancy before we expand
the life expectancy of some? Do not those who would
otherwise die young have a moral claim to be helped to
live a statistically average life? And should this not be
provided before resources are expended to increase
general life expectancy? In Dr. Goddard’s paper this
issue is put in more universal terms, whether a society
must solve its existing ills before taking an action which

 

‘Wilson, R.A., Brevetti, R-E., & Wilson, T.A. Specific procedures
for the elimination of the menopause. Western Journal of Surgery,
Obstetrics, and Gynecology, 1963, 7/, 110. Kirstner, R.W. The
menopause. Clinical Obstetrics and Gynecology, 1973, 16, 106-129.

'2For a treatment of some of these issues see H. Tristram
Engelhardt, Jr., The concepts of health and disease. Evaluation and ex-
planation in the biomedical sciences, Vol. 1, Dordrecht, Holland: D.
Reidel, 1975, pp. 125-141.

 

 
''could produce new problems, such as the problems that
will occur as a consequence of delaying aging or death.

To the person who will die young because money
has gone to aging research instead of to other disease
research, there are a number of possible replies. First, it
might be argued that investment in aging research is
justifiable as long as the same amount of resources is in-
vested to help those who would otherwise die young.
Also, proportions of research resources can be
established that are not problematic. Dr. Goddard sup-
plies a partial answer by pointing out how little,
relatively, is presently being invested in research con-
cerning aging.

Second, as long as those who die young die of dis-
eases that are randomly distributed in the population,
and given certain low incidences of diseases which en-
tail early death, it can be argued that one can take one’s
chances with disease. We should invest resources in ex-
panding the scope of useful life because one’s chances
of being benefited would be best under the latter ar-
rangements. The answer could, in short, be made with-
in a cost benefit analysis without affronting considera-
tions of duty. Pursuing research on aging would not be
unjust to those rare persons who die young.

The issue would be different if the incidence of such
diseases was itself due to unjust social practices.
Afflicted persons could then hold that they had been
dealt with unfairly, that the gamble had been rigged.
But as long as the distribution of illnesses is not due to
social injustice, the use of public resources for research
on aging is not more problematic than funding the Na-
tional Park Service.

In short, health and a long life are not absolute
goods. Rather, they are instrumental goods. One must
be in good health in order to enjoy good food, art,
nature, sex, sports, and philosophy. That is not to say
that life choices are not problematic. They involve the
issues of choosing a human life which has a proper
balance between goods, a life that will be worthwhile,
even beautiful. To choose to fund the National Endow-
ment for the Arts, rather than to build better highways,
is to assert that it is better to run the risk of accidents on
poorly constructed highways than to have a culture in
which it is not worth surviving. This should remind us
that postponing death is worthwhile only if the extra life
justifies the trouble.

The duties among societies is a difficult issue, even
after it is granted that all humans are in some sense a
single community, a community within which certain
general claims of distributive justice can arise. To give
priority to the claims of impoverished nations, such as

 

India, for food and assistance before extending our own
life expectancy—this would be a reformulation, in a
broader context, of the claim to a fair share of the op-
portunity for long life. That is, such societies could be
seen as claiming a right to life expectancy equal to our
own before we further increase our own life expectancy.
These claims can, to a certain extent, be refuted. As
long as such societies fail to make provision for ade-
quate birth control, their request would lead only to
greater injury to more persons, and to the creation of
further disadvantage to individuals who will be born.
To provide food and medical care so that more people
can live and reproduce, and to cause even more persons
to live under exigent circumstances, is surely not a
moral duty. Quite the converse. To increase the num-
ber of suffering people is not morally justifiable.
Moreover, there is no duty to allow potential persons to
come into existence if it would materially disadvantage
present persons (given that there is no overriding value
at stake such as continuing the species). One can injure
persons by creating more persons. In short, the alterna-
tive may be more problematic than to invest in aging
research.

When starving societies make provision for adequate
birth control, they will have actively joined us in the en-
terprise of changing mortality and morbidity rates, of
restructuring the human condition in order to increase
the general quality of life. Such a choice is, in many
respects, similar to the decision to increase life expect-
ancy by altering the aging process: it involves increasing
life expectancy (and quality of life) by decreasing the
number of humans who would otherwise be born.
Once these choices are embraced by such societies, the
argument can then be made that our assistance in sup-
port for population control, and for improvement in the
general quality of life, should take precedence over any
major efforts on our part to increase our own life
expectancy. !3

These issues are complex, furthermore, because
members of a society may be willing to work harder (or
contribute tax dollars) so that they themselves can live
longer, but not for other people to live as long as them-
selves. In short, the lines between duty and supereroga-
tion are difficult to draw, and it is difficult to determine

'3I do not wish to suggest that sorting out the moral issues involved
here is easy. A good argument for moral duties to aid other countries
is given by P. Singer. Famine, affluence, and mortality. Philosophy and
bublic affairs, 1972, 1, 229-243. Further, I am not arguing for a
“lifeboat ethics,” as proposed by Garrett Hardin, Living on a lifeboat,
Bioscience, 1974, 24, 561-568. I am presuming, however, that in-
dividuals achieve the good life in and through their societies, and that
one is not duty bound to help individuals if their society thwarts the
success of such efforts.

 
'' 

what wealth is surplus and what amounts can be ex-
pended capriciously without regard to the suffering of
others. The liberty to pursue one’s own selfish good
may, within certain limits, turn out to redound to the
greater good of all, even to the least advantaged.
Moreover, there are surely issues at stake in coercing
anyone to work for the good of another, even if in some
sense he ought to work for the good of the other.

Finally, Dr. Goddard and Mr. Hayflick suggest that
attempts to decrease the loss of vigor associated with
growing old could prevent more suffering than short-
range efforts to prevent disease. Just as it was more
beneficial to do research on polio than to provide better
iron lungs, it might be better to do research on aging
than to attend to the claims of the present aged. These
are, once more, issues of balancing the claims of the
young versus the aged. On the one hand, members of a
society have prima facie claims to equal access to com-
mon resources, and the present aged can not be aban-
doned in order to benefit the present young when they
will become old. On the other hand, projects that have
general public appeal (such as the postponement of
aging) can, with common consent, become a goal in
which national resources are to be invested. If the pres-
ent aged are not abandoned, then resources can prop-
erly be invested to benefit the future aged.

The criteria for such decisions can never be clear-
cut. Given certain basic abstract restrictions—e.g.,
never treating persons merely as means—a society can
properly decide on its configuration of values in much
the same way that an abstract painter chooses his col-
ors. There are many ways to achieve the beautiful,
although they involve proportions which are difficult to
specify. But some specification of the proportions are
needed to avoid both immoral and tragic outcomes.
Warnings such as Hayflick’s that “most gerontological
sociologists are persuaded that even as little as a 5-year
increase in life expectancy would be so profound as to
rupture our present economic, medical, and welfare in-
stitutions” are warnings that we must analyze the values
we wish to achieve, and that we must determine the
conditions under which they can be achieved.

IV. Aging, Death, and Human
Responsibility

issues associated with
postponing aging and death should not overlook the
fact that such postponement invites the question of
when death should come. The fact that death can be
postponed, not simply embraced early, as by suicide,
reiterates in a more pressing fashion the question raised

An examination of the

38

in ancient times with respect to the proper time to end

one’s life.'14 The question arises particularly when
postponing death leads only to prolonging the aged
state. That is, a general set of circumstances may arise
when many individuals will find the better choice to lie
in euthanasia rather than in an old age of great debility.
Hume’s remarks concerning suicide are appropriate
here. Man’s moral obligation is to act rationally and
there are at times good grounds to end one’s life. There
is, as Hume argued, a continuum of human respon-
sibility which is acknowledged as soon as man begins to
change nature in order to meet human _ goals.!5
Whether extending or ending life, this responsibility is
of one fabric with general human responsibility for
choosing rationally the conditions of life. Choosing to
increase life expectancy involves the choice of how long
one should live and when one should die.

Dr. Goddard appears to believe that the issue of
euthanasia is avoidable if longer life depends upon the
effort of each individual (i.e., individuals could cease to
prolong their lives). This position presupposes that
there is a moral difference between acting and refrain-
ing,!6 between refusing to lengthen one’s life and decid-
ing to end it at some point. But even if one grants that
there is a moral difference between acting and refrain-
ing (e.g., that acting to kill oneself involves a morally im-
permissible violence against oneself), both would in-
volve a choice for which one would be responsible. As
soon as one can postpone aging or death, early aging or
early death is one’s own responsibility, even if that
aging or death occurs only by omission.

Technology increases human responsibility by open-
ing new possibilities and thus making it possible to
make new morally significant omissions. For example,
Mr. Hayflick suggests that, once the means are availa-
ble, persons will neglect to use the means of increasing
their life expectancy, just as parents now neglect to have
their children immunized against polio. Even though
most parents who neglect to immunize their children
do not intend that their children become ill, those
parents are, all else being equal, as morally responsible
for the consequences as they would be if they
deliberately exposed their children to polio. Similarly,
with respect to euthanasia, the issue is not that of com-
pulsory euthanasia, but the fact that through omission
or commision one is now responsible for the scope of

 

'4Seneca, Letter LX X: Suicide.

'5Hume, D. Of suicide. Essays, moral, political, and literary, Vol. 4 of
David Hume, The philosophical works. T.H. Green and T.H. Grose
(Eds.). Aalen, Germany: Scientia Verlag Aalen, 1964, pp. 406-414.

'6Bennet, J. Whatever the consequences. In J. Rachels (Ed.),
Moral problems. New York: Harper & Row, 1971, pp. 43-66.

 

 
''one’s life. The decision whether death comes too late or
too early becomes unavoidable, given the ability to ex-
tend human life, and given that the life extended may,
at times, not be worth the difficulties to the person

whose life it is. In short, the technology of extending life
confronts the individual with the decision of when he or
she has had enough. Such decisions have always been
at hand, but the ability now to intervene more effec-
tively in the “natural course of things” makes human
responsibility much more explicit by increasing the
choices.

In conclusion, we are, as Dr. Goddard indicates,
faced with a national goal which could transmogrify
our society. But, as has also been pointed out, we em-
barked on the project of the prolongation of life when
we decided to decrease infant mortality rates. As a
result, we have already begun to face the issues which

39

 

further extension of life expectancy will raise: the value
of children, the use of leisure time, the care of the aged.
We need to recognize that we have already embarked
on this project, this national goal, and that we must pro-
ceed with care, for the project involves us in analyzing
the place and role of basic values in human life.
Moreover, it is important to recognize that health and
disease involve value judgments which structure our at-
titudes and actions with regard to aging and the aged. In
short, considering the prolongation of life should make
us clearer about the choices and presuppositions that
underlie our understanding of the human condition. In
particular, proposed research on ways of controlling
aging will press us further to cease viewing the human
condition as imposed by nature, and to recognize that
the human condition is fashioned by humans in terms
of particular goals and values.

 
'' 

 
'' 

The Aging Society and the
Promise of Human Life

Presuming that it serves a function to provide a
“keynote” for this Conference, I propose to take that
underlying musical metaphor seriously. A keynote may
not be where a piece of music starts; but it must be the
“home” note, determining the chord that ties every-
thing together at the end. A number of themes may be
stated, followed through a variety of developments, in-
versions, oppositions, and unstable balances; but they
all implicitly point toward a concord we recognize
when it comes, because it resolves the tensions and
brings the elements into focus. Thus the keynote sets
limiting conditions without dictating the content of the
music or how it reaches its goal. That, at any rate, is
how I conceive my role: to indicate a principle of unity
we ought to observe in organizing the problems at
hand, for judging the relevance of what we say, and for
measuring our success or failure in finding an orderly
resolution of our principal themes.

This Conference faces one of the most consequential
demographic facts to have affected the quality of
human life on earth. No matter what any of us may do,
it is practically certain that the balance of young and old
will soon be profoundly different from anything with
which human society has had any experience. Without
experience of a world in which any more than one per-
son in 30 or 40 is past 65, we have nevertheless been try-
ing to cope with a newly changed world. The one-in-
twenty ratio, which was achieved in this country about
50 years ago and led to the establishment of the Social
Security system a decade later, has been handled only
haltingly, by measures aimed at the most obvious points
of strain. We have not come to terms with its indirect
effects on our culture and consciousness; and such con-
tinuing stresses are a principal reason for conferences
like this one. But in the meanwhile we have passed the
one-in-ten point and are rushing ahead into unknown
territory at a pace accelerated by the recent unexpected
drop in the birth rate. As Dr. Hayflick observed in his
paper, “It is not too difficult to imagine a society in
which the major efforts of those under 65 will be
directed toward the care of those over 65.” A
“presbyterian” society of workers and ruling elders, we

41

Warner A. Wick

might call it, remembering that such an order of
governance was what the word “presbyterian” was
coined to designate.

“Experience keeps a dear school,” says the proverb,
“but fools can learn in no other.” The proverb, of
course, comments on individuals who could not or
would not learn from the funded experience and advice
of their predecessors, but only from the school of hard
knocks. Our problem with the aging society is of an
altogether different sort, for there are no men of ex-
perience and wisdom to advise us about its even-
tualities. We must anticipate the hard knocks and avoid
them if we can. Even so, a first formulation of our
problem is to ask how the present generation can avoid
being judged foolish by the tribunal of history—indeed
wantonly and irresponsibly foolish—if it should turn
out that we had plenty of evidence about the conse-
quences of the course we are pursuing, but that we ig-
nored that evidence.

