Spiritual, philosophical, or deeply religious essays and even whole doctrines, may focus on the ending of life and the processes that we endure during life that prepare us, or fail to prepare us, for that endpoint, so often euphemistically determined to be ‘untimely’ or ‘premature’. Laymen, that is individuals who are neither scientifically or spiritually inclined, may experience this process with a fatalistic approach, while others fight all the way, both physically and emotionally, to deny that they are in decline. Dylan Thomas, a Welsh poet of whom I shall write more later, famously wrote about his dying father who had been tempestuous in his youth and was now ‘going quietly’:
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.
Dylan Thomas “Do Not Go Gentle Into That Good Night”, 19475
It is not just laymen who have a view; some of the most brilliant minds have fought each other over the inevitability of the way we live and die. Even Einstein veered towards a deterministic position on life: “Human beings in their thinking, feeling and acting are not free but are as causally bound as the stars in their motions.” 6 Remember his “Gott wurfelt nicht,” – [God does not play dice (with the universe)].
Economists may judge the whole life-death scenario as a balance sheet exercise, and it is important that we understand what they say. There are several ways in which a ‘value’ can be placed on life, for example the VSL model (Value of a Statistical Life) where income and other factors are measured to estimate society’s loss from a single death, or the VSLY (Value of a Statistical Life Year) which reflects what value an individual places on each remaining year of life7 . These may be better than the most unfortunately named British parameter, the QALY, Quality Adjusted Life Years8 , which is used by the National Institute of Health and Care Excellence of the UK Government9 to justify withholding expensive drugs from certain classes of patients. Although in this book I will refer to the quality of life as objectively as possible, and even explain how we can treat this quality semi-quantitatively, which may well be an oxymoron, I shall not dwell on this in such insensitive monetary terms. Yet we must accept that real-life decisions are often made on the basis of the allocation of resource, which always has a monetary denominator, so I will take such arguments into account as appropriate; this will be specifically discussed in the section on the commercialization of the human body.
Both quality and quantity of life are relative parameters, although the former is far more subjective than the latter. In an absurdly simplified world, we could represent the quality of life as a monotonic decline from birth to death, as shown in line 1 in Figure 3. It is doubtful if any sane person would accept this relationship, which is why evolution has not resulted in such a scenario. Many years ago, in relation to the