Tarris Rosell – Center for Practical Bioethics

Transcript:

Im a Mortal Episode 17: Tarris Rosell – Center for Practical Bioethics Transcript

Speakers: Tarris Rosell (Guest), Sufal Deb (Host), Marvin Yan (Host)

[MUSIC – Im a Mortal Theme]

Tarris Rosell  0:26  

Thank you for allowing me to be on your podcast. My name is Tarris Rosell. My friends and family know me by Tarry, my nickname, so Tarry Roselle is good. I serve in the Rosemary Flanagan Endowed Chair at the Center for Practical Bioethics in Kansas City, Missouri. I am also faculty at Central Baptist Theological Seminary in Shawnee, Kansas.

Marvin Yan  0:55  

Thank you for that wonderful introduction. This [podcast] being Im a Mortal, a play on the word “immortal”, one question we always ask our guests is, what does the word “immortal” or “immortality” mean to you? 

Tarris Rosell  1:05  

Literally, immortality means living forever. In my faith tradition, that doesn’t mean, however, that one never dies. I’m Protestant Christian background, clergy actually. A lot of people in my faith tradition believe in immortality, personal immortality, but that is preceded by biological death. It’s just that some of the doctrines would indicate that there’s an ongoing spiritual existence that also will somehow result in a bodily resurrection as well. So, immortality is interrupted by physical death but there’s an ongoing personal existence, that then in some doctrines, again, becomes bodily as well. Figuratively, immortality can mean something else more like the works that somebody has done. An artist, a writer or someone else who has influenced the world while they were alive, that their influence continues on after their death. I think many of us who may not strive for personal immortality in some physical, maybe even some spiritual sense, some of us would like to influence the world in positive ways such that our influence continues after death. In that sense, someone might be able to say that we are immortal.

Sufal Deb  2:38  

Based on your description, both figuratively and physically, would you like to be immortal?

Tarris Rosell  2:44  

I would like to make a difference in the world, while I live in this life, sufficiently that some part of that continues on long after I’m dead. I am a teacher and I believe and want that what I have taught and what I’ve instilled in my students, how I’ve modelled, my life will continue on in their lives, even more so in the lives of my children, my grandchildren, and others who my life influences. That’s the kind of immortality that I strive for and would want.

Marvin Yan  3:26  

That’s a good definition. We’ve had a few answers, which is not the most common, about leaving a legacy or an impression on others.

Tarris Rosell  3:32  

Yeah, leaving a legacy is a very good definition of that sort of figurative immortality.

Marvin Yan  3:38  

Let’s say, scientists somehow figure out how to cure a biological age. No one ever dies purely by age anymore. How do you think that’s going to impact people in general?

Tarris Rosell  3:48  

Okay, so that’s a big “if”. It’s possible. We’ve already extended life significantly, in at least developed nations with greater resources. Less so in some other parts of the world where people still have very short lives. What if life could be extended, indefinitely? Yeah, I would say we ought to be careful what we wish for, if we’re wishing for that kind of immortality. I could imagine that some of the things we value in life because it is limited, would go away. We do some things in life because life is so short. We invest our lives in things that matter to us, in part because life is short. If life wasn’t short, one could get bored. One could have a loss of meaning in living, I could imagine. It’s the same problem of thinking about spiritual or personal immortality in some religious sense. I’m not sure that everyone has thought through the implications of that. What would that kind of life be? Not necessarily beautiful and wonderful because there is something important about limitations; about having a beginning and an end. Without an end, it may not be all that we would hope for.

Sufal Deb  5:19  

I will be jumping ship a bit. Obviously, when these technologies come out, we won’t know much about them. They’ll be novel technologies, we won’t know the long-term effects, especially with something such as life extension. Are we going to wait around until we see if life could get extended? It’s not exactly something we know. Do you think we should be providing these technologies before we know their effects and how they’re going to be affecting the end of our lives?

Tarris Rosell  5:40  

Of course, this is the same question that’s asked anytime we push the envelope in science, especially Health Sciences technology. The same questions we were asked when organs were first transplanted. That’s been an interest of mine for quite a long time, especially kidney transplant— heart and lung as well. Should we be doing that? I suppose one could still ask that question. For the most part, we, as a society, have answered that that was a good thing. It is a good thing. It helps provide life extension and improvement of quality of life for at least some hundreds of thousands of people. It didn’t come about without some trial and error and without knowing how it was going to end. The same thing is asked in terms of genetic manipulation and genetic therapies. We don’t know what we don’t know. I would be inclined to say that doesn’t mean that we shouldn’t try things to improve life for people who are living now. 