While the aging society is a fact, and must be dealt
with as such, Dr. Goddard, playing Mephistopheles, is
tempting us with a possibility: not, to be sure, the
possibility of everlasting life, but of life indefinitely ex-
tended. He invites us to consider investing in it as in a
national goal, much as we invested in the eradication of
polio or in the technology for going to the moon. He
suggests that it may be no more expensive in current
resources than the latter venture. But what a difference
in the pay-off! For those of our fellow citizens who have
felt that they got little from their moonshot dollars ex-
cept some good evening television shows, their eleva-
tion to a station scarely below the immortals would
be... .? I am afraid that words fail. We do not know,
and we can not imagine, what is being offered. It is like
wondering how we would spend our time in heaven,
although I don’t suppose many people do that kind of
wondering any more.

I am glad that Dr. Goddard has made his modest
proposal, for it opens up the primary question before
us—really a complex of related questions united
around a keynote. The keynote question was already

 
'' 

implied by the phrase, the aging society, but the keynote
question is broader. It does not merely determine the
reference points of this conference. Although I feel
some diffidence about using language that has been
cheapened by so many self-elected prophets, I should
say that the keynote question poses the ultimate
problem of men of any era. Briefly it is, What are we,
and what is our place in the scheme of things?

Of course the question, so phrased, is unmanageably
ambiguous. Any question presupposes unstated under-
standings that are themselves the conditions if the ques-
“What is the best road to
Kokomo?” presupposes that there is such a place, that

tion is to make sense.
it is within traveling distance, and that the questioner
has some interest in what is happening there.

Until recently our keynote question would have
presumed that its object, man living in society, is some-
thing “given,” circumscribed within limits capable of
being discovered, and expressible in such terms as
these: that mankind is a species having a constant
“nature; that man is a creature living within certain
bounds set for him by “‘nature” in a somewhat different
sense of the word; that he comes from dust—or pro-
toplasm—to which he returns after a brief excursion
whose nobility or shamefulness does not depend on
how long it lasts; that he is dependent on the economy
of the earth and its fruits; that he is also dependent on
other men and the security of whatever order in society
he and his fellows can maintain. And so on. Conceived
in this way, the problem seems to be mainly one of
knowledge, of scientific knowledge if you like. We can
learn to “know ourselves” in one of the possible mean-
ings of the famous oracle at Delphi; and having done so
we will have learned the range of possibilities that set
the limits of our freedom.

But by this time we can see that the keynote ques-
tion, formulated in the same language, has acquired
other presuppositions that change its meaning radically.
We can no longer assume that what we are, and our
place in the world, are simply given and waiting to be
discovered and understood; for we know that both have
been changing and may change still more, whether or
not it is our deliberate intention to change them. We
have become aware, for instance, that we now can—
and indeed may—make the earth uninhabitable for the
plankton of the oceans that are the foundation of the
food chain, and therefore also make the world unlivable
for us. We can do this if, beforehand, we have not inad-
vertantly eliminated ourselves from the scene through
some less roundabout agency. Some by-product or
“fall-out” from the pursuit of any of several national
goals might do the trick. That we have become actually

42

responsible for the future of the earth as a possible dwell-
ing place is a disturbing truth, even though it is far from
being generally “known” as a shared possession of
human consciousness. So much, for present purposes,
for “our place,” understood as our theater of opera-
tions.

As for ourselves, in the sense of our nature as a
species, it has been clear since Darwin’s time that we
can, and do, affect the workings of “natural” selection
and in doing so, we affect the distribution of genetically
determined human qualities. How many millions who
would have died of some genetic fault have we saved for
“useful lives”? And also for opportunities to increase
and multiply their defects, both directly and by con-
tributing recessive genes to circulate, like time bombs,
in the common gene pool? Such eugenic concerns,
much discussed a century ago, are seldom objects of
public attention these days. Perhaps they have been put
in that closet of our minds reserved for items that are
too embarrassingly touchy. And it is easy to reassure
ourselves by saying, often with justification, that the dis-
agreeable manifestations of genetic defects can be con-
trolled by hormones, drugs, surgical refabrication, and
perhaps even by replacing defective organs by spare
parts, either manufactured or recovered from
“neomorts.”

However that may be, eugenic devices for breeding
changes in the distribution of human qualities work so
slowly that their neglect is not surprising, especially in
view of the practical and political difficulties of manag-
ing them. In contrast, the revolution in molecular
biology provides techniques for direct intervention that
make it unnecessary to wait for the tedious processes of
selective breeding. A number of genetic diseases such
as Mongolism and cystic fibrosis can be detected in the
unborn fetus, which can then be aborted. With
systematic screening in early pregnancy, the frequency
of such disasters and their threat to future generations
can be reduced very quickly. A more spectacular
stratagem, still on the drawing boards so far as humans
lower
species, is cloning. It works by grafting a cell nucleus
from a selected donor into an egg cell, which then

are concerned, but demonstrated on some

develops as if fertilized and produces an exact genetic
replica of its single “parent.” Imagine the mass replica-
tion of baby Albert Einsteins! Or Marilyn Monroes?
The upshot of these brief observations is that we are ina
position to redesign the human species to at least a
statistically significant extent, and even to engineer the
production of models to order. Devices as yet unknown
for extending the cell’s lifespan, but which would owe
their eventual practicability to Dr. Hayflick’s funda-
mental research in cytogerontology, would be similar in

 
''that they would operate upon the basic regulatory
mechanisms of life and reproduction.!

So there is a second way in which we have acquired
unaccustomed responsibilities of awesome proportions.
We have become not only custodians of the earth but
agents in the processes of creation; and among the
species for whose capacities and defects we share
responsibility is our own. We can not regard ourselves
simply as creatures any more, having become self-con-
scious participants in the ways of Providence: demi-
gods, one might say.

My use of the word ‘god’ here, even in lower case
and hyphenated form, has been neither frivolous nor
designed to irritate the hard-shelled rationalists. It has
been partly to establish a perspective for judging the
warnings against “playing God” that usually turn up
when measures affecting life and death are discussed. I
hope it is evident that we are already deeply into the
Providential role and we can not get out of it. For to
forebear from doing what one can, when the stakes are
high, is as much an exercise of power as to act; and to
“let nature take its course,” when we can intervene, is
not to evade accountability for the outcome.

All this is to remind us that this kind of responsibility
for ourselves is not entirely unfamiliar in kind, however
unprecedented it may be in extent. It has been charac-
teristic of human culture, ever since our first efforts in
self-interpretation, to acknowledge that man has a
modest share in the attributes and prerogatives of
divinity. According to the story of Genesis, for example,
Adam and Eve at first enjoyed the innocent irrespon-
sibility of dependent creatures whose every need was
provided for, so long as they accepted the terms of their
good fortune. But as a result of Eve’s curiosity about
“the fruit of that forbidden tree” of knowledge, they
were elevated to another plane as knowing agents of
good and evil, becoming “as one of us,” as Yahweh is
reported to have complained. It was, as we say, a whole
new ball game. But as usually happens, a promotion in
rank brings new headaches along with it. Knowledge is
indeed power, as Francis Bacon taught a receptive
world when the age of modern science was beginning;
but the companion truth, that knowledgeable power is
responsibility, is one whose implications we have been
more reluctant to face, let alone to explore.

'For a general presentation of the opportunities and issues of such
biomedical engineering, I recommend the articles in Science by Dr.
Leon R. Kass, then Executive Secretary of the Committee on the Life
Sciences and Social Policy of the National Research Council, Na-
tional Academy of Sciences, a series of papers which appeared in
Science in 1970-71.

43

Having sketched how our keynote question—What
are we, and what is our place in the scheme of things?—
has changed in meaning as its presuppositions have
changed, I now ask you to join me in reflecting upon
the significance of this transformation of the question.
The first thing to observe is that it is no longer simply a
question of “knowledge” in the usual scientific sense;
for this presumes that the object of inquiry is independ-
ent of us and our activities, and that our task is to pur-
sue the truth by bringing our ideas into conformity with
the object. The paradigm of such knowledge is celestial
mechanics: the planetary motions were simply “there”
to be accurately described by Kepler’s laws and to be
explained by Newton as the effects of universal gravita-
tion. But with the question now transformed, so is the
relation of knowledge to its object also transformed. It is
not a question of discovering and explaining an “‘objec-
tive” situation, nor is the difficulty primarily one of ad-
Justing to a moving target rather than a stationary one.
Instead, the changes in what we seek to know about are
the effects of what we know about it, and vice versa—in
a continuous process of reciprocal interaction.

The second point to observe is that the problem, thus
transformed, is of a kind that is by no means unfamiliar
in everyday life, although it is one that our habitual
canons of scientific thought find troublesome. All un-
derstanding of human behavior and institutions is of
this sort; for when we think we know why there are ups -
and downs in the business cycle we immediately do
something to affect them, guided as we go by our con-
ception of the causes we have discovered.

Now it is of the first importance that we keep in
mind two essential components of this “practical” use
of knowledge. On the one hand, what we set out to do
often turns out differently from what we intended, and
even when we achieve our intended objectives the un-
foreseen fallouts of success may be appalling. On the
other hand, the point of investigating the causes of the
business cycle, and of social phenomena generally, is
that we do so zn order to change their operation, and
change them we do, for good or ill—a project that
would make no sense if we were investigating the
behavior of the solar system. Viewed more generally,
human culture has always been at once self-transform-
ing, aware that it is, and—when it has been most
thoughtful about itself—aware that only some of the
determining variables of change can be brought under
explicit control at any one time.

In sum, because man, the animal with a culture, is
constituted by his socio-cultural as well as by his
biological inheritance, inquiry about human society
modifies its object, modifies itself, and modifies man at

 
'' 

the same time in ways that can be only partially fore-
seen. It is therefore “no accident” that chance intrudes
itself into our best laid plans, and that we are more
vulnerable to it the more self-confident and single-
minded we are in pursuing our various limited objec-
tives. That is the lesson taught by the tragic dramatists.
What is new in the world is not man’s self-transforma-
tion through the use of an understanding which is
clearest about its ends when those ends are limited in
scope. What. is new is the encompassing of more and
more of the “natural” conditions of life under the
hegemony of that imperfectly reflexive, feedback proc-
ess.

Combining these points that, in being responsible
for our cultural and biological existence, what we know
and fail to know about the human condition also affects
it, and that whatever we do to ease man’s estate reflects
our partial understanding of it, we must conclude that
to ask what we are is at the same time to ask what we are
to become. However, this is not a request for a predic-
tion, as if we could stand outside our subject matter as
we do when calculating the time of a solar eclipse. It is
rather to engage in deliberation about deciding a line of
policy—a course of action subject to continuous revi-
sion. And so, finally, our keynote question asks what we
ought to make of ourselves and our place in the world. It
is not that “the is and the ought” are not distinguishable
in thinking about action, for when they are taken
abstractly they are clearly distinct. The point is rather
that they can not be made use of in a reasonable way ex-
cept in their mutual relations. That is to say that not to
reflect on what makes life better or worse while in-
vestigating what makes it longer or shorter is simply ir-
rational.

* oe Kk K OK OK OK

At this point I think that my job in this conference is
almost done. That is, I have tried to clarify the general
sort of question through which the specific subques-
tions of this conference can be brought into relation to
each other, but without prejudging any of them or inter-
fering where others can speak more pointedly than I. I
assure you that I find only cold comfort in the highly
general but humbling conclusion that mankind, having
become responsible for its future to a hitherto
unimagined and still undercomprehended degree, is
stuck with it; that our success in achieving well-defined
short-term goals—such as acquiring the know-how for
extending the life span—is accompanied by an
awesome and perhaps tragic incapacity to comprehend
“what we are doing” from the standpoint of determin-
ing the future quality of human life; and that probably
the best we can do is to try to relate our current choices

44

to a reflectively weighed discussion of the old questions
about what constitutes a good life in a good society. I
know of no technical rules for bridging the gulf between
such a comprehensive ideal and the immediate issues of
policy. But I can indicate a few lines of connection that
may provide food for thought.

In thinking about the aging society, necessity as well
as good will demand that we seek better ways to provide
for the support of the unprecedented number of old
people among us and for their disproportionate health
needs. Surely justice and humanity concur in endorsing
those goals. With regard to extending the life span, the
value, if not the immediate necessity of understanding
the biology of the aging process seems to be beyond
question. Whether it may be desirable to use that under-
standing in order to extend the limits of life—as op-
posed to increasing its average length by delaying and
shortening the period of deterioration by reducing the
incidence of disease—is a further question. Presumably
its answer should wait for information about how, and
at what stage in life, the aging process can best be con-
trolled. But despite these obvious values, each policy
goal is subject to questions of the utmost gravity. The
paradox that the pursuit of a number of patently ob-
vious goods may not be good on the whole, this paradox
is something I have tried to prepare for in a general way
in the first part of these remarks. It remains to suggest
some specific connections.

With respect to any set of policy questions, it is al-
ways relevant to ask, ““To what end?” until one reaches
a comprehensive end to which all the rest contribute. It
is natural to describe such an end as a world, or at least
a human society, ordered by justice and enriched by
welfare; and for many purposes it is convenient to think
of this end in largely quantitative terms: more desirable
things for more people, and all fairly distributed. But
when we reach fundamentals, this notion of welfare it-
self comes into question.

