Ethical and social implications of approaching death prediction in humans - when the biology of ageing meets existential issues

Abstract

Background: The discovery of biomarkers of ageing has led to the development of predictors of impending natural death and has paved the way for personalised estimation of the risk of death in the general population. This study intends to identify the ethical resources available to approach the idea of death as a process and consider the perspective of death prediction. The reflection on human mortality is necessary but not sufficient to face this issue. Knowledge about death anticipation in clinical contexts allows for a better understanding of it. Still, the very notion of prediction and its implications must be clarified. This study outlines in a prospective way issues that call for further investigation in the various fields concerned: ethical, psychological, medical and social.Methods: The study is based on an interdisciplinary approach, a combination of philosophy, clinical psychology, medicine, demography, biology and actuarial science.Results: The present study proposes an understanding of death prediction based on its distinction with the relationship to human mortality and death anticipation, and on the analogy with the implications of genetic testing performed in pre-symptomatic stages of a disease. It leads to the identification of a multi-layered issue, including the individual and personal relationship to death prediction, the potential medical uses of biomarkers of ageing, the social and economic implications of the latter, especially in regard of the way the longevity risk is perceived.Conclusions: The present study work strives to propose a first sketch of what the implications of death prediction as such could be -from an individual, medical and social point of view. Both with antiageing medicine and the transhumanist quest for immortality, research on biomarkers of ageing brings back to the forefront crucial ethical matters: should we, as human beings, keep ignoring certain things, primarily the moment of our death, be it an estimation of it? If such knowledge was available, who should be informed about it and how such information should be given? Is it a knowledge that could be socially shared? BackgroundDeath prediction is not a new idea, neither at a population level nor at an individual one. Since the late 17th century, demographers have routinely estimated and analysed multiple population-level

Deep Cox Mixtures for Survival Regression

“…For example, studies show that in the US, Black women with breast cancer have a higher mortality rate than White women (Yedjou et al, 2019 However, there is an ongoing discussion on whether the mortality rate is related to hereditary characteristics (Yedjou et al, 2019), other factors such as late diagnosis due to historical discrimination, or a combination of all these factors (George et al, 2015). The datasets used in these studies may have unobserved confounding characteristics that may be causally related to the final outcome (Gaille et al, 2020). As a result, the extent to which the reported effects of protected attributes like 'Race' and 'Gender' are causal is problem dependent, unclear in the settings studied here, and an open research problem (Dwork et al, 2012) beyond the scope of this paper.…”

Language, Time, and Death. An Ethico-Philosophical Perspective Following Hegel, Heidegger, Lévinas, and Blanchot

“…In such a context, expansive literature following various approaches addressing the question of death is already available, e.g., biological understanding of death in terms of medical ethics determining critical situations aimed to improve overall health communication (see e.g., Gaille et al 2020;Thompson 1984;Jakušovaitė et al 2016;Nair-Collins et al 2017;Rentmeester 2018); sociological understanding in terms of culture aimed to make sense of death in relation to socio-religious practices and beliefs (see e.g., Ahmadzai 2021;Setta et al 2015); psychological understanding in terms of symptoms of withdrawal of self from society while subjectivizing intra-communication (see e.g., Leach 2018;Purdy 2018;Hayes et al 2016;Morese et al 2020); political understanding of death focusing on existentialist paradigm (see e.g., Harris 1972) or using dead as symbols to maintain memories and citizenship rights of its deceased members (see e.g., Kearl & Rinaldi 1983) and various other political theories on death (see e.g., Dolgoy, et al 2020);…”

Conséquences éthiques et sociales de biomarqueurs prédictifs de la mort chez l’homme

“…venir de personnes apparemment en bonne santé, soulève d'importantes questions éthiques, notamment en ce qui concerne l'utilisation de ces connaissances en contexte clinique : elles pourraient en effet être mobilisées par les équipes médicales, afin de définir la stratégie thérapeutique la mieux adaptée à l'état du patient. Nous proposons ici quelques pistes de réflexion qui ont été détaillées par ailleurs [28]. CHRONIQUES BIOÉTHIQUES REPÈRES pour les personnes souffrant d'une maladie.…”