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Tallis in Wonderland

On Not Choosing The Alternative

Raymond Tallis reflects on living longer.

Woody Allan once observed that he didn’t like the idea of getting old until he thought of the alternative. For those who don’t like the alternative, there is good news. According to a recent report from the House of Lords Select Committee on Science and Technology, life expectancy in the UK is increasing at the rate of about two years for each decade that passes. Hang around long enough and you’ll live for ever. These trends are almost certainly going to continue. The dramatic decline in mortality from cardiovascular disease will be sustained as the identification and treatment of people with risk factors becomes more comprehensive and effective (in the UK, deaths from coronary heart disease below 65 have fallen by nearly 50% in the last decade).

These cheerful statistics have been greeted by some with cries of woe. They translate ‘the ageing population’ into more people living restricted and miserable lives due to chronic and disabling diseases. In fact this is not how things are turning out: despite large increases in life span, the length of the period of illness before death is remaining steady, and the proportion of life spent ill is declining. What is more, if present progress in postponing disabling disease is maintained, we might reasonably anticipate a ‘compression of morbidity’, in which the health span approximates ever more closely to the life span.

Even this welcome prospect does not satisfy some miserabilists: “We cannot afford all these old people” is the cry. Hidden in that statement is the assumption that old people, even in good health (as most are), are not going to contribute to the wealth of the nation. There is, of course, no reason why they too should not be producers – so long as they are not prevented from doing so by negative expectations and ageist attitudes, and policies ensuring that those negative expectations are fulfilled.

We may anticipate therefore that for many, perhaps most people in developed countries, average healthy, productive life expectancy will increase indefinitely. Some feel this raises important questions.

The first is the question of equity. Inequalities of health and life chances between rich and poor nations, and between rich and poor individuals within nations, may widen further, since treatments to prevent or postpone illness, ageing and death will most likely be affordable only for the minority who are already at an advantage in terms of life, health and comfort expectancy.

I am not impressed by this as an argument against research into diseases that affect us in old age. The vast majority of all effective medication is unequally available. A striking example is highly active anti-retroviral therapy (HAART) for AIDS. I for one find it difficult to regret the humanity, the science and the imagination that went into that therapeutic triumph, although I do regret that, for all sorts of reasons, HAARTs are least available in those countries that carry the heaviest burden of the disease.

There is a good general principle here: that being unable to benefit everyone should not prevent one from trying to benefit someone. The solution to inequity – whether of access to food, shelter, life-extending drugs or employment – is political. The contribution to inequity by more effective medical and anti-ageing treatments would be a very small evil compared with the disaster brought about in a decade by, say, Robert Mugabe in Zimbabwe. He has reduced the life expectancy of the wretched citizens of that country from middle 60s to middle 30s.

A further inequity relates to the differential opportunity to pollute our planet. Those who live longer will put out more CO₂. Again, global warming is a matter for which we need to seek political, economic and technical solutions. The contribution to fouling the planet by extending the lives of those who are currently alive will be minute compared with that of rising per capita consumption and the rising number of caputs doing the consuming.

Finally there is the issue of intergenerational equity. Is it right for the young to pay increasingly more to provide for the old? But this presents itself as a problem only if we see life extension as essentially idleness extension, and assume that everyone over a certain age will be an unproductive consumer, a useless mouth, irrespective of health. I have dealt with this ageist assumption already.

All right, then: it is OK to aspire to live to be 100, 110, 120, 130, or whatever. But where should we stop? Is there a point at which it makes sense to die? Is there any age at which we should consider death as not premature and tragic?

In the case of some individuals, we might think their death was post- rather than pre-mature. Adolf Hitler died perhaps 56 years too late. But I am thinking of the generality of decent yet flawed individuals, with the average freight of virtues and vices. When is the right time for them (us) to die? When is a life fulfilled? I think this is a question that is equally unanswerable both in general terms and in the cases of individuals. So long as one is happy and healthy, death will always be premature. A late death is never late enough; there is never a right, non-tragic, time to die. From this I conclude that postponement of death is a fundamental good, not pointless. Even those who don’t like the idea of living forever would rather put off dying until tomorrow, and hope that tomorrow will remain its obliging self and never come.

