Ethical and social implications of approaching death prediction in humans - when the biology of ageing meets existential issues

Abstract

Background: The discovery of biomarkers of ageing has led to the development of predictors of impending natural death and has paved the way for personalised estimation of the risk of death in the general population. This study intends to identify the ethical resources available to approach the idea of a long-lasting dying process and consider the perspective of death prediction. The reflection on human mortality is necessary but not sufficient to face this issue. Knowledge about death anticipation in clinical contexts allows for a better understanding of it. Still, the very notion of prediction and its implications must be clarified. This study outlines in a prospective way issues that call for further investigation in the various fields concerned: ethical, psychological, medical and social. Methods: The study is based on an interdisciplinary approach, a combination of philosophy, clinical psychology, medicine, demography, biology and actuarial science. Results: The present study proposes an understanding of death prediction based on its distinction with the relationship to human mortality and death anticipation, and on the analogy with the implications of genetic testing performed in pre-symptomatic stages of a disease. It leads to the identification of a multi-layered issue, including the individual and personal relationship to death prediction, the potential medical uses of biomarkers of ageing, the social and economic implications of the latter, especially in regard to the way longevity risk is perceived. Conclusions: The present study work strives to propose a first sketch of what the implications of death prediction as such could be-from an individual, medical and social point of view. Both with anti-ageing medicine and the transhumanist quest for immortality, research on biomarkers of ageing brings back to the forefront crucial ethical matters: should we, as human beings, keep ignoring certain things, primarily the moment of our death, be it an estimation of it? If such knowledge was available, who should be informed about it and how such information should be given? Is it a knowledge that could be socially shared?

Biomarkers of aging

“…On the other hand, the limited options for aging interventions make it possible for relevant disclosures to cause specific psychosocial distress that affects the life quality of participants/subjects and alters their social environment (Paulsen et al, 2013). For example, for those at higher risk for assessment or diagnosis of biomarkers of aging, they often fear stigmatization, discrimination, disruption of family relationships or life plans (Gaille et al, 2020;Vanderschaeghe et al, 2018), and the possibility of suffering from ongoing anxiety, high stress, depression and even suicidal tendencies (Draper et al, 2010). In this sense, the potential benefits of aging biomarkers research and its clinical trials are closely linked to the attitudes, beliefs, expectations, life quality, family support, and social environment of the research participants/subjects as individuals.…”

“…This affects not only equitable access to aging biomarkers testing, but also insurance coverage for other diseases in other groups. In the long run, these issues could undermine the principle of solidarity in social security and health care systems, change the future direction of national health care systems and social security systems, and even create new health care equality issues (Gaille et al, 2020).…”

Claridad conceptual y jurídica del personal de salud del Hospital San José de Bogotá sobre la limitación del esfuerzo terapéutico

“…A medida que la población mundial envejece y las ciencias médicas progresan, la expectativa de vida humana aumenta, por lo que el personal de salud debería estar familiarizado con la LET a fin de ofrecer la mejor atención posible, especialmente para aquellos pacientes cuya condición fisiopatológica está tan deteriorada, que las medidas instauradas son fútiles o no cumplen las expectativas del individuo para retornar a un estado de salud digno (26,27) (22)(23)(24)(25), lo cual es especialmente grave considerando el aumento de la población de mayor edad con enfermedades crónicas que, en las últimas décadas, son atendidos con mayor frecuencia en los servicios de hospitalización en general, pero especialmente en las UCI.…”

Biomarkers of Aging and Relevant Evaluation Techniques: A Comprehensive Review

“…While subjects may benefit from early illness care and life planning, which might increase their quality of life, disclosure is likely to induce psychosocial discomfort because of the restricted availability of aging interventions, which may be detrimental to the subject’s quality of life. For example, those who are assessed as being at high risk for age-related diseases are likely to face discrimination [ 222 ]. In short, testing researcher’s abilities has become a complex and long-term challenge.…”