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FROM an ethical point of view, two scenarios offer themselves in connection with the future of death. One relates to a situation in which the average human lifespan grows ever longer, but without major solutions to ageing and its many attendant diseases and disabilities. The other relates to the simultaneous conquering both of death and the current downsides of ageing, so that people live healthy well-functioning lives for 150 or 200 years or even beyond.

In the first case there will have to be a debate about the moral legitimacy and manner of elective death – both suicide and euthanasia – and the medical provision for them. In the latter case there will have to be questions about restricting conception, pregnancy and birth, to avoid a global population catastrophe.

Either way humanity will face much tougher moral dilemmas than already vex us about almost everything related to birth and death. Today, on the birth side of the question we debate contraception, abortion, family size, child care, suitability for parenthood, sex selection, cloning, the use of embryonic stem cells and more. On the death side we debate physician-assisted suicide, voluntary and involuntary euthanasia, passive and active euthanasia (turning off life-support systems or electing not to resuscitate, withholding treatment for infections or cardiovascular crises when post-treatment quality of life is predicted to be negligible) and more. We have not reached consensus, only some compromises, few of them stable and none of them uncontroversial. Longer lifespans will make at least one of these sets of questions vastly more pressing and more difficult. Are we ready for the intensified debate to come?

Prediction is of course a mug’s game; remember the early days of flight, when people thought that because biplanes flew better than monoplanes, aircraft of the future would have 12 wings? But it is reasonable to suppose that lifespans will continue to increase dramatically as they are currently doing and that the conquest of ageing and its deficits will take time to catch up. So there will be a period when many countries have the burden of high proportions of diseased and disabled elderly people. Questions about the propriety and even need for suicide and euthanasia, in most cases medically administered, will become agonisingly acute.

Then gerontological successes will catch up and negative aspects of longevity will fade, refocusing questions on reproduction. How many babies will be allowed? If birth is rationed, who will be allowed to reproduce, and who will decide? What effect will this have on the many women who will not be allowed to have children? Will there have to be public policy decisions about sterilising young girls whose genetic suitability puts them under the bar as possible mothers, to avoid accidental or subversive conceptions later? Such questions are every bit as acute, and China has already illustrated the difficulties and the heartache that attend them.

In one way, questions about elective suicide and euthanasia (at least the voluntary and passive forms) – are somewhat less horrendous than questions about restricting reproduction, if only because many old and chronically ill people would prefer a medically eased death to a life that has become difficult, and certainly if it has become intolerable. The arguments for carefully legalised physician-assisted suicide are already overwhelmingly strong, and the practice of passive euthanasia is already widespread and largely accepted.

What one does not like the sound of, though, is coerced deaths of old or ill people. Parity with forced sterility of women, a draconian-enough measure, raises the spectre of permission for suicide and euthanasia first becoming encouragement, then requirement, prompting chilling memories of Nazism.

It is doubtful whether choosing to shorten lives in these ways will be an adequate solution to the longevity problem. The greater likelihood is that we will be faced with both the death and the birth dilemmas at once.

A third solution is to abandon our current practice of promoting longevity. Supersize burgers and a cigarette, anyone?

Death – Delve deeper into the riddle of human mortality in our special report.