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In his 1910 JAMA address, the physician and pathologist Christian Herter (1865–1910) emphasized the importance of plasticity in science. Herter’s insight is significant for understanding how public health’s “ecology of ideas” must evolve and change as the health challenges facing populations alter through the different stages of “epidemiologic transition”. The foundational moral aspiration (ie, disease control) and intellectual suppositions (eg, that public health is “purchasable”) of the early twentieth-century public health pioneers C.-E.A Winslow (1877–1957) and his mentor Hermann Biggs (1859–1923) were shaped by sanitation science and were deployed to mitigate the risks of early-life mortality. But to meet the health challenges of today’s aging world, public health’s “ecology of ideas” must be plastic, and thus open to revision and refinement in terms of both its foundational moral aspirations and the intellectual suppositions concerning how to best improve population health. More medical research is needed in rate (of aging) control versus disease control.

Imagination and idealism are particularly important creative epistemic virtues for the medical sciences if we hope to improve the health of the world’s ageing population. To date, imagination and idealism within the medical sciences have been dominated by a paradigm of disease control, a paradigm which has realised significant, but also limited, success. Disease control proved particularly successful in mitigating the early-life mortality risks from infectious diseases, but it has proved less successful when applied to the chronic diseases of late life (like cancer). The time is ripe for the emergence and prominence of a supplementary medical research paradigm, the paradigm of ‘healthy ageing’ which prioritises the goal of rate (of ageing) control rather than disease control. This is the difference between extending the human healthspan versus extending survival by managing (or trying to eliminate) the multi-morbidities, frailty and disability currently prevalent in late life. The idealism of the disease control paradigm is myopic because it ignores the health constraints imposed by the inborn ageing process itself, a biological reality which is already inflicting significant economic and disease burdens on the world’s ageing populations. Unless the medical sciences retard the rate of biological ageing, these problems will continue to be amplified as larger numbers of persons survive into late life.

John Davis (New Methuselahs: The Ethics of Life Extension, The MIT Press, Cambridge, 2018) advances a novel ethical analysis of longevity science that employs a three-fold methodology of examining the impact of life extension technologies on three distinct groups: the "Haves", the "Have-nots" and the "Will-nots". In this essay, I critically examine the egalitarian analysis Davis deploys with respect to its ability to help us theorize about the moral significance of an applied gerontological intervention. Rather than focusing on futuristic scenarios of radical life extension, I offer a rival egalitarian analysis that takes seriously (1) the health vulnerabilities of today's aging populations, (2) the health inequalities of the "aging status quo" and, (3) the prospects for the fair diffusion of an aging intervention over the not-so-distant future. Despite my reservations about Davis's focus on "life-extension" vs. increasing the human "healthspan", I agree with his central conclusion that an aging intervention would be, on balance, a good thing and that we should fund such research aggressively. But, I make an even stronger case and conjecture that an intervention that slows down the rate of molecular and cellular decline from the inborn aging process will likely be one of the most important public health advancements of the twenty-first century. This is so because aging is the most prevalent risk factor for chronic disease, frailty and disability, and it is estimated that there will be over 2 billion persons age 60 by the year 2050.

The year 2021 marks the 50th anniversary of the National Cancer Act of 1971 and President Richard Nixon's declaration of a "war on cancer". In 1971 cancer was the second leading cause of death in the USA, and today it is still the second leading cause of death with an estimated 606,520 Americans dying of cancer in the year 2020. The half a century campaign to eliminate cancer reveals at least two important public health lessons that must be heeded for the next 50 years of the war against the disease-(1) recognizing the limits of behaviour control and (2) recognizing the significance of rate (of ageing) control. These two lessons result in a somewhat paradoxical conclusion in that we must have both humility and ambition in our attitudes towards future preventative medicine for the world's ageing populations. Geroscience must become an integral part of public health if serious headway is to be made preventing not only cancer but most of the other chronic conditions of late life.

