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Anti-Aging Medicine: The History

Establishing an Appropriate Ethical Framework: The Moral Conversation Around the Goal of Prolongevity

Department of Bioethics, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio.

Address correspondence to Stephen Post, PhD, Department of Bioethics, Case School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-4976. E-mail: sgp2{at}po.cwru.edu

	Abstract

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This article presents a triadic framework for ethical discourse around the biogerontological goal of prolongevity, which might someday become achievable through the deceleration of aging. The methods are those of the humanities and philosophical analysis. The perspectives of natural law, equalitarian justice, and beneficence are presented in a balanced manner, although the conclusion reached is that the goal of prolongevity through decelerated aging is ethically valid as a potential means to the beneficent amelioration of the many diseases for which old age is the major susceptibility factor.

Ethical theories do have consequences. A resurgence of natural law ethics, which asserts the goodness of human nature and aging as we know it, gave rise in 2003 to a significant set of criticisms of the goal of prolongevity, in particular through the work of Leon R. Kass and President Bush's Council on Bioethics, for which he serves as chair. The equalitarians, on the other hand, do not engage in the moralization of human nature as we know it, but nevertheless cannot support the goal of prolongevity until the vast inequalities that currently plague the world—including access to basic healthcare—are corrected. These are both important frameworks for critique of decelerated aging, should this ever become possible.

At first glance, however, it is difficult to see why the deceleration of human aging presents a major ethical concern. There are four reasons for this. First, aging may not be a "disease" by most definitions, but it is the major risk factor for innumerable diseases of old age, and is therefore so closely associated with disease that it is not implausible to think of it as such and to make therefore salutary efforts to slow its progression. Second, some claim that the scientific assault on aging could invite "ageism;" there is no logical connection between "anti-aging" research and prejudice. On the contrary, the goal of prolongevity through deceleration of aging has the more obvious inclusive aspect of making old age more enjoyable and acceptable by mitigating the frailties and infirmities that make the increase of years unwelcome. Third, the goal of decelerated aging and prolongevity does not violate the ethical principle of nonmaleficence. Contrary to abortion, infanticide, suicide, and euthanasia, enhancing the length of life is an affirmation of its worth. The addition of healthy years by the decelerating of aging is, in the most general sense, "pro-life." Fourth, the goal of longer and healthier lives is hardly new and we have been acculturated to it. Life expectancy has risen dramatically over the past two centuries and has been embraced as progress. Public health, sanitation, reduction of infant mortality, antibiotics, and many other factors have contributed to our current level of prolongevity, which some might have deemed an "unnatural" goal a century or more ago. In other words, the genie is in many respects already out of the bottle. (This progress in life expectancy might, however, be hampered by sedentary lifestyles, fast foods, obesity, and related diabetes, all of which are viewed as public health problems to be overcome.)

Deeply thoughtful bioethicists are concerned with the implications of anti-aging research and related prolongevity. Kass prepared a discussion paper for Council on Bioethics members prior to their meeting on January 16–17, 2003. Entitled "Beyond Therapy: Biotechnology and the Pursuit of Human Development," it established the Council's future agenda (1). Much of this paper is devoted to anti-aging research and the perils of anti-aging treatments to decelerate aging, should these emerge in the decades ahead, as Kass anticipates. Kass appeals to the dignity of human nature as it has evolved.

Yet, biogerontologists, one of whom is with the National Institute on Aging, creatively embrace the ideas of "The Serious Search for an Anti-Aging Pill," which would mimic the effects of caloric restriction as an approach to the eradication of disease (2). Aging is the prominent risk factor for so many debilitating diseases, and the best way to prevent such debilitation is to mitigate the risk. The removal of this risk is not obviously contrary to human dignity. In fact, we would all agree that removing the major risk factor for diseases such as Alzheimer's or osteoporosis would do quite a bit for the preservation of human dignity, for the control of health care costs, and for the alleviation of sometimes overwhelming adult filial duties (3). In this sense, anti-aging researchers are engaged in preventive medicine. Still, Kass's appeal to natural law must be taken seriously, and is a topic toward which we now turn.

