Old Age in Humans Primarily from the Perspective of Utopic Thinking as the Foundation for Resolving Bioethical Issues Relating to Old Age

Rapid growth of life expectancy and the intensive development of geriatrics and gerontology are a major challenge for philosophy. Old age poses multitude of complex bioethical issues and this paper aims to contribute to the search for the core ontological framework for resolving bioethical issues associated with old age. It strives to apply the following experimental methodological philosophical approach:
a) It can be assumed that philosophical contemplation on old age from the perspective of utopic thinking is one of the potential methods for seeking the core ontological framework for resolving bioethical issued associated with old age.
b) History of philosophy indeed assumes contemplation of old age from the perspective of utopic thinking in principle. This paper aims to characterize the attitude of stoic philosophy to old age, while striving to summarize the attitudes in modern philosophy based on mechanism.

Ageing is an irreversible, universal, yet at the same time species-specific process. It affects practically all organs at various pace, as they lose their functional reserve. By definition, old age is characterized by polymorbidity. According to epidemiological studies, almost 90% of people over 75 years of age suffer from one or more chronic illnesses. Accumulation of illnesses is usual, sometimes without a causal link, as in the case of concomitant diseases, while in other cases illnesses accumulate, as one disease leads to another through a cascade reaction. Regardless of the fact whether diseases are concomitant or caused by a cascade reaction, the process always occurs in an organism generally predisposed to polymorbidity due to the decline of functional reserves, involution and multiple organ pathology.

The specific nature of the clinical image in a geriatric patient also proves that ageing, as mentioned previously, is a process of irreversible decline in functional reserves, involution and multiple organ pathology. These specific characteristics include:
a) Microsymptomatology, i.e. minimal manifestation of symptoms in geriatric patients.
b) Monosymptomatology or oligosymptomatology, when a disease is not manifested by the usual range of symptoms, instead only a fraction of the relevant symptoms is evident.
c) Certain illnesses in geriatric patients may even have an asymptomatic course or are manifested by non-specific symptoms.
d) The so-called secondary involvement symptoms reveal the organ in a geriatric patient’s body with the least functional reserve, as the patient’s overall morbidity manifests the most intensively in the weakest organ.
e) Diseases in geriatric patients are disabling, i.e. result in declining independence.
f) Polypharmacy resulting from polymorbidity is complicated by atypical drug interactions [1].
g) The overall decline of functional reserves ultimately leading to the frailty syndrome may be caused by sudden deterioration of a patient’s condition or sudden deaths. Ladislav Kabelka, a specialist in enabling geriatrics states: “Enabling geriatrics is a medical discipline intervening in geriatric frailty, identifying further risks in the decline of health potential in a timely manner, and subsequently diagnosing and indicating the need for palliative care ….The change in the health potential from an “intervenable situation” to the “terminal condition” may occur within hours or days, and once a patient crosses this fine line, there is no return. The “therapeutic window” is therefore rather narrow [2]”.
h) As stated in the introduction to this paper, ageing is a process of irreversible decline in functional reserves, involution and multiple organ pathology. However, medical literature also opposes this notion to some extent by stressing out that ageing itself is not an illness: “Dementia in Alzheimer’s disease develops covertly, inconspicuously. Problems with memory in older people sometimes tend to be attributed to ageing. However, this is not correct, as ageing is not an illness. [3]” Another quote on this topic comes from a representative book by Helena Haškovcová: “Old age and diseases are considered synonymous. This is not correct, as diseases affect people of all age groups [4]”. From the philosophical point of view, these statements seem to identify a gap in the irreversibility of the ageing process, although a minute one. This leads to the following potential viewpoint: while old age is essentially an unresolvable problem within an individual human life, this no longer applies from the perspective of a technical civilization or technological utopia.

Out of all philosophical schools active after the death of Alexander the Great, i.e. during the Hellenist era, the stoic philosophy is the most significant or at least the school with the longest duration. It stands out from the rest owing to its systematic approach, as individual aspects of the stoic philosophy, i.e. logic, physics and ethics, are interconnected. Living in agreement with the nature based on a pantheist perception of the world’s unity is a key principle of stoic ethics. Life is meant to be consistent, meaning that it should be in agreement with itself and with the human nature. The human nature is predominantly controlled by the instinct of selfpreservation, but needs to be combined with the rational principle to the appropriate extent. Therefore, virtue is fundamentally rational, but virtue as such is sufficient for achieving contentment. Achieving virtue is essential, all else is of no consequence, it is adiaphoron: wealth or poverty, health or illness, honor or shame, life or death [5]. The Stoa is divided into three stages, with the last of them belonging to the era of the Roman empire. During this stage, stoic philosophy lost its original systematic character and began to focus mainly on moral issues. However, it is important that authentic writing of individual philosophers has been preserved precisely from this era.