The sequencing of the human genome and advances in gene therapy and genomic editing, coupled with embryo selection techniques and a potential gerontological intervention, are some examples of the rapid technological advances of the “genetic revolution.” This article addresses the methodological issue of how we should theorize about justice in the genomic era. Invoking the methodology ofnon-ideal theory, I argue that theorizing about justice in the genomic era entails theorizing about (1) the new inequalities that the genetic revolution could exacerbate (e.g., genetic discrimination, disability-related injustices, and gender inequality),and(2) those inequalities that the genetic revolution could help us mitigate (e.g., the risks of disease in early and late life). By doing so, normative theorists can ensure that we develop an account of justice that takes seriously not only individual rights, equality of opportunity, the cultural and sociopolitical aspects of disability, and equality between the sexes, but also the potential health benefits (to both individuals and populations) of attending to the evolutionary causes of morbidity and disability.

In this article, I argue that senescence (biological aging) is one of the greatest threats to human freedom in the 21st century. The two most prominent conceptions of freedom are "negative" and "positive" liberty. The negative conception of liberty equates freedom with the absence of interference, whereas the positive conception equates freedom with having the capacity to be self-determining. By critically examining both the negative and positive conceptions of liberty, I make the case that senescence does violate our liberty, on both accounts of freedom. Also, if this is correct, then the development of an applied gerontological intervention ought to be considered an integral commitment of a society dedicated to freedom. An aging intervention holds great emancipatory potential for the world's aging populations.

Measures of well-being have proliferated over the past decades. Very little guidance has been available about which measures to use in particular contexts. This chapter provides a series of recommendations, based on the present state of knowledge and the existing measures available, of which measures might be preferred in which contexts. The recommendations came out of an interdisciplinary workshop on the measurement of well-being and are shaped around the number of items that can be included in a survey and also based on the differing potential contexts and purposes of data collection such as, for example, government surveys, multiuse cohort studies, or studies specifically about psychological well-being. The recommendations are not intended to be definitive but instead to stimulate discussion and refinement and provide guidance to those relatively new to the study of well-being.

Philosophers have long asked profound questions such as “What is knowledge?” and “What is the good life?” Such questions compel us to engage in a deeper level of introspection. The philosophical question contemplated in this chapter is “What constitutes ‘well-ordered science’?” Invoking a virtue epistemological construal of knowledge as “success from ability,” the author argues that the study of pathology must be supplemented by the study of the determinates of exemplary positive phenotypes (e.g., healthy aging and happiness). This requires transcending the limitations of what the author calls “negative biology” and treating “positive biology” as an integral element of well-ordered science. Positive biology can help bring to the fore the importance of understanding the evolutionary and life history of our species, thus helping to provide the intellectual frameworks needed to inspire the development of novel and feasible interventions to improve human health and happiness.

The sequencing of the human genome and advances in gene therapy and genomic editing, coupled with embryo selection techniques and a potential gerontological intervention, are some examples of the rapid technological advances of the "genetic revolution." This article addresses the methodological issue of how we should theorize about justice in the genomic era. Invoking the methodology of

The World Health Organization designated the decade 2020–2030 as the “decade of healthy ageing.” It is a tragic irony that the year 2020 should begin with a pandemic that is so lethal for older persons. Not only are older persons the most vulnerable to COVID-19 mortality, but many of the mitigation efforts to slow the spread of the virus have imposed yet further emotional and mental health burdens on the most vulnerable among those older than 70 years. To help prevent future infectious disease mortality and suffering, as well as the profound health burdens from the chronic diseases associated with ageing, insights from biogerontology must become an integral part of global public health priorities. The timing is ripe for making the public health aspiration of developing an applied gerontological intervention a reality.

In A Theory of Justice John Rawls constructed and defended an abstract account of distributive justice founded upon hypothetical theoretical devices like the original position and veil of ignorance, the principle of maximin, and conceptual analyses of equality of opportunities. Such a methodology places a premium on abstract hypotheticals (vs. the actual history of injustice), and idealizations that involve making claims that are actually false, in order to simplify an argument. This chapter critically examines the idealizations employed by Rawls’s original theory of justice. It argues that Rawlsian ideal theory is inherently flawed because Rawls’s idealizations make our normative theorizing prone to the valuation distortions that arise in what psychologists call a “focusing illusion.”

