HENRY MARSH The way our lives end
It is estimated that in developed countries about 75% of an individual’s lifetime medical costs are spent in the last six months of life. This is clearly money wasted.
We are wired by evolution to fear death, to cling to life, and yet in the modern world, where most of us will live into our 80s or beyond, extra life is often bought at the cost of gruesome treatment, such as chemotherapy, or prolonged incarceration in miserable hospitals. And even if the treatment is successful, as so often it is not, it may well allow us only to linger on a little longer in a nursing home, with the chances of dementia increasing steadily with age.
When doctors like me face these difficult decisions as patients, they seldom choose the same solution for themselves that they often recommend to their patients. I hope that my grandchildren, not as doctors but as educated consumers of health care, will be appalled at the way that so much suffering was inflicted on the elderly in the past.
I hope that the doctors of the future will be able to provide patients with better and more realistic predictions of what treatment will achieve, and that they will be more honest. All over the world, health-care costs are escalating beyond the rate of inflation, which is not sustainable. Much of this is based on folly, greed and denial of the inevitability of death. I hope my grandchildren will understand that the problem facing us is not how to live a long life, but how to live a good life, and how to end it with a good death.
MEG ROSOFF The way we treat animals
“The time will come”, wrote Leonardo da Vinci, “when men such as I will look upon the murder of animals as now they look upon the murder of men.” About 500 years later, I read an article showing that snails have personalities—some aggressive, others shy. Something similar is true of squid, insects, birds and fish.
Anyone who deals with animals will instinctively confirm this—no two dogs, horses, cats, cows or (I’m told) crocodiles have the same nature. Animals experience joy, love, pain and loss; yet we express surprise when elephants mourn a dead baby, or whales carry a suffering pod-member to the surface to breathe.
My generation has been responsible for the genocide of animals, wild and domestic. Although the natural history of the planet has always involved extinctions, the accelerating rate of species eradication is almost all due to the voracious demands of capitalism. We have destroyed habitats and wild populations out of carelessness, ignorance and (most of all) greed. We breed farm animals for food under horrific conditions of stress, crowding and abuse, somehow justifying the slaughter of 80 billion creatures each year by minimising, sublimating and otherwise denying the extent of their suffering.
I like to imagine a not-so-distant future when farm animals will be raised and slaughtered humanely and in far smaller numbers, when our diet will depend much less on the consumption of sentient creatures, and when the preservation of habitat for wild animals has become a matter of universal urgency.
Future generations, seeing our exploitation and mistreatment of animals, will look back in horror.
ALLISON PEARSON Our child-care arrangements
In olden days a glimpse of stocking was looked on as something shocking. Now the fashion designers Dolce & Gabbana are threatened with a boycott by irate celebrities for objecting to gay couples having children. Imagine trying to tell Oscar Wilde, as he sat in his cell in 1897, serving a two-year sentence for gross indecency with other men, that, within 120 years, it would be considered outrageous to suggest that children should be born only to a mother and father.
Come to that, picture homosexuality—the love which dared not speak its name in Wilde’s time—become so unshocking that a bill to allow same-sex marriage in England and Wales was passed into law in 2014. Gay marriage is not a concept my grandparents could have grasped, let alone tolerated, when they walked my sister and me to Sunday service in Welsh Baptist chapels. Those were cold, judgmental places, at a time when to be judgmental was to align yourself with God, not to induce a hissy fit in Elton John. I’m glad my grandparents didn’t live to see two men getting spliced, which would have been an abomination to them, just as I was appalled to read of the great code-breaker Alan Turing, forced, as recently as 1952, to choose between incarceration and chemical castration for committing homosexual acts.
So what will our grandchildren find shocking about us? We assume the March of Progress takes a one-way liberal street to greater enlightenment. But maybe my granddaughter will be horrified to hear how little time I, a working mother, devoted to her mother or father in their infancy at the end of the 20th century. Just four months off for maternity leave, can you imagine anything so barbaric?
By 2015 it had become the norm for children to have both parents in full-time work. “What were they thinking? Putting tiny children in day care from 8am to 6pm. Didn’t they know what a terrible effect that would have on the kids’ cognitive abilities and their ability to empathise?”
By 2049 the long-term decline in educational achievement and a startling spike in youthful depression, heavy drug use and anti-social violence were clearly apparent. Traditional cultures, where the mother stayed at home to rear her young, outperformed Britain on every indicator.
