To Die Or Not To Die? - Health Week


By Timothy Dillon

Photo courtesy of Enric Juve.

The unexpected 2013 has come at last. We lack flying cars, are experiencing the early stages of climate change, and (almost) have universal health care. The future hasn’t exactly turned out as everyone would have expected. However, there are a few things in life that have always been certain: arguably taxes and, more definitively, death. Is that still true though? Is death so certain?

In a post-Information Age we are dealing with massive amounts of information at the tips of our fingers. Take two TED talks that can be easily found on the subject of age, health, and the inevitable. Both are informative about aging diseases, the science behind aging itself, and offer solutions to approaching the end of life. However, one approach is to prepare for death, and the other is to delay death. There are two branches of science, and arguably ethics, that deal in death — those who wish to die with dignity and those who are seeking the fountain of youth.

In the first TED talk, Alanna Shaikh deals with preparing to get Alzheimer’s and the inevitable decline in health. For anyone who has known a person who has Alzheimer’s, you understand the one-two punch it deals. First you lose the person you knew, their habits, opinions, laugh, smile. Once that is gone you have a person who cannot remember their connections to the world and is left incapable of being able to care for themselves.

Alzheimer’s is not the only disease that robs a person of their faculties. Every type of dementia does carries these side effects, so do degenerative nerve diseases, and of course tumors can take root in the brain and cause a person to become a shadow of their former self. Shaikh suggests that there are things that one can do actively to help their body, even when their mind is absent. Hers is a proactive approach to a long term problem that could very well be a viable option for those who have higher chances of contracting or falling victim to one of these conditions.

The longer view of end of life planning differs from most since it tries to work backwards from the end result of a disease. In Shaikh’s case, she analyzes Alzheimer’s and constructs a blueprint for what her body will need when her mind isn’t there to watch after it. Typically, this is not how end of life planning has been presented. Much of what we consider to be end of life planning revolves around choosing power of attorney and discussing what measures ought be taken to keep us alive. However, even this fairly logical approach to end of life care has not been without scrutiny.

Jane E. Brody, author and columnist for The New York Times, wrote an article in 2011 over the continued drama surrounding the resurfacing of the term “death panels” since the debate over the Affordable Care Act that had commenced over the year prior. These “death panels” were actually meant to give doctors and patients a forum to discuss possible end of life issues, and this was still met with a great deal of scrutiny. The question then becomes, if we, as a people, cannot even agree on having discussions of end of life issues, how can we encourage people to proactively prepare for their demise? Perhaps the majority of the scientific and health communities have approached the aging dilemma in the wrong way.

Our second TED talk features Professor Aubrey de Grey discussing his goal of true life extension. De Grey argues that instead of preparing for the end of life, we ought search for a way to extend life, beginning with the end of aging. The theory is that once we begin the process of temporarily stopping aging from occurring and granting longer life to individuals, by the time the age-extending “therapies” lose their efficacy, there will be new therapies to replace them. So what may buy just 10 years of extra life for a person, will be enough to get them to the next therapy. Much of this process is of course theoretical, but the science tries to deal with the same issues of aging that Shaikh suggests we ought prepare for. So which is better?

These two approaches come with certain obvious flaws. In terms of end of life preparation, a person must come to terms with their fate in order to address it. In the case of Shaikh, it was coming to terms with the fact that she has a high likelihood of falling victim to Alzheimer’s, but isn’t it fair to say this may be preemptive? In fact, couldn’t we argue that instead of preparing her body to cope with the loss of her mind, she could be instead enjoying the time she has left without becoming constrained to this preparation?

It would be fair to say that by preparing for this prospective disease, she is altering her behavior as well as her outlook on the world. In essence, she is changing herself in a way that she might not need to, especially since she is not guaranteed to fall victim to it. What remains unclear is when we ought draw the line between life as is and life in preparation.

In the case of de Grey, the obvious counterpoint is population control. If we start making it possible to have someone live the length of several normal lifetimes, or even, become “immortal,” then what happens to the earth and our population? Consider this and then remember that the human population of the earth is enormous and growing at such a rate that already appears to be unsustainable. From here, how can our world sustain it’s current population plus a new market of those  who might live multiple natural lifetimes? The answer is simple: it can not.

Practically speaking, what Shaikh suggests is more realistic, even if it is fatalistic and perhaps a little morbid. Yet de Grey is still intriguing, since some of the science is still theoretical. It may not even yield results as we might imagine; immortality may be fiction after all, but life extension could be within our reach.

Besides, we already seek to extend our lives everyday. It makes sense to want to keep life going, it is instinctual, even natural, but then again, so is death. If nature has taught us anything, it is that all things are temporary. Life leads to death, just as energy moves from usable to unusable. Somewhere between these two positions is a fundamental disagreement about the necessity of aging and death. To die, or not to die, that is the question, and the answer could be up to optional for all of us, one day.