Author(s): VanderWeele, Tyler J; Trudel-Fitzgerald, Claudia; Allin, Paul; Farrelly, Colin; Fletcher, Guy; Frederick, Donald E; Hall, Jon; Helliwell, John F; Kim, Eric S; Lauinger, William A; Lee, Matthew T; Lyubomirsky, Sonja; Margolis, Seth; McNeely, Eileen; Tay, Louis; Viswanath, Vish; Weziak-Bialowolska, Dorota; Kubzansky, Laura D

Measures of well-being have proliferated over the past decades. Very little guidance has been available as to which measures to use in what contexts. This paper provides a series of recommendations, based on the present state of knowledge and the existing measures available, of what measures might be preferred in which contexts. The recommendations came out of an interdisciplinary workshop on the measurement of well-being. The recommendations are shaped around the number of items that can be included in a survey, and also based on the differing potential contexts and purposes of data collection such as, for example, government surveys, or multi-use cohort studies, or studies specifically about psychological well-being. The recommendations are not intended to be definitive, but to stimulate discussion and refinement, and to provide guidance to those relatively new to the study of well-being.

I am grateful to Feeney and colleagues for their thoughtful engagement with, and application of, the normative analysis I developed concerning gene patents in Farrelly (2016). Their exploration of ...

Integrating insights from the Ancient Greeks (e.g. concerning virtue, eudaimonia, and the original meaning of “democracy”), John Dewey, and recent work in virtue epistemology, this chapter develops a virtue-based defense of democracy, one that conceives of democracy as an inquiry-based mode of social existence. This account of democracy is developed by responding to three common concerns raised against democracy, which the author calls the Irrationality Problem, the Problem of Autonomy, and the Epistocracy Objection. Virtue epistemology can help elucidate the link between democracy and human flourishing by drawing attention to democracy’s potential for cultivating and refining the “intellectual virtues” (e.g. intellectual humility, fairness in evaluating the arguments of others, the social virtue of being communicative, etc.) constitutive of the good life.

Political scientists have much to learn from the biology of play. The most important political activities of democracy, like discussion and debate, gathering new information, and even voting and elections, are perhaps best understood as forms of play. Play has both intrinsic attraction and a developmental function (i.e., it promotes skill acquisition). As such, democratic political activity can be conceived of as social and imaginative explorative play. This robust understanding of democracy and political behavior aligns with the American pragmatist John Dewey's (1916) conception of democracy as a “mode of associated living, of conjoint communicated experience.” In this article, I detail how the “politics as play” analogy can help enhance the study and pedagogy of political science.

The world's aging populations face novel health challenges never experienced before in human history. The moral landscape thus needs to adapt to reflect this novel empirical reality. In this paper I take for granted one basic moral principle advanced by Peter Singer — a principle of preventing bad occurrences — and explore the implications that empirical considerations from demography, evolutionary biology, and biogerontology have for the way we conceive of fulfilling this principle at the operational level. After bringing to the fore a number of considerations that Singer ignores, such as the probability that nonintervention will result in harm and the likelihood that different kinds of extrinsic and intrinsic harms can be prevented, I argue that the aspiration to extend the human biological warranty period (by retarding the rate of aging) is a pressing moral imperative for the twenty-first century. In the final sections I briefly address some standard objections raised against life extension and conclude that, while there may be some legitimate concerns worth addressing, they are not compelling enough to provide a rational basis for forfeiting the potential health and economic benefits that could be realized by extending the biological warranty period.

Does justice require we extend the human lifespan by slowing the aging process? Or could such actions actually be considered unjust if they exacerbate existing health inequities or increase problems of population density and climate change? If there are conflicting or competing demands of justice in this context, how can we be begin to disentangle them so that we respond rationally and fairly to addressing the diverse stakes that arise with respect to the aspiration to extend (healthy) life? This chapter addresses these important questions by examining how the aging of the human species alters the moral landscape in novel and important ways.