Let me illustrate by referring to the economic
problem of care for the aged. When we ask how we are
to provide for those who are unable to work and earn or
who are not allowed to, we should notice what is taken
for granted by the way we ask the question. It assumes
the whole complex of the job-conscious industrial
society, in which young and old alike have been
progressively excluded from the privileges of what is
called productive work. A first consequence of this is
that the entire burden of providing for youth and age
rests upon those who enjoy the possession of a job, and
that various custodial agencies become necessary for
the excluded classes. Custodial care is expensive,
whether it takes the form of “education” or a “Golden

 
''Years Club” (except that these are also “good” because
they ‘“‘create jobs”). A second consequence is that, since
one’s job is a principal source of a sense of identity and
self-respect (as can be seen in the morale problems of
the unemployed and the complaints of the women’s
liberation movement that housewives have no standing
because their labors are “for nothing”) both young and
old suffer from alienation and aimlessness. So the
problem of “supporting” both excluded groups com-
prises much more than economics and the distribution
of the GNP. It is indeed a problem of welfare, but in the
qualitative sense of the value of living well in a healthy
community.

If two major classes of society are excluded from the
sources of both self-respect and rewarding activity of
which one can be proud, we can expect disorder and
disaffection among the idle, as well as dismay and re-
sentment among those who work with such determina-
tion to enforce and provide for their idleness. Of course
we cannot redesign all the aspects of society at once, but
if I am allowed a little oversimplification to make a
point, an observer from another planet might conclude
that we make things unnecessarily hard for ourselves by
excluding significant aspects of a problem from con-
sideration in the very process of formulating the
problem.

Indeed, if welfare means living well, and if to live
well in a peculiarly human sense is to be active in the
use of one’s powers in a community of shared activities,
the welfare of the old is primarily a problem of their op-
portunities for meaningful occupations—which need
not be work for pay. In that sense, and without having
to make invidious judgments about what particular
ways of living are best, it would appear that a peasant
culture often does better by its old folks than we do.

Provide opportunities for meaningfully shared ac-
tivities as we may, there are many people who become
completely dependent on care for their physical needs
and who face the threat of being put away in mainte-
nance homes where the care that is needed will be poor.
Like prideful janitor service, good maintenance care
can rarely be bought at any price and our culture does
not freely reinforce its performance.

This is not an occasion for preaching, but I think
there may be some point in recalling Thomas Hobbes’s

classic description of that state where “‘the life of man is
solitary, poor, nasty, brutish, and short.” In up-to-date
language, I suppose the first four adjectives would be
“isolated, deprived, alienated and dehumanized.” They
seem to apply to all too many who have been put away.
For them I would hope we could also add the word
“short,” as Hobbes had it. But I am sure we sometimes
commit the ultimate barbarism by making it “long” in-
stead.

I should like to close these remarks with a few aimed
directly at Dr. Goddard’s proposal. I hope he will ex-
cuse me for thinking that this sort of “national goal” is
exactly what we do not need, and if he has followed my
line of reasoning through this essay he will understand
why. The pursuit of narrowly defined practical objec-
tives, however Promethean, without reflection about
their probable but unintended consequences is a prin-
cipal source of our difficulties. And the more mind-
blowing the project, the less basis we have for assessing
what it may let us in for. On the other hand, I heartily
advocate the balanced support of basic research in all
the sciences, for I believe that the life of scientific in-
quiry is one of the primary ‘expressions of human
powers and therefore of living well, and even nobly.

Eventually I should expect basic research to lead to
an understanding of the workings of the “biological
clock.” If and when it does, we shall have to decide how
to use that understanding, and I should expect that
there would be many possibilities. But to make it possi-
ble to live indefinitely? To what end? As I read history,
I have not been persuaded that our civilization has suc-
ceeded in making better use of man’s allotted years than
a number of other civilizations have done.

Plato attributes to Pindar a story about Aesculapius,
the demi-god credited with founding the art of
medicine. Although his guild refused to practice the
later system, which invented “the lingering death,” the
founder is said to have once accepted a bribe to stretch
out the life of a rich man who was at the point of dying.
In consequence Aesculapius was struck by lightning.
That was a Draconian measure, no doubt, but I think
there is much to be said for the view that life, simply as

such, is not necessarily worth preserving.

 
'' 

 
'' 

Havighurst: We will divide the discussion into two
parts, the first part dealing with the technical problem
of how to prolong life; the second part, the ethical issues
involved in the prolongation of life.

The Goddard, Hayflick, and Havighurst/Sacher
papers were all making the point that there are two

quite different ways of prolonging life, and that they re-
quire different kinds of research. One of the big policy
questions, assuming we want to prolong life, is which
kind of research to support.

Goddard: I am somewhat hesitant to say anything
on this subject after what Professor Wick said happened
to Aesculapius for promising to extend the life of one
individual. When we begin seriously to propose the ex-
tension of life for mankind, the resulting concomitants
might not be acceptable.

We should keep in mind the major distinctions in-
volved between extending life through altering what
Mr. Hayflick calls the “biological clock,” or on the
other hand, by extending life by eliminating certain
chronic diseases—cancer, coronary heart disease, ar-
teriosclerosis, and so on.

In the first instance we are talking about changing
the calendar of a person’s life so that the various seg-
ments are altered, Middle age might extend from age 40
through age 70, the young-old from 70—90, and the old-
old from 90—110. That is the concept of extension of
life, whether or not it is based on a biological technique,
or on providing an extraneous agent that must be taken
as a medication every day, or on a one-time surgical
procedure. The end result would be the extension of the
various segments of life.

The other approach, the more conventional ap-
proach, the one we have been involved in for a number
of years, is to alter the survival curve so that more peo-
ple survive to be 70 or 80 by eliminating disease. In this
approach, the survival curve is not only squared off and
more people live to an older age, but the maximum
average age at death might be increased slightly by
changing the prevalence and incidence of certain dis-
ease conditions.

Both these approaches should be considered. My in-
terest centers on the first approach, that of developing,
through research programs of rather substantial scale,
means of altering the basic biological calendar that is
inherent and programed in the cells of our body—so

47

Discussion

Robert J. Havighurst, Chairman

that we would live on the average, say, 110 years of age
rather than 70 or 80. It is a much more intriguing con-
cept, and one that has far different implications for our
society than the mere extension of life by 2 or 3 years
through the conventional methods that we are now
using.

Hayflick: I have been fascinated listening to the
sociologists and economists and ethicists discuss what
seems to me to be a purely biological phenomenon, but
without getting into the biology of the situation at all. I
would therefore like to take a few minutes to give some
insight into some of the biological considerations which
bear heavily on the issues before us.

For example, it might be observed that man may, in
fact, be unique in respect to having a substantial num-
ber of very elderly members of the species present.
From a quantitative standpoint, the degree of aging is
far greater in the human species than in any other
species (except the animals man chooses to protect, like
his domestic and zoo animals).

It seems reasonable to argue that aging, as we under-
stand it in its extreme condition as seen in man, is es-
sentially an artifact of nature. Aging has been revealed
only because of man’s ability to manipulate his environ-
ment to such an extent that he can control his predators
and his diseases to the point that individual members of
the species survive. This reveals age changes that,
teleologically perhaps, were never intended for man to
see in the first place.

I would like to comment on the changes that have
taken place in life expectation, which I think most of
you are familiar with, but I will restate them in a more
precise way.

We all appreciate that life expectancy at birth in
1900 was 49 years and in 1950 it was 68 years, a net gain
of about 19 years. But since 1950 the gain has been only
2.4 years, and in the past few years there has been really
no gain at all. The question is, why was there such a
profound increase in life expectation in the first half of
the century, and then an equally profound leveling off?
And this, despite the fact that most of the major ad-
vances in medicine took place in the years subsequent
to 1950—that is, in our ability to deal with infectious
diseases, which is the prime reason for the increase in
life expectation.

 
''I would also like to make a point in respect to dis-
tinguishing between life expectation and life span. Life
span, at least for man, as far as we know, has remained
essentially unchanged. The same is reasonably true for
most animal species. If we argue that the mean max-
imum life span is about 90 or 100 years for man, then
the apparent fact is that this has remained unchanged.
What has changed is that more people have been able to
live longer and reach this mean maximum life span.
Thus life expectation has increased, but life span has
not. You often hear it said that people are living longer.
They are living longer in thé sense of life expectation,
but the life span remains fixed. That distinction is es-
sential in discussing what is likely to happen in the
future.

In any consideration of increasing life expectancy
one must look at the major causes of death, which in
this country are, first, cardiovascular disease and stroke,
and second, cancer. It might come as a surprise that to
resolve cancer by some miracle tomorrow morning
would only result in a little more than 2 years’ increase
of life expectation. If heart disease and stroke were
resolved by some miracle tomorrow morning, however,
it would result in about a 15- or 16-year increase in life
expectation. The sum total is equivalent to the increase
in life expectation that has occurred between 1900 and
1950.

The current orientation of biomedical research in
this country and in the world is directed toward rec-
tangularizing the survival curves, simply making it
possible for more people to survive to the mean max-
imum life span of 90 years. The upshot of this is rather
interesting, and I stated it in a facetious way in my
paper, in saying that if we were successful in curing all
of the diseases and ills and man, the result would be
that all of us would nevertheless drop dead on the eve of
our 90th birthday. The reason is that very little attention
has been paid to the basic biology of aging—that is, the
physiological decrements that occur as a function of
time. The likelihood of lengthening the life span itself is
very slim indeed, because the number of dollars being
spent and, in fact, the number of people worrying about
it are so infinitesimal that the likelihood of success in
this latter area is virtually impossible.

So to restate it: there really are two ways to think
about increasing the length of human life. One is to
cure all the diseases that we are now prone to, which
would result only in an increase of about 20 additional
years of life expectation. The other, obviously, is to deal
with the lifespan, and this is a very serious and important
question that has not at all been dealt with effectively.

One does not ask cancer biologists what are the goals
of their research, because it would be a stupid question.

48

 

But it is not a stupid question to ask gerontologists what
are the goals of their research, for the simple reason that
the results of increasing human life expectation, or of
tampering with the biological clock and increasing the
lifespan, will result in social and economic discon-
tinuities of the kind that we are already unable to deal
with, even with our current life expectation. To in-
crease the human lifespan or life expectation by even a
few years would result in furthering the dislocations
and the problems we have been addressing here.

Thus this is a very important question that we
biologists would like to have answers to, and we need to
interact with our colleagues in the social sciences before
we set our particular goals.

There is one tantalizing point in thinking about our
goals. There is one way in which most biologists believe
we can extend our life expectation and possibly our life-
span, and this is based on work done in the 1930’s by
Clive McCay, in which caloric restriction—that is, un-
derfeeding animals to the extent that they received very
little in the way of calories but all they needed in the
way of vitamins and so on to maintain good health—
resulted in up to a 50 or even 100 percent increase in
life expectation. This type of life lengthening has been
seen in many other animals, and there is no reason to
believe, a priori, that it would not apply to man.

Having known this fact for many years, it is interest-
ing to observe that no one has opted to try this method. I
conclude that the quality of life is more important to
everyone than the quantity of life, and that is an impor-
tant point.

Another aspect is the apathy that undoubtedly would
result even if we did know a way of extending the
human lifespan, and in my paper I used poliomyelitis
immunization as an example. One probably couldn’t
think of an easier way to administer a drug than to put a
drop of a sweet-tasting solution on the tip of the tongue;
yet in spite of this, fully 40 to 50 per cent of preschool-
age children in this country are not immunized against
polio. The reason is, in my judgment, that we don’t see
polio cripples hobbling around the streets any more,
and consequently the problem doesn’t exist in the
minds of young people. I would extend this argument to
say that if we didn’t see anyone aging in our society—
say, by virtue of the delivery of some fluid from the
Fountain of Youth—people wouldn’t take this fluid,
simply because there would be no evidence in our
society that anyone needed it.

The likelihood is small that we are going to be able
to tamper with the biological clock at the genetic level,
where undoubtedly the action really is. It is very op-
timistic to think that anything can be done in the
foreseeable future— in the next 25 years, let’s say—for

 

 
''no other reason than that there are so few funds, and
fewer than 25 or 30 people in the world really working
in this area.

Sacher: Mr. Hayflick made a very important
point—that the discussion of social ethics in an aging
society can be conducted only in the context of an un-
derstanding of the biological nature, not only of aging,
but of man. An adequate context cannot be developed
in the time we have here, but I would like to make a few
remarks from the perspective of the evolution of the
human lifespan and human patterns of aging.

Man has an evolutionary history af about 2 million
years. Almost the entire 2 million years was a process of
what one might call hominization, during which man
achieved all his present physical attributes and—
although this is more speculative—all but one psy-
chological attribute.

Man is unique in having evolved old age, because
the years that have been added to the human life histo-
ry, as compared to the life of the great apes, are the post-
reproductive years. This is clearly seen in the fact that
menopause, as far as primatologists know, is a dis-
tinctively human evolved characteristic.

