Hacker News Reader

For a contrasting viewpoint, you might consider this New Yorker article from a practicing physician ("The Hidden Harms of CPR"): https://www.newyorker.com/news/the-weekend-essay/the-hidden-...

Death is a necessary consideration, but so is prolonged suffering.

I don't think it's so much that we kill people. It's that we let them die. If we are truly, brutally honest with ourselves (and overcoming denial, social, religious, whatever conditioning here is a huge struggle), much of the time, the efforts we put in to keeping loved ones alive is really often more about us than it is about them.

The elderly (and I'm generalizing, I realize) are far more accepting of death. It's easier to accept that when you feel you have lived a full and happy life. Contrarily, that full and happy life often involves having the presence of loved ones, who are NOT ready to accept that their life will be - or rather, will feel - less full and happy without that person.

Even just simple denial is a huge thing. One of my first experiences in emergency medicine was an older gentleman, family patriarch. The rest of his extended family had been able to gather at the hospital while he was in and out of arrest.

A provider and support person went to talk to the extended family, who was adamant about following his son, the 'number two patriarch', and his steadfast insistence, "He is a good strong Christian man, and he is going to be okay." (I say this not to mock Christians, to be clear, and also to be clear, he didn't mean in the "eternal life" sense, he and the family truly believed almost that divine intervention was going to take care of things).

After some discussion on this, a decision was made to bring the son into the ER where we were working on his father. Seeing the hopelessness and futility, seeing his father the shadow of the man he knew, and all of that assorted detail was no doubt traumatic, but it also made it viscerally real to his son. No matter the concerted efforts of nearly 10 medical professionals, drugs, defibrillation, ventilation, we were not going to be able to keep his father alive, and there was not going to be any divine intervention. He watched this silently for a few moments, and then asked us to discontinue CPR and if his father's organs were suitable for donation.

My heart broke for him. But this is a struggle we have not figured out, recently. We had it figured out, historically, by necessity, but we are complacent now.

Leaving aside the separate issue of healthcare costs, you can still look at the ratios:

In the US, on average we spend more on healthcare keeping someone alive for the last year of their life than we do on the previous decade. And we spend more on that decade than we do on the rest of their life. Some of which seems obvious, given youth, but nonetheless.

It's a powerful story, but it's simply not relevant to my argument, and I suspect the reason you think it is relevant is because you've deeply internalized the inevitability of death. Of course you, and we all, have: it's been inevitable for the entirety of human existence. But humans were never able to fly across the ocean for the vast majority of our existence either, nor were we able to orbit the Earth or communicate at near light speed with the other side of the Earth. People who say death is inevitable are putting it in a special category: it's the one thing humanity will never be able to solve with technology? We can colonize other planets, split the atom, develop computers and AI, but keeping oxygen flowing to the cells is just forever beyond our reach? No.

Your story is about a man's denial that his father, currently in critical condition, would die. Yes, the probability that humanity would solve death in the hour of life his father had remaining was low. I'm talking about humanity's denial that death is just a giant bag of problems that we can, eventually, solve one by one. The probability that humanity will solve death in the next thousand years is nearly 100%; the probability that it will be solved in our lifetimes may be low, but it's not 0. (Keep in mind, 1000 years is ten times the lifespan of an exponentially accelerating medical field, not simply 1% of the whole human history in which basically no progress was made.)

If we had a simple, maintainable, cheap machine that could keep people alive for 100 years without a working heart or lungs, there is no ethical dilemma, and the line between "killing them" and "letting them die" becomes pretty blurry.

The reason this matters is that once we actually start to realize that death is a problem that we can actually solve, then we can get the fuck to work on it! We could be investing so much more than we are in treatments like ECMO. There should be a national moon-landing-level initiative to make these machines available to everyone. But the longer we mope around with our learned helplessness, calling people like me naive and in denial, the more people will die needlessly.

Then going to your point, there are many discussions around theoretical upper bounds for human life, even factoring in technology.

Studies look at blood cells and footsteps and establishing hard limits. One of the more recent ones suggests around 150 (today it's around 120).