Theories of distributive justice tend to focus on the issue of what constitutes a fair division of 'external' goods and opportunities; things like wealth and income, opportunities for education and basic liberties and rights. However, rapid advances in the biomedical sciences have ushered in a new era, one where the 'genetic lottery of life' can be directly influenced by humans in ways that would have been considered science fiction only a few decades ago. How should theories of justice be modified to take seriously the prospect of new biotechnologies, especially given the health challenges posed by global aging? Colin Farrelly addresses a host of topics, ranging from gene therapy and preimplantation genetic diagnosis, to an 'anti-aging' intervention and the creation and evolution of patriarchy. This book aims to foster the interdisciplinary dialogue needed to ensure we think rationally and cogently about science and science policy in the twenty-first century.

The National Institutes of Health (NIH) is the largest source of funding for medical research in the world. With an annual budget currently over $31 billion, the NIH awards more than 50,000 competitive grants to thousands of researchers working in the USA and around the world. The NIH is composed of 27 distinct institutes and centers, many of which are institutes for specific diseases, such as the National Cancer Institute (NCI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Neurological Disorders and Stroke (NINDS), just to name a few.

In this article I explore three distinct advantages of linking virtue epistemology to an epistemic defence of democracy. First, because intellectual agents and communities are the primary focus of epistemic evaluation, virtue epistemology offers political theorists the opportunity to develop an epistemic defence of democracy that takes ‘realism’ seriously (e.g. the cognitive limitations and biases of humans). Second, because virtue epistemology conceives of epistemology as a normative discipline, it builds normative criteria into the exercise of assessing the ‘epistemic fitness’ of a political arrangement (e.g. democracy vs. epistocracy). Third, by assessing the epistemic powers of democracy from a virtue-epistemological perspective, a more robust (Deweyan) conception of democracy needs to be employed and assessed than the minimalist conception employed by the Condorcet Jury Theorem.

Why does the world have the pattern of patriarchy it currently possesses? Why have patriarchal practices and institutions evolved and changed in the ways they have tended to over time in human societies? This paper explores these general questions by integrating a feminist analysis of patriarchy with the central insights of the functionalist interpretation of historical materialism advanced by G. A. Cohen. The paper has two central aspirations: first, to help narrow the divide between analytical Marxism and feminism by redressing the former's neglect of the important role female labor has played, and continues to play, in shaping human history. Second, by developing the functionalist account of historical materialism in order to take patriarchy seriously, we can derive useful insights for diagnosing the emancipatory challenges that women face in the world today. The degree and form of patriarchy present in any particular society is determined by the productive forces it has had at its disposal. According to historical materialism, technological, material, and medical advances that ease the pressures on high fertility rates (such as the sanitation revolution, vaccinations, birth control, and so on) are the real driving forces behind the positive modulations to patriarchy witnessed in the twentieth century.

Where does the aspiration to retard human ageing fit in the ‘big picture’ of medical necessities and the requirements of just healthcare? Is there a duty to retard human ageing? And if so, how much should we invest in the basic science that studies the biology of ageing and could lead to interventions that modify the biological processes of human ageing? I consider two prominent accounts of equality and just healthcare – Norman Daniels's application of the principle of fair equality of opportunity and Ronald Dworkin's account of equality of resources – and conclude that, once suitably amended and revised, both actually support the conclusion that anti-ageing research is important and could lead to interventions that ought to be considered ‘medical necessities’.

The medical sciences are currently dominated by the "disease-model" approach to health extension, an approach that prioritizes the study of pathological mechanisms with the goal of discovering treatment modalities for specific diseases. This approach has marginalized research on the aging process itself, research that could lead to an intervention that retards aging, thus conferring health dividends that would far exceed what could be expected by eliminating any specific disease of aging. This paper offers a diagnosis of how this sub-optimal approach to health extension arose and some general prescriptions concerning how progress could be made in terms of adopting a more rational approach to health extension. Drawing on empirical findings from psychology and economics, "prospect theory" is applied to the challenges of "framing" the inborn aging process given the cognitive capacities of real (rather than rational) decision-makers under conditions of risk and uncertainty. Prospect theory reveals that preferences are in fact dependent on whether particular outcomes of a choice are regarded as "a loss" or "a gain", relative to a reference point (or "aspiration level for survival"). And this has significant consequences for the way biogerontologists ought to characterise the central aspirations of the field (i.e. to prevent disease versus extend lifespan). Furthermore, it reveals the importance of shifting the existing reference point of the medical sciences to one that is shaped by the findings of evolutionary biology and biodemography.