It can be concluded that the topic of old age is a major topic of the moral philosophy in the late Stoa, which maintains its association with the ontological foundations of stoicism as such, despite eclecticism. This means that the fate of individuals is perceived as a small part of the natural and cosmic events, which are unchangeable and take place in restoring natural and civilizational cycles. The key principles of the Roman Stoa are as follows:
a) The old age is determined already in the young age. It is essential to approach life with rational purposefulness from young age, as this eliminates the false problem of artificial prolongation of the human life in old age.
b) Therefore, the stoic philosophy approaches old age with the notion that a fulfilled life needs no old age and hence when an individual lives to their old age, the old age becomes more bearable.
c) Therefore, life is always short, mainly because it needs to be lived as if it were short.

Nuances can be documented on the two key personalities of the late Stoa and thinkers of the ancient Rome, Lucius Annaeus Seneca and Marcus Aurelius Antonius. Generally speaking, the stoic philosophy is a good match for the modest Roman national character; Marcus Tullius Cicero dedicated an entire book to the topic of old age, stating that the issue of old age is secondary compared to the concentrated lifelong performance in attaining virtues: “Any age is difficult for those who have no strength for good and virtuous life; however, nothing that comes as natural necessity will seem bad to those who seek all good within themselves. The old age is the first of these necessities [6]”. The essay by L. A. Seneca On the Shortness of Life is naturally a guidance for the key proposition, according to which “life is always short”; the nuances rest in the fact that the essay in fact is consolation, which means that the actual reality is even more painful than it would seem to be at the first sight.

By applying the genre of consolation, the philosopher addresses people around him from his solitude, which may not be desired and may even be forced upon him. The genre of consolation reveals the depth of the crisis of the era, which sees the control of one’s own resignation to the degree of almost daily contemplation of the possibility of suicide as a rational solution for an individual. From the aesthetic point of view, consolation impresses with the individual courage of the writer, who intentionally subjects himself to necessity as a way of achieving freedom; yet, the writer primarily consoles himself. As the genre of stoic consolation is mainly a private nostalgic ethically normative lyricism, it cannot be an accurate mirror image of the reality of the world. Despite this, or perhaps precisely for this reason, Seneca presents people with an ethically normative message so strong that it has survived over many centuries: “Do you want to know how briefly people live? See how keen they are to live a long life.

Enfeebled old men beg in their prayers for an additional few year… But why should life not be ample for people who spend it far removed from all business? None of it is made over to another, none scattered in this direction or that; none of it is entrusted to fortune, none wasted through neglect; none is lost through being given away freely, none is superfluous; the whole of life yields a return, so to speak. And so, however short, it is amply sufficient; and for that reason, whenever his last day comes, the sage will not hesitate to go to his death with a sure step [7]”. His Conversation with Himself by Marcus Aurelius Antonius, who ruled as the Roman emperor alongside his brother Lucius Verus, are a historically popular work once again in the genre of consolation. The aesthetic and literary power of the work written in Greek in the loneliness of the ruler of the Latin empire stems from the writer’s unique situation in constant wars on imperial borders. The historical uniqueness of the moment seems to be dictating the words to the humble writer; the book is essentially contemplation at the time of the gradually emerging great crisis of the empire signaling the end of the old times.

As in the case of Seneca, the melancholy of the late stoic philosophy is combined with an opposite approach, fascinating to this day: the general resignation is replaced with the requirement for philosopher’s self-training essential for managing difficult situations. The proposition of Marcus Aurelius Antonius, according to which the man has nothing but the present, can also be understood in this sense. Within this meaning, life is neither short, nor long; or in other words, life is always very short, almost imperceptible, like a blink of an eye. However, eternity is attained by accepting life as being very short. Interestingly, philosophers of the late Stoa abandon even the moral value in achieving longevity despite all obstacles faced along the way; living to an old age is not evidence of anything: “Looking at the vastness of time behind you and the other endlessness before you: what difference is there between a threeday life and three lifetimes of a doyen?” However, it is important to note that the middle and late Roman Stoa, specifically Epictetus and Seneca, are received positively by the emerging Christianity, which values old age.

