The Future More Predictable Death

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Will it be a good thing to inhabit a future world in which, routinely, we know our complete genetic makeup and hence—as is my specific conjecture here—have a far more concrete idea of the likely size and shape of our lives? We will never know in advance a specific date of death, of course, but we may well know when it is likely to occur within a far narrower range. Will this be a harm, either to specific individuals, to their family members and social groupings, or to society as a whole? And will it be a loss both of human innocence and of something central in human experience, something at the root of deepest human meaning? Or will the future mean relief from uncertainty, a waning of background anxiety over death, or the end of chronic, though suppressed, terror over impending doom? If we are now partway between a past in which human beings had little way of guessing when they would die and a future in which human beings will routinely almost all know more or less what to expect, is this progress in human experience, or a loss?

A science-fiction social-issues film like GATTACA tries to answer just this question, but does it in a perfectly predictable way. Like many other such films, including for example Clockwork Orange and Soylent Green, GATTACA works on a tacit "slippery-slope" model, taking a possible future technological change (whether sophisticated operant conditioning or genetic diagnosis and prenatal genetic engineering) and positing extreme negative social consequences that would ensue—usually, supression of individual liberty, the development of intrusive social constraints, and tyranny by the technological elite. Such films' plots work by focusing on one or two innocents who resist such a society, and in the process, typically, fall in love. What is glossed over in such films are the questions about why such a society might develop, and what other consequences might be forseen for the particular technological changes imagined. Hollywood needs challenge, threat, crisis, and the small forces of good against a huge, entrenched evil to make a powerful plot; but philosophers may want to look at the issues in a more open and informed way.

Would the world we can forsee be a better one, or not? This is a complex question, with a number of interrelated issues to be explored.

Some initial objections might be entered to assembling information about a person's overall genetic makeup or to divulging it to people in a routine way. For example, it might be argued that divulging such information to people would be undesirable because it would alter their risk-taking and health-maintenance behavior: believing they will live to 90, they will not protect themselves in their 20's. But such behavior would involve a logical error: that someone expects to die of Alzheimer's disease in her 90's does not mean that she cannot die of a skydiving accident in her 20's. On the other hand, at least some health-maintenance behavior would, presumably, be altered favorably to try to arrest the course of a known though not yet symptomatic disease: people testing positive for hemochromatosis, for example, would refrain from eating iron-rich foods.

It might also be argued that routine assembling and divulging of such information would undercut people's insurability. Certainly, information about genetic risk can currently constitute a real liability if it is disclosed to a health insurer. But in a world in which assessment of individuals' entire genetic makeup is routine—perhaps routinely disclosed, for example, to schools, employers, the military, the justice system—insurance as we now know it cannot exist, since both the prospective insureds and the insurers would have the same information, and cream-skimming—selective coverage of people with better health risks, but denial of coverage to those with worse risks—would be impossible. People with long expected lifespans and low expected morbidity would not need much health insurance, except coverage for accidents, though insurers would be willing to sell it to them; people with short expected lifespans and/or long periods of expected morbidity would seek health insurance but find it impossible to purchase at any reasonable fee. Thus, the entire system of health insurance would be undercut. Presumably, health insurance would be replaced by some form of universal-access program of care, and life insurance, trading as it does on risk, would cease to exist at all, to be replaced by individual savings or perhaps welfare programs for surviving dependents of those with shorter lives.

Greater predictability of medical and behavioral characteristics of individuals will raise many other questions as well. Workplace exclusion policies are already heavily debated, both publicly and in the courts: should employers be able to exclude from jobs workers who exhibit genetically demonstrable higher susceptibility to diseases associated with various workplace toxins and environmental factors? May mining companies refuse to hire miners at greater risk for black lung disease, or taxi licensure boards refuse medallions to drivers more vulnerable to air pollution? May the school system or the military or the criminal justice system track individuals on the basis of genetically-based behavioral predictions? Or suppose musical talent turns out to be genetically based: minimal endowment in this area may provide a reason not to save a child a place at the conservatory, but would it be sufficient reason to exclude him or her from the high school band? And there is GATTACA's practical question: may people with greater risk of heart conditions be excluded from eligibility for a space-flight program?

These questions and objections aside, the real issue concerns what sorts of changes might occur in the human experiential condition. How will we feel about knowing so nearly the likely character of our final illnesses and the time of our dying? Of course, not all deaths are due to heritable diseases, disease susceptibilities, or causes influenced by inherited or sporadic genetic mutations: some people will still be hit by lightning or be run over by trucks. But except for unpredicted trauma, including some but not all homicide and suicide (some of which may be associated with genetically based behavioral traits, like aggressiveness), we may conjecture that genetic factors control or at least influence most deaths. This includes both deaths from infectious and parasitic disease and also deaths from degenerative disease, but since degenerative disease is itself more predictable in time of onset and in its terminal course once begun, predictability is far greater here. Thus, newly available genetic information, together with advances in background epidemiology and other data-correlating sciences, will give rise to a dramatically new prognosticative picture. We cannot be sure of the details; but we can be sure that huge changes are coming, and indeed are already underway.

How will we feel about the far greater predictability this information will bring? Predicting how people will respond and behave in such a world is, of course, sheer conjecture; but it is not entirely uninformed. Here are some things to consider about how people now react to genetic diagnoses that may suggest how people will respond to new capacities for prognostication in the future. For one thing, as one genetic counselor currently puts it, people measure their plight in terms of everybody else.2 If a person believes (albeit falsely) that most people live to the average life expectancy, now nearly 73, but discovers that because of a genetic disorder he is likely to die at 30, he experiences this as deprivation compared to everybody else—he "loses" more than forty years. Furthermore, it seems to him that it is only he who has discovered that his life will be short; other people do not have such specific knowledge about when or of what they are likely to die. He is doomed, it seems, and they are not. He also loses the capacity they have to believe they will live long lives, even if it is not likely to turn out to be true.

How people react to the news about a future disability or death also depends on how everybody else reacts, or how that a person believes others will react: if they expect others to react to the news about genetic disease with horror, disgust, rejection, accusations of taint, and so on, that person's own reaction is likely to be that much worse. Furthermore, many people (and their doctors) do not process risk information very well: what does 1:200 mean? 1:5000? 1:2?, if you still cannot tell what this means for sure about your own specific case? Some people avoid genetic testing because, they fear, this would take away hope (they sometimes forget that the test result could be negative); others, even when they have a positive test result, continue to hope—not that they will not develop the disease, but that they will have a very-late-onset case, or a mild case, or that a cure is developed. It may also be that people seem primarily concerned with potential symptoms, disability, and the experiences of other affected family members when they are confronted with the possibility of genetic disorders, but these may also mask concerns about illness as the process which leads to death. We see all these responses to what is regarded as "premature" death; we also see them even for many individuals who live well past the average life expectancy, since even the latter deaths seem unpredictable and often, thus, somehow unfair when they do occur.

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How to Stay Young

How to Stay Young

For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.

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