Why did this come about? It is a complex question
that deserves the attention of biologists working in con-
junction with anthropologists and social scientists. I
would offer an explanation along these lines:

During this period of hominization there was selec-
tion for that kind of behaviors that led to the evolution
of increased brain size, increased manual dexterity, the
development of very complex traditions of hunting,
food gathering, and so on. However, the increase in
brain size meant a much lower reproductive rate and a
necessarily longer period of dependence. I suggest that
it is because of these latter characteristics that the
human lifespan evolved with what appears to be the ad-
dition of old age on the end—in actuality this post-
reproductive period of life was adaptive for the species
because of the long dependency of the young.

Until about 100,000 years ago that was the pattern.
What changed then? Until that time learned traditions,
and in fact all experience, could essentially be stored
only in the individual memory, the human social group
was extremely small, and the success of reproduction (a
critical factor in all this) depended on the survival of the
parents until the long period of dependency was over.
Then suddenly language and symbolism emerged, and
the increase in a person’s usefulness with age began to
come to an end, because now traditions could be
reduced to speech and communicated in less than a
lifetime.

An expansion of investigations in this area of the
evolution of the human lifespan would be important in

49

several ways. One way would be to help us to answer
one of the ethical questions we have been discussing:
“To what end should the lifespan be extended?” To
answer this we would have to ask what must be restored
or replaced in human life to give it a cumulative value—
value in the ultimate meaning of that term.

What I have said so far may seem very speculative,
but there is concrete evidence for it in the life tables of
species. If we go back to Mr. Hayflick’s question about
whether aging existed in nature before man began to
develop civilized environments, I would say the answer
is yes, but it existed only because it had a function. A
species survives in direct relation to the ability of the in-
dividual member of the species to develop, reach sexual
maturity, and raise its young past the point of depend-
ency. The lengthening of that period of dependency has
resulted in a rectangularization of the life table over the
course of mammalian evolution. In other words, the
human life table is more rectangular than that of the
mouse or the horse or any other species in which there
is a shorter minimum duration of life necessary for suc-
cessful reproduction.

The facts can be illustrated like this: Life expectation
increased from mouse to man by a factor of 30. This
refers to the average survival time. The average survival
is dependent on two fundamental parameters. One of
these is the rate of aging, which can be measured by the
rate at which the death rate increases with age. The
doubling time of the death rate is 100—200 days for
mice, and almost 8 years for man, so the rate of aging
decreases from mouse to man by a factor of 15 to 30.

The other parameter measures the initial constitu-
tion, what the organism started with, and in terms of life
tables this is measured by the initial death rate. In the
course of evolution of increased life span from mouse to
man, in which the rate of aging diminished by a factor
of 15 to 30, the initial death rate has decreased by a fac-
tor on the order of 1,000. That is, if one looks at the
minimum death rates at the preteen age in man, and at
the comparable age just before sexual maturity in the
mouse, the death rate in man is 1,000-fold lower.

In other words, in the course of the evolution of
human lifespan there was a disproportionately strong
selection for a decrease in vulnerablity to disease. Here we
come to a point discussed earlier. If we speak about the
reduction of vulnerability by, say, removing one cause
of death, such as cancer, indeed we get results which
show that life expectation would be increased by only a
few years.

However, there is another context in which to ex-
amine this fact. Mice also die of cancer. In the lifetime
of a typical population of almost any strain of mice ex-
cept high cancer strains, 10 or 20 or 30-odd percent of

 
'' 

mice in a population will die over their lifetimes of
cancer, that is, within a matter of 2 or 3 years.

Human beings die of cancer but at a lower rate—
perhaps a 10 percent mortality from cancer in a
lifetime, but the lifetime is now 70 years instead of 2.
But man has also increased in body size over the mouse
by a factor of something like 3,000 (20 grams compared
to 70,000 grams). That means that the risk of cancer per
cell is diminished by a factor which represents the num-
ber of cells at risk. Most biologists agree that this is the
way one should calculate this risk, because there is
almost general agreement that cancer originates in a
single aberrant cell, which establishes the whole clone.
So the risk of cancer is greatly diminished in man com-
pared to mouse. Compared to the difference in life ex-
pectation, which is about 30-fold, the decreased risk of
a single cell transforming to cause cancer has to be on
the order of 10,000 between mouse and man.

This has meaningful consequences for what we can
do in the future. For one thing, a program that is
directed toward decreasing these disease vulnerabilities
is likely to be feasible, because we know there is a great
deal of genetic variation in disease vulnerability be-
tween members of a given population. It is not quite
true that reducing disease death rates has only a limited
benefit for the extension of life. Since the doubling of
the death rate is 8 years, every diminution of the disease
incidence rate by a factor of two adds 8 healthy years to
the span of life. Hence, this program is beneficial as
well as feasible.

Curiously, in spite of the huge human populations
for which we have demographic information, we know
nothing about whether there is any real difference in
the rates of aging between human populations. We do
know something about this in mice, however, and the
data on survival of different mouse strains suggest that
any differences in life expectation that exist between
populations of the same species are due to differences
in disease vulnerability and not to differences in rates of
aging. In other words, the rate of aging seems to be
much more deeply embedded in a species genotype,
and does not have the amount of genetic plasticity that
resistance to disease has.

Why does this matter? Because if we were to prolong
life by bringing a decrease in the rate of aging alone, the
consequence of this would be to produce a shallower
life table. And as Mr. Havighurst and I tried to make
clear in our paper, this would disproportionately in-
crease the number of person-years at risk for (the last 10
percent, say, of survivors) who have the highest risks of
disease and debility.

On the other hand, if one carried out the alternative
program of getting access to the kinds of factors that
reduce vulnerability to diseases without altering the rate

50

of aging, the consequences would be to push the whole
survivorship curve over to the right. The person-years at
risk among the last 10 percent would be no greater, but
there would be many more person-years of life among
the other 90 percent. This means there would be a
decrease in the prevalence of the disabled in the popula-
tion, and in the relative costs of debility and medical
care.

Biologists frequently say that their goal is to decrease
the rate of aging, and they have tried to approach this
goal by several chemical therapies—for example, by
administering antioxidants or procaine (temperature-
lowering and caloric restrictions are separate cases con-
sidered below). However, all of the pharmacological
methods, although they are used and proposed as anti-
aging agents, do not, in fact, reduce the rate of aging.
Insofar as they are effective, they reduce the vulnerability
to disease. In other words, they have the kind of conse-
quence that I said would be more favorable—i.e., defer-
ring the senescent phase rather than stretching it out.
However, the researchers are getting a wrong result so
far as their original hypothesis is concerned.

Reduction of caloric intake and reduction of body
temperature do decrease the rate of aging and thus
lengthen life, but they have a curious consequence.
What a person can do in his lifetime is governed by the
amount of metabolism he is capable of. However, the
increased length of life produced either by caloric
restriction or by reduction of body temperature (hy-
pothermia) does not give the individual an increased
amount of metabolism or increased ability to work with
his environment. He doesn’t have any more caloric
lifetime—he just has more years of life.

To return to the point Mr. Hayflick mentioned,
maybe people haven’t tried caloric reduction because
they have an intuitive idea that it won’t give them what
they want. They want a full activity of life rather than a
mere extension of it. Merely to extend life on those
terms would be extremely disadvantageous, because
this would mean that with the same number of calories
spread over a larger number of years, more of these
calories would be expended on maintenance of essen-
tial body functions, fewer calories could be expended
on useful or meaningful activity, and the whole thing
would be socially disastrous.

Havighurst: Before I ask for other comments, I
might take a minute to report on a questionnaire study
that we are just completing, in which we have asked
questions of members of the Gerontological Society
who are in the biological and medical fields. We asked
about these two methods of increasing life expectancy,
namely, the rate control method that you just heard
about—slowing down the rate of aging, which can be

 
''done presumably by cooling off the body or starving it
at the right time or perhaps by the use of some drugs—
and the disease control method, which is the one that
clearly our colleagues here are favoring.

We asked whether they thought the one method or
the other was likely to be more effective in the next 25
years, or whether both would be effective. A good many
of them said “both.”

We also asked what they thought would happen to
life expectancy, and we are getting somewhat more
positive responses or optimistic responses than we have
gotten from these two gentlemen. Thirty-four percent
said there would be an increase of life expectancy at age
65 (life expectancy which is now 14 years on the
average), an increase of 10 years by the year 2000.
Another 34 percent said an increase of 5 years. Twenty
percent said an increase of 2 or 3 years. Twelve percent
said it would stay the same, and 2 percent said it would
decrease.

To some extent maybe these responses were in-
tended to influence the people in Congress to vote more
money for this kind of research, but in any case what we
have here is a rather positive view of the likelihood of
using one or both of these methods in extending life ex-
pectancy by a very substantial amount for people after
age 65.

Also, we asked this group of biologists how much
money. they thought should be put into research to ac-
complish this goal. We gave them several choices, one
of which was $500 million a year, which is roughly the
amount now being put into cancer research. Another
choice was $2 billion, which is about what the Federal
Government is now putting into social services for the
elderly. Sixty percent said they thought it could be done
with $500 million for biogerontological research.

This is a policy issue. The National Institute on
Aging is going to be asking for money for one or both of
these kinds of research, and the political process is
going to be heavily involved in deciding how much
money to ask for, as well as what kinds of research to
ask for.

Fullarton: This issue of priority setting and the
process for priority setting, particularly the assumptions
which underlie the process by which we set priorities in
biological research, is a critical issue. It comes up in all
three of these papers by Goddard, Hayflick, and
Sacher.

Policy analysis is both my vocation and my avoca-
tion, and in following that pursuit, I have identified
three characteristics in the priority-setting process that
might be useful for determining how we set priorities
for research.

First is the magnitude of the problem. Here, because
aging is the one biological condition common to all,
research on aging certainly qualifies under this first cri-
terion.

Second is the public’s perception of the problem,
and by “public” here I mean individual perceptions of
the problem, as well as the outcome of political deci-
sionmaking processes in terms of legislation. I will
return to this in a moment because it is the most con-
troversial of the criteria.

Third is the scientific opportunity for advance, and
here research on aging could certainly qualify as a
priority area.

The criterion of the public perception of the
problem has two facets. At the individual level of per-
ception, it can be thought of as a kind of horror factor,
and I think it is this horror factor that explains the war
on cancer. It has been shown that the condition people
most fear is cancer, and that fact is responsible for a lot
of the political support and for the grass-roots support
for the conquest of cancer. (There were also, of course,
opportunities for scientific advance with regard to
cancer, and the magnitude of the problem is signifi-
cant.)

We also have a National Eye Institute, not because
there are research opportunities for scientific advance,
and not because the problem of blindness is a large
problem, although of course both these things are
true—but because blindness is the thing second to
cancer which people fear most. As long as 65 percent of
our biomedical research is supported by public funds,
what the public is concerned about is a very important
criterion.

There is really an exquisite irony that struck me in
reviewing these papers, and that is that most people in
the field of aging are very concerned about the youth-
oriented society, and they decry the youth culture
emphasis. But it could well be that from this youth
fetish, sufficient horror of the process of aging will arise
to provide the kind of public perception of the impor-
tance of the problem that will then lead to more
research. I think most people here would agree that that
would be a great irony.

Broad public support for research on aging, includ-
ing research on the sigificant extension of life, does not
now exist. We have a National Institute on Aging,
established through the Research on Aging Act of 1974,
not for the reason stated in the preamble, that it is
because aging is the one biological condition common
to us all, but rather because gerontologists want a larger
investment in research that they call gerontology—
meaning those activities which are conducted by people

who now call themselves gerontologists.

 
''All of this brings me to my basic criticism of the
assertions of Hayflick and Goddard, that gerontological
research is grossly underfunded. We don’t have an
analytical base for making a statement of this kind. Iam
sure Hayflick would admit that research on aging is not
only that research done by people calling themselves
gerontologists, and that important ideas relative to the
fundamental processes of aging do not come only from
people who call themselves gerontologists. In one
analytic sense all research on organisms, from the first
cell division of the fertilized ovum, can be thought of as
aging research—that is, the process from the beginning
to the end, and the fundamental underpinnings of aging
research are such biochemical advances as Mr.
Hayflick’s own work.

In biomedical science, as in society, everything is
connected to everything else, and when people decry
the low investment of research it is very important
analytically to look at what it is people are talking
about. We make gross (if convenient) distinctions at
some point, but it is very important not to think of aging
research as only those things to be supported by the new
National Institute on Aging. Our investment in aging
research is much larger than the $25 million estimate,
and aging research greatly exceeds Mr. Hayflick’s
definition of aging done by gerontologists.

With regard to the prolongation of life as the primary
goal of aging research, that statement really distorts the
public policy problem, in my view, I commend Mr.
Sacher for the enlightment that comes from his paper,
and for the way he has drawn distinctions between
different goals of aging research. I support additional
investment in aging research through the National In-
stitute on Aging and through gerontologists, but it is
very important that we clarify what our policy objec-
tives are, and that we look at the problem especially in
terms of the public’s perception of the problem, since
that is where the bulk of funds for the support of this
research is coming from.

I would like to reemphasize what Mr. Wick and Dr.
Engelhardt and others have stated so well, that the
quantity of life isn’t everything, even as a research goal,
and certainly not as the national goal to replace the
space program.

