Biogerontology: delaying death, promoting healthy ageing, or both?

Seamus O’Mahony

Biogerontology is the study of the biological mechanisms which control ageing, with the ultimate aim of developing interventions to delay death. In some animals, selective breeding and caloric restriction can lead to significant increases in longevity. There is no evidence, however, that such interventions work in humans. A variety of drugs and nutritional supplements (“nutraceuticals”) have been postulated as effective anti-ageing treatments, but – as some biogerontologists concede – trials looking at interventions to delay ageing would be extremely difficult to conduct, as the only meaningful end-point would be age at death, likely to be several decades after commencing the intervention. Nevertheless, there is a growing belief within biogerontology that effective strategies to delay ageing will inevitably emerge. If ageing can be delayed in other mammals, they argue, then it is only a matter of time that it can be delayed in humans, too. The biogerontologist Richard A Miller wrote in 2002: “Thus one can, with some confidence, expect that an effective antiageing intervention might increase the mean and maximal human life span by about 40 percent”. (1)

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Is palliative care having an existential crisis?

Is palliative care suffering from “chronic niceness”? What is its future? Lucy Selman, Libby Sallnow, Ros Taylor, Seamus O’Mahony, and Richard Smith discuss.

The blog was first posted in BMJ Opinion: https://blogs.bmj.com/bmj/2019/11/12/is-palliative-care-having-an-existential-crisis/

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Learning from Canada about assisted dying


Richard Smith

Discussions on assisted dying are usually heated and about whether it should be legalised. But I recently found myself in the privileged position of discussing with a well-informed group of people from Canada not whether assisted suicide should be introduced in Britain but what Britain might learn from the Canadian experience of introducing a form of assisted dying. There are many issues to decide. The meeting took place as part of the UK-Canada Colloquium, and the group included a lawyer who took a case to introduce assisted dying to the Supreme Court in Canada, a palliative care physician who provides assisted dying, and other doctors and academics who have first-hand experience  of the system.

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Refusing Life-Sustaining Treatments in Advance: Avoiding a ‘Fate Worse than Death’

Celia Kitzinger and Jenny Kitzinger

Coma and Disorders of Consciousness Research Centre

Cardiff University

Contact: kitzingerc@cardiff.ac.uk

Israeli Prime Minister, Ariel Sharon, suffered a devastating stroke on 4 January 2006, a few weeks before his 78th birthday. He was kept alive for a further eight years in a Permanent Vegetative State and eventually died of kidney failure on 11 January 2014, without ever regaining consciousness[1].

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The pursuit of immortality

The pursuit of immortality

Richard Smith

Consciousness of death is one of the attributes that sets humans apart from other animals, and the dream of overcoming death and living for ever may be as old as the consciousness of death: with the realisation came the dream. The world’s oldest story, the Epic of Gilgamesh, tells how Gilgamesh sought immortality, and the Ancient Egyptians believed that they could achieve immortality. The dream of immortality has stayed alive ever since, and Steven Cave, the philosopher, has identified four stories of immortality. https://bigthink.com/design-for-good/the-four-immortality-stories-we-tell-ourselves Modern technology and aspirations have boosted all these stories, and serious people with substantial resources believe it possible to achieve immortality.

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On the Role of Death in Life and Medical Practice. Terror Management and Medicine

On the Role of Death in Life and Medical Practice

Sheldon Solomon

…it is our knowledge that we have to die that makes us human.

                                    Alexander Smith, Dreamthorp: A Book of Essays (1857)     

Terror management theory

Terror management theory (TMT; Solomon, Greenberg, & Pyszczynski, 1991) was originally derived from cultural anthropologist Ernest Becker’s (1962/1971, 1973, 1975) interdisciplinary effort to elucidate the motivational underpinnings of human behavior.  TMT starts with the Darwinian assumption that human beings share with all forms of life a basic biological predisposition toward self-preservation in the service of survival and reproduction.  We are however, unique in our facility for abstract symbolic thought (including, but not confined to, language), mental “time-travel” (reflecting on the past and pondering the future), mental simulations (prospective imagination), self-awareness, and theory of mind (the realization that others have internal mental states).  This mental agility has surely enabled us to proliferate in diverse and rapidly changing physical environments.  Moreover, explicit self-awareness can be emotionally uplifting; it also however, gives rise to the unsettling realization that life is of finite duration, that death can occur at any time for reasons that often cannot be anticipated or controlled, and that we are embodied creatures who are ultimately no more significant or enduring than lizards or potatoes. 

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The lawyerization of death

The lawyerization of death: lessons from the story of Janet Tracey

Seamus O’Mahoney

Over the past few years, there have been several high-profile cases in Britain where the families of dying patients could not reach an accord with their doctors, where the Difficult Conversation was a catastrophic failure. Many of these cases involved very young children, most notably Charlie Gard, Isaiah Haastrup and Alfie Evans. In all three cases, the hospital involved went to the High Court, and in all three cases, the court agreed with the doctors that nothing more could be done, and all three children have since died. I am going to focus, however, in this article on a less high-profile case – that of Janet Tracey. Janet Tracey died in Addenbrooke’s Hospital in Cambridge in 2011. Her story is a microcosm of the Difficult Conversation, and the legal proceedings (cases in the High Court and later, the Court of Appeal) after her death have had a profound effect on medical practice in the UK.

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Lessons from the Liverpool Care Pathway

Another chance to get it right:

lessons learned about evidence-based end of life care from the United Kingdom

Sam H Ahmedzai, Julia Neuberger  

In 2015, The Economist published a ranking of palliative care across the world, using its own ‘Quality of Death Index’.(1) Evaluating 80 countries using this Index, the UK was rated as having the best quality of death, “thanks to comprehensive national policies, the extensive integration of palliative care into its National Health Service, and a strong hospice movement. It also earns the top score in quality of care”.  Yet, just two years earlier, the UK Government itself had identified one of the biggest scandals that has affected the UK’s National Health Service (NHS) in how dying adults were being cared for in their last days.  This was the very public (and mainstream media) exposure and denigration of the Liverpool Care Pathway (LCP) for care of dying adults in the last days of life by the  Neuberger Commission’s report in 2013 and its subsequent abolition by the Government in 2014.(2)

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