Within my faith tradition too, there’s a value in helping to improve the quality of life for people and to reduce suffering. We ought to do that, to improve the quality of life for people and to reduce the suffering for people. How does that happen? It happens in a lot of different ways. We could probably do that best by simply making sure that every human in the world has clean water, clean air to breathe, and basic health care. Beyond that, if my family member needed a kidney, and that’s happened in my extended family, I think it’s a good thing that they are able to get a kidney from someone else and have their life improved in quality as well as life extension. We ought to be careful about what we don’t know. We ought to not go into things with hubris, not paying attention to potential consequences. 

That’s why it’s important that there be ethicists involved in technologies like the Human Genome Project, some percentage of that money went to hire ethicists, specifically to think about these questions about what might happen. What could happen? Is this a good idea? How could we do this better? We’re asking these questions now for AI, Artificial Intelligence. One of my colleagues at the Center for Practical Bioethics is working a good bit right now. Most of his time is devoted to thinking through the ethics of AI technologies, trying to think about what might happen that wouldn’t be good. What is happening that is discriminatory towards particular people, in terms of algorithms and outcomes. We do need to think about that, that doesn’t mean that we don’t do anything to enhance or extend life.

Marvin Yan  8:42  

These technologies themselves aren’t necessarily bad, but just the way we use them, just like all those movies, teaches about these things that could happen, we should think about them. Right now, you just mentioned that not everyone on Earth even has access to clean water. Yet, we’re talking about something which is so far away from a basic necessity. One issue that we thought about was that some people may not be able to access these technologies, or even choose to not undergo them. I don’t want a genetic enhancement, I don’t want to live forever, I don’t want to be some sort of cyborg, anything. Do you think we’ll still be able to have a compatible society filled with people who choose to undergo all these sorts of treatments, and others who choose to forego all of them? Will there be too much inequality or too much of a divide in either mindset or in terms of how enhanced they are?

Tarris Rosell  9:30  

I think it’s right to worry about making current inequalities, disparities of health and health care even worse. About creating some enhanced population and unenhanced population either by choice or more likely not by choice, by just the ways that we discriminate already. Racism. But even more so by geography. Where you live and where I live, we can look at zip codes in Toronto or Kansas City. Depending on which zip code you live in, your life expectancy will be different. In Greater Kansas City, it’s a difference of several years. Already, we have these disparities of life expectancy. It’s not all death that happens at birth, infant mortality, that’s part of it. It’s also those who do grow up, but just don’t live as long. African American males live significantly less number of years than white males in the United States. Of course, throughout the rest of the world, there are disparities by nation as well. It’s very classist or casteist even. We have to worry about that if technologies then become available. 

Your earlier guest talked about how cryopreservation of a body costs you $28,000 which, as she said, is nothing to someone who is wealthy, and therefore it’s mostly wealthy people who have elected to do that. $28,000 is huge to the vast, vast majority of the world, and the vast majority of Canadians and U.S. Americans. That’s just one sort of technology. Perhaps it gets developed and it becomes available by means of public health insurance or private insurers. It becomes available, like heart transplantation in the US is available to people of all socioeconomic statuses, with the exception of people who can’t get insurance, which in our countries, primarily those who are here without the appropriate immigration status, which is a whole different justice issue. Let’s say that it becomes available, the technology happens, one can extend their life dramatically. It, maybe, enhanced their lives dramatically, their health and it’s going to be paid for. 

I think we’ve already resolved the question of whether it ought to be mandatory or not because we already have life-enhancing and life-extending therapies. How we resolve that is ethically saying one has the right to choose, to refuse. One has the right to choose or refuse. I do ethics consultation for a hospital. It’s a significant part of my job, contractually, with the Center for Practical Bioethics. Recently, there’s a patient who is choosing to not be listed for a heart transplant for their own reasons. Many other cases I’ve consulted on situations where someone could have their life extended by some other therapy, including chemotherapy for cancer or ventilation, because their lungs aren’t working well. My own mother received a dire cancer diagnosis many years ago, and she was going to die from her disease. It was just a matter of how long her dying would take, really. That’s how she saw it but her oncologist saw it differently. She said we have chemotherapy and radiation options for you that could extend your life by six months to two years probably. My mother was relatively healthy otherwise. She looked like the picture of health for an 81-year-old, except for the cancer that was growing inside and it spread. My mother’s response was, “I’m not afraid to die, I just don’t want to hurt.”

