Fairness in Anti Aging Medicine

Critics might reply that appeals to the public welfare change the terms of the debate once again. At the level of social policy, the dangers of the off-label use of medical interventions for anti-aging purposes dim in comparison to the injustices that might be facilitated if anti-aging interventions are treated as elective enhancements. Public attitudes toward the enhancement technologies already available suggest that the demand for truly effective anti-aging interventions will be so substantial that legal prohibition would simply produce a robust black market in these interventions. On the other hand, if the interventions are seen as "elective" or "cosmetic" enhancements, they are likely to be left to the market to distribute, according to the ability of consumers to pay.

If anti-aging interventions are, like other cosmetic uses of medical tools, available only to those who can afford them, society would see the disparities between the haves and the have nots exacerbated in a particularly insidious way. For example, if wealthier older adults can maintain their youthful features, they may come to have more interests in common with young adults than with the poor elderly population, and this may lead to a shift in political allegiances. If they were to continue to identify with their age cohort, a larger population of youthful elderly might benefit the interests of the aging elderly. If other interests realign allegiances, however, the poorer aging elderly could find themselves increasingly marginalized. If anti-aging medicine ultimately stigmatizes the aging process as a pathology of the poor, this political disadvantage could be compounded even further by social intolerance (Seltzer).

One alternative, of course, is for the government to play a role in financing and distributing these interventions. For candidates of equal age, should the previously treated or the untreated have the highest priority? For candidates of equal health status, should the chronologically younger or older take precedence? Finally, how should the benefits of these interventions be measured in order to determine the amount of public funds that should be spent on making them widely available?

These are critical public-policy questions that will have to be addressed as anti-aging interventions become available. On the other hand, they are not problems that should guide the progress of scientific work. In practice, medicine is not likely to police anti-aging interventions for social policy reasons unless it becomes clear that the social problems created by their availability as elective medical services are severe enough to compare with public health emergencies. According to some critics, such crises are not unforeseeable in a long-lived society (Hayflick). But until it is clearer that medicine should steer by social justice as well as patient welfare, the advocates argue complicity that with these social problems is not likely to stand in the way of anti-aging medicine.

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