	NATURAL LAW CRITICISMS

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Natural law places moral value on human nature as we know it, and represents a necessary reaction to posthumanism, e.g., the view that today's humans will be superceded by superior models. (The expression "transformed humans," shortened to "trans-human," is equivalent to posthumanism.) One reason why natural law, a form of antiposthumanism, has an immediate appeal is because some defenders of posthumanism are rather cavalier (see, e.g., www.betterhumans.com, www.transhumanism.org, www.forsight.org). Websites reflect the enthusiasm of the young convert to some new image of the human future that is liberated from biological constraints, but lacking in wisdom. More reverence for human nature and aging itself as the product of millions of years of evolutionary selection would be the necessary corrective, and this is just what natural law theorists offer.

The posthumanist embraces decelerated and even arrested aging, but only as a small part of a larger vision to reengineer human nature, and thereby to create biologically and technologically superior human beings (4). Posthumans are the much more advanced models that we humans today will design for tomorrow, not unlike new models of automobiles. Genetics, nanotechnology, cybernetics, and computer technologies are all part of the posthuman vision, including the downloading of synaptic connections in the brain to form a computerized human mind freed of mortal flesh, and thereby immortalized, e.g., so long as the computer doesn't crash (5). Posthumanists do not take biology to be in any sense destiny; they see human nature as an obstacle to be overcome (6). The next great step in evolution, they argue, comes with our own re-creation by human ingenuity as so-called "co-creators."

The posthumanist may be irreverent of human nature, but let us recognize immediately that within the boundaries of the technology of the day, humans have been reinventing themselves anyway for millennia. And what is natural and what is unnatural, anyway, when the human condition has already been so deeply impacted by technological innovation? Where do we draw lines? As Freeman Dyson writes, "the artificial improvement of human beings will come, one way or another, whether we like it or not," as scientific understanding increases, for after all, such improvement has always been viewed as a "liberation from past constraints" (7). The idea of human flight was once deemed heretical hubris in the light of eternity and nature. Gregory Stock, in his book entitled Redesigning Humans: Our Inevitable Genetics Future, introduces the idea of "superbiology," the outcome of our taking full control of our own biology in turning toward perfectability (8).

In certain respects, the natural law theorist has the support of theological ethics, which generally asserts the moral goodness of human nature as we know it in more or less clearly defined contours. The wisdom of natural selection is deemed a reflection of a creative presence higher than our own, and it is considered hubris to assert the powers of scientific re-creation. But as David F. Noble (5) has shown, the roots of this posthumanist project actually lies within Western religion, beginning in the 9th century when the "useful arts" came to be associated with the concept of human redemption. As a result, we have a "religion of technology" that gives rise to enthusiasm for technological prowess. In essence, technological advance is always deemed good. Noble hopes that we can free ourselves from the religion of technology, from which we seek deliverance, through learning to think and act rationally toward humane goals (5). Is Noble right about these religious roots? Probably. As Gruman pointed out in his definitive entry in the Dictionary of the History of Ideas (9), the modern concern with enhancing longevity "stems from the decline since the Renaissance of faith in supernatural salvation from death; concern with the worth of individual identity and experience shifted from an otherworldly realm to the ‘here and now,’ with intensification of earthly expectations" (9). Carl L. Becker, in his classic work, The Heavenly City of the Eighteenth-Century Philosophers (10), similarly interpreted the great ideas of the Enlightenment and the merging goals of science as based on a secularization of the medieval idea of otherworldly salvation, resulting in an advance towards a heaven on earth. Thus did George Bernard Shaw, in his remarkable Back to Methuselah (11), take up the variations in life spans between species such as parrots and dogs, or turtles and wasps, and asks that science rise to the redemptive occasion by vastly increasing human longevity.

Indeed, Francis Bacon, a founder of the scientific method, in his millennialist and utopian essay The New Atlantis (12), set in motion a biological mandate for boldness that included both the making of new species or "chimeras," organ replacement, and the "Water of Paradise" that would allow the possibility to "indeed live very long" (12). Three centuries before Francis Bacon, the English theologian Roger Bacon argued that, in the future, the 900-year-long lives of the antediluvian patriarchs would be restored alchemically. Like many Western religious thinkers, both Bacons saw aging as the unnatural result of Adam's fall into sin. These Western dreams of embodied near-immortality could only emerge against a theological background that more or less endorsed them. In this sense, there is no antagonism between religion and science, the foundations of which were well established in the medieval period.

The modern goals of anti-aging research and technology are historically emergent from a premodern religious drama of hope and salvation (13). Longings for immortality within a religious context are understandable in light of existential anxiety over finitude and mortality, and the goal of prolongevity may be, at least historically, shaped by such passions. Renaissance science transferred the task of achieving immortality from heaven to earth. The economy of otherworldly salvation presented by Dante was replaced by the here and now. There is a residual millennialist optimism among secular biogerontologists, which proclaims aging itself to be surmountable to degrees through human ingenuity.

