João Pedro de Magalhães, professor at the University of Birmingham, is known as a prominent geroscientist who has been in the field forever, enriching it with top-tier research. He is also a skilled longevity advocate who has long taken interest in the ethics of longevity, first offering his perspective as far back as 2003. Prof. de Magalhães has been collaborating on this topic for years with Uehiro Institute at the University of Oxford.
A couple of weeks ago, de Magalhães and his co-author, Zhuang Zhuang Han from University of Cambridge, published a paper titled “The ethics case for longevity science” at the journal Aging Research Reviews. At the time when the debate around longevity is quickly moving into the mainstream, and public attitudes towards life extension can either accelerate or hamstring the progress of geroscience, a clear-eyed, well-argued overview of the ethics of longevity is a welcome addition to the discourse. As another pioneer of longevity advocacy, Lifespan News immediately jumped on the opportunity to discuss our favorite topic.
Why did you choose a scientific journal rather than mainstream media or podcasts? It seems a bit like preaching to the choir.
In the field of aging and longevity, we’ve always had this problem: if I give a public lecture and say I’m trying to cure Alzheimer’s, or cancer, or cardiovascular disease, people are delighted. But if I say I’m trying to cure aging – to cure all age-related diseases at once – there’s suddenly a lot of concern. It’s a fascinating and, I think, even disturbing phenomenon: the public wants to cure individual age-related diseases but doesn’t like the idea of curing all of them simultaneously. As researchers, I think we have an obligation to address that.
Some of these concerns are genuine. Overpopulation is a real issue, and if people aren’t dying as much, it’ll be worse. The equality question – what if longevity drugs are so expensive that only billionaires can access them – is also reasonable. These are not new questions; I’ve been encountering them for more than twenty years. I’ve actually had an essay addressing them on my website since 2003. I wrote a book chapter on the topic in 2013 with a colleague, and I’ve had an affiliation with the Uehiro Institute in Oxford, which focuses on philosophy and bioethics, where I gave a talk a couple of years ago.
More recently, in 2024, I participated in a debate in Cambridge on these very issues – that’s where I met my collaborator on this paper, a brilliant PhD student who is also interested in the ethics of aging research. So, it was a confluence of ideas over the past couple of years that made the time feel right to write this up. As for the choice of medium: the idea is that colleagues working on aging and longevity can use this paper as a reference. When ethical concerns come up – at conferences, on social media, in public talks – they can point to a piece in Ageing Research Reviews and say: here’s how we address these arguments. It provides the ammunition, so to speak.
Like you said, you’ve been in this discussion for more than 20 years. What has changed – in attitudes, in your own views, in the arguments being made?
Honestly, not that much. The concerns people had twenty years ago are still largely the same: equality, overpopulation, the ossification of society if people don’t die – something Elon Musk, for instance, has mentioned, and there is an argument to be made there. The “aging is natural and we shouldn’t intervene” position has also been around for a long time. If you think about it in terms of actual interventions, caloric restriction – first demonstrated in 1935 – is still the most robust longevity intervention we have. Life expectancy continues to increase, and there have been advances in statins, vaccines, and so on, but there hasn’t been a radical change in terms of dedicated longevity therapies. So no, I don’t think the landscape of arguments has changed dramatically.
Here is something I keep thinking about in this context: do we even need to engage the public on this now, when we’re still quite far from meaningful life extension, i.e., from the point where most ethical concerns about longevity even become relevant?
I think it’s about having clear goals. There’s a lovely paper from over a hundred years ago – from the turn of the twentieth century – openly discussing curing cancer. That was a goal. People have been talking about curing cancer for at least 120 years, and they still talk about it even if may not happen in their lifetimes. That’s what makes it attractive as a mission.
Contrast that with what some organizations in our field do. Altos Labs, for example, takes great pains not to sound like a longevity company. There’s still a reluctance, among both companies and academics, to say plainly that they’re working on aging, and I think we need to be honest about what the ultimate goal is: to completely abolish age-related diseases. Being healthy is good; being sick is bad. I cannot believe I still have to make that case.