So, we respect someone’s values in the US, Canada, and throughout the world. We have said that ethically, someone like my mother has the right to refuse life-extending therapies. She’s not obligated to go on living when her disease process is going to kill her anyway. In fact, that could create problems with distinctions between suicidality or simply a refusal based on one’s values. In my mother’s case, it wasn’t a question. She wasn’t suicidal, she would want to live. She loved life, but she was going to die and it was not going to be pleasant. No matter what kind of palliative therapy and hospice care she had. It was going to be difficult. It wasn’t hard to see that this wasn’t suicidality, it wasn’t a death wish. It was her exercising her right to refuse life-extending therapies. I think we’ve already resolved the question for the future in this regard. Certainly one should be able to opt-in or opt-out. But, it should be something that is not forced upon anyone, I would think.

Sufal Deb  15:01  

We’re gonna jump right back into this idea of the right to refuse and opt-in and opt-out, we have plenty of questions for you Tarry. Right before we dig into that stuff I’d like to ask, we have a lot of societies in our current world such as the Amish society or culture, or a lot of tribes and cultures in Papua New Guinea, which we leave in isolation. We let them have their own lifestyle without the advent of technologies and some might call westernization. If in theory, we were to be the population that does have life extension therapies should we have an obligation to create an alternative safe space or society for those who decide not to take it?

Tarris Rosell  15:34  

Again, I’m trying to wrap my mind around that sort of a world. What we do know, just by looking at history, is that norms change, our notions of what’s good and bad and then right and wrong. They change over time as options become available that weren’t available previously. It’s hard to know how our norms might change, how future generations or two, three or four from now might think about what’s good and bad. Therefore, the rules that are created to attain the good and avoid the bad. Some other things don’t change or not as much like we ought not to force things on people that they don’t necessarily want. That’s why we have these rules about not messing with tribal groups, ethnic groups, in other parts of the world that don’t want to be messed with. When people do mess with them anyway, whether it’s missionaries, anthropologists or politicians, we think it’s wrong. We think that’s a bad thing to do. Those are norms that will carry on into the future. If there are societies that don’t want to be that don’t want this thing, we probably will agree that we ought not to force it on them. 

Then within societies, as well, I think it is also analogous to what we’ve already resolved as the right to choose or refuse. The problem could be that we end up with two different— we already have it. We have those who are the “haves” and the “have nots”. Again, that’s mostly not on the basis of choice, that’s on the basis of resources and power. In the future, we ought to try to minimize that as new technologies become available that could enhance and improve and extend life. We ought to try to make those technologies available as a choice for anyone, as opposed to only those who are wealthy and powerful. We ought not to experiment— there’s another problem. We ought not to experiment on those who are more vulnerable, since we don’t know how it will turn out. We’ve done that before. We’ll use black men in the southern United States to test out some therapies for sexually transmitted diseases. Or we’ll use people in some ethnic group in Africa or Papua New Guinea, where we don’t have IRB asking us, an institutional review board, Human Subjects Protection Board, requiring consents that enable people to know what they’re saying yes to. We try things out on people who are unsuspecting, and less powerful, we ought not to do that. We can agree on a number of oughts and ought-nots well in advance because we’ve already been doing this relative to new technologies for hundreds of years.

Marvin Yan  18:34  

On the topic of the right to choose and the right to refuse. Sufal and I, right now we’re 20. At this age, let’s say a life extension, or some sort of enhancement came out, and I’d opt for it, but maybe when I’m 200, I don’t want it. I wanted to ask because I know you’ve had some experience in the healthcare field about this option of possibly undoing a technology. As far as I know, we don’t always talk about if I have the option to reverse certain therapies done to me. I just wanted your take on if there’s something similar to that in the current healthcare fields, and if we should have that option for something like life extension in the future?

Tarris Rosell  19:07  

There are analogous situations. I’ll never forget one case I consulted on some years back, involving an older gentleman who came into the hospital, walked in, wasn’t carried in on a gurney. He walked in and asked for his pacemaker— an implantable device that sits under the skin. It’s implanted, it is under the skin and with electrodes connected to his heart to handle the electrical part of the heart that keeps the heart beating at a steady pace. A pacemaker. He had a device— either two devices or one device that was a two in one, I don’t remember which. One of them shocks— if his heart were to go into arrhythmia or tachycardia or just stop, it would shock him. That’s one part of The device. The other part is the pacer that keeps the heart pacing at an even pace. The part of the device that shocks him, he had experience going off and shocking him. It’s not clear as to whether or not it actually did or if it was something called “phantom shock”. That he experienced the defibrillator as shocking him and he was tired of it, didn’t want it to go off again. He asked that the defibrillator be turned off. The cardiologist that saw him Friday evening, when he came in, said, “Okay, I can do that, because it would be torture to have a defibrillator going off and shocking you or even experiencing that it did, even if it didn’t. So, I can turn that off, ethically”. He said, “I also want my pacemaker turned off.” 