Similarly to Christianity, Epictetus points out the contrast between the soul and the body, although he does not mention immortality of the soul directly. As he is influenced by cynicism, his ethics propose moral strictness culminating in the encouragement towards suffering and asceticism [8]. Epictetus distinguishes between ethics in the narrow and broader sense; the core meaning of philosophy as a whole is in ethics; philosophy as a whole essentially is ethics.

Christian philosophy and to a certain extent also Judaism as a school of thought highlight fleetingness of the man’s worldly existence, naturally perceiving old age, which essentially is preparation for eternal life, as a significant and exemplary part of the human life. In his De Doctrina Christiana, a book reflecting the belief in utter dependence of the world on the God, Aurelius Augustinus looks at biblical texts, concluding: “After all, when the apostle in the Epistle to Timothy said “Nobody will disdain you simply for being young“, he added a reason for no disdain: “However, be the example in speech, behavior, love, faith and purity for those who believe [9]”. Christian philosophy is undoubtedly a separate and a major chapter in philosophical contemplation of the old age. According to this paper, the stoic understanding of life as a moment, which becomes endless owing to its inner strength is more original than the idea of eternal vastness after the physical life. Modern philosophy abandons the topics concerning old age. However, silence is also interpretation of a certain kind. As modern science and its generally relativizing trend is based on a subject (i.e. “self”), celebrates the utilization of science for gaining power over the nature, supports freeing the world from the God and magic, and naturally leaves the anthropological and ethical value of old age as a secondary issue.

In the 17the century, René Descartes presents his dualistic perception of the world, in which res cogitans and res extensa coexist independently of each other and the world is nothing but a complex mechanic machine [10]. Descartes’ book “The Passions of the Soul” presents the theory of emotionality, which presents an emotion as a state influenced by the soul, as well as the physiology of the body. This is where a brief mention of old age occurs, purely descriptive (typically for the modern philosophy) and finally excluding an anthropological and ethical approach: “Article 133: Why children and old people cry so easily: Both, children and old people are more prone to crying than middle-aged people, but the causes are different. Old people often cry for joy and loving enthusiasm, because these emotions drive large amounts of blood to the heart and great amounts of vapours then travel to the eyes. The motion of these vapours is slowed down by the natural coldness of the old age; they are easily transformed into tears without any preceding sadness [11]”. When La Mettrie as a representative of the Enlightenment states: “The man is a machine and the entire cosmos only knows a single, diversely modified substance [12]”, the conditions for replacing the moral ethos of longevity with a cult of youth free of any wearing out are created.

The cult of youth evidently appeared in the society of the 19th century. If the man is a machine, machine components can be replaced. A functional newness becomes the measurable criterion of humanness. However, the strictly mechanistic, deistic and evolutionistic interpretation of the world, which culminated in the philosophy of the Enlightenment in the 18th century, triggered a reaction in the modern philosophy, for example in the work of Arthur Schopenhauer and Friedrich Nietzsche. Yet, this reaction only confirms the mainstream, which focuses on the expansion of eternal youth in individual human lives. Nietzsche notes the following on the old age: “The tone of the mature age is strict, curt, moderately loud, but is carried over great distances, as everything clearly formulated. Finally, old age often brings certain moderation and leniency to the sound and literally makes it sweeter: although in certain cases it makes the sound sour”. He offers a solution practically in the sense of the stoic philosophy: “Killing oneself in this case is a natural and logical behavior, which should correctly be respected as victory of reason: and it used to be respected in the times when the greatest of Greek philosophers and the most devoted Roman patriots ended their lives by suicide [13]”.

Firstly, a quote from Plato’s Republic, a book generally considered to be the foundation stone of the study of the ideal arrangement of a society, can be included. In Book eight, Plato summarizes in the introduction: “Well, Glaucon, we have agreed on the principle that a society with the ideal arrangement should have shared women, shared children and their upbringing, shared activities at war and peace, and those who have proven to be best in philosophy and leading wars should be the kings [14]”. Each of the propositions included in this sentence triggered a separate series in the history of philosophy; this paper will only point out a significant fact that the ideal arrangement of a state does not abolish wars as such, yet leading wars is perceived as a necessary or even supernatural realism of those who lead them. Plato focused on seeking the ideal arrangement of a society, proposing that the ideal good embodied in the idea of justice is established by kallipolis, i.e. the ideal municipality, the ideal state. As he did not mention in the Republic whether such a society had ever existed, for example Kritias returned to this topic in his work; he started with the description of “the Atlantic Island” [15], where such a society had been reportedly established.