But in what sense do we actually live our long lives? More precisely, to what extent do we live their length? Our lives are extended over time, and are to a greater or lesser extent coherent – they are the lives of a more-or-less enduring individual. But it is equally true that we live in the moment, and that in any of these moments we do not have a complete overview of our lives. We inhabit a fairly thin time slice that entrains only a little of the past and only a little of the future. Admittedly, the present moment is pregnant with a very extensive implicit past and future. If you were to unpack the amount of my past presupposed in my writing this piece – my past as a doctor, for example, and all the choices, decisions and experiences that this entails – it would be quite extensive. But the past is mainly implicit, and is somewhat put into the shade by the experiences of the present moment and present preoccupations. Likewise, the longer-term futures into which we project ourselves through our plans are something of a rumour compared with the here and now. There is a sense, therefore, in which we do not experience the length of our lives, and that an objectively long life is subjectively no longer than an objectively short one. If we’re all just inhabiting our time slices, it is not entirely clear that the experienced length of a life of 110 years is greater than the experienced length of a life of 70 years.

Nevertheless, living in those thin time slices as we do, we are comforted by the knowledge that in all probability there are many other time slices between us and eternity. And as many thinkers have pointed out – most notably George Bernard Shaw – we might live better if we were sure that we were going to live longer. We would prepare the bed more carefully if we knew we were likely to lie in it for a couple of centuries.

So there is no right time to die, and the longer we live the better we might live. Should we desire, therefore, to live forever? There is something chilling about the prospect of an infinity of days, even if they are healthy. How long would the familiar continue to please and novelties bring delight? Just how many performances of Don Giovanni could one stand: a hundred, a thousand, a million? I am reminded of the old joke about the prizes in a beauty contest: first prize, one week in Skegness; second prize, two weeks in Skegness. Would not life without termination lack shape, direction, even purpose? Do not the shadows of mortality enhance the beauty of ordinary daylight? And how would the first generation to have freehold (rather than mere leasehold) on their patch of animate matter cope with survivor guilt?

The late, great Bernard Williams, who wrote about ‘the tedium of immortality’, argued that if we were to endure for ever, we would have two options. Either we would not change fundamentally – in which case our lives would be unbearably repetitious; or we would change fundamentally, in order to have endlessly varied, utterly different experiences. In the latter case, we would be virtually unrecognisable to ourselves after a thousand years. We would escape tedium effectively by dying, as one self gave way to another. Our immortality would simply be an unending succession of mortal selves.

This conclusion has recently been challenged by Timothy Chappell. He argues that Williams had a rather rigid idea of what counts as a continuing self. It is not necessary that there should be something that remains unchanged forever for immortality to have been achieved. We don’t so much endure through constancy as through ‘connectedness’ – as Derek Parfit pointed out. There are overlapping threads, as in a long rope; but no single thread that goes all the way from one end to another.

This notion seems to fit with our experience of the continuity of personal identity in our ordinary, finite lives. My eight-year-old self and my sixty-year-old self are numerically the same self, even though their experiences, bodies, and their physical and social settings, preoccupations and expectations are radically different.

Secondly, Chappell argues that it is projects which confer meaning on life, and that there is no reason why one should not engage in an infinite variety of projects. Indeed, this would seem very likely, as one project tends to lead to another.

The knowledge that we are going to die does add a certain sense of urgency, and the darkness of death makes the light of life brighter by contrast. As the proverb says, Lucem demonstrat umbra – the shadow demonstrates the light. At any rate, we know that for the foreseeable future, a relatively brief upward arc from speechless infancy to articulacy, and downward to silence, is all we are going to get. So far as I am concerned, the longer the arc the better.

Raymond Tallis is a physician, philosopher, poet and novelist. His new book The Kingdom of Infinite Space: A Fantastical Journey Round Your Head is published by Atlantic.