Okay, so back up, a lot of people have pacemakers that aren’t actually pacing until the heartbeat goes down below, say 60 or 50, or something like that. Then it starts working, it’s just sitting there otherwise. There are other patients like this gentleman, who have had an ablation. The part of the heart that would normally control the electric impulses has been ablated, and it’s not working at all anymore. He’s 100%, dependent on the pacemaker to live. This is your situation of 200 years out, “Now, maybe I shouldn’t have asked for this sort of life extension that keeps going on and on. I’m tired of this 200 years, I’ve experienced everything I want to experience. I’m done. Could it be reversed?” Oh, yes. It could be reversed. Should it be reversed? Well, that was the question the cardiologist had. We could turn off your defibrillator and then your pacemaker. We can do that. But should we? Would that be something like physician-assisted suicide. We got an ethics consult, met with the patient, family, physicians, and psychology, psychiatry, interviewed, the patient— decided he’s not suicidal. He’s just tired of being supported by machines. 

That’s been a crucial distinction. If it’s a machine that’s supporting life like a ventilator, dialysis, pacemaker, or defibrillator, whether it’s inserted or external, like a ventilator, we have decided as a society that it’s permissible, ethically permissible to stop those things. But, if it’s an implanted kidney or heart, that’s different. There’s probably nobody that’s going to explant a donor kidney or donor heart, nobody’s going to do that. We would say it’s permissible to refuse the medications that keep the heart from being rejected by the immune system. That would be a refusal of medication, we wouldn’t like it as a healthcare team, but that would be ethically and legally permissible. It just depends. What did they do to you so that you’ve lived 200 years and could keep going? I would think it would probably be considered ethically permissible to stop or reverse that, analogous to the pacemaker, defibrillator, ventilator, stopping dialysis, since it’s not an organic body part from somebody else unless it is.

Sufal Deb  23:49  

I’m gonna ask a question that’s more so on the opposite side of the story, you just told us, rather than the end of life, the beginning of life. Say, I’m a parent and I have a child. I would like this child to receive the same life extension, whether it’s genetic or orally administrative life extension therapy that I received. Should anti-aging and life extension therapy drugs be given at birth? If so— if not, what age should a child be or an adult be to be able to consent to drugs such as these?

Tarris Rosell  24:21  

Okay, so again, I’m going along with your hypothetical, having jumped over the question of whether we ought to be doing this at all. I have some questions about whether we ought to and how much life is enough. But let’s say that has been resolved and then agreed upon by society that it’s okay to create these sort of life extension therapies. Then your question, the answer to it is going to depend on whether doing so has become as normal as immunizations or more like some people do and some people don’t. That’s the case with vaccines too, of course, especially now during a pandemic. The majority of people accept vaccines, immunizations, and childhood immunizations. Vast majority, which is why it all works for the rest of us. It’s become normal. The question of whether I get my baby immunized isn’t really very much of an ethics question for most parents. If it was something else, if a child needed a heart transplant, there too we would say if that was possible and would provide life extension for the child, maybe 15-20 years or longer— we wouldn’t question that either and say, “Well, you need to wait until the child is 18”. The child isn’t going to live to 18. That matters too. If the child isn’t going to live to the time where they could choose, with capacity to do so then we say it’s in their best interest to help them live long enough, so that they can choose them. It might be that the child gets to be 18 or 20 years old, and says “Thank you, Mom and Dad, I know you meant well when you got a heart transplant for me, but the side effects, it’s not perfect. It’s not like changing out a carburetor in the car. I have to take immunosuppressive drugs and it’s just not worth it to me anymore.” Now they can choose, but they wouldn’t have had that choice, to stop doing the immunosuppression that’s required to keep the heart. They wouldn’t be able to do that if the mom and dad hadn’t made the choice in the child’s best interest. It depends on how this all comes off, becomes normative, relatively it enhances and extends life, and everybody does it, then probably parents could be expected to do it, and questioned if they didn’t. But if it’s controversial, about half of us think this is the worst thing that ever came out of the lab, and the other half thinks it’s the best thing, well, then we’re going to say, “You should probably wait until the child has grown a bit because it’s not like they’re going to die.” Not very many children die, at least in developed nations. Give them a chance to grow up and then if they want to get some life extension later on when they can choose at age 16, 18 or 20, then it’s their choice.