The resolution of issues associated with old age consists of two sub-issues: firstly, what is the social status of the old compared to the young and secondly, contemplation of old age as a period when physical and mental capacities of an individual may start to deteriorate, which is often the case, yet the value of the individual survival in the complex life works in the opposite direction. As regards the first sub-issue, Plato advocates for the necessity of the effects of time, maturing, and gaining experience so strongly, one would even say that the structure of the ideal society aims to prevent the chaos introduced by the youth cult. Plato particularly highlights the necessity of the effects of the power of time as a certain test within long-term education and training in the class of rulers, as they are definitely able to see the Good, govern the state and educate their successors according to the Good, after reaching the age of 50 years. As regards the second sub-issue, while it is possible to analyses all works by Plato from the methodological perspective, the character of this paper only allows for examination within the Republic. Plato proposes the following: if a life is lived honestly and devoutly, this gives rise to sweet hope nurturing the individual in their old age.

More’s Utopia, a book written in Latin, provided a symbolic term for the contemplation of an ideal society. While Plato’s Republic is described as a precursor of the Utopia by historians focusing on the history of philosophy, More’s Utopia is mainly a literary work with great deal of irony, which is in great contrast with the serious and poetic diction of Plato’s Republic. More’s work oscillates from captatio benevolentiae through Plato’s dialogue to coherent lecture, although the lecturer is not as trustworthy, being a well-travelled sailor Rafael Hythlodaios. This is a purely literary approach. While the introductory sections of the Utopia are somewhat anecdotal, the second book “On the Island of Utopia” is coherent. More is walking the path originally tread by Plato, mainly in interpreting the idea of justice in Utopia as mutual balancing of extremes. Utopia is an active world; inaction is not accepted in the excellently organized Utopia, but this only has a positive effect on individual human lives, according to More. The society is systematically mixed up with regard to its age structure: the respect for the elders is to control the uncultivated actions of the young – for example words and gestures. More agrees with Plato in preferring older people in the management of the society over the young, as shown in the following quote: “The oldest member, as I have previously said, is the head of the family; wives are obliged to serve their husbands, children their parents and generally younger people are obliged to serve older people [15]”.

However, contemplation of the old age as such is only minor in More’s Utopia and has a defeatist tone in the topic of euthanasia. More would have been expected to introduce the topic of the elixir of youth, as the perfect state of Utopia allows unmatched development of science and scientists discover the elixir of youth; and failing to discover the elixir of youth, they can at least discover the universal medicine, parerga. However, science and technical development are not the major driving forces in More’s Utopia. Plato and more introduce to the world Utopia of a non-technical civilization, while technics and civilization affect unavoidable dialectics, and this gives rise to a utopia of a new kind. A brief mention of More’s idea of euthanasia; those who suffer from terminal illnesses and are a burden for themselves and the society may leave the world voluntarily through fasting, or depart in delirium, without the sense of dying. An ancient Greek author Iamblichos also assumes this in his description of the ideal state. However, the rule of the bureaucracy and the priests in Utopia is so strong that any man who committed suicide for reasons not approved by the priests or the senate cannot be buried or cremated, instead they are humiliated by being thrown in a swamp. Everything said in connection with More’s Utopia and the topic of old age in both sub-issues stems from the notion of the ontological foundation of Utopia. Thomas More, a martyr for the Catholic faith at the times of Henry VIII had to assume these as they were: the soul is eternal; one has to follow the nature and reason; religion and reason form unity; the man lives with the notion of punishment after death.

