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The problematic openness behind the first capability concerning the end of a human life of normal length

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Slides of the talk I've given 9 September in London at HDCA conference. Martha Nussbaum’s first capability starts with the following phrase intended to capture the most fundamental capability of human life: ‘Being able to live to the end of a human life of normal length’. Despite its top position on the list, this capability appears to be under analysed in the literature. In the current study we are trying to partly fill in the gap critically and also extend the approach with another angle of looking at human lifespan. Our conclusion is that the 1st capability should be reformulated as ‘Being able to live a human life of acceptable length’ to incorporate our whole range of capabilities in terms of healthy longevity and lifespan, adjusted to the current scientific/technological trajectory.

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The problematic openness behind the first capability concerning the end of a human life of normal length

  1. 1. The problematic openness behind the first capability concerning the ‘end of a human life of normal length’ Attila Csordas Longevity Politics Global Cambridge, UK
  2. 2. Outline what am I? some data science update industry update central capabilities first capability interpreting ‘normal’ the conceptual twins open lifespan the argument discussion
  3. 3. The puzzle of aging mass-spec based proteomics bioinformatics business mitochondrial biology stem cell research 14 year old Attila decides this problem gives meaning to his life -> rational life plan philosophy of longevity Open Lifespan activism in longevity community science personal narrative technology politics
  4. 4. Open Lifespan project openlifespan.org/book/
  5. 5. global increase in mean life expectancy 2000-15: 5 years with 4.6 years as healthy longevity ‘An average 16–20% of life is now spent in late-life morbidity’ ~ Decades of late-life is now spent fighting age-associated diseases, compromising human life and life plans. 64 95 122 healthspan US, 2017 80% 65+ 1 chronic 68% 65+ 2+ chronic lifespan longevity
  6. 6. Hallmarks of aging, Cell, 2013 PMID: 23746838 treatments/interventions under way we genuinely don’t know how far we’re going to push lifespan New scientific consensus
  7. 7. 64 95 122 healthspan lifespan longevity Longevity industry & regulation billions of dollars invested ICD/FDA: can aging be classified as a disease??? TAME trial starts this November
  8. 8. Central Capabilities Life Bodily Health Bodily integrity Sense, imagination, and thought Emotions Practical reason Affiliation Other species Play Control over one’s environment lack of ambition < minimal thresholds < high thresholds, utopianism ‘What does a life worthy of human dignity require? At a bare minimum, an ample threshold level of 10 CC-s is required.’ Martha Nussbaum, Creating Capabilities should be enforced by governments should be prescribed to all citizens
  9. 9. First capability “Life. Being able to live to the end of a human life of normal length; not dying prematurely, or before one’s life is so reduced as to be not worth living.” Martha Nussbaum fundamental explicit quantity disconnected from more social capabilities
  10. 10. Interpreting ‘normal’ statistical/descriptive average and typical acceptable/prescriptive subjective and indexical ‘the end of a human life of normal length’
  11. 11. Statistical, life expectancy average number of years remaining for an individual or a group of people at a given age “Although “normal length” is clearly relative to current human possibilities and may need, for practical purposes, to be to some extent relativized to local conditions, it seems important to think of it—at least at a given time in history— in universal and comparative terms, as the Human Development Report does, to give rise to complaint in a country that has done well with some indicators of life quality but badly on life expectancy.” Martha Nussbaum, Human Capabilities, Female Human Beings. Note 49.
  12. 12. Monako toy example 11 people, age of death: 20, 65, 77, 81, 85, 86, 90, 90, 99, 109, 111
  13. 13. Mean age of death: 83 arithmetic mean: (20 + 65 + 77 + 81 + 85 + 86 + 90 + 90 + 99 + 109 + 111)/11 = 83 mean
  14. 14. Median age of death: 86 median: middle value: 20, 65, 77, 81, 85, 86, 90, 90, 99, 109, 111 mean median
  15. 15. Typical, modal, most likely age of death: 90 mode: 20, 65, 77, 81, 85, 86, 90, 90, 99, 109, 111 mean median mode
  16. 16. Not toy numbers: 83, 86, 90 https://medianism.org/2017/06/12/median-vs-mean-life-expectancy/ Numbers of women expected to die at each age, out of 100,000 born, assuming mortality rates stay the same as 2010-2012, example by David Spiegelharter
