(’11)How far should medical resources be used to extend life expectancy?

Related: (’98)‘The first duty of a doctor has always been to preserve life.’ How far can this principle still be maintained?

(’03)Should medical science always seek to prolong life?


(Introduction) Shakespeare had King Lear lament the tortures of aging, while the myth of Spanish conquistador Ponce de Leon’s Fountain of Youth, Sumerian tale of “Gilgamesh” and the eternal life of the Struldbrugs in “Gulliver’s Travels” all fed the notion of overcoming aging and immortality. These may be more than fiction now. Research from the World Health Organization claimed that people are living longer, healthier lives now than they did in the past. The global life expectancy increased from around 64 years in 1990 to about 70 years in 2011. The notion of possibly continuing this trend forever becomes an increasingly relevant concern that we, as a society, should deliberate about.

(Refute 1) Some say that medical science should always seek to prolong life, as that is what medicine and medical resources are used for. That is its ultimate purpose. Whether in the fields of maintenance of health, the prevention or treatment of disease, research done develops inventions of medicines, vaccines, or techniques that eventually enable an individual to live longer. Furthermore, practitioners of medicine have a duty to preserve the lives of their patients. In many countries, doctors/physicians recite the Hippocratic Oath upon entering medical practice. One of the oldest binding documents in history, this Oath written by Hippocrates is of great historic and traditional value. Most of the Hippocratic Oath has been revised over the centuries, to encompass current values; today, it is most often cited as a single phrase, “First, do no harm”. The significance of the Hippocratic Oath hence does not reside in its specific guidelines, but rather, in its symbolism of an ideal: the selfless dedication to the preservation of human life. Therefore, aligning with the purpose of medical science and the responsibilities of a medical professional, medical science should always seek to prolong life.

(Supporting 1) I feel, while the above is indeed true, in some situations, aggressive medical treatment to prolong one’s life will only become sanctioned torture. This is especially true for patients who have little hope of surviving through/recovering from their diseases. When technology and medicine are used to simply keep them alive (life support), their suffering increases. Life support machines such as pacemakers, defibrillators or ventilator, may lead to unnecessary pain. Defibrillators reboot the heart with a powerful shock when it races uncontrollably or falls into quivering arrhythmias, sometimes causing excess shock to patients. When they did, patients would feel as if they have been kicked in the chest by a horse. In intensive care units (ICU), patients who require a combination of such devices to keep them alive will then be often consigned for weeks or even months to a medical purgatory, attached by tubes in their tracheas to ventilators, with catheters protruding from their necks, chests, abdomens or bladders. When awake, they are in constant discomfort, chronically deprived of sleep, so they are often sedated to the point that they are no longer in communication with their environment. Under such circumstances, it may be considered immoral to keep using medical resources to extend their lives. Hence, medical science should not always seek to prolong life.

(Supporting 2) Furthermore, medical science should not always seek to prolong life, because when more people live longer, there is consequently additional burden on society. Already, many developed countries face the problem of an ageing population; if life spans of people were to be extended even more than necessary, social, economic and political problems will only build up. A good case in point would be Japan, the first major nation to turn gray. Japan has one of the world’s highest life expectancy rates; women on average live to 87 and men to 80; but its public debt in 2013 hit $10 trillion, twice the nation’s GDP. As life expectancy rises, a Japanese person entering early adulthood may find that parents and grandparents both expect to be looked after. Because the only child is common in Japan’s newest generation, a big cast of aging people may turn to one young person for financial support, or care giving, or both. Politically, the young in Japan have some of the world’s worst voter-participation rates, as they think the old have the system so rigged in their favor, there’s no point in political activity. Hence, in mind of these negative consequences, medical science should not always seek to prolong life.

(Alternative view- a concession of sorts) However, since the above argument is based on the assumption that medical science only prolongs life without prolonging health, some would counter it by arguing that in the process of aiming to increase life expectancy, solutions/cures to many other problems/diseases that plague human health will also be found. Hence, medical science should always seek to prolong life. Instead of concentrating on the prevention/cure of individual diseases, for instance cancer (which is a roundabout way to prolonging life, and may lead to other repercussions, such as Alzheimer’s disease, according to Olshansky, a sociologist at the University of Chicago School of Public Health), when scientists directly aim to prolong life, they target the ageing process. As scientists investigate the details of this process with a view to finding ways to slow/prevent it at its root, they fend off the whole slew of diseases that come along with ageing. These include chronic diseases such as heart disease, stroke and Alzheimer’s, which are now more prevalent. In another example, A recent clinical trial by Novartis that tests an anti-ageing drug in healthy elderly volunteers from Australia and New Zealand also enhanced their immunity to flu by 20%. Hence, given that there is evidence that medical science which seeks to prolong life can improve health along with longer life, medical science should always seek to prolong life.

(Alternative view, cont.) As such, if science really manages to achieve the above, life might extend in a sanguine manner, with most men and women living longer in good vigor and also working longer. This will partially negate additional burdens/negative consequences on society, as pension and health-care subsidies are kept under control. In fact, many of the work being done in longevity science concerns making the later years vibrant, as opposed to simply adding time at the end. More than two decades ago, scientists discovered the daf-2 and daf-16 genes in worms that can be changed in a way to cause the invertebrates to live twice as long as is natural, and in good vigor. Now, Buck Institute, the first independent research facility dedicated to extending the human life span with better health, has quintupled the life span of laboratory worms. Their focus is on extending the ‘health span’ of an individual, so that people are still able to maintain a healthy, quality way of life, even in their last few years. Furthermore, one of the main findings of a Harvard University study published in 2013 shows that quality of life has already been improving, even as people live longer; most people now no longer are very sick for six or seven years before they die. Instead, that stretch of poor health has shrunken to about a year or so. With the exception of the year or two just before death, people are healthier than they used to be. Such is the win-win situation that longevity science manages to create. Hence, medical science should always seek to prolong life.

(Conclusion) Although it has to be acknowledged that the above views are valid, there will definitely be situations where treatment to prolong life becomes torture instead (as previously discussed). Therefore, we cannot say that medical science should always seek to prolong life; even if they ensure that the person, living longer, stays healthy and maintains a quality standard of living, there will definitely come a time where life itself fades away. Our bodies were not made to be immortal in the first place; the fact is, longevity science ultimately just adds time before our end, regardless of whether this ‘time’ is quality or not.

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