Marvin Yan  27:17  

As a follow-up, these are all worrisome questions, but some countries have an opt-in and opt-out policy in terms of organ donation. I was wondering, does your answer to whether this technology should be an opt-in or opt-out depend on how normalized it is? Are there other factors that we need to consider?

Tarris Rosell  27:36  

With opting into organ donation, it’s a little different, because then it’s considering that your body parts belong to society. In more communal societies, like some in Europe, maybe Canada at some point, where there’s a greater sense of solidarity. It’s about us and not so much about me, that makes sense. In a society like the United States, which is very individualistic, a policy where your organs will be used unless you say no, that’s not going to happen anytime soon. Not until the norms of society become much more communitarian rather than individualistic, and I don’t see that happening. I see it going probably the other direction. I’m not sure that it’s apples and apples that we’re talking about. Unless the notion of life extension therapies is perfected to the point where we no longer will have to expend public resources to take care of people. 

If I choose not to have my life extended or enhanced, that means that you, as a taxpayer, are going to end up having to pay for my having said no. Then we might say, “Well, that’s not fair. You have the option of being healthier for longer and if you choose not to, maybe you should be taxed for that.” I don’t see that happening either. Maybe we should be forced to do it or maybe we should assume that you would want it unless you tell us no, I’m not sure that that would happen either. At least not in my society because there are all kinds of people who do things that cause their health to be bad. They make choices to smoke or vape and we still take care of them, we still pay for them using Medicaid and Medicare dollars. That happens in Canada as well. We don’t say we’re not going to take care of you or pay for your medical expenses just because you smoke. We might not like it, but we placed the value of caring for people in their time of need, over the value of people choosing things that would be healthier for them. Probably analogous to what you’re thinking about, although it might not be, it’s hard to say. Depends how it all works out, right?

Marvin Yan  30:09  

Let’s say the hypothetical life extension was getting rid of aging. Healthcare burden, a huge part of it is because of age-related diseases, right? Based on what you told me about standard of care, just because someone chooses not to undergo some sort of anti-aging therapy doesn’t mean that they should receive any sort of substandard care, then. We should still care for them to the same extent, whether or not they accept technology or not.

Tarris Rosell  30:34  

Yeah, yeah. Why should anyone receive substandard care intentionally? If care of other humans is a very, very weighty value, and it is, then we take care of people, regardless of how they came to us. Again, we might not like it. We might not like the young man that came in having ridden his motorcycle 120 miles an hour down the interstate, without a helmet. But, when he comes into our hospital we take care of him like he was our son or brother. Why? He’s human, even though he was foolish. I think that’s probably the same principle that ought to be factored in. If someone is— why would someone refuse life extension therapies or anti-aging therapies? Why? They don’t trust that it’s all going to work out well, or maybe because their faith perspective says this isn’t right. We shouldn’t be doing this, we’re playing God. Maybe it’s because they have other values that correlate with life limitations and they don’t want to give them up. I think what we would do is say we ought to respect those [reasons] that are all reasonable but even unreasonable. Things like vaccine hesitancy, we still say, “Okay, we’re probably not going to tie you down and stick the needle in your arm. Even though it frustrates us, even though it puts the rest of us at risk and our children.” What we do is we try to be patient, we exercise the virtues of respecting your rights to even make poor decisions and even sometimes when it places other people at risk. It depends on how far it places other people at risk. In that scenario you’re presenting, it’s not like it places other people at risk, it might cost them more money because aging creates health issues that then cost money. It’s usually not the patient that’s paying for it all but society at large. I think we’re weighing values that conflict with each other and ultimately if we’re a good society, I think we’ll weigh the values of respecting people’s choices. Over against, maybe, our own annoyance that their choice costs us a bit more money.

Sufal Deb  32:56  

Since you brought it up, there’s a whole economic standpoint to the idea of living forever. As we get older, it costs us more money to pay for these medicines and these diseases. Don’t you foresee insurance companies or things that pay out people as they pass away, to start charging exclusive taxes or additional costs just so that somebody can afford life insurance because they don’t have life extension drugs? Since they’re no longer taking these life extension drugs, they’re going to die sooner. Why shouldn’t they be charging them more money?

Tarris Rosell  33:25  

That’s a reasonable question. Anyone in insurance is going to do the calculation if there is a cost to them as an insurance company, which is ultimately a cost to all of those in their pool of insured persons. If that can be calculated against refusal of anti-ageism, or anti-aging therapies, they may well charge more or refuse clients on the basis of what they have chosen. There are some new laws in the United States about who you can refuse and pre-existing conditions and that sort of thing. But there have been situations— there still are, where an insurance company can refuse to insure someone who smokes, especially for insurance for long-term care. My spouse and I are getting older, so we decided to purchase long-term care insurance and they could choose to take us or not, depending on their perceived risk of doing so. I would expect that would happen.