In 2052 the prime ministers ordered a public inquiry into what had gone wrong and why the birth rate was at an all-time low of 0.7 per woman. “How did the British forget the most basic of our instincts?” she and he asked via the universal, personalised messaging system. “How could we ever have thought that making women ‘economically productive’ was more important than shaping the next generation?”
On Twitter, a campaign to issue a posthumous pardon to Penelope Cuthbertson, jailed for being the last full-time mother in England in 2037, gathered more than 10m thumbprints in 24 hours. In maternity hubs across the land, new parents were implanted with a chip to detect the love hormone and keep a running total of meaningful emotional interactions. Babies found to have a high level of the stress hormone cortisol in their bloodstream, linked to neglect and absentee parents, were put up for adoption by families in India, who would offer them a better life.
In 2065 my granddaughter was talking to her 16-year-old, already pregnant with IVF triplets. “Your great-grandmother wasn’t a bad person,” she said. “She just did what everyone thought was right at the time.”
BEE WILSON Our sugar habit
The French utopian socialist Charles Fourier (1772-1837) believed that one day sugar would replace bread as the staple food of the masses. In the future state of Harmony, he promised, people would satisfy their hunger not with boring old loaves but with Harmony Bread, a toothsome mixture of fruit and sugar.
Almost everyone in the West eats Harmony Bread now, and it’s not such a paradise. Many aspects of our eating will strike our grandchildren as dysfunctional. They’ll deplore our over-dependence on meat, our gargantuan portions, and our inability to countenance the mildest grumblings of hunger while, across the world, millions starved. But most of all, they will wonder how we allowed sugar to become a staple food, even as diet-related illness became (according to the World Health Organisation) the leading cause of death.
We use sugar both to quench our thirst, in Coke, and to sauce our main courses—some pasta sauces now contain more sugar, gram for gram, than ice cream. Sugar rules our morning cereal and our “healthy” snack of yogurt. We reward our children with sweets or force them to drink fruit smoothies; either way, it’s sugar. To celebrate good news or cope with bad, we devour cupcakes or boxes of chocolates.
Our grandchildren will marvel at our ability to construct “meals” where, even if you skipped dessert, sugar was the main ingredient. As the endocrinologist Robert Lustig reported in “Fat Chance”, as of 2009 only seven items on McDonald’s American menu did not contain sugar: black coffee, unsweetened iced tea, Diet Coke, sausage, hash browns, fries and Chicken McNuggets—assuming you didn’t add ketchup.
If our grandchildren succeed in reducing this dependence and retraining the palate to appreciate other flavours, they will see our largesse with sugar much as we view smoking on aeroplanes. If it wasn’t so crazy, you could almost admire the recklessness.
ADRIAN WOOLDRIDGE Our freedom to have children
Freedoms taken for granted in one era can easily be redefined as unacceptable in the next. In 1900 people kept almost every penny they earned. Today they give half their earnings to the government, and those who question this are demonised as extremists. In 1980 people smoked in their offices and pubs (I was one of them). Today smoking in public places is verboten.
The next freedom that will become unacceptable is the freedom to have children. Our grandchildren will be appalled to hear that the biggest decision we take was once seen as a purely private affair. That they could have families without thinking of the environmental consequences, without taking a simple exam to test their competence, without having the means to support their children. Governments will show episodes of “Little Britain”, featuring Vicky Pollard, who has children in order to get a council flat, as an example of a society gone mad.
Our laissez-faire attitude to having children is an accident of history. Architects of the welfare state such as Sidney and Beatrice Webb argued that the government could be expected to provide education and welfare only if it also had a say in who had children, and how many. Burgeoning welfare states everywhere experimented with eugenics, encouraging some people to have more children and preventing others from having any. The horror of Nazi eugenics shifted these policies from mainstream to unacceptable.
The next 50 years will see the unacceptable become acceptable again as the memory of the second world war fades and worries grow about the pressure of billions of people on a fragile planet. Three things in particular will make the new eugenics mainstream. The first is the enormous cost of today’s arrangements. In the United States 14% of children under 18 are growing up in single parent families who have difficulty supporting them. The attitude of the poor contrasts sharply with the careful planning of the rich: educated parents who delay childbirth until they have a career and a partner. The rich will demonise the behaviour of the poor.
The second thing is the growing soft power of China and aligned states such as Singapore. The Chinese have embraced state regulation of reproduction with the one-child policy (now loosened). Soon they will take a more sophisticated line—giving people with high IQs incentives to have more children and denying those with hereditary diseases permission to have them.
