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

Summary Background: This project was prompted by the ambition to investigate, from the outset, the potential consequences of a future translation to a human context of research on natural death prediction 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 and insurance matters. Recent advances in biology have made predicting the onset of natural death a technically feasible prospect. Methods: This project resulted in a study ahead of application based on an interdisciplinary approach, a combination of philosophy, clinical psychology, medicine, demography, biology and actuarial science. The question was put into perspective with regard to contemporary theories of ageing as well as our understanding of what death is. Philosophy (literature review and conceptual analysis) and psychology (theory and clinical experience) have allowed us to break down into distinct themes the individual relationship to death, its anticipation and its prediction in order to better understand the challenges that the prediction of natural incoming death might raise. Our approach to the problem in the medical field has been focused on intensive care because of the high frequency of death secondary to acute illnesses. It is therefore natural that we have examined how the development of tools to predict the risk of death could become a medical decision-making tool and enable the teams involved to better cope with it. Demographic and actuarial approaches have allowed 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 of demographic models used in the implementation of pension and public health policies and insurance decisions. Outcomes: This interdisciplinary work has led to the co-construction of a framework for scientific and ethical reflection that can be relevant to define public health policy. Unlike a downstream approach that only provides data after the fact or at least after society has adopted a scientific and/or technological innovation, this work strives to accompany the implementation of the innovation and to anticipate its effects. Interpretation: In this study, we propose a first sketch of what the implications of death prediction as such could be - inasmuch as it affects both the awareness of death and its anticipation - from an individual, medical and social point of view . The potential benefits of such tools for society may yet be outweighed by ethically problematic applications. Here, we seek to provide a framework for reflection 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/Avenir young group leader program.