Hayflick: I would like to respond to the observation
that gerontological research is not necessarily grossly
underfunded. I think the error was committed when the
NIH was initially established, in categorizing biomedi-
cal research into a National Cancer Institute, and a Na-
tional Institute on Allergy and Infectious Diseases, and
so on. One must now live with this categorization and
argue that without having the initial wisdom to simply
stop at the level of calling the entire enterprise a Na-

52

tional Institute of Health, one now must continue the
categorization in order to emphasize the research
efforts carried out in various areas of biomedical
research.

I would be the first to argue that we should have
simply a National Institute of Biomedical Research,
and let the scientists worry with regard to where the
priority issues lie. But you have already committed the
original sin, and one must continue, since in the eyes of
the public the categorization has now been made, and
since the impact of aging on everyone’s life is so impor-
tant.

I have argued in my paper that disease-oriented
research should not be the mission of the National In-
stitute on Aging, and in fact I think it is reasonable to
>xpect that it won’t be. The other institutes at NIH are
concerned with disease-oriented research. Aging is not
a disease, and it is a fact that the physiological decre-
ments that occur with age simply allow for one expres-
sion of disease to occur at higher rates. But one must
separate the two concepts, and this is a critical point.

Goddard: The selection of priorities on a national
basis is indeed a critical issue. I would hasten to point
out that the public’s perception of the problem often
has nothing whatsoever to do with the priorities that are
selected, or the amounts to which those priorities are
then funded, if by “the public” we mean the general
public. Rather, the power structure that exists in the
biomedical field has a great deal to say about what
programs are funded, how much they are funded for,
and at times who are the recipients of the funds.

If we do anything as a result of such discussions that
are beginning to emerge in other parts of the country as
well as here today, we might focus upon the mechanism
by which we set priorities for health research, and in-
deed for health services. We are now talking about $115
billion a year. We have never done any careful analyses
of the results of these expenditures, not to the extent
that we analyze expenditures in other fields. I am
speaking not only about research, but also about health
care.

I am struck by Mr. Hayflick’s remarks concerning
the gains in life expectancy, which from 1900 to 1950
really can be viewed as stemming from changes in the
environment. The malaria rate in the United States
dropped to zero not because of malaria control or its
successor, the National Communicable Disease Center,
but because economic development permitted people
in the South, where malaria was existent, to move into
better houses that had screens on the doors and win-
dows.

Unfortunately we make some very dangerous
assumptions, that inputs into the health systems are

aene

 
''going to result in outputs that are roughly equivalent. It
has been shown in recent years that we should not be so
naive.

With regard to gerontological research, or research
on aging, I suggest that as a part of our concern, as I
said in my paper, we should examine our national
priorities, and we should begin to look at how we spend
our research funds.

I think one of the major benefits from funding a
large-scale program in aging research will be the
spinoff in terms of new knowledge in a whole range of
biomedical fields. I would not limit the scope of the Na-
tional Institute on Aging. I think it is a bad institute, not
because of the people who call themselves geron-
tologists, but simply because it perpetuates a system of
categorization in biomedical research that I think we
have outgrown. I hope we will be wise enough to see
that we need to spend more money on research on the
fundamental processes of life. We might get much
farther in a much shorter period of time.

One final note: We have to be patient. I am very
much discomfited by the current criticism of the cancer
program. It has been in existence 3 years, and critics are
saying, ‘You really haven’t done anything to reduce
cancer; in fact, cancer deaths are somewhat on the in-
crease in certain categories.” I think the same thing
would hold true should we establish the extension of
life as a national goal. It will be a difficult task to extend
the lifespan, and I think Mr. Hayflick would be the first
to agree that, stated positively, there is no reason why
we cannot extend life if we are willing to expend the
amount of funds and involve the number of scientists
required over the next 25 years. It is a rational national
goal, and one that would have many benefits, in addi-
tion to what you may perceive as the benefit of making
life longer.

Havighurst: Thank you. Now we will take the rest
of our time on the ethical side of the issue, and I will
call first on Dr. Engelhardt and then Mr. Gustafson.

Engelhardt: First I want to make a few general
points. There is an important difference between being
old and being aged, which is a great deal of the concern
that has been raised here.

That leads to my second point that length of life has
an instrumental but no intrinsic value; that is, it is good
only if you can do something with it. When speaking of
extending the length of life, the issue at once becomes,
“To what end?” And again it relates to ways in which
one can make the life that is extended of significance to
the person whose life it is. So a caveat has to be raised
here with respect to what might be taken to be ax-
iomatic goals concerning the extension of life.

53

The third point is the assertion that the ability to
control aging will extend human responsibility in many
ways. One will be forced to decide in what ways. This
will bring us to sketching out what are reasonable
human projects, what are the sorts of human projects
that can make extension of life worthwhile. With
respect to the polio immunization that is now available,
one can say that people who do not have their children
immunized are now responsible for their children get-
ting polio, an issue not raised before.

As a fourth general point, this expansion of respon-
sibility is the same one we assumed when we began
changing infant mortality rates, and again when birth
control programs were instituted to stem the popula-
tion, just as when malaria control was undertaken. In
other words, we have long ago embarked on extending
life expectancy and the quality of life.

The final general point in my paper was that any talk
of the possibility of immortality is dangerous. It
obscures the real human problem of dealing with finite
issues, of necessarily finite and mortal means.

I raised four particular issues in my paper. First, I
argued that the sense of premature aging, as well as
what counts as premature death, depends upon (1)
what is generally the case for one’s cohort, what is the
usual expected age at which one’s peers die, and (2)
what is the scope of one’s life projects. These are, of
course, related.

The life projects we had for a much more cir-
cumscribed life expectancy will no longer be adequate
for a longer life expectancy. So, defining or redefining
human projects becomes part of the whole issue of
shifting human expectations and human values with
respect to life.

Second, research to control aging and to treat aging
will, whether we like it or not, turn aging into a dis-
ease—for if aging or death occurs at a time when it
could have been postponed, it comes to be regarded as a
disease. Judgments of what counts as health or disease
are obviously related to value judgments about how
people live.

Third, I briefly addressed the claims that could be
made against those who wish to do research to postpone
aging. I contend that those persons who are ill due to
socially unjust disadvantages have a primary claim
upon the resources of the society, and those resources
should be given to them, before going to those who sur-
vive to usual cohort age but want their lives extended
farther.

Other than for the unjustly disadvantaged, I argue
that as long as frequently occurring disease is treated,
then to invest money to postpone aging rather than to
cure the diseases of the young would be a justifiable
''gamble to impose on the particular population con-
cerned—presupposing some other guarantees about
democratic participation. Such a choice is not unlike
other general choices such as whether to have better
highways or to have better art museums.

Finally, I touched very briefly on the issue again that
the possibility of extending life accents the respon-
sibility to determine the length of one’s life, an issue
that arises with such current questions as the “living
will,” and other decisions regarding the use of tech-
nology in prolonging one’s life.

Gustafson: Most of the points I would have raised
have already been made. I have a question from a
somewhat theological point of view and that is the
whole question of finitude. To put it in a kind of crude
way, I suppose something that has happened in the
secularization of Western culture is a growing disbelief
in any kind of existence after bodily death. I suspect
that this has accentuated an anxiety which everybody
probably had before, namely, the anxiety that emerges
out of our finitude. If I may make a play on an old
Calvinistic belief, it used to be said that the chief end of
man is to glorify God forever, or the chief end of man is
salvation. In a sense, in the absence of that kind of post-
life view, the chief end of man has to be health. The
chief end of man has to be the provision of the neces-
sary conditions for full satisfaction of all aspirations that
can be reasonably held within a finite lifespan.

I take it that some theologians in the past have said
something that is verifiable on a number of grounds
other than very private grounds, namely, that to recog-
nize our finitude and to accept its reality is a very, very
difficult thing. Surely one of the reasons we undertake
many things that are beneficial to ourselves and to
others is that we try to overcome finitude to some ex-
tent; that is to say, we try to learn more and more, we try
to provide conditions which not only extend but enrich
life, and so on.

There is also a kind of perverse desire to extend
one’s life, and I suppose in traditional religious
language it is talked about in terms of the problem of
idolatry—that is to say, the anxiety that emerges from
the recognition of our finitude drives us to find some
measure of security to which we can latch on. This in
turn can be translated into a strong drive simply to sus-
tain the necessary conditions of survival.

I want to make one other comment, which comes
not so much from a religious tradition. The question in-
trigues me, and I want to address it to George Sacher
and Leonard Hayflick: What is the proper group, when
we are talking about the benefits of life extension? We
talk about the proper social categories when we talk
about the distribution of such things as income or

54

health care, but what is the proper group when we talk
about benefits of a longer lifespan?

When working with physicians, it is benefits in terms
of the individual patient. The covenant between them is
to have the physician seek that which is beneficial to the
particular patient. In other settings, one also thinks
about what is beneficial with reference to certain collec-
tivities, such as families, communities, nations, and so
on.

Frequently, when one reads another kind of
literature, for example population genetics, one finds
the concern is for the human species and its survival.

I want to ask a technical scientific question that I
think would make a moral difference: What is likely to
be the significance, for whatever one wants to count as
benefits to the species, for an extension of the human
lifespan? I think the question has implications if we
think in terms of obligations to future generations.

Hayflick: It is a very interesting question. As a mat-
ter of fact, you may be surprised at the answer, because
to the best of my knowledge there is no benefit to the
species, including the species of man, to have its mem-
bers survive much beyond the period of maximum
ability to procreate. I know of only one exception,
which is rather curious. There is a species of moth in
which the older members of the community take on the
coloration of the younger members, and go through col-
or phase changes. When they do so, they can mimic the
movements of the young moths, and therefore attract
predators away from younger members of the com-
munity.

Unless we can evolve a similar situation in the
human species, then I would say that there does not
seem to be any benefit to our species to have individuals
survive beyond the period of maximum ability to
procreate. I think this is the root of the question before
us today.

Sacher: My study of population biology leads me
to believe that there is a definite adaptive value for man
in surviving completion of his immediate reproductive
role. Obviously, rearing the young is important, and
while the presence of older individuals may not be ob-
viously beneficial in all animal societies, in elephant
societies mothers help their daughters and other mem-
bers of their kin group to bear young. The leader of an
elephant herd is typically a postreproductive female.
Apparently, in circumstances where there is a long
period of dependency and an extremely low reproduc-
tive rate, both of them found in elephants and in man,
there has been evolution of postreproductive survival.

The problem should not be put in only those terms,
however, because if we examine the question in terms

 
''’

that Mr. Gustafson raised, namely, the problem of
finitude, we can see it in another light, and we can see
also an urgent need for a dialogue among biogeron-
tologists about what is the nature of aging. There is cer-
tainly a widespread view that an organism’s life consists
of norms, and in some sense perfect function, on which
is superimposed a process of aging—so that if we can
eliminate aging, then we will achieve indefinite exten-
sion of life, physical immortality.

I don’t share that belief, an alternative view—that
the finitude of life in its temporal duration, i.e., in an ex-
tensive characteristic, is inseparable from the finitude of
intensive performance of vital functions. In other
words, the quality of life of the living organism is in
some essential way related to its duration. Living longer
is necessarily living better.

I would point out that there has been progression of
both aspects of life during evolution. Man is the longest
lived of all mammals, and his whole life is a
qualitatively much richer one. Therefore, if the limita-
tions on man’s lifespan are the consequences of his
finite precision vital function, then the transcendance of
finitude in this intensive sense is the only path to a
transcendance of the finite duration of life. That is
basically different from the idea that there is something
called “aging” which is separable from a perfect exist-
ence that we already possess. The research programs
that would be involved are also very different because if
man’s longevity is limited by his finite physiological
stability then research on the control of aging should
focus on getting down into the fundamental genetic
determination of the stability of life systems.

That is not a research program that will give a rapid
payoff, and solving the problem in those terms is not
going to be easy in the atmosphere of a_ national
program because—you know how it is—you are going
to be asked, “What have you accomplished this year?”
It is not a research question of that type. We have to
develop a disciplinary basis, which requires decades of
very basic work, without constant harassment. Mr.
Gustafson’s question on the ethics of life extension is
closely linked to an almost immediate question of
policy—what kind of research on aging shall we en-
courage?

Engelhardt: I want to be briefly meddlesome, Mr.
Gustafson, and raise a number of questions before you
get an answer to the one you raised.

You asked what is likely to be the species benefit of
the increase in life. I want to draw our attention to the
question, What do you mean by “benefit”? Almost all
the discussion turns on the different ways one could
define benefit. More than that, it is not at all clear what
is “species.”’ What is a species, that it can be benefited?

55

Is it a continuity of germ plasm? Is it a culture that can
be enriched? Some sort of community of rational per-
sons? It is well to attend to the richness of the question.

Gustafson: Yes, we must be aware of the complex-
ity. Mr. Hayflick, since you indicated there are no
biological benefits of postreproductive life, are there
any predictable disbenefits? Are there harms for the
species that might arise from extension of the lifespan?

Hayflick: There are very likely to be disbenefits,
and I tried to make that point in my paper and also in
what I said earlier—we wouldn’t be sitting at this con-
ference if we weren’t worried about the problems or the
disbenefits.

I think the problems we now face are based on the
fact that we have increased life expectation by 20 or 30
years since 1900. Since we haven’t dealt with those
problems in a spectacularly successful fashion, I doubt
that any further increase in life expectation is going to
make the problems any less severe, but that they would
become even greater. This is the dilemma.