Sufal Deb  34:32  

Staying on the topic of money, I’m sure you’ve heard of the idea of a comfortable death. Typically, not everyone can afford a comfortable death, whether that be in a first-world country or a third-world country. It’s expensive. With this idea of immortality, again, theoretically say it exists, I’m sure some people if they would like to age and die like they naturally would, they might be able to afford to undo therapy or something along the lines of that. But since medicine has some cost to it, whether it be through your insurance or through your government, do you think something like doing medical assisted suicide or euthanasia, in order to pass away might become a little bit more popular, since it would no longer require therapy to age and then pass away?

Tarris Rosell  35:10  

I would think so, if one did not have natural death to end things, how is it going to end? Well, I suppose one could drive really, really fast, or do something else that would get you killed. There are lots of ways to die, other than from disease or aging. Young people die too, right? It would either be suicide or somebody helping you, right? For those who would prefer to have it done in a way that they were not directly responsible but someone else was. I think the appeal for medically assisted dying is in part— it’s legal. Society has agreed, either by vote, by a court decision, or by legislation that it’s permissible. Whereas suicide is looked at very unfavorably and in some faith traditions, it’s a mortal sin, it’s bad and wrong. Whereas, if you live in Canada, Oregon, Washington in the United States, or eight other jurisdictions where medically assisted dying is legal, you can go there and ask a physician to help you with this and a pharmacist. As long as you follow the rules and you meet the protocol, your death is ethically and legally permissible within that society, that part of the society. I think that might be an appeal for someone who can’t die from pneumonia, cancer, or any of the other things that happen eventually, inevitably, if we don’t die from an accident, gunshot, fire, or some other accidental death. Why wouldn’t suicide and medically assisted suicide increase pretty dramatically?

Marvin Yan  37:00  

We had two questions that were related in terms of justice-related systems. The question I had was— I know there’s a big controversy over capital punishment and life in prison and if there’s one that’s better than the other, what’s more ethical, what’s better for economic burden. When I thought about it in terms of— let’s say, people had the ability to live indefinitely, if either was ethical anymore? because life in prison indefinitely is torture. But at the same time, I feel like ending someone’s life was already such a monumental decision, but ending their life knowing that they could have kept on going also seems terrible. I wanted your take on what do we do about a situation like that now? What’s going to be the ultimate punishment from now on?

Tarris Rosell  37:47  

Yeah, so capital punishment, death by the government, may seem terrible to you and me. It doesn’t seem terrible to lots and lots of other people, which is why it still continues to exist. In many parts of the world, including the United States. In some parts of the United States, it’s actually coming back. From my perspective, ethically regressing. The means of capital punishment are now being discussed in some states as possibly involving execution squads. People have talked about hanging. Things that we thought we had moved away from some of us that we’ve moved away from as a result of moral development as a society. That could probably be expected to increase if you had prisoners who had done horrible things, and some part of society, the majority still thinks that killing someone who has killed someone else is ethically permissible. There probably would be more capital punishment, life in prison would change dramatically as well, surely, on an economic basis. Why? It costs a lot of money to incarcerate someone, even if you’re doing it very inhumanely and not feeding them much or [keeping them in] very, very poor conditions. It still costs tens of thousands of dollars in the US right now to house somebody in an incarcerated state. If someone’s life was enhanced, they’re in a relatively safe environment from accidental death, and they’re not going to age out, I’ll bet that society would figure out that life imprisonment was not something we’re going to do anymore. So that we [don’t] keep paying $100,000 a year for someone to just sit in prison and not have any usefulness to society. We’d do something else, hopefully, something more humane, like try to find other ways to keep society safe from people who are a threat to society otherwise, but doing so without incarceration or killing them.

Sufal Deb  40:05  

On this idea of incarceration and justice to a certain degree, there’s this whole juvie versus regular prison. A lot of that has to do with the fact that younger people have more of a chance to reform and re-educate themselves to be upstanding citizens. Yet, some people claim that with immortality, alongside immortality, we might have that idea of reversing aging. As a 20-year-old, I might want to reverse my age to a 15-year-old. If we have something like this, do you think people will still blame their poor decisions or their criminal negligence or something along the lines of that on their age? Will the entire Justice System readjust itself to work more on their chronological age rather than their biological age?

