The Way We Die Now (24 page)

Technology ever increasingly fuels our utopian hunger. Sam Parnia, an English intensive care specialist working in New York, has written a book called
The Lazarus Effect
(2013). Parnia is an evangelist for a technique called Extracorporeal Membrane Oxygenation (ECMO), which is used to resuscitate people who have had a cardiac arrest. The blood of the patient is removed entirely, put through a membrane which oxygenates the blood, and pumped back into the body. The idea is to buy time while the problem that caused the arrest can be fixed. Parnia claims:

It is my belief that anyone who dies of a cause that is reversible should not really die anymore. That is: every heart attack victim should no longer die. I have to be careful when I state that because people will say, ‘My husband has died recently and you are saying that need not have happened’. But the fact is heart attacks themselves are quite easily managed. If you can manage the process of death properly, then you go in, take out a clot, put a stent in, the heart will function in most cases. And the same with infections, pneumonia or whatever. People who don’t respond to antibiotics in time, we could keep them there for a while longer [after they had died] until they respond.

Parnia’s idea is very attractive in the case of say, a fifty-year-old man with cardiac arrest caused by myocardial infarction (James Gandolfini), or a footballer collapsing during a match with a disorder of the heart rhythm (Fabrice Muamba). However, were ECMO to become standard treatment and widely available, I could easily envisage frail, elderly, wealthy patients, dying of pneumonia (in theory, reversible), receiving this therapy. And this is the problem with every new exciting treatment: you can’t be seen to ration it. Isn’t the life of the old lady with pneumonia just as worth saving as that of Fabrice Muamba? And all death is ultimately preceded by the heart stopping: ‘the one thing that is certain about all our lives’, says Parnia, ‘is that we will all eventually experience a cardiac arrest. All our hearts will stop beating.’ The definition of illness that is ‘reversible’ is so vague that most dying patients could qualify for ECMO. This technology is highly likely to take root and flourish in America. The cost, financial and spiritual, is likely to be steep. And this technology blurs even further the line between life and death, a line that is becoming increasingly more difficult to identify.

Sam Parnia and William Haseltine’s belief that death is mainly preventable, finds an echo in the contemporary reluctance on the part of doctors to write ‘old age’ as the cause of death in a death certificate.

*

John Gray, in his book
The Immortalization Commission
(2011), wrote about a prevailing belief in Victorian Britain and later, in Soviet Russia, that science could deliver immortality. He describes the bizarre attempts by the Soviet scientist Krasin to preserve Lenin’s body, an undertaking that failed disastrously:

[In] 1924, he constructed a refrigeration system designed to keep the embalmed cadaver cool. But the cryogenic technology failed to work, and the body began showing signs of decay... Told of these problems, Krasin was adamant the freezing could succeed. Any condensation that might be damaging the cadaver could be dealt with by installing double glazing and obtaining a better refrigerator from Germany, always the best source of technology in Bolshevik eyes. The German refrigerator was imported, but the process of deterioration continued...

Gray referred to cryonic suspension as a variety of ‘techno-immortalism’. Ray Kurzweil, the American ‘visionary’ is a modern Krasin, and is currently engineering director of Google. In
Transcend: Nine Steps to Living Well Forever
(2009), he and his co-author, medical doctor Terry Grossman, suggest that a rigid regimen of diet, vitamin supplementation, regular exercise and preventive medicine could keep us going long enough until the time when technology can help us transcend our biological limitations, and give us a form of virtual immortality: ‘if you stay on the cutting edge of our rapidly expanding knowledge, you can indeed
live long enough to live forever.
’

In
The Singularity is Near: When Humans Transcend Biology
(2005), Kurzweil claims that we are on the verge of a scientific revolution, which will allow us to ‘remodel’ ourselves. Tiny robots – ‘nanobots’, operating at a molecular level – will ‘have myriad roles within the human body, including reversing human ageing (to the extent that this task will not already have been completed through biotechnology, such as genetic engineering)’. Fusing human and artificial intelligence will create an immortal entity, in which ‘the non-biological portion of our intelligence will ultimately predominate’. Kurzweil currently leads a project called ‘Calico’, under the aegis of Google, a programme of medical and genetic research with the goal of ‘ending ageing’. He has specified a time when this sudden acceleration in human knowledge could make immortality technically possible: ‘I set the date for the Singularity – representing a profound and disruptive transformation in human capability – as 2045.’ (I would then be eighty-five; if I keep myself alive until then, maybe I, too, could become an ‘Immortal’.)

