While (active and non-active) aging is increasingly recognized in society and in the biomedical sciences as one of the most pressing issues of this new millennium, it has received surprisingly little attention in philosophy and related fields. The goal of this workshop is to bring together philosophers of science and bioethicists to discuss the metaphysical, epistemological, and ethical implications of aging, broadly construed, as well as the philosophical implications of extant assistive and biomedical practices.

The workshop is organised with the collaboration of the Health Ethics and Policy LAB of the ETH Zurich.

Here are the abstracts of the speakers

Alessandro Blasimme: Care for the old age: from long-term facilities, to homes, to community

Existing models of care for elderly people are considered unsuitable to meet the needs of a rapidly ageing global population.

In light of this ongoing demographic transformation, the transition to alternative, more sustainable and possibly more inclusive and respectful forms of care for aged citizens is the object of intense debate. In this chapter, I will discuss ethical challenges posed by three different models of care: residential care in nursing homes, aging in place and aging in community. In my analysis, I will draw on insight from the ethics of care as well as from social gerontology to illustrate which normative assumptions each of the above-listed models embodies, and I will argue that, while all the three models are able to address different ethically important needs, more efforts should be made to promote the aging in community model as the one that is less stigmatizing of old age and more likely to contrast ageism in the long run.


Giovanni Boniolo: Human aging: The question of identity between cognitive and physical decline.

Starting from an empirical approach to identity, developed some years ago and based on post-genomics, in particular on epigenetics, it will be shown that the physical and cognitive decline in elderly people does not imply loss of identity as a whole. Certainly, cognitive decline, in particular memory decline, could be something which affects the perception of the self. To face this situation a relational approach grounded on the cognitive support offered by caregivers and relatives is discussed.


Stefano Giaimo: The concept of aging in evolutionary biology: a first philosophical analysis

The concept of aging in evolutionary biology has not yet undergone philosophical scrutiny. In this work, I attempt a first analysis in this direction. I consider different notions of aging in evolutionary biology and, to some extent, their historical developments. My tentative analysis has two main objectives. First, it aims at showing where there is potential scope for philosophical investigation. For example, I relate the concept of aging in evolutionary biology with the classic debates on Darwinian fitness and on biological function. Second, I try to place emphasis on the methodological consequences that different notions of aging imply. In particular, I stress the tension between notions of aging that are based on individual-level properties and notions that are based on population-level properties.


Justin Garson: Ageing and the Metaphor of “Evolutionary Neglect”

Mainstream research in the evolution of ageing routinely presupposes that the fundamental “goal” or “purpose” of evolution is the continuation of the species. As a corollary, it is routinely assumed that once an individual has contributed to this goal through producing offspring (and perhaps raising them to maturity), that individual has, as it were, fully discharged their evolutionary function. From this perspective, the continued existence of the individual after reproduction is considered irrelevant, and perhaps even harmful, to evolution’s goal. Accordingly, biological changes associated with ageing, such as cellular senescence, are explained as a form of “evolutionary neglect.” Here, I trace the development of the metaphor of evolutionary neglect, beginning with August Weismann’s “programmed death” theory in 1881, Peter Medawar’s 1952 “mutation accumulation” theory, G. C. Williams’ 1957 “antagonistic pleiotropy” theory, and contemporary formulations such as Kirkwood’s “disposable soma” theory. I argue that this metaphor embodies and perpetuates a bias, in that tends to discourage the search for scientific hypotheses that would confer more of an evolutionary value or functional role on ageing.

Sara Green: Big data and human ageing

In this paper, I examine how data are collected and used towards the aim of better treating and preventing age-related disorders, and how these practices influence the conceptualization of aging itself. With the increasing challenge of growing elderly populations, age-related disorders have become a big focus area in data-intensive sciences, such as systems medicine and personalized medicine. Many newly funded projects highlight the aim to prevent or delay age-related conditions. Within the focus on disease prevention, aging is sometimes conceptualized as “the single biggest risk factor for virtually every significant human disease”. I argue that this reframing of aging is associated with both opportunities and challenges. On one hand, big data approaches can reveal unexplored relations between different age-related diseases. On the other hand, concerns have been raised that conceptualizing aging as a risk factor leads to (over)medicalization


Nancy S. Jecker: When Autonomy Fails: New Values for Old Age

As health and social care systems are tasked with caring for growing number of older adults, do these systems reflect the values that matter most to older adults? This paper will argue that our longstanding emphasis in the West on respecting patient autonomy must shift to respecting patient dignity, understood as making reasonable efforts to support floor level human capabilities. This shift is warranted because during later life, we face greater threats to central human capabilities than at any other life stage. The argument develops in three stages. First, I introduce the life stage relativity of values, which holds that at different life stages, different ethical concerns become salient as the conditions of human life change. Second, I give examples of life stage bias, which is the

tendency to privilege the values that are important at one stage of life and apply them across the board, to all life stages. A common form life stage bias takes is midlife bias: we assume that the midlife value of autonomy is focal at all life stages. Third, I propose that healthcare for older adults should focus on respecting dignity and show what a life stage sensitive approach looks like, using dementia to illustrate. This presentation is based on my forthcoming book, Ending Midlife Bias: New Values for Old Age (Oxford University Press).