Should we invest more public funding in basic aging research that could lead to medical interventions that permit us to safely and effectively retard human aging? In this paper I make the case for answering in the affirmative. I examine, and critique, what I call the Fairness Objection to making aging research a greater priority than it currently is. The Fairness Objection presumes that support for aging research is limited to a simplistic utilitarian justification. That is, a mode of justification that is aggregative and permits imposing high costs on a few so that small benefits could be enjoyed by numerous recipients. I develop two arguments to refute the Fairness Objection. The Fairness Objection mischaracterizes the utilitarian argument for retarding human aging. It does so by invoking the fallacious conceptual distinction between “saving lives” and “extending lives”, as well as making a number of mistaken assumptions concerning the likely benefits of retarding human aging. Secondly, I argue that the case for tackling aging can be made on contractualist, in addition to utilitarian, grounds. Because the harms of senescence are "morally relevant" to the harms of disease, contractualists can permit aggregation within lives. And thus no one could reasonably reject, I contend, a principle that makes the aspiration to tackle human aging more of a priority than it currently is.

In this article I argue that theorizing about justice at the level of ideal theory is inherently flawed and thus has impoverished liberal egalitarianism. Ideal theorists (falsely) assume that a political philosopher can easily determine (or has privileged access to) what constitutes the ‘best foreseeable conditions’. Furthermore, by assuming full compliance, ideal theorists violate the constraints of a realistic utopia. More specifically I argue that liberal egalitarians who function at the level of ideal theory adopt a cost-blind approach to rights and a narrow view of possible human misfortune. The former issue leads liberal egalitarians to give priority to a serially ordered principle of equal basic liberties or to treat rights as ‘trumps’; and the latter to a stringent prioritarian principle (Rawls' difference principle) or luck egalitarianism. Taken together, the cost-blind approach to rights, coupled with the narrow view of human misfortune, mean the liberal egalitarian theories of justice cannot address the issue of trade-offs that inevitably arises in real non-ideal societies that face the fact of scarcity. This makes liberal egalitarianism an ineffective theory of social justice.

According to one account of distributive justice, called the Sufficiency View, justice only requires that we bring everyone above some critical threshold of well-being and nothing more. This account of justice no doubt explains why some people believe it is unfair to invest scarce public funds into combating aging. In this paper I show why the sufficiency view is wrong. Furthermore, I argue that the real injustice occurs when we disparage or ignore all potential avenues of extending healthy living. We must be both ambitious and imaginative in our attitudes towards health extension.

Rapid advances in human genetics raise the prospect that one day we may be able to develop genetic enhancements to promote a diverse range of phenotypes (e.g., health, intelligence and behavior, etc.). Perhaps the biggest challenge that genetic enhancements pose for medical practitioners is that they will compel us to re-think a good deal of the conventional wisdom of the status quo. Radical enhancements are likely to have this effect for a variety of reasons. First, the status quo is premised (at least in large part) on a sharp distinction between treatment and enhancement; a distinction that at least some genetic enhancements will call into question. Second, the prospect of radical enhancements requires us to keep an open mind concerning how we conceive of the harm of non-intervention (i.e., the harm of the status quo). Third, some enhancements might compromise the preservation of personal identity. All of these issues may have important consequences for state medical boards, ranging from the way we view the aspiration to prevent harm and ensure reasonable standards of care, to malpractice, continuing competency and medical specialization.

Consider the following scenarios which could occur in any affluent, liberal democratic society: Scenario 1: Intelligence gathering operatives believe that there is a good chance that the country will be the target of a terrorist attack within the next 48 hours. The exact nature of the attack is unknown, but there is good reason to believe that the risk of attack is significant. Military personnel and equipment have been stationed at airports and some airlines have cancelled flights. Much debate takes place in the media concerning how much is being done to guard against this possible attack. Critics of the existing government claim that more should be done. One prominent critic complains that “citizens should not have to be fearful of such attacks in their own homes, schools or airports; the government needs to do more to eliminate these threats!”