Kurzweil is not alone: there are many ‘immortalists’ and ‘transhumanists’ who believe that the technology which may dramatically lengthen human longevity is just around the corner. Perhaps the most famous of these is Aubrey de Grey, a Cambridge-based, self-taught biologist of ageing. Grey, who started as a computer scientist, is a proselytizer for what he calls ‘Strategies for Engineered Negligible Senescence’, a range of putative molecular therapies to prevent ageing.

It is entirely possible that de Grey and his fellow immortalists are right; but I disagree with their assumption that this is a good thing. Bryan Appleyard, in his book
How to Live Forever or Die Trying
(2007), has speculated on how a dramatic rise in longevity would affect our work, our relationships, politics, our sense of self, art, philosophy and religion. For meliorists – those who believe in the inexorable progress of mankind – prolongation of life and avoidance of death are core beliefs. The still-wealthy baby-boomers are enthusiastic believers; those who are sceptical have been dismissed as ‘mortalists’. The boomers, the richest generation in human history, are most definitely not content to make room for the next generation.

Madeline Gins was an American artist and poet who died, aged seventy-two, in January 2014. She and her husband, the Japanese conceptual artist Shusaku Arakawa, were ‘transhumanists’ and believed that people died because they lived in surroundings that were too comfortable. They designed buildings which were uncomfortable enough to ‘counteract the usual human destiny of having to die’. They called this philosophy ‘Reversible Destiny’. Her obituary in the
Daily Telegraph
reported:

Their ideas remained largely theoretical until 2005 when they unveiled a small apartment complex in the Tokyo suburb of Mitaka, known as the Reversible Destiny Lofts. Painted in lurid blues, pinks, reds and yellows, each apartment features a dining room with a warped floor, making it impossible to install furniture, a sunken kitchen and a study with a concave floor.

Gins and Arakawa invested all their money with Bernie Madoff, and Arakawa died in 2008. This sad little tale reminds me of the photograph of a dejected-looking man, posing with a huge, defrosted refrigerator, containing the mortal remains of his wife; he had hoped, at some unspecified future date, to have her resurrected by whatever technology would become available. An unanticipated electrical failure had dashed any such hope.

But not all transhumanists are deluded eccentrics. There is a critical mass of sober, objective scientists who predict that the technology which could significantly extend our longevity is highly likely to become available in the coming decades. Advances in stem-cell biology and regenerative medicine may make organ replacement as routine as replacing a used battery. It is more likely, however, that maximum human lifespan will remain static at 110–120, and average life expectancy will increase dramatically, but only among the well-off and well-educated. Professionals retiring at sixty-five are now expecting thirty years of healthy, active retirement. The poor, even in developed countries, may experience a fall in longevity, mainly because of obesity and smoking. Meanwhile, the rich and well-informed, with the help of diet and exercise, screening for disease, and preventive medications, will fuss and jog their way to a hundred years old. For £125, the US company 23andMe will analyse your DNA for your risk for a variety of diseases. The CEO, Anne Wojcicki, is the estranged wife of Google co-founder, Sergey Brin. Brin’s DNA tests showed a risk of Parkinson’s disease. He responded to this news by ‘increasing his coffee intake and intensifying his workout regimen’, two factors thought to have a preventive effect against the disease.

