Published May 07, 2015 · Estimated reading time: 4 minutes · Filed under , ,

A while back I read a very intriguing op-ed in NYT by Princeton ethicist Peter Singer. The article, titled “Good Charity, Bad Charity”, argues that the decision to contribute to one charity versus another should be based on an “evidence-based approach” that “[offers] the most positive impact for your time and money”. As someone in public health, I thought this was a nicely laid out and pragmatic approach to decision making with limited resources. For example, as a high-impact or “good” charity, Singer gives the example of the Schistosomiasis Control Initiative, a Neglected Tropical Diseases (NTDs) -oriented organization. Learning about NTDs related issues for years, I’ve personally observed that a lot of the underpinning drivers in research or advocacy for NTDs appeals to people’s utilitarian sensibilities: You can impact the lives of millions of people in a truly meaningful way for very little (monetarily at least).

Image created using public domain & creative commons licensed images: 1, 2, 3, 4.

However, what I think is a point that is really worth examining is the argument that Singer lays out in how we can “objectively” determine that by contributing to one initiative versus another that “we’ll be able to do more good”. Singer asks us to make a hypothetical choice between contributing to the creation of a new art museum wing, versus contributing to an organization working to reduce incidence of trachoma, a debilitating NTD which causes blindness. In a classic utilitarian fashion, he lays out our utility measurement for $100,000 invested. On the one hand the museum will provide 50 years of expected service and aesthetic pleasure, and he estimates that our contribution will improve the “aesthetic experiences of 100,000 visitors”. On the other hand contribution to a trachoma-reducing charity will spare “1,000 people from 15 years of blindness”.

The crux of the argument is that in this hypothetical scenario we are in zero-sum game where somebody’s visual/aesthetic pleasure comes, very literally, at the cost of a number of people’s eyes. Would we be, in essence, willing to have people’s eyes gouged out to enjoy a new museum wing? Singer posits to do so “You’d have to be nuts”. We are therefore drawn into a moral quandary, where one choice denotes empathy or humanity or whatever it is that makes us not want to have other people suffer. The other choice is a selfish choice. What kind of a person would choose art at the cost of people’s eyes? Except for, you know, those people that get eyeball tattoos.

I wandered if this was a false dilemma, where extremes are drawn out to force a choice. Singer acknowledges this to some extent by saying that that choosing, for example, between charities that will help people in the long-term versus those that will help in the short-term is much more difficult. Nevertheless, he maintains the objective measure ought to be considered two-fold, focused on human welfare, and focused on where a dollar investment will go further.

Interestingly, I found a similar sentiment in another article I’d read some time back regarding a different but related topic. Bloomberg Businessweek published an interview with Bill Gates, where he questioned the merit behind Google’s “internet blimps”. I’m not aware of the details of these blimps, but let’s assume they’re designed to provide Wi-fi internet access to poor and underserved areas for free. I don’t want to take Gates’ words out of context because in the article his criticism is really leveled at other initiatives that Google was planning to do, but ultimately did not. Nevertheless, in the interview he said:

“When you’re dying of malaria, I suppose you’ll look up and see that balloon, and I’m not sure how it’ll help you.”

Let’s assume that for a limited amount of funding our choice is between providing chloroquine (malaria medication) or wi-fi to a malaria-endemic area. Obviously, chloroquine would save more lives. What if the choice is between drugs and anti-malarial nets? Someone would have to do the cost-benefit analysis (apparently some people did), but as a preventative measure, nets would probably save more lives in endemic areas. Extending this argument to its extreme you could probably end up rationalizing that curative care is not worth it, and investment should be solely on preventative medicine. As decision-makers, with imperfect knowledge mind you, we end up in a utilitarian limbo where by contributing to an organization that provides a person with life-saving drugs, we’re effectively killing dozens of other people whose infections could have been prevented and so on. And who is to say the calculus is in favour of any health intervention anyways? Some social scientists have argued that broad structural changes are more effective than any nets or pills, any day of the week. Perhaps we should invest our money on funding those riding on turtles all the way down in pursuit of the rootiest cause?

We live in a world where decision at the broad level can be made more and more based on evidence rather than gut-feelings in what Singer calls “effective altruism”. But how you make those decisions? This is something that I am trying to figure out myself, and this article worth reading left me with more questions than answers.

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Permanent linkMarzieh Ghiasi

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