I also would like to respond to Dr. Engelhardt’s
statement, in trying to break down this question of
benefit to the species. This is an important question.
We tend to think that increasing our life expectation
from a biological standpoint is somehow desirable,
because unconsciously we feel really that what we want
to extend is our own consciousness. That we do have a,
mechanism for maintaining the immortality of our
germ plasm is obvious to everyone. What we really
mean when we speak about immortality is perhaps the
selfishness of wanting to continue our own conscious
state for a longer period of time.

Fullarton: There was one point in Dr. Engelhardt’s
paper that I would like to comment on, because it is a
very important analytic contribution to the analysis of a
social policy issue, and that is his emphasis on life proj-
ects. This is opposed to the economic productivity
model that characterizes many discussions of policy
decisions and their benefits.

Jonsen: May I say something about life projects
and life expectancy? It seems interesting that when we
talk about extending life expectancy for individuals, we
are experiencing at the same time a very rapid accelera-
tion of social and political change and technologies. We
might ruminate about the problems of coordination
between extended personal life and very rapid tech-
nological change. We have been talking about the
problem of meaningful life for the elderly. At the same
time, if we talk about extending that life, we mean that
elderly people will live out a kind of planned obsoles-
cence perhaps several times in the course of their lives,

 
''because meaningful participation would involve
familiarity with the changing world and the efficacy of
skills and knowledge.

One might reflect on the manner of the ancients,
thinking of the finite individuals as being part of an
unchanging, eternal society or state. One thinks of
Horace talking about having built in his poetry a monu-
ment that would last forever. What we might be doing
instead is creating an infinite individual who would live
through a succession of societies in the course of a
lifetime.

Nell: Is there any evidence to suggest that prolong-
ing lifespan might lead to a similar sort of result that we
have seen in industrial societies in prolonging our life
expectancy through disease control, which is that women
have been affected more favorably than men? Might
there be a sex difference in the prolongation of the life-
span?

Sacher: I believe that the sex differences in human
life expectation is probably the consequence of natural
selection and that it accompanied the differentiation of
roles for men and women under the conditions in
which the selection occurred namely, in precivilized
society. Therefore, I don’t see any reason why any
specific means of prolonging life would affect the sexes
differentially from this point onward.

Havighurst: Do you mean this would tend to
equalize longevity between the sexes?

Sacher: It would not necessarily increase the pres-
ent discrepancy.

Havighurst: How did we get the present discrepan-
cy? Is that built in?

Sacher: [| am afraid it is a genetic factor.
Havighurst: It is not environmental?

Sacher: As I said, males and females have different
roles, and a logical way of accounting for them is by
saying that the burdens of childbirth and an extended
period of childrearing on the female were compensated
for by a sexual dimorphism with regard to disease
resistance and resistance to death—that is by a kind of
persistence factor that females have as part of their
reproductive adaptation.

Havighurst: Are you talking in biological
language?

Sacher: Yes. I relate it to the fact that the human
female has evolved the role of having offspring and rais-
ing them, in which success requires a long period of
persistence. This undoubtedly had some reflection in
female physiology.

56

Havighurst: In general, mammals have this
general sex difference?

Sacher: The sex differential in longevity of the
human female is only a phenomenon of this century,
and before that life expectation for women was less than
that of men. The same is observed in other species:
removal of the stress of breeding prolongs the life of the
female and frequently, although not always, it then ex-
ceeds the male.

Neugarten: Dr. Goddard, we talked about caloric
and temperature reduction, but we have heard little to-
day about the effects of drugs. Can you talk a little
about that? Also, in view of the comments Miss Fullar-
ton made with regard to policy, and your own comment
about the power structure, would you elaborate a bit
about the potential role of drug therapies on prolonga-
tion of life, and where the power structure in the
policymaking side of government enters into it? For in-
stance, if you had a drug in your hand this morning that
could extend the lifespan, what would happen? Would
policymakers decide to produce it on a large scale? And
encourage people to take it?

Goddard: As a matter of fact, I did take such a
drug this morning. I take three of them each morning.
It is an interesting drug. It is a well-known compound,
and in animals it does prolong life substantially. I have
been taking it experimentally for about a year. It is a
very fortunate compound, in that it has one side effect:
It relieves anxiety. So, even if you die soon, you don’t
worry about it.

With respect to pharmaceutical agents, I would say
that it would be almost serendipitous if we were to dis-
cover one that would have the effect of extending life.
The reason is because there is so much to be learned
with respect to the intracellular phenomena and the in-
terrelationships that occur, that these phenomena must
be understood before one can tailor a drug that would
have.the effect of extending the lifespan.

Alex Comfort makes the point that in fact we may
discover a way of extending life before we understand
why. Oddly enough, one would think that the Food and
Drug Administration might today provide a substantial
barrier to testing such an agent, and some people
therefore think of the FDA as possibly standing in the
way of life extension. But I am concerned in the other
direction. I don’t think FDA is concerned enough about
the requirements for testing.

The one agent I have been taking has been approved
for investigative trial in people who are age 75 and over.
This tells me that the protective screen is not as tightly
drawn as it should be. I would hope before we take that
step of human experimentation with life-extending
drugs that a great deal more thought is given by a

 
''regulatory agency or any agency that is given the
responsibility—in fact, one of my major concerns
would be how we would reach a decision, as a society,
that such a drug should be developed and marketed.
The same would hold true for other types of pro-
cedures, whether a drug or something else. We have a
lot of moral and ethical issues that we are very familiar
with, surrounding other medical procedures, and they
might enter here, too.

As far as the power structure is concerned, I listened
to the comments about the National Cancer Institute
and the National Eye Institute, and the fact that the
public fears cancer and blindness. Of course they do.
But I have to tell you one thing they fear even more, and
that is death. We don’t have a National Death Institute
or National Life Institute.

Not to be facetious, I think it is going to be extremely
difficult to get the kind of public support that would
satisfy those persons who are interested in life extension
as a national goal—the support needed to develop the
training programs, and the basic research programs, the
underlying support of the magnitude suggested in my
paper. It would be very hard to do, because there isn’t a
coalition of interests today, such as the Mary Lasker-
Lister Hill-John Fogarty actionists who pushed so much
of the health program in the early days. That kind of
leadership is lacking.

Oriol: I was a little disturbed at the description of
the National Institute on Aging that developed here to-
day. It is almost as if the NIA as described here was cre-
ated to make use of the information it develops to ex-
tend life. But I assumed one of the purposes of the NIA
is to have greater understanding of the aging process
and, once that information is available, to make wise
use of it in some other way, not necessarily that the NIA
be put in charge of the use of the information it
develops.

Bernice Neugarten and others have gone to very
great lengths to assure that in the NIA there will be
other disciplines represented in addition to biology.
Perhaps the problem is that the NIA is in the NIH, and
that it is not fighting a disease but attempting to provide
information on a number of social as well as biomedi-
cal fronts—information which we all need if we are to
deal with some of the issues we are discussing here.

Noble: To be provocative, this discussion has gone
on about the extension of life, without consideration of

57

the trunication of life. I wonder how the theologians
and the biologists would vie- certain policies which
would relate to the reduction of suicide among the aged
population. There seems to be a trend toward higher in-
cidence of suicide as the cohort ages.

There is also the question of what do you say to the
cancer patient who, in intractible pain, cries out for sur-
cease of that pain, for the drug that will put an end to it?
It relates to the quality-of-life issue, I am sure, but it
also relates to some common, everyday dilemmas.

Engelhardt: I will comment only in part on the
points you raise. As you know, at the end of my paper I
give a truncated apology for allowing suicide under cer-
tain circumstances. I suppose I should remark that up
until January 1973 it was not a crime to aid or abet
suicide in Texas. Still, remarkably few people took ad-
vantage of the loophole, which is to say that if one
removes sanctions against aiding and abetting suicide
for those people who are in great pain, I don’t think one
would need to worry about a rush of people to exit. This
is a utilitarian answer to those who have developed
arguments against allowing people who are in pain to
end their lives. I can’t imagine what general moralistic
argument one would ever give to constrain a person
whom one felt fulfilled other criteria for making ra-
tional decisions—how would you argue he should be
constrained from choosing to end his life?

Wick: I would like to pick up a point Mr. Oriol
made about the support of research. It pleases me to
know that the Institute on Aging is concerned primarily
with understanding what goes on in aging, how it hap-
pens, and so on. It does seem to me that we may use our
knowledge foolishly, but knowledge itself is never really
a bad thing, aside from being one of the chief orna-
ments of man.

It does seem to me, however, that if we tried to gain
support—and I am only saying in another way what I
think Dr. Goddard and Mr. Hayflick mentioned
earlier—if we try to gain support for this project of un-
derstanding the aging process as a great crash program
to bring us indefinite life, it will backfire, because it will
raise the same old question in the public mind, ‘What
have you done for us this year?” I think also it will be a
matter of making clear why we are doing it. The ques-
tion must be answered, ‘‘To what end?”

 
'' 

 
'' 

Appendix A

Future Numbers of Older People

Proportions of Older Persons:

At the turn of this century, 4 of every 100 persons liv-
ing in the United States had reached the age of 65. Now
itis 10 of every 100. The proportion may rise, then fall,
or it may rise steadily, depending primarily upon future
fertility rates.

If the condition of zero population growth were
reached and then maintained (a situation that would
result from replacement-level fertility, zero net im-
migration, and slightly declining mortality rates), about
17 percent of the total population would be 65 or over,
and about 8 percent would be 75 or over. The stationary
condition could be reached about the year 2025 at the
earliest.

Table A—1 shows the projected percentage of the
population that will be aged 65 and over in future
decades. The range of the projection becomes greater at
successive points in the future. If fertility rates are high,
the proportion of older persons will remain around 10
to 12 percent; but if fertility rates are low, the propor-
tion might climb as high as 20 percent after the year
2030.

Table A—1 Projected Percentage of the U.S.
Population Reaching Age 65 and Over

 

 

Year Percentage (Range)

1980 11.0 10.9 — 11.1
1990 11.7 11.1 -—12.2
2000 11.7 10.7 — 12.5
2010 11.9 10.3 -— 13.3
2020 14.6 11.8 -— 17.0
2030 17.0 12.8 — 20.9
2040 16.1 11.0 — 21.1
2050 16.1 11.3 — 20.7

 

Source: U.S. Bureau of the Census. 1976. Demographic
Aspects of Aging and the Older Population in the United
States. Table 5-1. (Current Population Reports, Series P-23,
No. 59). Washington, D.C.: U.S. Government Printing Office.

59

Number of Older Persons:

The number of persons aged 65 and over has gone
from 3 million to 22.3 million since the turn of the cen-
tury, a sevenfold increase. Future numbers of older per-
sons can be predicted with relative accuracy because
they are unaffected by future fertility. All the people
who will reach 65 by the year 2000 or even 2040 are
already alive; and while mortality rates have declined,
they have changed slowly, without the wide fluctuations
that have been characteristic of fertility rates.

The numbers of older persons are expected to in-
crease substantially over the next 75 years, but at differ-
ing rates in successive decades. The Bureau of the Cen-
sus projects the numbers to go from 22 million in 1975
to over 30 million in 2000; then to jump to nearly 43
million by 2020, as the large number of persons born
during the “baby boom” of the late 1940’s and 1950’s
reach old age; then to grow more slowly again and
reach 50 million by 2040.!

These projections are based on the assumption that
mortality rates will decline “slightly” to the year 2000,
with no further declines thereafter.

McFarland? has calculated other sets of projections,
one based on a I-percent decline per year in age-
specific death rates for persons aged 20 and over, with
the declines cumulative to the years 2000 and 2020;
another based on a 2-percent decline per year.

These various projections are shown in table A-2.
They have in common the presumption that declines in
mortality will result from a variety of factors: changes in
dietary habits and smoking practices, working condi-
tions, atmospheric pollution, the extension of medical

'U.S. Bureau of the Census. Demographic Aspects of Aging and
the Older Population in the United States. Table 2-1. (Current Popula-
tion Reports, Series P-23, No. 59). Washington, D.C.: U.S. Government
Printing Office, 1976.

2D.D. McFarland, The aged in the 21st century: A demographic
view. Paper to appear in L. F. Jarvik (Ed). The long tomorrow: Aging into
the 21st century. New York: Gardner Press, 1977.
'' 

knowledge through public information campaigns,
changes in the organization of medical care, and new
diagnostic and treatment procedures. They do not
presume any major new biological discoveries or scien-
tific breakthroughs of the types being pursued by
biogerontologists that might lead to a dramatic exten-
sion of the human lifespan.

Projections Based on Changing Causes
of Death

Diseases of the heart, malignant neoplasms (cancer),
and cerebrovascular diseases (mainly stroke) are the
leading causes of death among persons 65 and over; and
taken together, they account for three out of four deaths

in this age group. Cause-of-death life tables produced
by the National Center for Health Statistics have indi-
cated that, if cardiovascular-renal diseases could be
eliminated, the gain in life expectancy at age 65 would
be 10 years; if malignancies could be eliminated, the
gain would be 2.3 years.3

The latter statement is often misinterpreted. Cause-
of-death life tables do not provide a useful basis for pro-
jections of mortality. They are merely analytical tools,
providing guides to where it may be most important to
apply medical efforts in extending life expectation. For
one thing, heart disease and cancer are not likely to be
eliminated in the foreseeable future, although death

Table A—2 Projected Older Population of the United States: 1975, 2000, 2020
(Numbers in Millions)

 

 

 

2000 2020
1975° 1% decrease U.S. 2% decrease } 1% decrease U.S.
in ASDR** Census* in ASDR** in ASDR** Census*
All persons
55+ 42.2 52.2 53.5 57.2 79.3 79.5
65+ 22.4 30.9 30.6 35.3 44.4 42.8
75+ 8.5 14.8 13.5 18.1 18.8 15.4
85+ 1.9 3.2 3.8

 

 

 

 

 

 

 

*Source: U.S. Bureau of the Census. 1976. Demographic Aspects of Aging and the Older Population in the United States. Table
2-1. (Current Population Reports, Series P-23, No. 59). Washington, D.C.: U.S. Government Printing Office.