St Paul believed that death was caused, not by inevitable biological decay, but by sin: ‘Sin entered the world through one man, and through sin death, and thus death has spread through the whole human race because everyone has sinned.’ St Anselm, writing in the eleventh century, also attributed death to human sinfulness:

Moreover, it is easily proved that man was so made as not to be necessarily subject to death; for, as we have already said, it is inconsistent with God’s wisdom and justice to compel man to suffer death without fault, when he made him holy to enjoy eternal blessedness. It therefore follows that
had man never sinned he never would have died
[my italics].

In our own post-Christian society, we have come to believe in a similar doctrine. But the sins are not those I learned about in my catechism as a child; the sins that cause death are not old-fashioned ones, such as avarice, sloth, gluttony, anger, lust and so on, but newer ones, such as smoking (now also an official Catholic sin), low fibre intake, lack of regular exercise, failure to take advantage of preventive measures against ill-health and ‘internalizing’ anger. Healthiness has become the new godliness.

Many within medicine view with alarm the direction modern health care has taken. Much of what Ivan Illich predicted in the 1970s (and which was dismissed at the time) has come to pass. Many health economists believe that spending on medicine in countries like the US has passed the tipping point where it causes more harm than good. We have seen the rise in the concept of disease ‘awareness’, promoted, not infrequently, by pharmaceutical companies. Genetics has the potential to turn us all into patients, by identifying our predisposition to various diseases. Guidelines from the European Society of Cardiology on treatment of blood pressure and high cholesterol levels identified 76 per cent of the entire adult population of Norway as being ‘at increased risk’. This ruse of ‘disease mongering’ (driven mainly by the pharmaceutical industry) has identified the worried well, rather than the sick, as their market.

A growing resistance movement has taken root, with various strands to it, such as the Slow Medicine movement, founded in Italy in 1989, inspired by the Slow Food movement. At a meeting of the movement in Bologna in 2013, Gianfranco Domenighetti listed the characteristics of health systems as follows: ‘complexity, uncertainty, opacity, poor measurement, variability in decision-making, asymmetry of information, conflict of interest, and corruption’. The British Medical Association has backed a ‘Too Much Medicine’ campaign, which shares some of the aims of the Slow Medicine movement. The ‘Choosing Wisely’ campaign in the US has created an evidence-based list of medical interventions that are frequently futile and unnecessary.

The founders of the NHS naïvely believed that a free health-care system would result in a healthier society, and thus less demand for its services. Enoch Powell, who held office as a health minister, was among the first to point out the fallacy of this argument. Ivan Illich coined the term ‘Sisyphus syndrome’, meaning the more health care given to a population, the greater its demand for care: ‘I invite all to shift their gaze, their thoughts, from worrying about health care to cultivating the art of living. And, today, with equal importance, to the art of suffering, the art of dying.’

We cannot, like misers, hoard health; living uses it up. Nor should we lose it like spendthrifts. Health, like money, is not an end in itself; like money, it is a prerequisite for a decent, fulfilling life. The obsessive pursuit of health is a form of consumerism and impoverishes us not just spiritually, but also financially. Rising spending on health care inevitably means that we spend less on other societal needs, such as education, housing and transport. Medicine should give up the quest to conquer nature, and retreat to a core function of providing comfort and succour.

Julian Barnes’s 1989 novel,
A History of the World in 10½ Chapters
, concludes with a parable about immortality. The narrator wakes: ‘I dreamt that I woke up.’ He is attended by a woman, ‘like a stewardess on some airline you’ve never heard of’, who brings him the most delicious breakfast he’s ever eaten. It gradually transpires that he is in some form of paradisical afterlife, which will last for eternity. Every fantasy he has ever had comes true, and he indulges every desire he has ever had. He meets all the famous people he has ever admired, and even gets to have sex with them. (Barnes’s paradise echoes the afterlife promised to Islamist suicide-bombers.) He completes every round of golf with eighteen shots. Eventually, he runs out of new experiences. He discovers, to his dismay, that most of his fellow occupants of this paradise (‘Heaveners’) tend to choose a second death – oblivion. ‘It seems to me’, the narrator remarks, ‘that Heaven’s a very good idea, it’s a perfect idea you could say, but not for us. Not given the way we are.’