COMMENTARY

A Test Predicts Your Death Date: Should Insurers Find Out?

Arthur L. Caplan, PhD

Disclosures

January 30, 2020

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU School of Medicine. Would you want to know the time of your death?

It's an ancient question. In Greek culture, people asked the Oracle of Delphi when they were going to die. Today, people have an endless fascination with knowing the date or the time of their death. It's all over Hollywood movies and our literature, and it's even in our science.

Recently, a team of scientists at the University of Leiden in the Netherlands came up with a test that uses 14 biomarkers, which you get by analyzing a blood sample from an individual, to predict pretty accurately when you're going to die.

It's not like they can predict death within the next 24 hours, but for all-cause mortality, they have a more sophisticated way of predicting within the next 2 or 3 years whether you are highly likely to die.

Would you want to take the test? Would you want to have your patient take the test? I think many people are fascinated by this possibility of knowing. They say they would want to do it, and they would want to know because they would change their plans. They would take that cruise to Alaska this year instead of waiting until later. They might decide to spend more of their savings if they knew they were certain to die.

Many people might say yes. Many other people are certainly going to say no. They don't want that hanging over their head, they don't want to know, and it would make whatever years they have left miserable.

If the prediction was that they weren't going to die soon, even that good news wouldn't outweigh the terror of knowing that they might find out they were going to die within the next 1-3 years.

I think there's likely to be a pretty strong split if that were presented as an option to patients. The moral issue around having a test like this isn't really whether you or your patient would want to know. It's the third parties who definitely want to know.

Remember that the life insurance industry is predicated on being able to predict mortality. Are they going to use this test? I don't know when I'm going to die, but I can predict with certainty that they will. Actuaries and insurance people are already trying to forecast time and risk for death. That's why they ask you all manner of lifestyle questions and do all kinds of medical testing before they write a policy—they're interested.

Your boss probably would be interested. Will an employer hire somebody who's going to be dead in 3 years? Many employers would say, "You must take the blood test before we hire."

Medical school admissions committees may say that if we're taking you at age 40, you're kind of an older student; let's see what the test says, just in case you're going to pass away by age 45. If you are, we're not going to take you; it's not the best use of a medical education if you're going to die prematurely. You can go on and on trying to figure out what third parties might have an interest in a death-predictive test.

I think the moral obligation is not so much to decide whether we should offer it to people—if it becomes very accurate, people will be aware, and some will ask for it and some may not. It's whether we can participate in a dialogue about which third parties should be able to force, compel, or require testing even if the patient doesn't want it.

It may be important to establish a right not to be tested even though the boss, the insurance company, the admissions committee, or some other third party would really like to know.

I'm Art Caplan at the Division of Medical Ethics at NYU School of Medicine. Thanks for watching.

Arthur L. Caplan, PhD, is the director of the division of medical ethics at New York University Langone Medical Center in New York City.

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