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‘I hope that I get old before I die’: ageing and the concept of disease

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Abstract

Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that concludes that ageing is not a disease, based on an account of natural function. I also criticize other arguments that lead to the same conclusion. It is important to be clear about valid reasons in this debate, since the failure of bad analyses is exploited by proponents of the view that ageing is indeed a disease. Finally, I argue that there could be other reasons for attempting to eradicate senescence, which have to do with an evaluative assessment of ageing in relation to the good life. I touch on some reasons why ageing might be good for people and conclude that we cannot justify generalized statements in this regard.

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Notes

  1. Note the difference between asking for an opinion on whether ageing is bad for the affected person and asking for an opinion on whether it is disadvantageous if ageing is called a disease. Arthur Caplan and Harry Moody had an interesting exchange on the latter question [8]. Caplan sees benefits for defining ageing as disease, because it would justify claims to funding for research and give an excuse for certain behaviour that is due to senescence. Moody, on the other hand, senses that old people might be held individually responsible and be blamed for their disease status, if they do not do anything about it.

  2. An explicit purpose of the BMJ was ‘raising consciousness about the slipperiness of the concept of disease’ [7, p. 885].

  3. There are, of course, more. Transhumanists in general and several biogerontologists, such as Aubrey de Grey, believe there is, or ought to be, a 'cure for ageing'. Ralph Waldo Emerson supposedly stated: ‘All diseases run into one, old age.’

  4. To be sure, the American writer Dorothy Fulheim is reported to have said, ‘Youth is a disease from which we all recover.’

  5. The most important competing theory of functions is the ‘aetiological’. Supporters of this theory are Ruth Garrett Millikan [16] and Karen Neander [17]. Jerome Wakefield [18, 19] purports a similar aetiological theory of function in the context of the debate on the concept of disease.

  6. See [20, p. 84]. An interesting question is whether these goals also apply to mental functions. I have dealt with this issue at some length in [21].

  7. Note the reference to a chosen region. It seems that values come into play, as Boorse himself notices: ‘It has been suggested that how much abnormality counts as disease varies from function to function for reasons of value. If such variation can be shown, perhaps even negative health is value-laden in this minimal way’ [13, p. 571].

  8. It is therefore wrong to try to lead Boorse's theory ad absurdum by claiming that every life-threatening condition like driving races would involve a dysfunction and hence a disease in his sense [22, p. 44]. Dysfunctions are not identical to impairments of individual survival and reproduction, even though particular processes become functions because of their contribution to individual survival and reproduction. Maybe this misunderstanding is due to a confusion of Boorse's with Scadding's [23] account, who proposes ‘biological disadvantages’ as criterion of mental illness. For example, Kendell [24], who takes up this criterion and interprets it to mean increased mortality and reduced fertility, discusses empirical findings regarding impaired fertility and increased mortality of mentally ill people. However, Boorse does not introduce survival and reproduction as criterion of health or disease but as criterion for the identification of functions, and these are characterised as biological organismic processes. Not every threat to individual survival or reproduction is a dysfunction and therefore a disease.

  9. To be sure, Caplan claims that ‘our willingness to accept aging as a natural process’ (emphasis added) depends on showing that ageing has a function [26, p. 729]. But that does not change my objection to his argument.

  10. If it should prove impossible to maintain the earlier functions without detrimental effects on later biological processes, it seems to follow that if we change functions in mature life to prevent ageing, we may cause serious health problems, e.g., a weakened immune system, before the beneficial effects can kick in (cf. [28, p. 12]). Glannon [29, p. 346] makes a similar point when he discusses possible germ line interventions to prolong life. The effects on future generations could be harmful because genes would be maintained that would have been selected against without human intervention.

  11. I believe it is obvious that treatment by doctors cannot serve as a convincing criterion for calling something a disease. On the other hand, it is also obvious that medicine may treat problems that are not diseases. So a decline of abilities in old age may be treated by medical means even when it is not called a disease.

  12. To be sure, there are important borderline cases, which have already been discussed in the relevant literature, especially post-climacteric osteoporosis (cf. [30, p. 170; 15, p. 92]).

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  1. Department of Philosophy, University of Hamburg, Von-Melle-Park 6, 20146, Hamburg, Germany

    Thomas Schramme

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Schramme, T. ‘I hope that I get old before I die’: ageing and the concept of disease. Theor Med Bioeth 34, 171–187 (2013). https://doi.org/10.1007/s11017-013-9256-2

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