Journal of Aging Studies 50 (2019) 100800 Contents lists available at ScienceDirect Journal of Aging Studies journal homepage: www.elsevier.com/locate/jaging A matter of life and longer life T ⁎ Kristin Kosticka, , Leah R. Fowlerb, Christopher Thomas Scotta a Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States of America b Health Law & Policy Institute, University of Houston Law Center, Houston, TX, United States of America ABSTRACT While the major scientific discoveries that would extend the length and health of human lives are not yet here, the research that could create them is already underway. As prospects for a world in which extended and improved lives inches closer into reality, the discourse about what to consider as we move forward grows richer, with corporate executives, ideologues, scientists, theologians, ethicists, investigative journalists, and philosophers taking part in imagining and anticipating the rich array of humanity's possible futures. Drawing from in-depth interviews with key stakeholders (n = 22), we offer empirical insights into key values and beliefs animating the “longevity movement,” including what constitutes an ideal human state, the imperative to intervene, and the role of individual liberty and concerns for equality. Emerging from these interviews are common concerns about reducing suffering, preserving diversity in visions of successful aging and how best to promote access to a future that may not remain hypothetical for long. Introduction conversations about aging. His appeal encouraged a number of in- quiries into what is meant by “successful aging,” which can be cultu- Our knowledge of variables that influence exceptional longevity in rally or individually defined based on personal beliefs (Flatt, Jr, humans continues to grow, from biological to genetic factors con- Ponsaran, & Fishman, 2013; Lamb, 2014), as well as lay attitudes to- tributing to survival into extreme ages (Pradas et al., 2019; van den ward life extension and its technologies. These works reveal general Berg et al., 2019), to advancements in prosthetics and artificial organs, support (in Western culture) of life-extension and anti-aging research skin, and muscle that stand poised to reduce or remove physiological but enduring skepticism of technologies like genetic manipulation or human limitations (Acome et al., 2018; Grimmer, Riener, Walsh, & human cloning as routes to enhanced longevity (e.g. Lucke & Hall, Seyfarth, 2019). These rapid advancements in biomedical and bio- 2006, Partridge, Underwood, Lucke, Bartlett, & Hall, 2009, Shepherd technological innovation, coupled with the recently reinvigorated de- et al., 2007). As our understandings of public opinions toward life ex- bate about the natural limits of human lifespans (Brown, Albers, & tension and contemporary science continue to evolve, we must also Ritchie, 2017; de Beer, Bardoutsos, & Janssen, 2017; Hughes & Hekimi, weigh them against attitudes from experts within the field whose close 2017; Lenart & Vaupel, 2017; Rozing, Kirkwood, & Westendorp, 2017), (sometimes first-hand) proximity to emerging longevity research af- creates a renewed urgency to consider what we wish to prioritize in the fords them intimate knowledge and a potentially heightened ability to context of our growing capacity to delay, stop, or even reverse aging. As gauge realistic potentials and consequences for individuals and socie- part of this effort, we turn to key stakeholders in the “longevity ties. movement” (Scott & DeFrancesco, 2015) to examine what they perceive The actors involved in this pursuit are central in modeling our un- to be the broader goals, values, and ethical imperatives shaping the derstanding of the potential bene fits and downsides to pursuing long- pursuit of longer, healthier lives in light of modern approaches to evity research. Despite the influence and importance of these views, few human life extension. These are embedded in larger narratives about empirical studies on stakeholder perspectives focus on the major social technology, aging, and death, and how we should prioritize today's and ethical debates animating the field, and instead focus on internal resources in anticipation of an imagined—and sometimes ideali- divisions among longevity experts. Much of the empirical literature zed—future. describing the viewpoints of these two groups gives evidence of the “boundary work” (Gieryn, 1983) by which classical aging researchers Background attempt to distinguish themselves from the non- or “pseudo”-scientific providers of therapies and commodities in the highly profitable anti- Over fifteen years ago, Juengst et al. (Juengst, Binstock, Mehlman, aging industry (Cardona, 2007, Fishman, Flatt, & Settersten Jr, 2015, & Post, 2003) called