CHAPTER 13 The “Unnaturalness” of Aging—Give Me Reason to Live! ARTHUR L, CAPLAN NOT EVERYONE THINKS IT 15 a giod lea to live longer lives. Some viters, perhaps, most notably Daniel allahan, the co-founder of the Hastings Center, argue that the quest to nd life is nota selfevident good.! A longer life, Callahan contends, is necessarily a better life. Other writers, such as the philosopheriphysi- ian Leon Kass? and the political theorist Francis Fukuyama,} argue that ¢ extension of life should not be pursued because lengthening life is ot consistent with human nature. Itis “unnatural” to extend hurnan lives yond the proverbial three score and ten that the demographers assure is what the average citizen of an economically developed nation can ect, nyArthur L. Caplan Sills ruse panies rn sock that ight ea a ees Inman ine, eh cits ne pled ive ht ine 367 bax von enti toring Or ackatishae prt ne Tred i eh al prints y phi he ‘nom fon eared. Me tho shanties engin tig ath lend sic ne i for eine cael inte acto ‘Callan anesthe and estomic eves of Te sant toot sth nr cao airline ft elven ibe enh Rr tle cope wise Bae seas vant Fung as isn Ha seal entices hate edo st Aowrulgtheexenineesnetr Orte pl the pnt net ay hs mt a ae Sew aging ecco eat aia fpcesesai sich gua thig, Cantlaese bene Inoaysee sea o ooion he"n vans of presario maging Peal Ragga al proce ‘tad A Wie Ue pepest of aging tay be fgrte ith ined ling. there woul seo Fe lens dub tc ct tha gig ‘mended nestor nd abe halite ‘mon ese, he ti Ua ing 2 froma aa uta pat of a exer refed inthe prc fwd Tres ‘e-news iva fed al pie fing ‘roma nnd rte of dene. Invethtacevofenconsin chaperone ‘the nl bet of dn coe cit hago ona the ey Bott us beds clip, er alert. ea 14 he ing ce tll ta ea the ha deni Fon ani ‘Why chow his tase Wa ected he pli saad erations cect wil I pe thatthe a emit meee she vt pres, le ler deat ‘hang ae deme da ting Trac tr sip bth keting ape fDi, Svcancnecorathannelrn batting Use pro Ha agg Fol ws te tht aly nse nag we co ttn erin ese ne ptt i gig ih pradesh ae nate eo pean fhe day Nora ete a iy nd ners agit re meal sccice ih atl npets Higa lov ie ftom al pte ae all ‘gdp, Yet tr itn ‘acl deren sane tae the pis rc Fo a ih i ls toed he ‘lati changsthalocee digg Wnt be aed hat he pres dent Uy raging de not he soared eo conf sen pein i xa uae Towser in wail dite diene ab twat aay defn as aon plea change in the aah Patol ce stay ‘financing nr proces ine Teh Aa arid pes re naa defied incamofdone tel he ol Hees sth city sing ths expt of thecaseptnutiedesagng soem to ave a rina ii cat ing coed nce. lel ow cane ‘i these apy ame Wl e fo diet agg fr ter pron les tally iid {5s tt aging psd aThe “Unnaturalness” of Aging—Give Me Reason to Live! “orn proces: Medicine ar teaiinlly “ewe i oles that of amelating reba Iagtheaboonma cither og herspeat i Ienentonsor preventive, propiaticregimene. ‘The pt fewyears have seen he rise ofa pacer rata sod the nora whle nol ouside fl movement rte "aight w de Some have [ie sphere of meine oe concep tht play even gone so 2 to abn Bt poss and rlsinliensingtheinteventonsfkerned- heh polesionas have a neal ligation to racine or itis pone to rin an- ply 2 active re in allowing patients to die [Ecpson of normaly tht physician ative under erin ceunstanes Toa eat extent, thestatr of apingand ings natural process looms Ire in cui sbot the “ight to ene sthatsaeinwhich elise die" and “death with gy” Oflen those who al hve been tamgresed Nate: dette the deg a which he meal pee M mormaliy have, Fsrelh, been uaed a2 sion shoul interne the paces fing ai- Tine te deemine the prennce of esse areesbout the atalnessl the phenomenaof the neces of medial acti Un gt of aging and dying i thealleged right