What you’re saying, essentially, is that we need to own the aim of meaningfully extending the human lifespan rather than trying to hide or obfuscate it.
Yes, we shouldn’t be afraid of it. We have to be realistic – this isn’t happening anytime soon. But if a cancer charity said, “We don’t actually want to cure cancer; we just want cancer patients to be a bit healthier while they’re dying of it,” everyone would find it absurd. Nobody would support it. Yet, in aging, we effectively do the same thing – we say we want to improve health a little but not completely. That, I think, is a discussion we need to have openly.
One of the strongest points in your paper is the idea that people don’t apply the same ethical framework to longevity medicine that they apply to any other branch of medicine. Can you expand on that?
Curing cancer would be wonderful, but it wouldn’t radically extend life expectancy; the calculations suggest we’re talking about single-digit years of gain. It would improve health, but it wouldn’t fundamentally change the human condition. Curing aging would be a transformative shift in how human societies work, in everything. I’ve written about how longevity is depicted in science fiction, and the changes would be massive. I suspect that’s why some people are uncomfortable: it would be such a dramatic revolution in the fabric of society that they apply a different standard to aging research than to disease research.
I mostly agree with your paper, but let me play the devil’s advocate about two concrete problems. The first is eternal dictators – that hot-mic chat between Xi and Putin last year got a lot of attention. The second is the US Supreme Court: its justices hold lifelong appointments, and this is enshrined in the Constitution, which is virtually impossible to amend in today’s political climate. I think these are actually compelling examples of the problems meaningful life extension could create.
The Supreme Court is a good example I hadn’t thought about. I suppose many social and government structures would have to be adjusted – like what “life in prison” means if you’re living a thousand years. Twenty years in prison is a very significant portion of a normal adult’s life, but if you live a thousand years, it’s a rounding error. Legal structures would certainly need to be revised across the board, and the Supreme Court’s lifelong appointments would fall into that category.
On immortal dictators: yes, I think that’s a valid concern. A dictator with an enormous grip on power who never ages could remain entrenched indefinitely. North Korea is instructive here – dictators do die, and yet power simply passes to a family member, and the system carries on. We don’t have an easy solution to that even now. The silver lining is that the proportion of the world living under dictatorships is much lower than it was a hundred or two hundred years ago. But I do think immortal dictatorships are a genuine potential issue.
Combine this with the plausible idea that AI-powered surveillance and enforcement will enable dictators to rule eternally, nipping any opposition in the bud, and you get a rather grim picture.
It’s a concern, yes. The argument about the ossification of institutions applies broadly: if the CEO of a company never ages, they could remain in place essentially forever, which stifles progress. Scale that up to a state with AI-augmented control, and the concern is amplified. I don’t think there’s an easy solution.
Which brings me to a broader point: I feel our field should have a much more structured, “friendly-adversarial” discussion about these questions. We need to break out of our echo chamber and stress-test our arguments. Do you agree, and do you have ideas on how to achieve this?
I completely agree. I’ve done some of this – in Oxford, in Cambridge, in France, and now with colleagues in Birmingham on a project addressing future technological developments more broadly. But the key thing is to be honest: curing aging would not make everything magically wonderful. There are real issues. Overpopulation is already a problem, and reducing mortality will make it worse. I agree with that. The right response, though, is not to abandon the goal of keeping people healthy; it’s to engage with philosophers and bioethicists who have valid concerns, acknowledge what’s legitimate, and debate what isn’t.
Regarding overpopulation and similar concerns, you write about the moral priority of existing persons over abstract future populations, which I read as a pointed argument against long-termism – a camp that is well-represented within the longevity field as well.
The core moral argument is that the people alive today matter more than prospective future individuals who don’t yet exist. You can make all sorts of arguments premised on the interests of people who don’t actually exist – “it’s immoral not to have more children,” and so on – but it’s very difficult to make those claims with confidence. What we can say with confidence is that technological progress has, historically, expanded our capacity to support larger populations at higher living standards. We now have the largest human population in history and the highest life expectancy and the best quality of life in the history of civilization, simultaneously. The Malthusian doomsday predictions never materialized because human ingenuity adapted.
