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人类接近死亡预测的伦理和社会影响——当衰老生物学遇到生存问题时。

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

作者信息

Gaille Marie, Araneda Marco, Dubost Clément, Guillermain Clémence, Kaakai Sarah, Ricadat Elise, Todd Nicolas, Rera Michael

机构信息

Université de Paris, SPHERE, UMR 7219, CNRS-Université Paris Diderot, bâtiment Condorcet, case 7093, 5 rue Thomas Mann, 75205, Paris, France.

Université de Paris, CRPMS - EA 3522, IUH - EA 3518, bâtiment Olympe de Gouges, 8 rue Albert Einstein, 75013, Paris, France.

出版信息

BMC Med Ethics. 2020 Jul 27;21(1):64. doi: 10.1186/s12910-020-00502-5.

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 a long-lasting dying 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 to the way 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 anti-ageing 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?

摘要

背景

衰老生物标志物的发现推动了自然死亡临近预测指标的发展,并为普通人群死亡风险的个性化评估铺平了道路。本研究旨在确定可用于探讨长期死亡过程这一概念的伦理资源,并考量死亡预测的观点。对人类死亡率的思考虽有必要,但不足以应对这一问题。了解临床背景下的死亡预期有助于更好地理解它。然而,预测这一概念本身及其影响仍需阐明。本研究前瞻性地概述了在伦理、心理、医学和社会等各个相关领域中需要进一步研究的问题。

方法

该研究基于跨学科方法,将哲学、临床心理学、医学、人口统计学、生物学和精算科学结合起来。

结果

本研究提出了一种对死亡预测的理解,其依据是将死亡预测与人类死亡率及死亡预期的关系区分开来,并类比疾病症状前阶段进行的基因检测的影响。这导致识别出一个多层次问题,包括个人与死亡预测的关系、衰老生物标志物的潜在医学用途、后者的社会和经济影响,尤其是在长寿风险的认知方式方面。

结论

本研究致力于从个人、医学和社会角度初步勾勒死亡预测本身可能产生的影响。随着抗衰老医学和超人类主义对永生的追求,对衰老生物标志物的研究使关键伦理问题重新成为焦点:作为人类,我们是否应该继续忽视某些事情,主要是我们死亡的时刻,哪怕是对它的估计?如果有这样的知识,应该告知谁以及如何提供此类信息?这是一种可以在社会上共享的知识吗?

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c9dd/7385957/c868ada59ddd/12910_2020_502_Fig1_HTML.jpg

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