Ethical and social implications of approaching death prediction in humans - when the biology of ageing meets existential issues
Résumé
Background: This project was prompted by the ambition to investigate, from the outset, the
potential consequences of a future translation to a human context of research on natural death
prediction today actively conducted in the biology of ageing field. It is centered on ethical issues,
challenges faced in medical decision processes and finally their implications in economic and
insurance matters. Recent advances in biology have made predicting the onset of natural death a
technically feasible prospect.
Methods: This project resulted in a study ahead of application based on an interdisciplinary
approach, a combination of philosophy, clinical psychology, medicine, demography, biology and
actuarial science. The question was put into perspective with regard to contemporary theories of
ageing as well as our understanding of what death is. Philosophy (literature review and conceptual
analysis) and psychology (theory and clinical experience) have allowed us to break down into distinct
themes the individual relationship to death, its anticipation and its prediction in order to better
understand the challenges that the prediction of natural incoming death might raise. Our approach
to the problem in the medical field has been focused on intensive care because of the high
frequency of death secondary to acute illnesses. It is therefore natural that we have examined how
the development of tools to predict the risk of death could become a medical decision-making tool
and enable the teams involved to better cope with it. Demographic and actuarial approaches have
allowed us to put prediction of death in the context of the long-standing analysis of mortality tables.
Novel methods of death prediction pose new challenges to long-established assumptions of
demographic models used in the implementation of pension and public health policies and insurance
decisions.
Outcomes: This interdisciplinary work has led to the co-construction of a framework for scientific and
ethical reflection that can be relevant to define public health policy. Unlike a downstream approach
that only provides data after the fact or at least after society has adopted a scientific and/or
technological innovation, this work strives to accompany the implementation of the innovation and
to anticipate its effects.
Interpretation: In this study, we propose a first sketch of what the implications of death prediction as
such could be - inasmuch as it affects both the awareness of death and its anticipation - from an
individual, medical and social point of view . The potential benefits of such tools for society may yet
be outweighed by ethically problematic applications. Here, we seek to provide a framework for
reflection ahead of such applications.
Funding: This project was partially funded by the IHSS (Institut Humanités, Sciences et Sociétés,
Université Paris Diderot), the CNRS (Centre National de la Recherche Scientifique) and ATIP/Avenir
young group leader program.
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