Tarris Rosell  40:49  

Who knows what people would be thinking at that point, once there was a possibility of reversing aging? My first thought is, why would you want to do that? I am almost 64. I live with a partner who is roughly the same age and we often comment to one another, as we watch our young adult children grow up and think about life at 20, 30, or 40. We then say we’re grateful for what we had a chance to experience and sure would not want to go back. I think there are a lot of people who would say, “Thank you, but no, thank you.” Those who would make the choice to reverse their aging, who knows what excuses they might give for their behaviour at that point? I have to say, I don’t know. It’s an interesting hypothetical. But I start with, why would anybody choose to reverse and go back? I can’t understand that.

Marvin Yan  41:51  

Well, maybe this could be inspiration for some Netflix series, right? Where people change their age, the whole justice system has to figure out which one matters more, biological or chronological. Something more familiar, because you’ve done theology for a really long time, so we can’t have you on without asking you a few questions about it. Earlier, you mentioned this idea of playing God, this is something that sort of troubled me because I was thinking, well, all the technologies, as you said, can be a net good for society. I imagine anyone, not necessarily Christians, would all say, this device, like the pacemaker you talked about, saves someone’s life then it’s good. At the same time, I was thinking, I don’t know if there’s a point where we have too much power or become too much like God, where we’re playing with technologies and manipulating things that we really shouldn’t. With your background in theology, I don’t know if there are differences between different Christian denominations in terms of how they think about this, but would, at least Protestants, be accepting of some sort of life extension technology?

Tarris Rosell  42:49  

Yeah, that’s an interesting question. I suspect that Protestant Evangelical Christians would embrace life extension, as much or more than anyone else. That’s interesting because that part of Protestant Christianity also tends to strongly believe in spiritual immortality in heaven with God. When therapy options are presented to Protestant Evangelicals, the value of life in this world, the sanctity of life, seems to weigh heavier than going to live with God. Now, that wasn’t the case with my mother. She was a Protestant Evangelical. At the point where she was not going to live a healthy, comfortable life here, at that point, she was quite ready to give this life up, as in her thinking, to go live with God and be reunited with her family members, parents or siblings who had died before her. But what I’ve noticed, and others have noticed, other clinical ethicists that I’ve worked with is how often Evangelical Christians cling to this life, even when they’re dying. Often they say, or their family members say “No, try to do resuscitation, even if it won’t work. It’s worth it to keep trying. Even if chemotherapy isn’t going to work anymore, try it anyway.” Now, I don’t have any empirical evidence that Evangelical Christians do that more, but anecdotally, it seems like that’s the case. There probably are some empirical studies that would give us data on that as well. I would say on the basis of my experience with at least Protestant Evangelical Christians, I think there would be an embracing of life extension therapies. But there’s also surely some other folk within my faith tradition of Protestant Christianity, Evangelicals too, who would question whether or not this sort of immortality striving is really a good thing. 

I think there’s nothing wrong with wanting to live longer. To live a long life, in biblical language, is a blessing. A long life is a blessing. You read the Hebrew Bible, the Old Testament, some of us call it, there are lots of stories about someone who has lived a long life, and that was considered a blessing from God. There’s nothing wrong with wanting to live longer; to live a long life. What’s wrong is when there are disparities of mortality of life years. As we talked about earlier, one can look at a zip code and there will be a significant disparity of life years, from one zip code to another. That’s wrong. That’s just wrong. We ought to work on equity. Wanting to live longer— if you live in one of those zip codes, I think wanting to live longer is wanting justice, wanting to live a life that is normatively available to others. 

I think wanting to live longer at the expense of others— we’ve talked about the economics of some of this, I think when you live longer at the expense of others might not be wrong, either. If we understand ourselves to be interdependent, we’re not islands. I don’t have a problem with Medicare, Medicaid and my insurance, the pool of money from my insurance company, helping other people even when I have been blessed and my partner, we’ve been blessed with really good health. We’ve paid tens of thousands, hundreds of thousands of dollars that have been paid into our insurance pool that has been used by other people. We don’t have a problem with that. We’re interdependent, we see that as our blessing being able to help someone else. I think wanting to live longer at the expense of other people’s ability to live at all or to live a normal lifespan. I think that is wrong. If my getting life extension therapies or anti-aging therapies is at the expense of someone else getting clean water, there’s something wrong with that. We need to question even the therapies that we already have that are incredibly expensive that provide life extension for a few people, when that money might have been used to provide basic health care, immunizations, clean water, clean air for some other child, perhaps, who dies young or doesn’t live a normal lifespan because somebody else got very, very expensive therapies. That ethics problem still exists. I have to ask, from a theological, religious, faith, ethics perspective, how much life is enough? How many years would be enough? It’s like money, how much money is enough? We already have a lot of empirical evidence that having more and more and more money does not make one happy.

