Distributing Life: Justice, Life Extension and a Fair Innings
Caloric restriction mimetics (CRMs) are emerging biotechnologies that promise to substantially extend human lifespan. CRMs like resveratrol, metformin and rapamycin have been extensively tested in animals and have undergone clinical trials in humans, with positive indications for health and longevity. This raises important questions for distributive justice. In this paper I assess the concern that life extension is unjust, since it would result in an ‘unfair innings.’ Interventions that substantially prolong lifespan seem likely to exacerbate existing disparities in healthspan, since they would be available only to wealthier groups that already have a greater chance of achieving a fair innings of healthy years. This has led some to contend that it would be fairer to ban substantial life extension. I begin by clarifying the theoretical basis of the fair innings argument. I indicate how it may be grounded by three different principles of fairness – egalitarianism, prioritarianism, and sufficientarianism. Thereafter I assess four policies with respect to CRMs – laissez faire, banning, equal access and differential access. On the basis of a sufficientarian version of the fair innings argument, I argue that it would be fairest to provide differential public access to life extending CRMs.