But the most important thing is the march of science. Contraceptives will be ever cheaper and more effective, making it impossible to treat pregnancy as an accident. And genetic science will make it easier to spot defects in the womb. The new eugenics will be quite unlike the old ones: it will be thoroughly green and heavily Confucian. But they will be accepted by almost everyone except a few hardline Catholics and eccentric advocates of 19th-century liberalism.
A.D. MILLER Our baldness
Babies are mesmerised by baldness. It is tempting for slap-heads to think the fascination arises from fellow-feeling, since new-borns are often skimpy on top themselves. But babies don’t know what babies look like. They stare at us because, in this cruelly hirsute world, we look weird. Possibly they are scared.
In a generation or two, we will look odder still, and the nervous attention will be more intense, for baldness will probably have been cured. Not because addressing it is one of medicine’s urgent challenges, but because the science will advance and many men are willing to splash out to reverse a cosmetic loss that, from Samson onwards, has symbolised a waning of virility. Witness the bogus, overpriced potions bought in droves from mountebank clinics across the world.
Once a cure is found, and pharmaceutical firms make it universal, bald pates will become rarer and more exotic than bald eagles, and much less admired. As they die out, the baldies who remain will become objects of pity, their affliction considered a shaming mark of poverty, as rickets is today.
Before long the compassion will curdle into infantile scepticism, then wariness, and finally disgust. As the eternal tragedy of difference is re-enacted, those who don’t take the pills or rub in the ointment will be avoided, then shunned. Hairless hold-outs will think twice before venturing into the streets without a hat. In the end their blameless, naked heads will be exhibited for paying gawkers in seedy online circuses.
Finally baldness will be eradicated altogether. The shaggy-haired multitudes will rejoice. And an unsung part of human diversity, and a harmless augury of mortal imperfection, will be lost.
ROBERT BUTLER Our response to climate change
In one felt-tip drawing, the Queen wears a yellow crown, a purple dress and red shoes, and stands up to her neck in water. On her left, there’s an octopus, and on her right, completely submerged, the London Eye. In a speech bubble, she asks: “Can one of my loyal subjects help me?” Another picture depicts the Earth as a face weeping tears; a third shows polar bears perched on tiny blocks of ice. This is how one class of primary-school children see their future.
As a child, my mother had the Blitz to worry about (a bomb fell on the house next door). My generation grew up with the threat of nuclear war. In each case there was a strong sense of Them and Us. With climate change, children grow up with a depressing new twist to their fears. This time, we are the bad guys.
What will appal their children is the way we consume and waste energy, knowing full well that burning fossil fuels drives climate change. And yet there are still 1.3 billion people on the planet without access to electricity—and another 2 billion-3 billion who will be on the planet by 2050. The classroom walls should be filled with bright felt-tip visions of a low-carbon, low-energy world. But we have largely failed to imagine it.
MATTHEW ENGEL Quite a few things
My grandson spent his 150th birthday surrounded by his descendants. They arrived as usual in their kiddie-drones, landing in the drone-port in the old loft.
He tried to be relaxed as they rootled around in his study. “Great-great-great grandpa,” shouted one. “Is this one of those things you called books?”
“That’s right, my dear.”
“These pictures!” she cried. “Are they those African tribesmen you told us about?”
“No, no. They’re white people like me. Humans used to be all sorts of colours and hated each other if they were a different one. Those markings were called tattoos. People thought it was cool to have a needle stuck in them and get their body defaced.”
They were all with him now, giggling and making faces. “Weird!”
“And what are those?”
“Cars. You had to pilot yourself. Damn dangerous.”
“And those funny buildings?”
“Ah, that was London. It had to be abandoned after the floods in the 2040s, but the water wasn’t the real problem. It was the poison and all the plastic bottles. No one could clear up the mess.”
“The houses are so big. Did anyone live in them?”
“Oh, yes. That was Kensington. All the basements had been dug out, so when the water came in the houses just floated away. Company bosses lived in them. They earned 300 times more than the workers and said they deserved it because they were so clever. We had a system called capitalism. But then a famous writer produced two brilliant books called ‘Human Farm’ and ‘2084’. And we got rid of it.”
“And why are those people walking around outside? You can’t do that!”
“Well, you could do all kinds of things. It was quite safe before the sea rose and the big heats came and then the Chinese smog. That’s why we just go from house to house in our drones.”
“So was it better in the old days?”
My grandson paused. “Yes, in many ways it was,” he said finally. “But the people who ran the world were really, really stupid.”