> with things that usually kill us omitted, our body's capacity to restore equilibrium to its myriad structural and metabolic systems after disruptions still fades with time. And even if we make it through life with few stressors, this incremental decline sets the maximum life span for humans at somewhere between 120 and 150 years. In the end, if the obvious hazards do not take our lives, this fundamental loss of resilience will do so.

https://www.scientificamerican.com/article/humans-could-live...

Ctrl+F > "telomere" -- 0 results

Weird to not mention telomeres in that article. It sounds like basically what they're talking about. We already know about Telomerase:

https://en.wikipedia.org/wiki/Telomerase

We are rapidly developing gene editing, e.g. with CRISPR:

https://en.wikipedia.org/wiki/CRISPR

Not to mention that we already know about "immortal" organisms that beat this "limit". There's no reason to think that "fundamental limit" is anything more than yet one more problem to solve.

Leonardo da Vinci imagined flying machines. When most people may have believed it to be a priori impossible during his time, instead da Vinci probably believed it to be simply another (solvable) engineering problem.

That being said, even if da Vinci had absolute certainty that his viewpoint was correct, that heavier-than-air flying machines were a factual inevitability... what could da Vinci have done to capitalize on this knowledge? Other than draw some diagrams and hope future generations pick it up, but in his own contemporary timeframe, this knowledge of the inevitable future would still be generally useless to him. It would not affect his daily life, it likely would not change a single decision that he would make otherwise.

Likewise, let's say you're right, that conquering death is an inevitably solvable engineering problem. So what would you do with that knowledge, right now? Of the cases called out in the article, of people who could not live off of ECMO, how does having this knowledge of inevitable immortality that's coming 100s of years later, how would that change the decision-making rubric today for those patients or whether those ECMO machines are better used on someone else?

I venture to say that, even if you knew with absolute certainty that engineered-immortality would be achieved by a known future date, say 200 years from now (though it took ~400 years between da Vinci and heavier-than-air flight)... IMHO it shouldn't make any difference at all to the present-day decisions of how those ECMO patients should be treated today. Only if you knew the date of pending immortality was let's say, <10 years away, would you make some kind of drastic push to try and keep everyone alive barely long enough to benefit from that breakthrough.

... In fact, I vaguely remember reading a short story about this very conceit, of generations of humans in a fictional setting, working towards immortality, and how at a certain point, they reached a stage of awareness that, achieving immortality was likely going to happen soon in the next generation, so what would they do with that "last generation" of humans to ever need to face death? How would people feel, how would they react, if they knew that they were just a little bit too early to benefit from the breakthrough that might come 20 years from now? Sadly can't recall what that story was called or any more details that would make it easier to search for.

For your analogy to hold, let's assume that everyone on Earth in 1500 A.D. had a strongly vested interested in heavier-than-air flight (as they do with not dying today), and Leonardo da Vinci was completely convinced it was possible. You assert it wouldn't have made a difference. I assert it could have changed the course of human history.

Leonardo would have done what everyone like him did around that time: convinced a wealthy patron to fund his experiments. If he had gotten many very rich nobles convinced as well, he may have gotten tons of money to hire lots of people to build and test various designs. We might have had heavier-than-air flight 400 years earlier. Of course, without powered engines, they wouldn't have had nearly the success they have today, but one can imagine some pretty elaborate gliders, or possibly hot air balloons, showing up hundreds of years earlier than they actually did.

So I absolutely reject your notion of "it would never have made any difference." The fallacy that history must always have gone exactly as it did is a common one, but it is a fallacy nonetheless.

> Likewise, let's say you're right, that conquering death is an inevitably solvable engineering problem. So what would you do with that knowledge, right now?

I already told you: organize a nation-wide (or international) Moon-landing level effort to make ECMO machines 100x cheaper, more portable, and more widely available by the end of the decade. Spend 4% of GDP on it. Keep spending 4% of GDP on similar research.

> Only if you knew the date of pending immortality was let's say, <10 years away, would you make some kind of drastic push to try and keep everyone alive barely long enough to benefit from that breakthrough.

It's not one date. It's a long path with many problems to solve along the way. It may indeed take hundreds of years to achieve complete agelessness. But every year that we wait to start (and we are waiting, because of our belief that it's not possible), is another year that people are needlessly dying. Every problem solved along the way is a few more years for many more people.