At the end of The New Atlantis, to which we have already alluded, Bacon lists more specifically among the goals of science "the prolongation of life, the restitution of youth to some degree, the retardation of age," along with "making of new species, transplanting of one species into another" (12). This Baconian goal of "the retardation of age" is pursued by today's biogerontologists who create scientific breakthroughs with fruit flies, roundworms, rodents, and monkeys, but with an eye toward the alleviation of senility in an already aging society plagued by chronic age-related diseases.

But the natural law theorists attempt to stem such scientific enthusiasm. One of the wiser minds of the last century, Hans Jonas (d. 1993), an intellectual inspiration for Kass and the antiposthumanists, first articulated deep questions about the prolongevity agenda. He wrote in 1984 that "a practical hope is held out by certain advances in cell biology to prolong, perhaps indefinitely extend, the span of life by counteracting biochemical processes of aging" (14). How desirable would this power to slow or arrest aging be for the individual and for the species? Do we want to tamper with the delicate biological "balance of death and procreation" (14), and preempt the place of youth? Would the species gain or lose? Jonas, by merely raising these questions, meant to cast significant doubt on the anti-aging enterprise. "Perhaps," he wrote, "a nonnegotiable limit to our expected time is necessary for each of us as the incentive to number our days and make them count" (14). Jonas's later essays raising many of these same questions were published posthumously (15).

Many of these questions are echoed in the writings of Kass, who accepts biotechnological progress, but within a narrowly therapeutic mode; his argument is against those who, in hubris, wish to enhance and improve upon the givens of human nature. He draws on the technological dystopians, such as Aldous Huxley and C. S. Lewis. An early antiposthumanist who used nature to criticize scientific ambitions, Oxford's Lewis wrote The Abolition of Man in 1944 (16). He defended a natural law tradition: "what is, is good," and that we should live within our God-given limits. He cautioned against a world in which one class of enhanced human beings would dominate and oppress the other. We might ask, then, with Lewis (and H. G. Wells), if those freed from the decline of aging would become the superior and elite humans, while those who age are deemed inferior.

Kass makes a potent appeal to the great books of the humanities, in which longevity and even embodied immortality are resisted as temptation. He urges us to slow the pace and think before we leap into the unknown. His leadership role on the Bioethics Council gave wide public attention to the need to reconsider the goals of medicine in the name of a more natural science. In a creative essay, "L'Chaim and Its Limits: Why Not Immortality?," Kass provides arguments against prolongevity, not all of which were raised by Jonas (17). He asserts, for example, that the gradual descent into aged frailty weans us from attachment to life and renders death more acceptable; that our numbered days encourage a creative depth in our humanity—a depth that escaped so many of the immortal Greek gods and goddesses, whose often-debauched and purposeless behavior made Plato wish to ban from the ideal Republic; that a preoccupation with the continuance of our lives is a distraction from that which is best for our souls; that in a world transformed by anti-aging research, youth will be displaced rather than elevated, and the parental investment in the young will give way to "my" perpetuation; and that in such a new world we will grow bored and tired of life, having "been there" and "done that." These assertions are all thoughtful, creative, and appropriately cautionary, for the implications of slowing or arresting aging itself are ambiguous.

Jonas and Kass both touch on virtue. There is arguably a tone of solipsism in grasping at extended life rather than accepting old age and celebrating rejuvenation in the lives of our offspring. Whatever capacities for compassionate love we possess emerged evolutionarily on the parent–child axis, and on this axis we generally achieve our higher degrees of self-forgetfulness and love—even if so-called "selfish genes" provide a hidden substrate. It is impossible to imagine our capacities for kindness and benevolence evolving without a dominating investment in the young rather than in ourselves. Responsibility to future generations precludes a clinging to our own youthfulness. There is wisdom in simply accepting the fact that we evolved for reproductive success rather than for long-lived lives. Without such wisdom, will we lose sight of our deepest creative motives? And so it is written, "teach us to number our days that we may get a heart of wisdom" (Psalm 90).

