Bioethics Forum Essay
On Living to 100 or More
Sometime around my mid-50’s I began to ask myself a question: how long should I want to live? My father had died at 64, my mother at 85, my various uncles and aunts in their 60s and 70s. Occasional news stories, always with a picture, reported on those few people who made it to 100. I am now 85 and still turning that question over in my mind.
I could serve as a geriatric poster-child for my age: some Parkinson’s disease, fairly advanced emphysema, arthritis, moderately severe asthma, and elevated but controlled high blood pressure—a typical potpourri of those chronic diseases that now mark the elderly. I call this the great trade-off. Earlier generations lived shorter lives and had faster deaths. We now live longer but medical advances typically give us a slower death from those diseases.
I did over time answer the question of how long I should want to live. First, to live long enough to do most of those things that life makes possible: to become educated, have a satisfying career, see a bit of the world, develop a circle of friends, and to marry and raise a family. I have now done all those things, well and fully (if not always perfectly). Second, I want to die at a stage in life when those in my family and community see no significant social loss to society in my death even though (I hope) they will personally miss me.
It was once acceptable to say, with few tears, that “he died a natural death.” But now that death has been medicalized, a specific disease that caused the death is required. My views on a long life are not notably idiosyncratic. Two American public opinion surveys found that 90 is taken to be a long enough life, for Germans it is 85, and for Australians 80. Hardly anyone wanted to live beyond 100. While some might say that life itself is an intrinsic good–and the more of it the better–others have contended that it is the reality of our finitude that forces us to shape a meaningful life. That is my own bias.
But apart from what you and I might find acceptable for our individual lives it is no less necessary to ask: would a significant increase in average life expectancy–say, well over 100 and as long as 120 or 150–benefit us as a human community? I can’t imagine how it could be a benefit, but I can imagine the damage a pursuit of that goal could bring. A number of wealthy Silicon Valley entrepreneurs and innovation-driven scientists seem to want just that. Or do they? A parallel and often overlapping effort–supported by prominent geriatric and medical researchers–is the goal of compressing morbidity; that is, a long, healthy life followed by a quick death. They concede that the compression goal would likely increase life expectancy, but that is not their intention.
Another research group, Calico, in Silicon Valley, enthusiastically seeks both compression and increased longevity. That group worries me the most. Consider that even now there is in the U.S. a looming long-term problem with our aging society, living to an average of 79. By 2050, just as the millennials will be coming in to middle age, 20 percent of the population will be over 65, with 400,000 over 100. Yet even now a large and growing proportion of the elderly are going into old age without adequate savings and pension plans–and often devastating medical costs beyond their Medicare coverage. The Social Security and Medicare programs will have to be significantly ramped up. Whatever their health care system, every developed country faces a similar problem.
The poor countries face far greater pressure. Some 60 percent of their deaths now come from aging populations and the same chronic diseases that afflict the rich countries. They neither have, nor are likely to have in the foreseeable future, the kind of high-tech medicine and social security systems we lavish on our elderly. Their care will fall heavily on their families and children. Global life expectancy is 69 compared with 79 in the U.S. (and 84 in Japan, the country with the highest life expectancy), but the poor countries are rapidly catching up. It is reasonable for poor countries to try to catch up with us, but that’s all they need.
We don’t need to live longer either. Although our country has many needs, I have heard no one contend that we could collectively solve them better if we could just live longer. For that matter, I never heard it said of my parent’s generation, mainly dying in their 60s and 70s. Evolution, replacing the young with the old, knows what it is doing. Smart scientists and Silicon Valley entrepreneurs would do well to exercise some of their innovative imaginations on the problems that already plague our present life spans, particularly those of poor countries. I wish them well in the search for a compression of morbidity, even though I will be long gone before it ever happens.
Daniel Callahan is the cofounder of The Hastings Center and author of The Five Horsemen of the Modern World: Climate, Food, Water, Chronic Illness, and Obesity, to be published next month by Columbia University Press.