> I vaguely remember reading a short story about this very conceit,

Yes, bad sci-fi has used the inevitability of death as a plot element for a long time, along with the silly argument "do we really want to live forever!? BUT EVIL!!" It's never really held up to scrutiny.

> complete agelessness

I'm still puzzled why you think an ECMO machine of all things is related to this at all. It's no more sensible than thinking a tourniquet has anything to do with prolonging lifespan. They both might save your/a life in the moment, but people still age, they get old, and no one basically even knows where to begin on that one even if they agree with you that it may be possible. I would go even further that those that sincerely imagine it is possible in the foreseeable future have no specialized knowledge of how it would actually work or be done (people like 4000 supplements and alkaline water Ray Kurzweil only prove out this point). You don't even know what you don't know.

And even if possible there is no sane reason to think that ECMO has any role in prolonging lifespan any more so than a ventilator or dialysis, you've completely lost the plot on that one.

> But every year that we wait to start (and we are waiting, because of our belief that it's not possible), is another year that people are needlessly dying.

Amusing that when dealing with eternity, what difference does it make if its 100 years, 400 years or 1000 years. Unless you have a better prediction than 1. build a better heart-lung machine 2. ??? 3. eternal life, chances are it's not going to be in your lifetime, so it really is of no consequence to you or your peers. And I'll guess you have little practical or actionable to add to this body of "research".

You get very close to the real issue here:

The important part of a flying machine wasn’t the machine itself, but the engine to run the machine itself. We’ve had flying machine designs for centuries but it only took 27 years after the Otto engine was invented to put one in the air.

ECMO is the flying machine design

What is the engine we are missing?

> There should be a national moon-landing-level initiative to make these machines available to everyone

You are doing a logical jump here. You argue, quite convincingly that “solving death” is a problem worth pursuing, and we should prioritise it higher than we are already do. We are on the same page about that.

Then you posit that we should pour huge amount of money into development of ECMO. But you don’t say why? Why do you think pouring all those resources in particular to ECMO research is the best way towards “solving death”?

ECMO even in the best possible dream circumstances will always remain a shitty, painfull and risky procedure which can only help a few. On the other hand senescence will affect every one of us who is lucky enough to live long enough. For some reason, most likely for a bunch of reasons, our bodies start to fall apart as we age. Understanding how exactly that happens and what can be done about it should be a higher priority. The national moon-landing-level initiative monies you plan to pour into ECMO research and development should be spent on senescence research and anti-senescence development.

Which future do you want to live in? One where masses are kept kinda-sorta alive by machines, always on the knife edge of dying from a bleed, or a blood clot, or an infection? Or one where 150 year olds go rock climbing and windsurfing because through medical and technological advancements we figured out how to keep their bodies younger longer?

I want to live in the real world where most people live a hopefully fulfilling natural life of 75-100 years and then "make room" for the next generation.

I want a world where geezers like Joe Biden and Donald Trump are not our choices for who will be running things. Imagine if they were 40 years older than they are.

People get old, and die. It's OK.

ECMO is short term, and you're talking long term. We're not going to cure aging in 10 years. We probably could have an ECMO in every home in 10 years. Of course senescence research must be a part of it. And that research will benefit tremendously if cheap ECMO keeps a few veteran senescence researchers alive who otherwise would have died of heart attacks.

Excuse me, but I do want to live in a world where death is inevitable and will choose that option at any time. It has nothing to do with helplessness, it's pure reason and engineering considerations.

The current system with auto-refreshing humans has got us very far and obviously it works really well. Not only it solves biological problems like cancer (which you can argue eternal humans will solve themselves) but most importantly it solves scientific, engineering and social problems.

It avoids dead-ends, it can't get stuck, it iterates relentlessly over infinity of alternatives to find the one that brings us further. A mistaken scientist dies and so does his theory. A tyrant dies and so does his regime. A liar dies and no one maintains his lies.

Starting life afresh, without decades of mental baggage is a blessing. Carrying it with you forever is hell for you and for others who will have to endure your presence.

> Excuse me, but I do want to live in a world where death is inevitable and will choose that option at any time.

This feels a little like saying "I like death, therefore everyone else must die too." Besides, you'd always be able to choose that option at any time. I'm not talking about some cursed-monkey-paw version of immortality.