Another leading antiposthumanist, Francis Fukuyama, who also serves on the Council on Bioethics, is the author of the widely reviewed book entitled, Our Posthuman Future: Consequences of the Biotechnology Revolution (18). Fukuyama challenges those who would march us into a posthuman future, characterized by cybernetics, nanotechnology, genetic enhancement, reproductive cloning, life span extension, and new forms of behavior control. He views the posthumanists as arrogant, pretentious, blind to adverse consequences by enthusiasm, and lacking in fundamental appreciation for natural human dignity. Fukuyama argues powerfully that the anti-aging technologies of the future will disrupt all the delicate demographic balances between the young and the old, and exacerbate the gap between the haves and the have-nots. Thus he adds equalitarian themes to a natural law framework.

In summary, the natural law thinkers exhort us to live more or less according to nature, and warn that our efforts to depart from what we are will result in new evils that are more perilous than old ones. To use an analogy, we are like the sailor who climbs as high on the mast as one can in order to rise high above the waters of nature, but only to see the boat capsize under our weight tipping the mast into the waves below. How can we presume that the brave new world will be a better world? Should not the burden of proof be on the proponents of radical change? Who are we today to impose our arbitrary images of human enhancement on future generations?

Thus are antiposthumanist thinkers critical of biogerontology to the extent that it seeks to slow the aging process. Our focus, argue the antiposthumanists, should be on the acceptance of aging rather than on its scientific modification. The intergenerational thrust of evolution, by which we are inclined toward parental and social investment in the hope, energy, and vitality of youth, provides the basis for a natural law ethic that requires us all to relinquish youthfulness (19).

I agree with the antiposthumanists that a decision for or against decelerated aging based on superficial thinking and a libertarian commitment to individual freedom is a formula for the easy destruction of what is good in being human. They are right to place an emphasis on Aristotelian "final causes" and the human goods of an objective nature. Unless we are radical relativists, it must be asked whether any scientific aspiration contributes to the human condition or detracts from it. And yet, the natural law criticism of the goal of prolongevity does not leave me quite convinced, although before stating why this is so, we turn to the equalitarian position.

	EQUALITARIANISM

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The equalitarian tradition is emphatic in its equal regard for a common humanity. Its moral focus with respect to prolongevity is the problem of our creating two classes of human beings, those with longer and healthier lives and those with shorter and illness-ridden lives. Respect for equal moral status suggests that anti-aging research should only go forward when no human being any longer falls below a reasonable level of flourishing, and that if scientific breakthroughs occur, anti-aging treatments should be available to all. It is indeed unconscionable that some people might be living to be 120 or 140 years old and relatively free of morbidity, while the vast majority of humanity lives in dire circumstances.

Yet, there is a fallacy in strict egalitarian thinking. If we were to insist that technological developments of all sorts wait until the world becomes perfectly just, there would be absolutely no scientific progress. Requiring equality as the prerequisite to biogerontological advance is to establish an obstacle that is virtually insurmountable, and so exceedingly high as to be implausible. Indeed, this is not a requirement imposed in any other area of scientific research and development, from new dental treatments to organ transplantation.

Nevertheless, there is something disturbing about a world in which so many are destitute and starving, while others are wallowing in wealth and, perhaps, some years from now, in greater prolongevity. But we are already living in a world where life expectancy is radically lower in the poorer regions, and where disparities in length and quality of lives are pronounced. From the perspective of international health, many technological advances seem unjust because they remain well outside the reach of the neediest. One worries about a world in which the developed nations enhance the human nature of their citizens while the underdeveloped nations struggle in marginal conditions. And one worries about the inevitable reality that even within developed nations, the wealthy classes will be able to afford what the poorer classes cannot.

While the equalitarian concern is of moral importance, it has never been implemented as a limit on biotechnological ingenuity. We developed treatments for AIDS that eventually, under the weight of public pressure, have become somewhat more available in poorer areas of Africa, although disparities remain. Anti-aging research and, eventually, derived treatments, will emerge in technologically advanced countries and be affordable to those who can pay. This is the unavoidable future of all biotechnological efforts in human enhancement. And yet scientific creativity of this sort will not be inhibited.

	BENEFICENCE: THE HEALING OF THE AGED

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In the context of posthumanism, the religion of technology and scientific hubris, efforts to slow or arrest human aging appear morally ambiguous at best. And yet one aspect of human nature has always been freedom over itself. Freedom causes us to break the harmonies of nature and establish new harmonies.