Now, not having enough money for food, water, and keeping your kids sheltered is a problem. Once you have enough money for the basics of life, there’s a lot of empirical evidence throughout the world to show that greater happiness does not correlate with more and more and more money. I suspect that that will be an analogy to apply to more and more and more life years. It strikes me frankly, as narcissistic to do cryopreservation. $28,000 or $2,800. Why would I want to do that? I would want to do that if I was so narcissistic that I could not imagine a world without me. The narcissist cannot imagine their own nonexistence, right? Personal nonexistence is an intolerable thought. I want to continue to live and live and live and live. Why wouldn’t I? If I’m a narcissist, of course I would want to! Why? Because I am the world. That’s the narcissist that’s never grown out of the infantile state. For the infant, they are the world, then it’s them and their mom, then it’s them and their parents. We say that normal moral development enables us to notice and embrace more and more people outside of ourselves. The narcissist is still an infant, morally an infant, and therefore grasps at the extension of life and personal immortality, I think, out of narcissism. 

There’s healthy narcissism, we also have to care about our own life. It’s sufficient to take care of ourselves to make sure that we’re fed, get enough sleep, and preserve our life. Frankly, for me, I don’t really have a hard time with mortality. I think even in my 40s, I would get on an airplane and think, “Okay, I don’t need to really look”— until my children were grown I was looking for the safest place. But once my children were grown and didn’t need me in the same way, I would think, “Okay, where’s the least safe place? There’s a whole lot of other people on this plane, who haven’t had a chance at life like I have. Let me sit by the door where I can help people get out. Which means that I’m the last one, right? If I can sit at the exits and help people out, or if the tail is the least safe place, well, maybe I’ll sit in the back because there’s a whole lot of younger people on this flight who haven’t had a chance and I’ve had a chance,” I don’t really understand the grasping, the appeal of personal immortality that some people seem to have. The only way I can think about it is that it arises from some sense of I am the world. It’s infantile narcissism. 

I don’t think that spiritual immortality, these concepts of living with God and Heaven, are necessarily bad. They’re probably ethically benign. Why? It helps a lot of people have hope, for a life hereafter when life in this world is not very pleasant. It helps them get through death and dying when their life isn’t going to be extended, like my mother. It enabled her to die better, with greater hope. Grasping at immortality may not be ethically benign, but just simple narcissism. I would hope, as we talked earlier, that my life would go on, that my immortality would be in your lives from the conversations we have but even more so in the lives of my students, in the lives of my children, and my grandbaby. I invest in them and then when I’m gone, they carry on. Hopefully, something that I have invested in them will carry on as well. More than my name or my memory, but something else. That gives me great hope and great purpose in life. I don’t need to live forever. I don’t need any kind of personal immortality when I think in terms of investing in the lives of other people now, who will live after I’ve gone for a while.

Sufal Deb  52:55  

I really like that answer, you really have a deepened thought right now. One of our last questions is if there’s one thing you want this audience and all the listeners to take away from today’s conversation, what would it be Tarry?

Tarris Rosell  53:06  

There are worse things than getting old. There are worse things than dying, so be careful what you wish for because if you get it, you might wish you had not.

Marvin Yan  53:19  

Yeah, there’s plenty of folktales about that, that teaches that to you as a kid too. We haven’t had someone who considers bioethics on a daily basis like yourself. There will definitely be listeners who want to learn more about you and your work. If they are interested, where can they go to learn more about you?

Tarris Rosell  53:34  

They could email me at trosell@practicalbioethics.org. That’s T-R-O-S-E-L-L at P-R-A-C-T-I-C-A-L dot O-R-G. If it’s more specifically theological, my email address for the seminary is trosell@cbts.edu. If they want to learn more about the artist side of me, they can find me on Instagram @amanilamps. A-M-A-N-I-L-A-M-P-S, Amani Lamps. I’m a potter on the site, I make pottery and post my photos there. Everything that’s posted on my Instagram account is available for a donation to livingloveinternational.org, which is a new international humanitarian organization that I am— a couple of my students and some of my colleagues have just launched in the last year and we hope to do collaborative work in parts of Africa. Everything that is donated for any of my pottery creations is a donation to livingloveinternational.org.

Marvin Yan  54:50  

We’ll definitely be putting all these links below so people can find your work, the pottery, and support what you’re doing because Tarry, you are a good person doing all this stuff. On that note, we really appreciate you coming out to Im a Mortal, your source for all things immortal. Thanks for taking the time to speak with us today. 

Tarris Rosell  55:06  

Thank you so much for what you’re doing.

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