The unusual, tumultuous and martyred life produced in particular one well-known book, which was written in Italian. Readers studying this book currently are motivated to think mainly about the link between eugenics and old age, although this is not specifically considered in the book itself. However, the idea is clearly present for anyone contemplating old age philosophically from the perspective of the ideal society. The emphasis on eugenics and a certain focus on science makes Campanella generally more futuristic than more. The world he describes is more of sci-fi compared to More’s. Campanella builds on the eugenic character of Plato’s proposed ideal society, which applied to the class of guards in the case of Plato. To quote from the city of the Sun: “Reproduction is controlled meticulously by the benefit of the state, not individuals. The authorities must be obeyed….Because individuals reproduce and bring up their offspring poorly, usually to the detriment of the state, the offspring is entrusted to the care of the authorities as their key task and holy responsibility… They associate women for bearing children and men for fathering offspring according to philosophical principles [16,17]”.

The topic of old age in its two aspects, firstly as a ratio of legitimacy of the elderly compared to the legitimacy of the young, and secondly as the social status of a person who is beyond their zenith physically and mentally, is mentioned less compared to the works by Plato and More. This is hardly surprising, as the city of the Sun in its eugenic message gravitates towards adoration of youth, as the eugenic program is viable through the youth. At the anthropological and ethical level, Campanella’s City of the Sun circles around the topic of communism of women and children, i.e. their joint ownership. Campanella clearly follows Plato’s tradition of interpretation of the world as a hierarchy derived from unchanging ideal principles, which is also evident in the proposal for the ideal society, while deviating from the empiric Aristotle’s tradition, which asserts the necessity of private property for the good of the society, and other guarantees of privacy for people, more significantly than more. Yet, Campanella at the same time follows the modern tradition based on Descartes’ notion of a questioning subject, who finds their certainty in the evident truth. While the City of the Sun enjoys constant attention within the genre of utopic literature, it gives rise to certain questions when studied more closely. These are also mentioned by J.B. Kozák in the afterword to the 1934 edition of the city of the Sun: “Campanella’s Neoplatonism is missing its rational character and is left only with its superstitions, such as the belief in three types of magic – divine, natural and devilish. Campanella considered the book De rerum sensu et magia from 1620 to be his major work”.

Two basic types of utopias can be recognized:
a) Utopia created by the power of the ideal human will, striving to create an ideal society as a general repair or faulty human conditions. This vision could be referred to as the utopia of the ideal human will.
b) Utopia gradually created by autonomous development of technology, independently of the human will. Development of technology seemingly uplifts and at the same time equalizes. It is mainly evident in distribution of labour, which is simplified, yet also multiplied. Therefore, this technological utopia as a second type of utopia alongside the utopia of the ideal human will brings unique equality in inequality; while inequality of assets remains and perhaps deepens, dependency on technology produces the general sense of coherence. The technological utopia is unique owing to its irreversible character, since development of technology cannot be made responsible or stopped; this irreversibility strengthens the generally perceived equality as the loss of traditional control over individual fates and equality of the fate as such.

The solution of old age in the technological utopia is a typical situation and option for the technological utopia, as technology can separate the man from his traditional anthropological and ethical dilemmas. Utopic solution of issues associated with old age is only possible in the technological utopia. Utopia of the ideal human will be not even capable of proposing a solution specific to its conditions. The writer and philosopher Aldous Huxley in his novel entitled Brave New World abolishes old age as such. Having lived an intensely hedonistic life full of experiences, individuals die according to a plan, fast and without suffering pain, healthy and surrounded by eternal youth, with the assistance of the latest technology [18,19]. The author of this paper is of the opinion that Aldous Huxley and George Orwell primarily criticize the technological utopia covertly guiding the updated utopia of the ideal human will of the 20th century. The totalitarianism criticized by George Orwell is in fact the technological utopia, as it dictates to humans what they should wish for in the utopia of the ideal human will while believing that they create this utopia through their desires. In fact, they are controlled by technological utopia.

Life is always short and life as a cult of eternal youth requires solutions provided by the technological utopia, which separates people from anthropological and ethical contemplation on the topic of old age by the imaginary wall of technological progress. The factor of the autonomously developing technological utopia is the first key ontological framework for resolution of bioethical issues associated with old age. Utopia of the ideal human will and technological utopia may potentially be in conflict. The utopia of the ideal will may start to perceive preventing the absolutist rule of the technological utopia as its main task. This conflict is ongoing and has its history. The line defined by this conflict is the second key ontological framework for resolution of bioethical issues associated with old age.

The author would like to thank Iva Holmerová (the Chairperson of the Czech Society of Gerontology and Geriatrics ČLS J.E.P., the Chairperson of Alzheimer Europe) for her support in working on this topic.

No conflict of interest

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