Marco J. Nathan: Does anybody really know what time is it?

In his celebrated 1922 debate with Bergson, Einstein famously proclaimed: “the time of the philosopher does not exist, there remains only a psychological time that differ from the physicist’s.” Einstein’s dictum, I maintain, has been metabolized well by the natural sciences, which typically presuppose— more or less explicitly—the existence of a single, univocal temporal dimension, to be determined by physics. This assumption is reflected in much biomedical practice, which assigns to organisms a specific age, measured objectively, allowing us to straightforwardly compare aging within and across species. This essay suggests that hallowed practice of assessing the age of organisms might be more at odds with contemporary biomedical thinking than many philosophers and scientists realize. My general discussion is inspired by two questions raised by Chicago, in one of their classic songs released in 1969. Does anybody really know what time it is? Does anybody really care? I suggest that, when it comes to molecular biomedicine, both questions should be answered in the negative. And it might be for the better.


Silke Schicktanz & Mark Schweda: Ethical issues in an ageing society

Due to increasing average life expectancy and demographic change, aging and old age are receiving more attention in current debates of applied ethics. This chapter will provide a systematic overview of central ethical questions and topics related to individual aging and aging societies in the context of medicine and healthcare. We will propose four main dimensions that should be addressed. First, the increasing role of modern medicine in the interpretation and handling of aging processes should be critically reflected. The ethical scope comprises topics of improved medical care and prevention of age associated diseases and conditions such as dementia, but also includes problematic promises of anti-aging-medicine as well as the risk of medicalization and pathologization of aging and the promotion of agist stereotypes. A second dimension refers to the ethical reflection of technologies that are considered to manage the social challenges of aging and care. Here, we will exemplarily reflect on the ethical challenges robots and monitoring systems pose by promising independent life and improved care in old age. A third dimension reflects on the ethical aspects of medical strategies of predicting and planning later life. We discuss how images, visions, and anticipations of old age as well as the human life course spark debates on responsibility and solidarity, thus requiring a particular normative stance within medical ethics and bioethics. Finally, we want to elaborate how modern medical and bioethical reflection considers (or ignores) the special perspectives of older persons themselves. Relying on deliberative and participative approaches, we will critically reflect on the momentums of normative debates and the opportunities and limitations of including directly the perspectives of people living and experiencing later life.


Jonathan Sholl: Health states vs. health-spans

The distinction between lifespan and healthspan is often stressed, but living longer with diseases (lifespan without extra healthspan) or just making the elderly healthier (healthspan without extra lifespan), are not the (only) end goals. Recent aging research suggests that health promotion at any stage of life is the real target, and that it is only this that will lead to significant and reliable lifespan extension. Healthy aging thus becomes a form of anti-aging. Recent advances even suggest the provocative idea that as control over diseases and mortality increases, along with the technical and behavioral possibilities to improve health, aging becomes a necessary part of health. What is rarely discussed in these contexts, however, is the very nature of “health” that is being promoted and extended. Health is the target at all ages, but if health is not just the absence of deficiency or disease, nor an idealized state of complete well-being, how could aging and longevity research contribute to explaining what health is? One obvious way is to more explicitly introduce temporality into considerations of what constitutes health. Philosophical literature often presents health in terms of states, whereas aging research clearly has the duration of such states in mind. Does the concept of healthspan imply a shift from states, or a series of states, to health as a process? A second contribution to explicating health might come from considering the ubiquity of trade-offs throughout stages of our life course (be they evolutionary or physiological) and the aim of improving functional performance at the lowest physiological cost. Does considering health as a dynamic, optimized trade-off better capture this temporal dimension? Answering such questions can begin to show the benefits of incorporating more longevity research into metaphysical considerations of health.


Christopher Wareham: Aiming to die and longing to live longer

In this chapter, I distinguish two types of concern in ethical debates about extending the human lifespan. The first focusses on the desirability of longer lives as such, from prudential and social perspectives. The second, and more subtle type of concern focusses on the desirability of aiming for longer life. This distinction, which is overlooked in the ethical literature on life extension, is significant because there are features of human psychology and the structure of a life, that should give us pause when considering how long we should hope to live, but which do not neatly coincide with considerations about how desirable a longer life is likely to be.

As one example, consider ‘Parkinson’s law,’ the empirically-evidenced phenomenon that ‘work expands to fill the time available for its completion.’ Barring a few fortunate individuals, anyone who has worked towards a deadline will be familiar with this rule, which entails that work continues up until, and sometimes beyond, a given deadline. In the current context, Parkinson’s Law highlights the potential importance of the subjective timing of the ultimate deadline of death. As such, it is an excellent illustration of a consideration that, without influencing judgements on the desirability of longer life as such, potentially impacts on the desirability of aiming to live much longer.

Drawing on Ezekiel Emmanuel’s controversial piece ‘Why I hope to die at 75,’ this chapter provides further examples of this distinction and its usefulness. I argue that, while Emmanuel’s case that it is desirable to die at 75 should not convince us, he nonetheless provides pro tanto considerations in favour of taking a moderate life span as a prudential aim, around which to base at least some of our significant life plans.