**Source: McFarland, op cit.

Table A—3 Numbers of Persons Reaching Age 65 and Numbers Reaching 75 in the Year 2000
(Numbers in Millions)

 

Number aged 65 Number aged 75

 

If current age- and cause-specific death rates
CONTINUE... 6. cette eens

If death rates from cancer are reduced by 10
percent......... 0.0... ccc cee eee

If death rates from heart disease are reduced by
10 percent....... 0... cc ee eee

If death rates from cancer are reduced by 100
percent......... 0.0... cee eee

If death rates from heart disease are reduced by
100 percent ......... 0... cc eee

If both cancer and heart disease are reduced by
100 percent

1.681 1.284
1.692 1.302
1.703 1.331
1.799 1.482
1.912 1.834
2.045 2.112

 

Source: McFarland, op. cit--

60

 
''rates from these causes may be moderately reduced. For
another thing, it is often overlooked that a reduction in
deaths from one disease implies an increase in deaths
from other diseases.

Pursuing the latter point, McFarland has made sets
of projections assuming that the age-specific prob-
abilities for dying from a given cause are reduced while
those for other causes stay at their current values—if,
that is, the lives saved by eliminating heart disease and
cancer are redistributed across the remaining causes of
death. These projections for the year 2000 are shown in

61

table A-3, where cause-specific death rates are aggre-
gated into three groups: heart disease, cancer, and all
other causes.

As McFarland points out, the latter three projections
in table A—3, those that assume complete elimination
of deaths from heart disease and/or cancer, are highly
implausible. The main conclusion from the table is that
the more plausible assumptions, of reductions on the
order of 10 percent, yield fairly small differences in the
predicted numbers of persons surviving at various ages.
'' 

 
'' 

Appendix B

Life Expectancy in the United States’

Although the natural limit of the human lifespan,
presumed to be about 110 years, has probably not
changed since ancient times, the average age of death
(average life expectancy) has increased dramatically
since the turn of the century and an ever-increasing
number of persons now live to age 80 or 90. This in-
crease is due to biomedical advances, improved
economic status and living conditions, and improved

public health measures.

The major factor in increased life expectancy is the
marked reduction in deaths in infants and children that
followed the conquest of major infectious diseases. In
somewhat different words, advances in biomedical
science and other social and economic changes have
resulted in a redistribution of deaths so that deaths now
occur much less frequently in childhood and much
more frequently in old age. Of all deaths occurring in
the year 1900, for example, 25 percent occurred to per-
sons aged 65+. In 1970, it was 63 percent.

Table B-—1 shows how life expectancies have
changed in the United States from 1900 to 1974. There
has been an enormous gain in life expectancy at birth, a
gain of some 23 years; but only a small gain for persons
who reach 65, a gain of only some 4 years.

Women not only live longer than men, but the in-
crease in life expectancy since 1900 has been greater for
women than for men. The increase for both sexes was
dramatic between 1900 and 1955, but has since been
diminishing.

While the gains have been greater for nonwhite per-
sons than for white persons, white persons continue to
live longer than nonwhites.

'Figures for life expectancy are calculated on the basis of past
death rates. Such “expectancies” are not forecasts of survivorship, for
death rates change. For example, life expectancy was about 49 for
persons born in 1900. If that expectancy had been borne out, there
would now be only a handful of people aged 75+ instead of the 8
million actually alive. Death rates dropped dramatically since 1900;
thus average life expectancy rose dramatically. While average life ex-
pectancy is not, therefore, a good forecast of survivorship, it is a useful
index by which to show the changes in length of life that have oc-
curred over time.

Table B—1 Average Life Expectancy in the
United States, 1900 to 1974

 

 

1900 1955 1974
For all persons
At birth 49 69.5 72
At age 65 12 14 16
At age 80 5 7 8
For white persons
At birth: men 48 67 69
women 51 74 77
At age 65: men 11.5 13 13
women 12 15.5 18
At age 80: men 5 6 6
women 5.5 7 8
For nonwhite persons
At birth: men 32.5 61 63
women 35 66 71
At age 65: men 10 13 13
women 11 15.5 17
At age 80: men 5 9 8
women 6.5 10 10

 

Source: U.S. Bureau of the Census. 1976. Demographic
Aspects of Aging and the Older Population in the United
States. Table 5-1. (Current Population Reports, Series P-23,
No. 59). Washington, D.C.: U.S. Government Printing Office.

U.S. Census Projections

Future gains in life expectancy will depend directly
on progress in reducing death rates. The U.S. Bureau of
the Census has taken a number of different approaches
to the task of projecting death rates: by extrapolating
past mortality trends in terms of age-sex-race-specific
death rates; by analyzing the components of death rates
in terms of causes of death, factors affecting specific
causes, and possibilities of reducing the rates for par-
ticular causes; and by carrying out comparative
'' 

analyses with data from other countries where mortality
rates are very low. Among various such studies reported
in arecent publication of the Bureau of the Census, one
study produced the projections shown here in table
B—2.2 It indicates that little increase in life expectation
at birth or at age 65 is anticipated for the period be-
tween 1972 and 2000.

The conclusion drawn from the various studies cited
was: “In sum, there is no sound reason for expecting
major increases in life expectation or any significant ex-
tension of the lifespan in the foreseeable future.’’

2U.S. Bureau of the Census, op. cit.
3U.S. Bureau of the Census, op. cit., p. 43.

64

 

 

Table B—2 Projections of Life Expectancy
Increase,
1972 2000 1972-2000
At birth
Male 67.4 69.0 1.6
Female 76:1 76.9 1.8
At age 65
Male 13.1 13.6 0.5
Female 17.0 18.1 1.1

 

Source: U.S. Bureau of the Census. 1976. Demographic
Aspects of Aging and the Older Population in the United
States. Table 5-1, p. 41. (Current Population Reports, Series
P-23, No. 59). Washington, D.C.: U.S. Government Printing
Office.

 
''Appendix C
What Is the Likelihood of
Major Life Extension?

 

 

The projections shown in the preceding Appendix A
and Appendix B are based on the assumption that mor-
tality rates will decline as the result of advances in what
we have called “disease control.” No projections have
been made of the possible gain in life expectancy that
might result from the discovery of one or another
method of “rate control” of aging.! This is because such
a discovery itself lies somewhere in the future. Neither
the nature of “rate control” nor a possible “treatment”
to slow the rate of aging in the human organism can
presently be specified.

The prior questions, therefore, are these: What is the
likelihood that increased knowledge of the biology of
aging and of “rate control” will lead to a major exten-
sion of the human lifespan? Does such new knowledge
lie in the near or in the distant future?

One method of approaching these questions has
been to gather the predictions of experts. Several such
studies have been reported, all of them based on the
Delphi technique. (This technique is one in which
opinions are gathered from a number of expert judges
by questionnaire or interview; each judge is then in-
formed of the opinions of the others and is allowed to
reconsider his own response. When the opinions have
been thus refined one or more times, they are tallied for
the degree of consensus among the judges. The method
is described in detail by Gordon).2

 

'The Bureau of the Census has, however, indulged in speculation
regarding the most extreme situation and has set forth some projec-
tions of growth rates of the older population that would occur if
deaths were eliminated altogether—in short, if no one were to die.
“The population 65 and over is currently increasing at 2.4 percent an-
nually; with zero death rates the growth rate would jump to 8.3 per-
cent in the first projection year and then gradually fall back to 2.9 per-
cent in 2000, and 2.8 percent in 2025.” (U.S. Bureau of the Census,
op. cit., p. 44). A life expectancy of infinity taxes the imagination; and
we know of no reputable scientist who considers it a serious
possibility.

2Gordon, TJ. 1968. New approaches to Delphi. In J.R. Bright
(Ed.), Technological forecasting for industry and government. Englewood
Cliffs, N. J.: Prentice Hall, 1968 pp. 134-143.

One such study, by Bender, Strack, Ebright and von
Haunalter3 compared the findings from three earlier
inquiries:

(1) One was by Helmer and Gordon,‘ sponsored by
the RAND corporation, in which a small group of ex-
perts were asked for their predictions of “scientific
breakthroughs.” One of the 31 items was “Chemical
control of the aging process, permitting extension of
lifespan by 50 years.” (While the average number of
Judges responding to successive forms of the question-
naire was 14.5, neither the actual number of judges re-
sponding to the item regarding life extension, nor the
qualifications of those judges, was reported.)

(2) A second was based on a panel chosen from the
scientific staff of the pharmaceutical firm, Smith, Kline
and French Laboratories, in which participants were
asked to list needed and feasible breakthroughs and
trends in the areas of biomedical research and drug
therapy, and to indicate when they thought each event
would be implemented or widely accepted. (While the
total number of judges was 196, neither the number nor
the qualifications of judges responding to items regard-
ing life extension was reported. )

(3) The third, also supported by Smith Kline and
French laboratories, used the same approach as before,
but with an outside panel of 35 persons who repre-
sented the major biomedical disciplines. In this in-
stance, the qualifications of the 35 judges were
described in some detail. (The majority were giving
substantial effort to teaching, biomedical research,
clinical research, or clinical practice; and they rated
their own levels of expertise by indicating whether their
knowledge was derived from “awareness,” “reading,”
or “working in the area.”’) Here, again, the number of

 

3Bender, A.D., Strack, A.E., Ebright, G.W., and von Haunalter, 4

G., 1969. Delphi study examines developments in medicine. Futures,
1969, 4, 289-303.

4Gordon, T J., and Helmer, O. 1964. Report on a long-range forecast-
ing study, P-2982.” Santa Monica: The RAND Corporation, 1964.

65
''judges who responded to items regarding life extension
is not reported.

In making their comparisons, Bender, Strack,
Ebright, and von Haunalter used items which had ap-
peared in similar (although not identical) form in the
three studies. Generalizing from those items, the in-
vestigators reported predictions regarding “The ability
to control the aging process, permitting significant ex-
tension of the lifespan.”” The predicted date (median
date given) for achieving control of the aging process
was the year 2023 in the first panel; “beyond the year
2017” in the second, and the year 1993 in the third. The
investigators pointed out that, as might be expected,
great variation occurs among judges in areas such as
this where very little hard data are available on which to
base projections.

A more recent study by Boucher, Gordon, and Lam-
son5 was aimed at identifying areas in the physical,
biological, and social sciences that warrant attempts at
the assessment of technologies. It included the item,
“Chemical control of the human aging process, adding
at least a decade of productive life.” Judges were asked
to estimate the probability of this occurence by the year
1983. In this instance, a total of 37 judges, all of them
with prior interest or experience in technology assess-
ment, responded to this item, but only five were
regarded as experts because they were actually working
in this area. Of these five persons, one thought the
probability of widespread use of chemical control of the
human aging process was “‘virtually certain” to occur
by 1983; two thought it ‘“‘as likely as not;”’ one thought it
“not very likely;” and one thought it “virtually impossi-
ble.”

While the date queried in this study, 1983, is con-
siderably nearer at hand than the dates given in the pre-
ceding three studies—the years 1993, 2017, and 2023—
the range of responses indicates the same general lack
of consensus, even among persons regarded as expert in
the area.

A more elaborate study is now underway by The
Futures Group of Glastonbury, Conn. The objectives
include the identification and forecasting of life extend-
ing technologies in the next 25 years, and the examina-
tion of demographic, economic, and societal conse-
quences that might flow from different technological

5Boucher, W.I., Gordon, T.J., & Lamson, J.E. Candidates and
priorities for technology assessments. Vol 5. A survey of candidate technologies.
1973. p. 34. National Science Foundation: Office of Exploratory
Research and Problem Assessment: Research Applications Director-
ate. Washington, D.C.: U.S. Government Printing Office, Stock No.
3800-00176

advances. In the first phase of this study a carefully
selected panel of 25 biomedical experts was interviewed
at length regarding technologies that could affect life
expectancy. The panel members are experts in car-
diovascular, cerebrovascular, and cancer disease con-
trol, tissue regeneration, organ transplantation, cellular
aging, whole organism aging, and the effects of the
physical environment on health status.

While the findings from this study are not yet
published, a preliminary report by Gerjuoy and Gor-
don® summarized the forecasts made by this biomedical
panel.

Two classes of technologies were differentiated:
those aimed at increasing the maximum lifespan
(“‘span-extending”’), and those aimed at increasing the
numbers of middle-aged people who live to extended
old age, thus adding to average life expectancy (“‘curve-
squaring.”)? The span-extending technologies are those
involving dietary control or supplementation, those that
might alter the aging of key organ systems in the body;
those that might alter “programed” aging, such as hor-
mone-induced aging; and those that might involve
tissue regeneration. The curve-squaring technologies
are those relating to the prevention, diagnosis, and
treatment of cardiovascular and cerebrovascular dis-
ease and cancer, organ transplantation, nonbiological
prostheses, improvements in life style (as through.
public health education) and improvement in the en-
vironment.