dieistobe powell thatthe sbnoralandunaat- bolton conception of he atuanes of aging icindstneofmedcnesrangeainiees, and dying then the concep stats ofthese ey lee why many bclopelpocees erm ids raul” mst be throughly oot Toughttobe the proper sje of med- examined. The uation ofthe oats of Tntementon or theapy,Pubery, goth, aging senescence, and dah most ot be pee mation ox precese athena alp- miedo Bee lst in complex debates co ostnd cutie the sphere of medal con- _cernngtheighsandclgeons of oensand since they ne normal andra ecu. health profenionl among human begs Sn, seems The perception of bloga events or px fo think ef sean or etiation ar pon cee st mata or unt ree de ene dates prectely becase thet snes sve in determining wheter pics teat ramonythowghtbe al and onmsl alto process s deus.” One need ony ronetrfthe Ruran candi, ‘hin of the conto it vid sound alle thle iti tv at cst bilge gations concerning the bill natrlnes of such asconaception, prognancy,and__ havent oshizophreato se tht hiss ty have ben the objet io ecent yea of. This cla is further bone out by an ag ebtranotheitandingss posed ment thats equ made by oer pins er The ation hat Rizal andor. tonew media student. Medial students fen realy men and woren a have en n-fndiaiBealtiointent wih orexasine ely 1 fr women lo unde menopaure patents. They may fel pores when com een chillenged in many quater, The Fronted with heseeingyevesible debits tucsata wheter the proces ofaping of ld age. To overcome tis rehclance, elder off can be chrfed abnormal and phscian reilly opt out that ging and na maythatwillopen thedoarfarthe | senecnce ate pecs that happen Yo ey fone even young medical sade. Aging sin ‘vpn of he haan condo; should hal olen for young dete Student ar tldArthur L. Caplan Uhataging inated and tht whieh may be ating they can do taltertheinetableemine otis proces, the mst ent elp patents ope ith hie est hey ean aif teaching physic el olga tla theo oly debian disuse tats fod ‘ge ornaualin ler todcouag the students ‘ncination nteatheldey eck diesel hat are te grounds on ich this abel ap lid? Why do we think of aging 2 mata roves ‘There hat cme edie ind that agin is comsnan andra proces, occur nh a sate freuen of 103% Inevitably unary bones become ite sision din inti, nde oe thee fone. ebvoas queen Us abs i ithether commons: fans and ines. baliyaresfleneondions fren ince tai bilgi states srt. To aor this qoetin i isnecesayta ist dears distin etree agngand chrnalgielage Ina tiv seme, gen the eiteee of a chronologies devil bodies atest ean be ‘sidtagerelatvelohe mest rovided by tat device But since puss hae ale tcl intrest in making plop ae ‘ent abot in-bound nations, ‘or empircl clit bout he elt of pace sl tei ein Ua they dole thi hrnolgi some ia mind io spesting abot ‘hein ard nesabty agg, peak ing of aging sans are intcted i 3 ps til tf Boag changes Hs ce we ‘epettotine. Inf age ind cl nar iat x high froqoeney of ible chromo keratin, The mice of nen ells become ited by lamps of eon and te ae rounding etoplon contains fever engaelle, ‘ach ae miochonia. Collagen hes Bconie increasingly iid nd ile, a ae ‘helo pense fi wining The sneahecomesiderand ote tons Thing ‘noel opto weakens andthe elds ee son becomes nore suseptble 1 into Melininpigen fatness no sequent hirbointowhiten hang of his in in main with gig sro wnieoal and inital nivel sd crib donot hove eb iio Conlon raring fe poses nd Gerona aero ropa igh ed rears st, eld ot dd Go Prion eal nent esl a tha ton and smi rb phnarc sn detec woh age calgon tice {Nngeantal poco orate The hi fy of ineton by mcompnan aang a Ina doesnot ae te planed the ction mtr ecarenes ef a Aes eet The pin ty at tere tor ever sent pee nh ie come btn tchaor arf dan