More practically: nobody in their right mind would argue we should kill people to solve overpopulation. So why would we let people die of disease for the same reason? Besides, the major driver of population growth is fertility rates, not life expectancy. The way societies that face genuine population pressure deal with it is by reducing fertility – not by allowing people to die.
Let’s move to the inequality argument, which says that anti-aging therapies will be available only to the privileged few. What I’m concerned about is whether we’re not accounting enough for the nature of longevity treatments. It begins to look like in order to reach any meaningful life extension, it will have to be a barrage of many interventions starting from a young age. That doesn’t fit our current healthcare model, which basically works by redistributing money from young people who rarely require healthcare to older ones. I understand that investing in longevity treatments for younger people will eventually reduce the cost of healthcare for old people, but I’m worried about a possible transition period.
You’re right that healthcare costs are heavily skewed toward older individuals, and there are real open questions – how early do interventions need to start? Does caloric restriction, which works better when initiated earlier in animal models, set the template? We don’t know yet whether rejuvenation technologies will be more applicable later in life, but the economic logic of intervening in aging is actually very strong. Even a drug that slows aging by ten percent – not radical life extension, just ten percent – would generate enormous medical and economic benefits. Andrew Scott and David Sinclair have a paper in Nature Aging on exactly this point, and we cite it in our paper.
On the accessibility question: yes, novel therapies start expensive and available only to the wealthy. That’s the pattern across the history of medicine. Antibiotics, when first available, were so scarce that urine from patients who had received a dose was collected and the antibiotic was purified from it to give to the next person. Today, antibiotics are widely available. The market for an effective anti-aging intervention would be enormous, and strong market demand has historically driven the democratization of technology. I would expect longevity interventions to follow the same trajectory.
Regarding the “naturalness” argument. I think it’s the easiest one to refute, and I’m actually wondering if people still use it.
Rarely, at this point. We’re so accustomed to technology – AI, global video calls, air travel – that the “nature knows best” argument has little traction with most people. There are specific groups, certain religious communities for instance, that refuse particular medical interventions. But they’re exceptional. The embrace of mobile phones, of medicine, of technology generally, is now a worldwide phenomenon – not confined to wealthy countries. So, I don’t think the “aging is natural” argument carries much weight anymore.
That said, there is one corner of the “naturalness” landscape that I do think deserves more serious engagement: genetic interventions. Curing a disease is one thing; changing someone’s genome to prevent a disease is another, and people instinctively feel the difference. Personally, I think that’s largely a technical safety issue rather than a philosophical one – if we could safely modify genes in embryos to eliminate, say, the APOE4 allele that dramatically raises Alzheimer’s risk, most people would consider that a straightforward medical intervention.
Your paper also addresses more individualist objections: boredom and loss of meaning. Personally, I find these almost too subjective to discuss seriously – some people are bored at thirty, some are never bored. People should simply have the choice. But walk me through how you engage with these arguments.
I never really found the boredom argument compelling, and frankly it wasn’t in the first draft of the paper. We added it after discussions at the Uehiro Institute in Oxford, where some people raised it. But, you’re right – boredom is an individual experience. It can happen at twenty, at fifty, or never. If someone with an extended lifespan reaches a point where they feel they’ve had enough, they retain individual agency to end their life on their own terms. It’s not an argument against offering the option of a longer life.
I’ve always found these arguments a little apologetic about aging. Aging and death are, for now, inevitable – and I think a lot of these “death gives life meaning” claims are coping mechanisms. We say, “maybe it’s not so bad after all,” because we have no alternative. The paper actually does address this: we note that the “death gives meaning” thesis mistakes a coping strategy for a normative truth. If boredom is a real concern for someone after several centuries, the solution is individual choice, not denying everyone the option.
I liked your autonomy argument – the idea that access to life extension is fundamentally a matter of individual freedom.
