Transcript Le secret professionnel

The Choosy Reaper: From the
myth of eternal youth to the
reality of unequal death
Heidelberg Nov 5-6, 2004
Prof. Alex Mauron
Bioethics Research and Teaching Unit
From the
announcement
of the 2004
Wright
colloquium,
Geneva
Anti-aging medicine
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Many aspects of current medical research
(stem cells, neuroscience, etc.) are
currently united under the label:
« regenerative medicine ».
This fuels legitimate hopes for innovative
treatments of degenerative diseases.
This also fuels futuristic speculations
about massive increases in human lifespan or even the abolition of mortality.
Arguing for death

These speculations have raised many
criticisms, often on ethical grounds.
1. Disturbing the workings of nature (or
« Playing God »)
Example: mortality is needed for the frictionless
motion of evolution to occur.
Answer: who needs evolution? Not we, the
current humans!
Who wants to be superseded by a « new and
improved » species (unless we do the
superseding, of course)!
2. Upsetting the moral confines of the human
condition. Many high-powered conservative
intellectuals want to persuade us that mortality
is part and parcel of what we understand to be
humanity.
Answer: This argument is based on the
assumption that content-full, naturalistic
statements about mortality and disease are
morally binding. Difficult to sustain outside of
special ethical or religious communities.
3. Breaking the “laws of the species” (Habermas)
Answer: The notion of species that operates in these
arguments is far removed from current biological
concepts (Robert, Baylis). Still, there are arguments
invoking the cultural significance of species
characteristics that are more sophisticated than the
« playing God » kind.¶ But at the end of the day, they
amount to a kind of philosophical anthropology that
has little normative force by itself.
¶American Journal of Bioethics. Issue dedicated to
“Crossing Species Boundaries”. 2003, vol 3.
The various organised reactions against hightech interventions in human nature, such as:
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« yuk-reaction » à la Leon Kass
Culture wars against « scientism »
Religions and/or philosophical wars against
« anti-humanism »
… are basically « symbolic crusades ».
The sociology of « symbolic crusades »
Classical example (Gusfield, 1963): The
temperance crusade in early 20th century
America was basically a « status conflict ».
It was a political move to assert the power of
Protestant, rural, small-town America against
the Southern immigrants as well as against
the urban elites (does that ring a bell?…).
« Symbolic crusades » and pharmacology
-
Symbolic crusades create moral panics as a tool to
gain, or maintain, social influence (Howard Becker,
1963). The panic about « designer drugs »,
« lifestyle drugs », « genetic enhancement »…
points to a genealogy of moral crusades that all
involve:
1.
2.
Unusual, articifial, tamperings with the natural
order
« moral entrepreneurs » (Becker) that have an
intellectual, but also political, stake in the issue
Example: the politics of indignation in
current German debates
1- Habermas vs. Sloterdijk
The issue was often framed to be about who
will be the official « court philosopher » in the
reunited Germany.
2- The influence of the churches and of
academic theology (which is rather strong in
Central Europe, as opposed to France or Italy,
for instance) may relate to their ability to be
efficient « moral entrepreneurs ».
Traditional moral entrepreneurs…
… Tend to be conservative in outlook, and to
instigate moral panics about « eugenics »,
« de-humanization », « the complete
instrumentalisation of human life ».
This explains for instance the Mitteleuropean
attitude to futuristic technologies, but also to
more current issues such as:
- preimplantation genetic diagnosis
- embryonic stem cells.
Non-traditional moral entrepreneurs
- Proponents of high-tech intervention into human nature
are also organized in militant, ideologically-charged
movements.
example:
 World Transhumanist Association
 Extropianism
- Transhumanism is touted as an all-encompassily
philosophy, medicine, aesthetics, culture, etc.
From the website of Natasha Vita-More
A symbolic crusade for hypercapitalism?
Transhumanism embodies the mix of
futuristic optimism, individual
assertiveness, libertarian denial of limits
and techno-enthusiasm that has
become the hallmark of the current
entrepreneurial culture.
Transhumanism is the « optimistic »
version of a symbolic crusade
Radical anti-ageing medicine
It is difficult to argue cogently against it.
 Still, one ought to ask what its effects
would be if it became a workable
proposition in the current demographic,
social and ideological context.
 An essential feature of this context is
that life expectancy is an important
marker of inequality.

Life expectancy at birth (WHO, 2002)
Japan
Switzerland
Greece
Cuba
Costa Rica
USA
Brazil
Bhutan
Russia
Uganda
Mali
Zimbabwe
male
78.4
77.7
75.8
75.0
74.8
74.6
65.7
60.2
58.4
47.9
43.9
37.7
female
85.3
83.3
81.1
79.3
79.5
79.8
72,3
62.4
72.1
50.8
45.7
38.0
We are not yet a
genetically engineered
species, but do we still
belong to the same
species?
Universal inequality

Marmot, Wilkinson, the Whitehall
studies:
Inequality in life expectancy is not (just) an
“us vs. them” issue. It cuts across all
societies and all social strata.
The pecking order
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
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Disease and premature death are more
prevalent on the lower rungs of the social
ladder
It is not just a matter of material
circumstances and access to medical care.
Life entails a series of more or less stressful
transitions and the lower you are on the social
ladder, the harder you are hit at each of these
steps. This is the case even in affluent
societies.
From: Social Determinants of Health: The Solid Facts. WHO 2003
Social inequality is bad for you…

…especially if you experience relative
deprivation from an early age onwards.
From: Social Determinants of Health: The Solid Facts. WHO 2003
Insecurity kills

Precarious jobs are chronic stressors
that exert profound effects on health
From: Social Determinants of Health: The Solid Facts. WHO 2003
Social support is good for you…
..but in turn depends on a social context
that values social cohesion and equality.

Although social hierarchies exist
everywhere, the associated « health
gradient » can be steeper or shallower.
From: Social Determinants of Health: The Solid Facts. WHO 2003
All this is not inevitable…
Michael Marmot (University College, London):
- « If you want to hang around, get ahead. Higher status
is a prescription for a longer life »
- « You might say the whole thing is inevitable: let us just
give up and go home. Let’s start worrying about obesity
again. My argument is it is not inevitable. Hierarchies
are inevitable. But how hierarchies translate into
differences in health is the crucial question. »
The Guardian, June 8, 2004
…but the prevailing mood does not
lead to optimism

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« Liberté, égalité, fraternité » : only the first
and the last seem to have a future.
« Liberté » is what everyone argues for, you
cannot have enough of it.
« Fraternité » is nice, chummy and
sentimental.
« Egalité »: try to argue for it (and I mean the
real thing, not the bland « equality of
opportunity »), and you stand accused of
bringing back the Gulag.
Yet if we do not take equality on board as a
central value in social ethics, we must remain
blind to an essential aspect of the life
perspective of today’s humankind…
…namely that even as the basics of life are
secured, at least in the developed world,
longevity remains an important marker of
social stratification.
Will radical anti-ageing medicine make it worse?
Conclusions

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The more flamboyant claims of anti-aging
medicine, just as the moral panic about them,
are two sides of the same coin: a culture war
about status.
The conservatives defend their status as
moral entrepreneurs for the frightened,
disconcerted, « back-to-good-ol’-morality »
crowd.
The techno-progressives defend their status
as trend-setters for the libertarian,
entrepreneurial crowd.
Conclusions

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Equality is a central value of the
Enlightenment.
But nowadays, equality is unfashionable as
a source of social-ethical guidance.
Since longevity is an important indicator of
global inequality as it is, our culture may
have little moral resources when it comes to
implementing radical anti-ageing medicine in
a way that wouldn’t aggravate inequalities
further.