Pointing out that the span-extending technologies
are much less certain than the curve-squaring tech-
nologies, Gerjuoy and Gordon report consensus among
panel members that the span-extending technologies
will not be available until after 1990, and that their
effects—if those technologies can be achieved at all—
will not be felt demographically until well into the next
century.

The curve-squaring technologies, on the other hand,
are expected to affect population size and age distribu-
tion over the next few decades, and by the year 2025, to
increase life expectancy at birth from the present 72
years to 85 years. The consequence might be that the
numbers of persons aged 65 and over will increase to 40
million by the year 2000, and to 72 million in the year
2025 (instead of the 31 million and 45 million projected

by the Bureau of the Census).

66

6Gerjuoy, H., & Gordon, TJ. “A Technology assessment of life
extending technologies.” Presented at the RANN/2 Symposium,
Washington, D.C., December 1, 1976. THE FUTURES GROUP,
Glastonbury, Conn.

7See, in this connection, the paper by Havighurst and Sacher in
this volume.

 

 
'' 

 

Another study by Havighurst, Neugarten, and
Sacher is reported here in some detail because it is
based on the opinions of a relatively large panel of
judges, all of whom are specialists in the field of aging.

In the winter of 1974-75 a questionnaire was
directed to American biologists and medical scientists
who were Fellows of the Gerontological Society asking
their opinions on two issues related to the extension of
the human lifespan:

1. The likelihood of increased life expectation for
people over 65, gained through one or the other of two
kinds of research:

a. Reduction of mortality due to improved control
over specific diseases, especially cardiovascular
disease and cancer (Disease Control)

b. Reduction of mortality due to slowing down of
the rate of biological aging of the body (Rate Con-
trol)

2. The amount of money that should be spent on
research on biological aspects of aging during the next
25 years.

The questionnaire contained the following introduc-
tory question:

Some biologists are drawing a major distinction
between: (A) slowing down the aging process in
the body (“rate control”) and thus increasing
average life expectancy by increasing the
“natural” lifespan; (B) reducing mortality from
specific diseases, especially cancer and car-
diovascular disease (‘disease control”).

In your opinion, is this a useful distinction? (Yes,
No)

If you answered “‘yes,” do you think increased life
expectancy is more likely to be achieved by
method (A) by method (B), or both?

This questionnaire was mailed to all Fellows of the
Section on Biological Sciences of the Gerontological
Society who resided in the United States or Canada (N
= 95); and half of the Fellows of the Section on Clinical
Medicine taken alternately from the published list, (N
= 68).

Response Rate

Of the 151 questionnaires delivered by the post
office to persons on the list, there were 65 responses, or
a 43 percent return (12 were not deliverable by the Post
Office). The rate of return was much higher from the
members of the Section on Biological Sciences than

67

from the Section on Clinical Medicine, 58 percent and
22 percent, respectively. (These are approximate
figures, since the questionnaire did not ask the name of
the respondent, but did give a space for “comments,”
and asked if the respondent was willing to be identified.
In this connection, 42 respondents gave their names,
and 23 did not. The 23 who did not give their names
were arbitrarily allocated to the Biological Sciences and
Clinical Medicine Sections in the ratio of those who did
identify themselves. )

Opinions Concerning Life Expectancy

The Questionnaire contained the question: Do you
anticipate that by the year 2000, average life expectancy
in the United States for persons who reach age 65 will
increase or decrease (categories of response are shown
in table C—1).

Responses to this question are shown in table C—1
and are related to the respondent’s answer to the ques-
tion cited earlier: Do you think increased life expectan-
cy is more likely to be achieved by method A (rate con-
trol), by method B (disease control), or both A and B?

The consensus was that life expectancy will be in-
creased between 5 and 10 years,8 and more by method
B (disease control) or by a combination of the two
methods, than by method A (rate control) alone.

Opinions Concerning Biological
Advances

The questionnaire contained the items:

It has been predicted that the essential mechanisms
of the biology of aging (factors that govern the rate of
aging) will be fairly well understood by the year 2000. Do
you agree? (Strongly agree, think it likely, uncertain,
disagree).

To achieve a greatly increased understanding of the
biology of aging, what is the approximate investment in
research that will be required?

An amount equal to that presently being spent on
cancer research. (approximately $500 million a
year)

 

8These opinions that life expectancy may increase by 5 to 10 years
by the year 2000 should be compared with the statement made by the
U.S. Bureau of the Census (quoted on p. 158, Appendix A) that
“there is no sound reason for expecting major increases in life expec-
tation in the foreseeable future.” The latter statement is based on
demographers’ analyses of mortality and morbidity data, and thus
represents a quite different perspective. It is based also on anticipated
changes in disease control (B), without regard for possible rate control
(A).
''Table C—1 Opinions Concerning Life Expectancy

 

 

 

 

 

 

 

 

Increase likely to be achieved by: Distinction Total
Rate Disease Both between
Control Control A&B A &Bnot
(A) (B) useful
By the year 2000 life expect-
ancy at age 65 will increase
by:
10 years 3 4 10 4 21
5 years 3 10 4 3 20
2-3 years 2 5 3 2 12
stay the same 2 2 2 8
will decrease by:
2-3 years
5 years 1 1
Total 10 22 19 62
Table C—2
Factors governing the rate of aging
will be understood by 2000?
Agree Likely Uncertain Disagree
Fellows, Bio Sci Section , 3 15 7 5
Fellows, Clin Med Section 1 4 4 0
Fellows, Section unidentified 2 8 6 3
Total 6 27 17 8

 

An amount equal to that presently being spent on
federally supported services to the elderly (ap-
proximately $2 billion a year)

An amount equal to that presently being spent on
higher education. (approximately $15 billion a
year)

Other (explain)

Suppose the mechanisms of the biology of aging
WERE understood by the year 2000, do you think the
knowledge could be put into practice by that date? (Yes,
No). If you answered ‘“‘No,” why not?

Responses to these items are summarized in tables
C-2, C—3, and C—4, with the respondents separated
according to their respective sections.

There was no consensus that the “essential mecha-
isms of the biology of aging” are likely to be well under-
stood by the year 2000, although a sizable group of the
biological scientists regarded it as likely.

Neither was there consensus tnat knowledge about
the biology of aging can be put into practice by the year
2000. For the group as a whole, opinions were evenly
divided on this point. At the same time, of the 18
biological scientists who regarded it as likely or certain
that the biology of aging will be understood by the year
2000, 16 believed also that the knowledge will be put
into practice by that date.

With regard to the expenditures of funds for
research on the biology of aging, it is of interest that the
majority of respondents (especially, of the biological
scientists) believed that a half-billion dollars per year,

68

 

 

 
''Table C—3

 

This knowledge can be put into
practice by 2000?

 

 

 

 

Yes No Uncertain
Fellows, Bio Sci Section 16 12 2
Fellows, Clin Med Section 6 2 1
Fellows, Section unidentified 12 1
Total 31 26 4
Table C—4
Should spend annually for research on biology of aging
Less than More than
1/2 billion 1/2 billion 2 billion 15 billion 15 billion
Fellows, Bio Sci Section 5 18 5 0 2
Fellows, Clin Med Section O 5 1 3 0
Fellows, Section unidentified 1 6 1 2
Total 6 31 12 4 4

 

 

 

approximately the amount then being spent on cancer
research, would be an appropriate amount.9

Illustrative Comments from Respondents

Stress on Treatment of Disease

While fundamental research into the biology of
aging is necessary for long-term goals of understanding
and retarding aging, improvements in health by better
nutrition, exercise, and attention to the prevention and
treatment of disease and stress will more quickly
achieve short-term goals of longevity within our life-
time.

The elucidation of the basic causes of the aging
process cannot possibly be foreseen within the next two

9It is of interest to compare this figure with Hayflick’s estimate
that funds spent on cardiovascular disease and cancer research are
100 times as great as the funds spent on research in biogerontology.
Another comparison is that in 1976-77 a total of approximately $20
million was being spent for research on aging in the behavioral and
social sciences, while the research budget for the new National In-
stitute on Aging was $19 million, most of this probably to be spent in
the biological area.

69

decades or so. In this interim, emphasis must be placed
on the aspect of preventive medicine, utilizing our present
understanding of life processes, aging and disease, en-
suring that our present acquired knowledge is being
used to maximal advantage, It is here that measures of
established value and information are not being fully
employed.

Stress on Rate Control

It is important that the strategy of “rate control” be
kept on the “front burner.” Competition between the
disease-oriented institutes and the Institute on Aging is
unavoidable, and we need to face up to this problem
rather than attempt to avoid it by the artificial separa-
tion of biological and pathological aging. It is also im-
portant that biogerontologists understand the implica-
tions of a “rate control” strategy.

In my opinion, there has been a regrettable lack of
recognition of the fact that the aging process is a field of
study which should be pursued, aside from the attack
on specific diseases. I believe that this is due in part toa
lack of breadth of vision and of acquaintance with the
broad world of living things.
''Combination of Both Approaches

I surmise that (knowledge of) whatever maintains
the integrity of the cardiovascular nervous system and
brain vascular systems would be most helpful. Here I
would surmise that long-term nutritional studies
preferably with human subjects on a volunteered basis
would be very helpful. The study of hereditary
longevity in a given human family with thorough
laboratory measurements over many years would be ex-
tremely pertinent—if it could be achieved.

Another major goal of biological research in aging
would be to determine the main effects of a variety of
extrinsic factors such as drugs, alcohol, pollution, ir-
radiation and exercise on mortality and longevity of ex-
perimental animals and to evaluate some biochemical
and morphological variables in human and animal
brains as a consequence of advancing age. Clinically,
the overall objectives of a research program concerned
with environmental factors in aging would be to deter-
mine whether the adult capacity of a mammal may be
effectively extended by environmental influences ena-
bling the organism to function optimally for a greater
portion of its mature and most productive period of its
lifespan.

Social Implications and Other Comments

Research on prolongation of lifespan must face the
“For what?” aspects—economic, social, and psy-
chological overtones may be more important in the long
run than the technological advances which would make
it possible.

An understanding of the mechanism of aging is im-
portant in its own right. There may be a moral impera-
tive to make life better. I am not convinced that there is
a moral imperative to make it longer. In fact, the social
consequences of life prolongation could conceivably
make the quality of life worse. Since if life prolongation
is possible, the methods will be utilized, the problems
as well as the benefits should be considered now.

Despite the optimism of the enthusiasts, I doubt the
validity of their expectations. It is one thing to prevent
polio or to cure cancer. It is another to enter on a life-
modification program with long-delayed visible results,
especially one which may (and probably will) require
long-term rather than isolated manipulations. Our
record for control of arteriosclerosis, diabetes, hyper-
tension, etc., is not that good; in fact the long-term use

70

of many modalities has just as often revealed unantici-
pated late and serious complications.

An enormous amount of information on mecha-
nisms of aging and relationships between aging and dis-
ease is available. We know enough to be able to list
priorities for (research) work that can provide answers
to the major questions. Most current work on the sub-
ject is with inappropriate systems, and consists of the
generation of data in the absence of significant ques-
tions or the testing of useful hypotheses. Large numbers
of people have vested interests in keeping the subject
diffuse, and I suspect reducing support would narrow
the field down to those who are serious about trying to
understand aging, and would be beneficial. It would, of
course, be essential that those making decisions about
funding have extensive knowledge of the field, and be
committed to making progress on the most important
questions.

My firm conviction is that longer life should emerge
only as a consequence of qualitatively better life, as has
been the case throughout evolutionary history. It would
be folly to interdict some molecular aging process, and
thus arrest aging, while leaving man’s mental
capacities, personality integration, motor skills, and
physiological integration unimproved. Man literally
made himself in all these respects during the past
million-odd years, and increased longevity was a con-
comitant. If that process does not continue, human
history will abort within a few centuries or millenia. Yet
all the chemical “‘quick fix” approaches do shortcut the
improvement of man’s biological and psychological
nature.

Although I firmly believe in the ultimate triumph of
man over present day ecological and energy crises, I am
concerned that the continued “technological explo-
sion,” during the next 25 years, and the many adapta-
tions required, will create great psychosomatic illness
and the ravages of cardiovascular disease, e.g., hyper-
tension, “strokes” and myocardial infarction will
greatly erode the advances made in other areas re reduc-
tion of the tempo of the natural aging process. That is,
the tempo of modern living will cause accelerated aging
or a progeria-like syndrome.

A problem that plagues this situation is that regard-
less of increases in lifespan neither the individuals
(aged) nor the competitive young are prepared to cope
with the psychic problems of the aged. The main point
is that if life is to be prolonged we should know what
goals we are trying to achieve.

 

 

 
'''' 

 

 
''PUBLIC HEALTH LIBRARY

FEB 7 1979

sERK S

Tn

e

|

Wh

O°

 
''National Science Foundation
Washington, D.C. 20550

Official Business
PENALTY FOR PRIVATE USE, $300

Postage and Fees Paid ye
National Science Foundation ey

THIRD CLASS
Bulk Rate

NSF/RA 770123

Chee oy)

eet.

 
''