Corcening on wont i, not at eons Sof uaensiy nd nea are ade «qe cones for ate ae oy oer ‘esate br obi natinc canbe Seon and wed ven dg bec png nddhowe Thewisehrsoc ona hat may poe fp yg destin ty pln teat lee aga dr cam peeing tif rail paces "Thee of natal oo nthe. No of dea, pine and enton Ar deg one ao fo cing es Ss pebae meat oe etn haa Se eel wer mun oe a sige ands rnb tne ‘mag lf suger mgt in et ese em suger than a, old ‘ammo doe Say ny blyre The "Unnaturalness” of Aging—Give Me Reason to Live! quote Ht splen. Hhaa ohide, a many Gash con poetry met ie cui three Hes te mage ar saben Race arent thepe— Wihe wternes faging resect [peeve ft thy ware “vient ets iterpetation hepiesoper tapi and Fo, Wie thc atric uno are—ahanat Marte he sujet ft copie of otic ine gee av up. Howese, tage ure the sore ael eet fo al ding tao of Bilge procs nes of triage eck the finer of arcs faetion a prpne a ani ate he ‘Sut tect in rons ich pir probe Bing tha plilphers ae stances The plese of areas el fein ft antl Yael sina the senblingacasensvavatthemeaninget ich qnssimthalsovathinglisemevinnls re tenon an een pe Inthebed noukdans tha cof Hetty pane to il Bec ingrentsaesplaghg ssa tga oes pac. brgge dan also fil sb apn tiene fl eto ne lini analingthe ft of Toanacn ae coon ght tothe iow Sgn he al dition eit or wr fo: What he faction fain henge ation faith bev “hobgislesplaatiny Gopi in of epi the xem of a pain Fert si of mr cst he ener) Mate og, a poe an lof xpi ‘lofi, can sis aed die, waste. ego pros workin api Onision pooleage bet Cretersts Tarte ae Pel pnie Fltodesgn cw ut wr etautsmrpune eyes arent hap thes hen Agigsencsanaccinicrafourierl Hence af Bait proces hie Meher tia meshes, Fis sic stmteate wel metic, The sccm len ih patil wiles bess how something wurorapetats \yesad nace ike bit the pamper skalaisthefasction.ormicorperpac fe fencnn ofagingisbclarana thc oTtonake ple the una bad peso ean Be sf the nef evenness Tine we wa ow des he aple "hwy was akan the Conant wen dos te i chy? Or ey den ‘ita ectionan Dike gn Wbnssn Usp est iit atthe a Aihetumetibe entry *\Neban argh fala the here on exp. xing and cbt watt bese adap ly perenne spleen La espero he ro cas tak Water oe fe te tered bene tt td i eps ce aise athe dein fhe ‘efhtting comin, gig bef he alrdoser wate agg ile ‘ulti by rong he npn to eae, rete i shorts he ‘maker Tit ing eis pening expla hn axing wos ‘toca eda logan la cc hse Hee te wt eat th leary change a new aapttion ber, Hie athe po set Ue o> Onhat se views agg inde fan The delenit of the nara Devnet tn, Ard Hn Hh sk fag to be me in i: wl ‘bhictauaiv earth d-we—dcpe at ew th pee aging etal "lf ing htm i ner bt athe ee xan one es L e min aby sama esl athingesenArthur L. Caplan forthe extence or presence of aging human!” “hie the sera of naturale tht Ka and kayans and thers ust ly upon 19 make her cae again extending ie thug eo weing sng ‘Too pupoted exlvtions—one tela cone emiio=of the fonction er purse of aging hae ben gen Beth ate Baved: We the theologies explanation of ging may eaty geatwightfornumerousnddal li potdoar seni esplnation hy ging ‘orc n humans, Medial profesional ay fave to cope with the patient advocay fis explanation an ther religous elings on ‘he bjt But, Rom a sintifepespectve, sel aly dot lai tht aging, ae eal of Gad vindicnenes, i trl bilgi! ro cas andhencenoa dese worthy ofestmen ‘Noresuprisingy. these explanation of agingatserngancvoltorar oleorpurpoe alo inadequate tis simply notte that aging. xs to sere amy srt evstionsy pare of function. The claim that aging exit occ ‘indus becae ana wider le or fine ton inthe elton scheme af hing eon fly evltonary ans The anal in ‘coral sme that itis pombe forbid ‘process tox tat ect Benet or advance {he evlatinary ssees of specie ot pop tion other word, oppo hat proces such as aging ext Beene thy sre anton ‘x perpein thee itor of species this ‘ne Hatofzemovngtheoldtomakewaylorhe ew However erolonny lection ly a6 tostanoe the prospect ofan entie pei or population Selection acts on india og fms aed ther phenanpic tait and properties, Some tit or properies confer adntage! in terainemionmentson the grim th or sorter nd thi ct incre the lio hat the genes rerponsible fr pedicng the ts il be ped on toute mais, “Given tha selective ree ten nid and ther enatypes and not pci makes Senseo speskafagingarcoving as elton Funan 9 purpoe to bene especies. Ho hen do evlutonary biologi msi the tence of aging Briel, he estonia estes, tat properties in iil xp ‘ssw be lected for they ener aie ‘eprouctesdenag on th nid her else in. Ay ition tha nce thai repodacive nares high el billy of being sected and waitalned in al {gene pol af species, Selection, seve, a Bot lookahead Yo Forse the pub con quences faring cern as given tng the erieonment select fe the tt ade ‘utes thre sn edit etura Anineend rmeablite, reams, may rove deta rouseatl inl nt ty presdemreen. gy seeking mater and vig pred it ‘nay shores in ely dteraton of theo fs due w an ncresed accumulation of {cx wastes inthe by ofan nda thse ddved. Natur eldeton cannot eee sochde layed deitaingconequences ‘Aging exis then, ar a cosequence alackf colutionay freight Rss by produc ‘cline forces working ta incense the chanel feprodute succes in theilectan ogni, Senecene hs no function simply the ‘abet ubrenion of oni action ler Ii fv of maining epodiete aan tage enn ie “The common bebe ht aging serve fe Viner pros thisbele based on wisp prehension of luonay theory mistaken Ad iftisis tool seem th the conenon bli that ging i ata proces, 83 co sequence ofthe fnction pure itsene a the life of te Species, i als taken. Conse query uns spate to mt the de {Eipon on elke grounds, i wold see htnn The “Unnaturulness” of Aging—Give Me Reasou to Live! ingen levoslrdoalasavital piss mabe or bl th srl na wlth tsk eso daring ing py cas eves ata the ach Te ne pac hthe anges hal eur dat paste ets thom fal Mince ame ape Ie cumphef dn Ha hve vc tate an eka ood vad se sige agai He ae nl Tis the ges hin th hn checcopuns wow aeciie avin Hm HOUT he peggeote iain ws, Tecnu highs kn mre boas sk aut ts Souris: of he lungs da este aac i i natal Tio aehzinlnonm being innccthesoadesin hg ‘sbtiglstecsnagincanderskarcolywnr Akg ith he crite adit Bsefsmuatic dienes The wa eae tal ioaeistinn or gran sain et. saerongtic ce fa He rae inewaned snwepubids tothe sali thom tlie pest hese Mitomsumbrtanand paths ser lef Th ay bc act ental Hewat we the tn cen oe gi ge taal inked asennad cli ae teas dtean ws ee ing ssbetaarcanae Ie preset anny yl lf wl gy mtr Mn 2d a ohne onrinere artnet Stnaedpaagnatcessnplset dsc Me themes gia it alogspicbodabs fori. thcciee at lial asda ket “igagieadiciappeamtebavene en sil peicinnanmatemplomat ofl ‘tone stl Ui etn elton Thane ate nan thes wha cats ofthe anne yen Wet heey shangevatthe clades that choca to cena thoy. he a peice the and syphiny sett anise bos al ncaa ang ® One vag thal sg cn mare sl in dentin bran screase in che mer of ceinages cx ut ball, pele ok latest pcan nde acd lc, ar eal dicts at cms a deg inka ert buena cs lth: soley of etinoncranite Mol ees to kl ay fhe tobe talon ade shi ice panes chet ab tn Feral gps nts ate ot aatane pels, he ee Sheng to acvmatein ethos foto he the cmeet explanation of ai amine val Tiger piste Mews ane fit cle ele ta ingmmeccacdstanisonauthatnghisincel enselikags ea rol an pre expe sont Tn fencing thot Wy saagei sad ca price atic noni the aging of lagen, encarta that ext inetd The