What [are] the prospects of further and possibly unlimited increases in human longevity? It is clear that between 75 and 100 years of age humans today become increasingly susceptible to a very large range of those fatal diseases caused by various internal factors. As these problems swiftly descend one after another upon an aging individual, their amelioration by medical intervention is often extremely costly - and as each problem is individually dealt with, the next is likely to be on its way. Furthermore, apart from this multitude of potentially fatal diseases, a great army of misery-inducing conditions is mobilized against the aging person: arthritis, pain, brittle bones, enlarged prostates, incontinence, pain, failing hearing and vision, loss of sexual potency, pain, erosion of memory, depression, helplessness, thankless children, and so on. As one experienced wag has put it, as one ages, everything either dries up or starts to leak. Thus, while only limited extensions of aged life can be anticipated from medical advances, they will inevitably be accompanied by an increasing deterioration in the quality of life for most of the elderly. The conclusion is brilliantly clear: under present circumstances, the average life span cannot be extended indefinitely in a personally tolerable way.

The only biological escape from this conclusion is the remote possibility that some unknown master gene could be manipulated to turn off, or at least greatly postpone, most of these numerous fatal or misery-producing conditions more or less simultaneously. But the existence of such a single master gene, one that could control so many different biological processes, seems unlikely to me. Furthermore, even if such a master gene existed, and we could learn how to modify it suitably, how could such a gene transformation be widely disseminated in the human population? Or would it be the exclusive privilege of those who could pay for it?

Besides these biological reality checks on the mirage of the indefinite extension of human life, serious difficulties in providing health care for the aged loom on the horizon for society as a whole. If current trends persist, the resulting economic encumbrances for our society will become very burdensome [1]. Health care expenditures for the elderly have outpaced the gross domestic product (GDP) by 3.5 to 4.0 percent per year in recent decades. This increase is the consequence of two changes: the rapid increase in the proportion of the elderly in the population, and the continuous escalation of the cost of medical technology that is used to postpone death. In 1900, only 4 percent of the U.S. population was over 65 years of age. Today that figure is 13 percent, and by 2030 it is projected to be over 20 percent. (This increase is despite the effects of immigration, which increases the younger age groups.) In addition, medical technology has become ever more complex and expensive over time. If the present course continues unabated, these factors suggest that health care consumption by the elderly may cost more than $30,000 per year per person by 2020 (in 1995 dollars, when the cost was $9,200). With the current distribution of health care payments between the public and private sectors, these projected costs in 2020 will require an enormous increase in taxes as well as a substantial decrease in the living standards of the elderly. These and other socioeconomic problems will only be exacerbated by further increases in the average life span.

The present "me first" approach of the majority of Americans to problems of health care is largely egocentric, with no awareness of the societal perspective. In that climate, it is understandable that the average 80-year-old expects society to pay for expensive kidney dialysis to treat kidney failure, or to provide access to expensive open-heart surgery if the individual is afflicted with a heart attack or atherosclerosis, or to pay for a hip replacement if it would improve mobility - all with no questions asked. Medical intervention to prolong life is considered a right of the elderly, irrespective of the low additional life expectancy or of the cumulative effects of such costs on the society. Unfortunately, this is not a tenable long-term policy.

Underlying and basic to all these critical concerns are the largely uninformed and naive views of the nature of aging and death that are held by the irrational majority as well as the complacence of physicians and medical researchers toward these problems. Rationalists urgently need to work toward the acceptance of sane and reality-based views of aging and death. Scientific research and medical technology that are directed to expanding human longevity per se should be viewed with a serious concern that the biological as well as the social realities of the human condition are being disregarded. [*]

Death is the ultimate and unavoidable result of the degradative operations of physics, chemistry, and biology acting on the body's molecules, cells, and organs.

Death is thus not a curse visited upon humanity because of its ancestral transgressions. Death is instead an integral part of life. It is not an independent event inflicted on the living, one that can somehow be circumvented by advanced medical technology. Immortality is not biologically, let alone socially, feasible.