It’s about taking responsibility for our own lives. At the moment, aging is the binding constraint – a shackle on individual existence. If we can lift that constraint, people can live longer and, I would argue, happier lives. The argument for autonomy is also a counterweight to the paternalistic reasoning embedded in the anti-longevity position: the idea that some authority should decide how long a life ought to be, or what counts as sufficient years. That strikes me as deeply problematic.
You make an interesting analogy in the paper between geroscience and the Apollo program – the idea that a concerted effort on aging could actually accelerate progress across many fields.
The Apollo program generated technologies that impacted fields far beyond space exploration. Aging underpins most of the diseases and functional changes that accumulate in our bodies over a lifetime. A well-funded, systematic program with geroscience at its core – modulating aging itself rather than tackling each disease separately – would, in principle, cross-fertilize and benefit medicine and biology much more broadly. We’re not there yet; the field of aging is still relatively small compared to, say, cancer research. But, the aspiration of an Apollo program for aging is something that comes up in the field, and I think it’s worth articulating explicitly.
Another point you raise is that the anti-longevity discourse is often heavily ageist: it makes an implicit assumption that older people have had their run and are now disposable. Why does this attitude persist, and how do people not see themselves defending a fundamentally inhumane position?
It’s almost always implicit rather than explicit. There’s a general cultural tendency to view older individuals as having “lived their lives,” as if their remaining years are somehow worth less. You see it in some of these arguments: “Well, you’ve had a good run; a natural lifespan of about a hundred years is enough.” That is a form of ageism, even if the person making the argument doesn’t recognize it as such.
Should we be confronting this directly – trying to change attitudes not just toward longevity research, but toward older people and aging in general?
Probably, though the right framing is an open question. Should we talk about “healthspan,” “longevity,” “anti-aging,” or “aging research”? I’ve had many discussions about what language best advances the field. My instinct is that there’s no single answer – different framings work better for different audiences. If you’re addressing governments, medical doctors, or students, you’ll need to tailor the message. I don’t think there’s a one-size-fits-all approach to marketing the field.
Do you think public attitudes have become more favorable to longevity in recent years?
There’s certainly more awareness. People like Aubrey de Grey, David Sinclair, and Bryan Johnson have pushed the ideas toward a broader audience, and the internet and social media enable mass communication that simply didn’t exist thirty years ago. But, there’s still a lot of suspicion, and part of the reason is that we don’t yet have treatments that demonstrably work. Into that vacuum have stepped a lot of “longevity influencers” – some of whom come across as snake oil salesmen. The field has a long history of charlatans promising extended life.
The recent controversy around Peter Attia and the Epstein files generated criticism of the longevity field more broadly. That perception problem is real, and the way to address it is by doing rigorous science, not overhyping results, and – ultimately – producing something that actually works. If we develop an intervention that demonstrably slows aging in humans, people will take us much more seriously.
On the other hand, I wonder whether we should be less apologetic and more aggressive in making the ethical case – essentially shame people into supporting the longevity agenda and research, even if we still don’t have a lot to show for it.
It depends on context and audience. When we face ethical pushback, we should push back in return. We’re sometimes too cautious. We can make a strong case that this is an ethical endeavor: we have an aging population, aging is the primary driver of suffering, disease and death in modern societies, and we should be addressing it. We shouldn’t be ashamed of that. At the same time, we have to be realistic and not overpromise. Don’t claim we’re about to cure aging next year, but also don’t apologize for trying.
Last question: what is your “elevator pitch” for our cause?
The major killers – the major sources of suffering – in modern societies are age-related diseases: cardiovascular disease, dementia, Alzheimer’s, frailty, multimorbidity. These are horrible conditions with no effective treatments. Dementia is watching someone’s mind be destroyed. If we could understand the underlying processes that drive all of these diseases simultaneously, and slow those processes down, people would be healthier for longer. That would be a massive medical advance with enormous social and economic benefit. That is what we are trying to do, and we should be proud of it.
View the article at lifespan.io