If we bracket out this ancient debate between the natural law and its detractors, there is another context that is more immediate. The stark reality of our already aging societies is that, factoring out infant mortality, people can expect to live into their 80s. Many will experience chronic illness for which old age is the dominant risk factor, ranging from Alzheimer's and Parkinson's to osteoporosis and vascular disease. Our demographic transition to greatly increased life expectancy through means that do not involve the deceleration of aging has resulted in a scenario that is clearly not idyllic. The solution to this problematic of age-related disease may rest with advances in the basic science of aging that would achieve even greater prolongevity in a manner that avoids the massive debilitation that currently plagues us. In other words, to resolve the problems of senility and dementia, brought on chiefly by enhanced life expectancy absent anti-aging interventions, we must now develop those interventions or suffer the consequences, which include future generations of young people extremely burdened with the direct and indirect support of tens of millions of severely dysfunctional citizens.

When one considers the goal of decelerated aging in this context, it begins to appear more rational, salutary, and necessary. No longer the bizarre dream of superficial technology zealots, decelerated aging appears to be a more reasonable aspiration. Indeed, the biogerontologists hard at work in serious research are much less the children of posthumanism than they are of a will to benefit a common humanity regrettably caught between the old world of relatively short and "natural" life expectancy and the future world of the nonfrail and nonsenile.

So, the individual confronted with the possibility of decelerating his or her aging process may not ask the question of the dignity of human nature as we know it, or of whether we humans are wise enough to control our future development, or of equalitarian justice. Instead, he or she may reflect on loved ones who have struggled with a syndrome that strips away memory and self-identity, such as dementia, and quickly declare that his or her true dignity lies in decelerated aging consistent with the retention of cognitive temporal glue between past, present, and future.

But will this next step really work? This raises the Swiftian caution. Jonathan Swift published Gulliver's Travels in 1727, while the rector of St. Patrick's Cathedral in Dublin. Recall the remarkable voyage of Gulliver, in which he encounters the Luggnaggians, a people among whom is occasionally born a baby with a red circular spot on its forehead above the left eyebrow. This is the mark of the Immortals, or in the language of this people, the Struldbrugs. The spot grows over time and changes colors, until at age 40 it is coal black and the size of an English shilling. These are rare births, but not uncommon. Gulliver is entirely enthusiastic to hear about these immortal embodied beings, and even envious:

I cried out as in rapture: Happy nation where every child hath at least a chance for being immortal! Happy people who enjoy so many living examples of ancient virtue, and have masters ready to instruct them in the wisdom of all former ages! But happiest beyond all comparison are those excellent struldbrugs, who being born exempt from that universal calamity of human nature, have their minds free and disengaged, without the weight and depression of spirits caused by the continual apprehension of death. (20)

But Swift was of course mocking the Baconian hubris of embodied life immortal. In fact, the Immortals, lacking the wisdom that comes from accepting aging and death, are "peevish, covetous, morose, vain, talkative" and the like (20). They are altogether superficial and lacking in wisdom or insight. As they age, they become increasingly demented: "The least miserable among them appear to be those who turn to dotage, and entirely lose their memories" (20). By age 90, all "forget the common appellation of things, and the names of persons, even of those who are their nearest friends and relations" (20). Suffering with what we would now call progressive dementia, they are "despised and hated by all sorts of people; when one of them is born, it is reckoned ominous" (20). Moreover, "They were the most mortifying sight I even beheld, and the women more horrible than the men. Besides the usual deformities in extreme old age, they acquired an additional ghastliness in proportion to their number of years, which is not to be described ..." (20). The king of the Luggnaggians wished for Gulliver to bring a couple of these creatures back to his own country, "to arm our people against the fear of death" (20).

Dean Swift's satire of the Baconian waters of paradise remains relevant. While his dystopian alternative is purely imaginative, it raises all the right questions regarding efforts at embodied near-immortality. Will we live in a world where everyone outlives their brains? Where dementias of the Alzheimer's type are even more plentiful than is already the case in our aging society? Will we have life-span extension in the absence of the compression of morbidity? Perhaps we should set some immediate goals associated with the concept of quality of life. Few people would welcome the onset of Alzheimer's disease as the price for extended life (21).

Yet again, it may well be that the only real progress we will see in ridding the world of such debilitating diseases as Alzheimer's is through slowing the process of aging because old age is by far the most significant risk factor. Currently, there is no reason for strong optimism about scientific breakthroughs to cure this disease, or to stabilize symptoms in the long term, although there are some compounds in use to ameliorate some symptoms for a limited period. Thus, basic scientific advances in the area of aging itself could, if successful, significantly reduce the incidence of diseases associated with old age that are too complex to be solved on their own terms. It is, then, unfair to responsible anti-aging researchers to suggest that they are engaged in an effort that will only radically protract the lives of the most deeply forgetful, create near Immortals. Maybe greatly enhanced prolongevity is not all bad if a number of conditions can be met regarding preserved memory and other dimensions of health and rigor. It might also be that, given the realities of the old age boom, anti-aging research will prove curative where all else has failed.