subtane tapont edof he ott fntion ew exe anole atin amplons we common exit wil aig, Wa porn eve, tre such acne iad sen ess ofthe thes rae ho i Gt he oe i. rettbo oan bth aloo pate i nc pth beArthur L. Caplan rmethanisns that re clsly analogous to hate ‘mechanism ced by inibnsindescbing dh ‘ae procensin he bs Te eaneap fs without debt 2 signa ond esive notin odcne!” Once tnenes aay fom whan be termed pace erat” amples of Snes, sucha bere lansor ighther, toward mote nebulos exam le suchas ane or iter Nene, it becomes “iat sy ely whatare the citer Ste fr lbeting 9 conon a somatic dss However, cven though otros dificult toconcstastof ncesaryandsufiien cond ons for emplyingthe tem “oxi dene" is pole tote alt of genera esiteriathat ‘emselevnt in atlerptingo decide wheter ‘aly state or proces pproprtely beled a Giese ‘One citron ie thatthe tate or process pro eerdconfot otefeting Ascend thatthe proces vse can beware bck specie ose, even ar elcomitance. A hid i that theresa ett claret aeuctural hangs, both Irecosope apd miro, that allow in & (ofr sequent manner subsequent the ital reciaing orca event A fouth is That tere a ef tineal symptoms or nani Fettions (headache, pain in the chest pid pie, horns of bet) common sociated With the obened phylgia lations im ete Fly, Bere i sully sme or of Famesiona impairment i he fnetions, bas Tor ov activity of» penoa thougt tobe dt coed" Not al deter wil sal oany of the citer hvesuggeed, One ee oly one {Ser the argent oundig the asa fon ef asignsim,sleshalim, drupaidcton, fling ad Iypeactiy to reaize the nae (gs fthesecterin a necessary adult ondons forthe determination of ese, Bat thothesopgetedeeraaereleantosuch de. termination sahown bythe that ocatesof ‘Mpemusionrepudngcontovesial aes and provene:conmenly resort fo considerations of heaton, clinical manfeatons tly ane 134 tional pier and ering i ting the nes fhe vros ves concerning Ke (ovofeontovenislenes ‘Wil respect othe conceal mbit na rounding the notion of ese, npr ‘emoriber tht edie by no meats wnigue fn being saddled with what might be lee “fara coeept One need only ose, the sof em sch as “speci” “adapt tion and ation i bilo “atinuls? “havior” and "iat in psychology ore teethatmetcneisntdone in theambipy et ‘tke ers sto thats the bil tise to ue bslegea thon ti in the Aetcrination of leat itera or 3 cone, the phy able to we his or her know the vette a Fatton fe body od fide on relevant eters fo the deternainn tf diese. Irane accep the relesance ofthe Fre suggested eres, ang, 2:2 blag proces sscentopiesalthe ey ropes Moen. Unlike atguatsm of nerounes, gg posenes adenine goupof clinical men Tetons or smplany 8 learnt tology of Sct changes by he macosope sad fncrnope level a giant measure o firmentscomf seeing and.ifweste tingle grnttiesametelerncetocurenthe tris of agingaswe grat totheois inch 3 ‘esitwofmedcin, next of presiptating fev: Aging hav al he leven makings of seae procs And my ete argument it ‘ound, een fan alana cision of wat- tales were appendel, aging would sill met A the reguicements thought relevant tothe ‘lsifeatin of procs rsa as indeed diene What hinges the eon to eer toa proces oxstteschsaginghy he word dese” rth Thanby some eet? Obvious aret de‘The “Unnaturalness” of Aging—Give Me Reason to Live! ial stenton, meted support, mele segment ofthe population; ovew the age’ a res and media esearch ate devoed to ik ordueted woud only ince the burden treatment, cre, smeloration, ad presen stead bomneby thismachabused segments tit The paler wih this argument i htt tend to Bend puble perception of diesen tener withthe paticlar problem of whebher Seeing aging a esse ought cay negeive ‘tedden onan Te deny thang ‘Sadbessemaybesinpiyaneasy ayo arith ‘nor diesh