> the current system with auto-refreshing humans has got us very far

The system of hunter-gathering got us pretty far too, and switching over to agriculture was indeed not 100% positive at first. The system of feudal/clan-based government and labor-and-wood-based energy economy got us very far, too, and switching to the industrial revolution also had its early downsides. Just because systems are working doesn't mean they can't be improved.

> importantly [Senescence] solves scientific, engineering and social problems.

Again I ask: if we already lived forever, and we were running into those scientific, engineering, and social problems that death supposedly "solves", then would your solution be to start killing everyone approaching 100 years old? Another solution to all our problems is that the sun goes supernova and the Earth is completely annihilated. That's along the same line of "solution" as yours.

Besides, I haven't seen any convincing argument that such problems would necessarily occur, or at least be insurmountable.

> A mistaken scientist dies and so does his theory. A tyrant dies and so does his regime. A liar dies and no one maintains his lies.

This is unfortunately quite accurate for the time being. But death is a rather blunt solution to these problems, and I believe there are better ones. I also believe people would be more interested in ousting tyrants if they didn't think they just need to wait for them to die.

> This feels a little like saying "I like death, therefore everyone else must die too."

Well you sound like "I'm so scared of death that I'm ready to pay for immortality with eternal suffering for the rest of humanity".

I don't like death in particular but I can admit I enjoy being born in the XX century and not being a slave in the mines of Ramses II. And I'm not too bothered by death because I'm already immortal in a sense. My kids are literally a piece of me that keep on living, I see no reason to worry much about the meatbag I currently reside in.

> Again I ask: if we already lived forever, and we were running into those scientific, engineering, and social problems that death supposedly "solves", then would your solution be to start killing everyone approaching 100 years old?

You ask it like some smart theoretical brain teaser whereas it's simple reality. Your gametes don't age and it cost nothing to nature, however the rest of you do age. Ever think why is that? That is THE solution found by natural selection, literally kill everyone nearing 100 years old. And no, reset of body and consciousness to a clean state is not the same as end of life by supernova, it's the opposite. It's a way to ensure continuation of life.

> This is unfortunately quite accurate for the time being. But death is a rather blunt solution to these problems, and I believe there are better ones

The problem is I don't see another solution for corruption of humans. If humans are the ones who are responsible of implementing the solution then they'll just corrupt it too. It's like trying to reason your way out of insanity, doesn't work because your reasoning mechanism is affected. Solution has to be outside of our control like death is now. Conquering death would be a mistake even though I don't really see a way to prevent it long term.

I can 100% promise that death will be a regular part of life not just 1000 years, but 100,000 years from now as well. Even if we solve senescence and we get 1,000,000 times better at emergency medicine, transplants etc. There are numerous ways to almost entirely destroy the brain in fractions of a second, or in hopelessly irreversible ways, or in covert ways that are slow but only get discovered too late. And, as long as such accidents are possible, if your life is otherwise endless, then they are in fact inevitable, no matter how unlikely they appear.

There will always be some probability of dying in a given year. Let's say our futuristic society has solved aging/senescence, and is able to reduce the rate of "random death" by about 1% per year, through technology, medicine, brain-redundancy, whatever. So if you have a 1 in 1,000 chance of randomly dying this year, next year it will be about 1 in 1,010.

The area under an infinite exponential decay curve is finite. In the scenario above, you have a finite probability of dying, ever. And it's not 100%, either. It could even be quite low. With the numbers above, it's about 10% chance to die, and 90% chance to never die. I know that's counter-intuitive, and it may be that maintaining 1% reduction in random death every year is impossible, but it's not a foregone conclusion that everyone must die.

Of course the heat death of the universe presents a problem. That's a good problem to have.

Death is not a problem that needs to be eliminated. It's fine that people eventually die. We are all expendable.

The goal of medical care should be to extend healthspan, not lifespan. Minimize the burden of diseases and injuries.

Despite the claims from charlatans and grifters like David Sinclair, there is no scientific evidence that significantly extending human lifespans is even possible. If we were making progress then we would expect to see a few outliers living to 125+. But instead the record remains at 122, and that was set in 1997. It's time to put aside pointless fantasies and focus on achievable goals.