Will anti-aging researchers provide the solution? Two respected researchers from the University of London conclude in Nature that ultimately we will find the human life span to be quite plastic, and scientific progress in this area "may allow us to reduce the impact of ageing-related diseases as the limits on the human lifespan recede" (22).

	CONCLUSIONS

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While I share natural law and equalitarian concerns over the unleashed powers of biotechnology to influence what increasingly appears to be a somewhat malleable human nature, and while I too cringe at immature millennialist enthusiasm over the remaking of the species, I nevertheless can appreciate the goal of eradicating our modern epidemic of chronic illness, which grows more extensive and costly with every elevation in average life expectancy.

Indeed, it is because of the potential positive health consequences of anti-aging treatments that they will probably not be easily restrained in the name of natural law or equalitarianism. It may well be that, in the process of decelerating aging with the intent of ameliorating chronic diseases, the human life span will be extended. We do not have much choice but to move forward. The goal of prolongevity as preventive of morbidity is rooted in the reality of the 80-year-old who has struggled with hip replacements, a diagnosis of dementia, retinopathy, and related depression.

A number of scientists convened in 1999, under the auspices of the National Institute on Aging, for a conference entitled, Caloric Restriction's Effects on Aging: Opportunities for Research on Human Implications, where they charted a bold new therapeutic research agenda focused on slowing or "retarding" the aging process, which implies the extension of the life span (23). The driving motivations expressed, however, were focused on slowing aging in order to prevent the many diseases for which old age puts people at risk. This scholarly meeting sparked no significant public debate, although few things could be more deserving of critical reflection on human aspirations than this. A principal topic was the research to develop a treatment to prolong life and youthful vigor through imitating the remarkable effects of caloric restriction, which for more than 60 years has been documented for its dramatic ability to slow aging in nonhuman mammals and significantly extend their life spans (2).

I surmise that more research on the basic science of aging will eventually give rise to the ability to decelerate this natural process. People will be attracted to this technology because they know how burdensome are the diseases of old age. Should they wish to select this medical option, few would condemn them unless the Swiftian problem of prolonged senescence arises. We simply cannot predict the future, but over the last century we have seen a dramatic rise in life expectancy, and it is hard to imagine that the addition of more healthy years would be widely deemed contrary to human dignity.

But there is reason to urge caution. The technology to slow the aging process may be coming nearer to reality, yet the goal of prolongevity has not been carefully considered (24). In a time when biotechnology is allowing for the reconstruction of both nature and human nature, all thoughtful citizens must ponder the implications of potentially dramatic change. Of the many possible biotechnological goals on the horizon, which ones are likely to enhance the human condition, and which ones are likely to diminish human dignity? We think of the provocative developments in therapeutic cloning, in fertility and reproduction, in organ procurement and transplantation, in genetic testing and therapy, or in the treatment of a myriad illnesses, and our collective breath is taken away by the pace of change. But we are also rightly haunted by the reality that, while biotechnological powers grow, human nature has in no obvious way progressed with regard to unselfish behavior, humility, peace, and equality. Thus, we raise the question of the very nature of goodness, and whether some biotechnological developments divert us from growth in virtue, or even tempt us to create a new class of an ageless elite that inevitably begins to look down upon the ordinary older adult as a misfit.

Should we move forward in the 21st century as bold new "cocreators" of our somewhat malleable human nature, or should we accept a more humble approach that endorses a caring and just stewardship over human nature more or less as it is, seeking therapies rather than transformations (25)? At least in the area of decelerated aging, where therapy and enhancement merge, science should go forward in exploring the potential to eradicate the overwhelming morbidity associated with old age. The intended and direct moral goal must be to free older adults from senility and decrepitude, while an indirect side effect would be the addition of good years in which long-lived individuals can hopefully contribute to the common good through prosocial and generative behaviors that themselves seem to contribute to health and longevity (26).

	Acknowledgments

 
Supported by a grant (1RO1-AGHG20916-01) from the National Institute on Aging and the National Human Genome Research Institute; and by the John Templeton Foundation.

	Footnotes

 
Decision Editor: James R. Smith, PhD

Received December 10, 2003

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