  17. 17. 1. Central Capabilities should be prescribed to all citizens. 2. Definition of averages makes it impossible for ~50% to reach ‘the end of a human life of normal length’ Conclusion: 1st capability cannot be tied to default statistical concepts of life expectancy via a descriptive analysis of ‘normal’.
  18. 18. ‘normal’ as acceptable ‘minimally’ or ‘ok’ acceptable ‘Capabilities belong first and foremost to individual persons, and only derivatively to groups. The approach espouses a principle of each person as an end.’ M.N. prescriptive, subjective and indexical 1. How long would you like to live that you think is ‘minimally acceptable’ for you? 2. How long would you like to live that you think is ‘ok acceptable’ for you? -> concept ceases to be about a minimal, enforceable threshold the theory expects it to be. -> opens up to a different, open interpretation including a range of values, with an upper limit, maximum interpretation as well.
  19. 19. Conceptual twins, separated at birth biological life lifespan/longevityhealth there’s only health when there’s a quantity of life and there’s only a quantity of life when there’s a a threshold, viable amount of health present. which is a more fundamental concept? 2 approaches health lifespan life
  20. 20. CH ‘capability to be healthy’ ’There is something of value in being able to live as long as possible for every human being. This means that making life prospects relative to each society denies what is shared across the human species. It should be the case that every human being would also give value to being maximally unimpaired throughout a life span that reaches for the upper bounds.’ p206 in Sridhar Venkatapuram: Doctoral Dissertation, 2007. • Health is the first and central capability • Health is a metacapability to achieve a cluster of basic capabilities and functionings. • Capability based theory of health causation and distribution integrates biomedical with social determinants research beyond clinical disease. • Lifespan/longevity are parts of the health bundle, not separate. • Aging is not a separate topic yet within this approach.
  21. 21. Open Lifespan, Open Healthspan what is the theoretical, reachable maximum? what is as long as possible? Open Life is a possible world, where people can choose Open Lifespan, an open-ended, indefinitely long healthy lifespan. Open Lifespan is achieved via Open Healthspan Technologies developed and accessible enough that all people can choose to go through continuous interventions to counteract the biological aging process and have a fixed, small but nonzero mortality rate due to external causes of death. not utopian, only one parameter is changed
  22. 22. Open Life Actual World Less Probable Worlds Highly Probable Worlds Limiting Possible Worlds current thinking
  23. 23. Open Life Actual World Less Probable Worlds Limiting Possible Worlds Highly Probable Worlds Increasing Life Expectancy Closed Lifespan Breaking Maximum Closed Lifespan Barrier Open Lifespan Open Lifespan thinking
  24. 24. Argument 1. Central Capabilities should be prescribed to all citizens. 2. A minimum threshold level of Central Capabilities should be provided. 3.‘normal’ in ‘end of a human life of normal length’ cannot be interpreted statistically as average life expectancy as it cannot specify, by definition a minimum threshold level accessible for all. 4. ‘Normal’ cannot be interpreted as ‘minimally acceptable’ 5. ‘Normal’ can be interpreted as ‘ ok acceptable’ to capture a wide range of plans in terms of lifespan including maximising healthy lifespan or specifying maximum lifespan. 6. Science/technology can specify a healthy longevity trajectory with an uncertain/indefinite Open Lifespan at its theoretical upper limit. 7. Specification/Implementation of Capabilities are up to particular traditions/histories. 8. Science/technology are the particular traditions/histories with relevance to healthy longevity (Capability 1 and 2). Conclusion: 1st capability should be reformulated as ‘Being able to live a human life of acceptable length’ to incorporate our whole range of capabilities in terms of healthy longevity and lifespan, adjusted to the current scientific/technological trajectory.
  25. 25. Conclusion Conclusion 1.: conceptual problem with statistical interpretation of ‘end of a human life of normal length’ Conclusion 2: a range interpretation of ‘acceptable’ might work, including maximising healthy longevity Conclusion 3: a new theory of health and longevity needed, that accounts for both at the same level Conclusion 4: this new theory can re-phrase and possibly merge the 1st and 2nd capabilities Thanks!

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