for better engagement of the public into Fishman, Settersten Jr, & Flatt, 2010, Mykytyn, 2006, Settersten Jr, ⁎ Corresponding author. E-mail address: [email protected] (K. Kostick). https://doi.org/10.1016/j.jaging.2019.100800 Received 18 April 2019; Received in revised form 3 July 2019; Accepted 6 July 2019 Available online 19 July 2019 0890-4065/ © 2019 Elsevier Inc. All rights reserved. K. Kostick, et al. Journal of Aging Studies 50 (2019) 100800 Fishman, Lambrix, Flatt, & Binstock, 2009). Juengst (Juengst, Binstock, Table 1 Mehlman, Post, & Whitehouse, 2003) has gone so far as to identify a Interviewees by category. “ ” war on words by which biogerontologists have sought to discredit Interviewee type Frequency what they judge to be fraudulent promises from anti-aging specialists to intervene in the aging process. This war is further fraught with persis- Executive 5 tent disagreement about what the very terms used in these debates refer Ideologue 2 “ ”“ ”“ ”“ Philosopher/ethicist/scholar 10 to (e.g. life extension, aging intervention, anti-aging, longevity Scientist/researcher 4 medicine,” etc.) (Settersten Jr et al., 2009). The tension between them Theologian 2 stems from historical differences in how each of these groups have Writer/author/journalist 1 ⁎ taken the stage in today's “longevity situation” (Scott, 2017). Over time Total # interviewees 22 additional, more polarizing factions have joined this discourse, in- Note: ⁎ Frequencies do not sum to 22 because of role overlap for cluding transhumanists who endorse the use of technologies to improve 2 respondents. and lengthen—even perfect—human lives and fundamentally alter the human condition (Bostrom, 2005a; Bostrom, 2005b). As a result, the and desirable – in reality these two groups are not mutually exclusive, conversation surrounding what constitutes legitimate science and who with many thinkers in the field acknowledging both positive and ne- rightfully belongs at the fringe continues to intensify. gative potentials for greater longevity, and spanning different roles While an intractable part of the longevity discourse, this boundary outlines in Table 2. Similarly, we speak about enthusiasts of transhu- work potentially distracts from a deeper engagement with how in- manism referring to those who wish to move beyond current human dividuals and societies should address the potentials of this longevity capabilities through the use of enhancement technologies, some of movement with respect to agreed-upon values or ethical guideposts. An which entail achievement of a radically longer human lifespan (Overall, important exception is Settersten et al.'s (Settersten Jr, Flatt, & 2003). Ponsaran, 2008) study which goes beyond questions of professional All interviewees were first contacted by the principle investigator identity and legitimacy to address perspectives of 43 biogerontologists (PI) via email, and interviews were conducted by the PI and/or two on some of the primary criticisms of longevity research, including the fellow researchers via a secure online meeting portal on a server misconception that a central goal is to achieve immortality rather than through the host institution (Baylor College of Medicine). An interview eliminate or “compress” (Fries, 2005) the period of age-related disease guide was developed collaboratively among co-authors to explore key and decline. Their study also addresses objections related to interfering influences, aspirations, and values that propel longevity research, with with the “natural processes” of aging (see also Callahan, 1995, special attention to questions probing the uncertainties, fears, and an- Fukuyama, 2003, Kass, 2004), concerns about implications of enhanced ticipated consequences of aging and longevity research. Questions ex- longevity for fairness and distributive justice (Glannon, 2002; Mauron, plored how social actors interact and respond to one another in an ef- 2005; Pijnenburg & Leget, 2007) and the utilitarian costs versus ben- fort to provide context for a “thick description” (Geertz, 2008) of values efits of extended lifespans for individuals and society (e.g. Baron, 2006, and beliefs implicated in the longevity situation (Scott, 2017). Caplan, 2004, Post, 2004, Stock & Callahan, 2004). Interviews were audio-recorded, transcribed verbatim, and ana- Our study contributes an empirical view of these stakeholders' ra- lyzed using MAXQDA software (Kuckartz, 2014). A code book was tionales for supporting or criticizing the pursuit of longevity research as developed collaboratively by the research team, all of whom partici- a whole, drawing from interviews with major players in the contentious pated in coding and analysis. The group completed three rounds of social world of longevity