Ethical and social implications of approaching death prediction in humans - when the biology of ageing meets existential issues

Background: This project was prompted by the ambition to investigate, from the outset, thepotential consequences of a future translation to a human context of research on natural deathprediction today actively conducted in the biology of ageing field. It is centered on ethical issues,challenges faced in medical decision processes and finally their implications in economic andinsurance matters. Recent advances in biology have made predicting the onset of natural death atechnically feasible prospect.Methods: This project resulted in a study ahead of application based on an interdisciplinaryapproach, a combination of philosophy, clinical psychology, medicine, demography, biology andactuarial science. The question was put into perspective with regard to contemporary theories ofageing as well as our understanding of what death is. Philosophy (literature review and conceptualanalysis) and psychology (theory and clinical experience) have allowed us to break down into distinctthemes the individual relationship to death, its anticipation and its prediction in order to betterunderstand the challenges that the prediction of natural incoming death might raise. Our approachto the problem in the medical field has been focused on intensive care because of the highfrequency of death secondary to acute illnesses. It is therefore natural that we have examined howthe development of tools to predict the risk of death could become a medical decision-making tooland enable the teams involved to better cope with it. Demographic and actuarial approaches haveallowed us to put prediction of death in the context of the long-standing analysis of mortality tables.Novel methods of death prediction pose new challenges to long-established assumptions ofdemographic models used in the implementation of pension and public health policies and insurancedecisions.Outcomes: This interdisciplinary work has led to the co-construction of a framework for scientific andethical reflection that can be relevant to define public health policy. Unlike a downstream approachthat only provides data after the fact or at least after society has adopted a scientific and/ortechnological innovation, this work strives to accompany the implementation of the innovation andto anticipate its effects.Interpretation: In this study, we propose a first sketch of what the implications of death prediction assuch could be - inasmuch as it affects both the awareness of death and its anticipation - from anindividual, medical and social point of view . The potential benefits of such tools for society may yetbe outweighed by ethically problematic applications. Here, we seek to provide a framework forreflection ahead of such applications.Funding: This project was partially funded by the IHSS (Institut Humanités, Sciences et Sociétés,Université Paris Diderot), the CNRS (Centre National de la Recherche Scientifique) and ATIP/Aveniryoung group leader program