pblen of eluting te medal ofenon ad the ypublic toward beter un- ‘entaning ofthe teatning and nonteien- Iabelof diese from behavior tchashomo- ing apect of diese. Conalousnes, dex, ity, maturation, and schizophrenia. Ads, sd nglct ay be the eal objec of ihe of moter nd concer under thee concer in mpening of dese, not dase in amen. The question, what ideo con- el fon shoud be contered relevant ote Finally, might be lied, x Callan ind rmination of whebera price state pro- her, that hete woul be tweendouso- lorcondionisa diese) Cilandeconomie oat clingaginga diese, ‘The claim is pehaps the mast uncoovining of ‘ofwhatarethe relevant norogaices- the thee tha te offered. One tor ee flcting the chic of the deere label. cially clean to the delrminaton o ages 1 want to conse hee pect argo» of dacse would sem to be thatthe pysian that mightbe avedagsietealingeings_sofne hi he concen othe psi and a clafeaton that of rece Roce mental tte othe india patent scan gel in ouch with the medial profesionsconomic comsidetons would appear tobe intcoulerargumet thatthe decision quteosofpice.Geneiesod pacheloials- tees places lege urdenonsoiey dime Bn cannot at present inierene to fet or chines end omepaphy nisare enol "Tht argument does ot tad up pense, Butthee es donotin anyway change lic, Therese ny enesin exe the dese sas of Downs, schizopei, ie olay frwhich no ere sna, bus 29 ne fare cance Imay be the se tate rposethathee doer areanylesdi+_ govermentay decide nottospenone eon 2 2 eozeqoence. Furthermore the em esearch ino agng the weatentof aging But on esiment and cure implict nth such a dessin shoul be consequent on, ot at igererthe equal vil components of rir to adage of deme. This sgt i are imehing ndersandng, edie simply lrthe vale questions lean de Rand suppor. The profsson’s andthe pa ction lo whether something ina dese, ih Biter nthe healing function of mad vale quetione relevant odeiing what do might make I fc fr physics to aboutsometing fer tas Ben decided Yat t ing a dics, but the diffu in ise des. ng sich accepance dae nt provide a [have mggeed a romberof pole vale or ejecting the view: suesand soi problems that may ete int the Besscondargusentsthatiocallagingads- ection ofthemeical prefessonto label ale ive the gmalation of ge ox process diese, hve aio suggested ht asArthur L. Caplan rumah lbs woe Fulesttaceiertin agate To Aerio of dice dtd he plas kl eat 4 ‘scat dit as Caran of el ‘ut Bealls la itl des in dos tea de ‘in pervs in set ah sscaghgcloistontated nadie. fe nites w sue sification des fran the ve hata atl pro ae tha kets atl pnts, oe thet ede sabjet afer on sap conta. Eve tl sew that rt othe esgic the tiation a aging 4 vai on recently bl la gigs ft the gt or aif tela pres, tir as del bet ft pr em econ iowa to eli tie natianosofagng ome offered ig desig opr sce aging vee osc eo be at pid ages a) bale fr excladngaging ote purien fine. Homeve, clara ‘al, dhe ado onstrate tr thar ht ofthe atrlefaing LIB: Pc Chat lak Btn Gla, Ns 222 Dae Glin Wht Phe tr Hi Bh: Un veel Califia Pe 09) > Garine Bonen, akin, Dsl 6 =e Pres Come Bellic, “By hsp Waking, DOs Th Fat ss Cfo tN Ce satin Wii Ke ed He Coe Th AA: enna Hae sas cay ad he Tht ofa Pathan Hc telnet er ty, 2 4b Sst cite Phin tl Vid Daten 2b Alans WB Saay {te ag Hote are Aha Fata acre 7045.86 11 Mtb AS al Vapor Nay Mh ine tin 18 Call,“ Nana gh the Qe cel hse Bay tn Mn batt on el ew snp Tae ih Tins Ce Ses rah ‘Tasman afk “the Sag Se se” la 9 th Ha on tiie ty 4, an Aang edn tee tog un, Epo id ai hod keke Pb ced Sr Clee Pron stat plato rc A TP yp Com, rl” Pong os sb Cane, Area shin seni Pos 4 fist teen Pit patina te ugh igo rece atest fe pn" ga Kae Ha ks Ret 1 Cola,“ Unt Wh ot aac Wrong Seka ef Ag tf 3, Be CN Yk Oi