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I'm increasingly convinced that EA needs to distance ourselves from this framing of "saving lives=good". And we need to avoid the satisfying illusion that giving to global health charities is saving a life "just like our own". (Particularly disagreeing with @NickLaing's comments here). If you've decided to save the lives of the ultra-poor, you should be able to bite the bullet and admit you're doing that.

We all like the idea of saving a kid who's "playing with their friends in the schoolyard, maybe spending time with their grandma, or maybe just kicking a football, alone", and " celebrating her birthday" and the "first kiss".

But you don't need to be a negative utilitarian to recognise that the kid whose life you've saved probably isn't having a great life- mostly for the reasons you donated to that charity- it's shitty being a poor person in the poorest countries in the world.

Let's say you saved a life in Burkina Faso:

- If you saved a girl, she'll probably be a victim of FGM, and get married as a child to an older man - that "first kiss" you mention might be as a 15-year-old girl with her 30-year-old husband
- If they don't go to school, they'll do hard and dangerous work in agriculture, fishing or worse as children.
- If they do go to school, they'll probably spend their days in extreme boredom, getting left behind, and end their school years functionally illiterate and innumerate
- They're likely to spend a lot of their childhood hungry - they will get ill often, with malaria, diarrhea, or other communicable diseases
- They will be likely to grow up stunted or wasted, and with diminished cognitive abilities
- All of the above tend not to be great for mental health, so they're fairly likely to become depressed, anxious, or suffer from more serious mental issues
- When you ask them how happy they are on a life satisfaction/ happiness scale, they'll give you around 4/10

Based on this reality, and your estimates about how the world is likely to improve in the coming few decades, you have to work out whether you think this life you've saved is more likely or not to be net positive.

I'm not saying that we shouldn't give more money to global health charities- they improve lives and stop people getting horrible diseases. All else equal, fewer communicable diseases are better. But I'm disagreeing strongly with the framing of this piece.

Showing 3 of 7 replies (Click to show all)

michel

Aug 17 2023

Thanks for engaging with this post! I appreciate the seriousness with which you engage with the question “is this actually good?” If it’s not, I don’t want to celebrate this donation or encourage others to do the same; the answer to that question matters. I think your arguments are plausible, and I agree with the comment you make elsewhere that the EA Forum should be a place for such (relatively) unfiltered push back. But in the absence of any inside view on this topic and the fair push back Nick made, I still feel solid about holding the outside view that donation to GiveWell top charity = good. Neither the specifics of GiveWell charities nor subjective well-being in LMICs are my areas of expertise, so I‘m mostly deferring to GiveWell. But I also think most lives are worth living, and I’m weary (although I could be wrong) about “lives not worth living” lines of reasoning in countries and cultures I don’t understand well.

AdriansSkapars

Aug 16 2023

Would current use of QALYs factor in some of the features you mentioned? I suppose the focus on lives saved is a criticism of the post not of GiveWells method in general?

DzoldzayaAug 22 20233

My argument questions the ideas of lives saved, DALYs and QALYs as metrics - just like using lives saved as a metric, QALYs generally implicitly assume that death is worse than a very bad life, no matter the levels of mental suffering, pain, and physical debilitation.

I'm probably criticising GiveWell's methods as much as the post- their methodology assumes that the value of saving lives/ averting deaths is positive.

I generally agree more with HLI's 'WELLBY' approach, as long as negative WELLBYs are taken seriously.

See in context

I saved a kid’s life today

by michel

Aug 7 20232 min read 17

312

Global health & developmentEffective givingPublic givingMotivationalGiving What We Can

Frontpage

I'm working writing more, quicker, and not directly for an EA Forum audience. This is a post copied over from my blog.

I wonder what they’re doing today, the kid whose life I saved. Maybe playing with their friends in the schoolyard, maybe spending time with their grandma, or maybe just kicking a football, alone.

Whatever they’re doing today, some day they’ll grow up, and they’ll live. They’ll have a first kiss, a favorite dance, a hobby that makes them feel free, a role model they look up to, a best friend… all of it. They’ll live. And I think it will be because of what I did today.

. . .

It isn’t thrilling or adventurous, saving a life in the 21st century. I opened my laptop, clicked my way to a bookmarked website, and donated to a standout charity. Someone watching me couldn’t be blamed for assuming I’m doing nothing of much importance, maybe answering some text messages about plans tonight. The whole thing (the donation part after you check in with what you really care about) probably took less than 5-minutes.

. .

What did I do to wield this power? Nothing. In an important sense, I think I did nothing to be able to save a life without getting up from my couch. (I certainly did nothing to ‘deserve’ this power). I just won the birth lottery. I was born in an upper-middle class family, born on track to get a good education, and –just like that – born to become one of the richest people in the world.^[1]

I didn’t do anything crazy to make slightly more than the median US income, yet here I am making decisions about whether someone lives or dies.

I just wish it wasn’t so easy. The five-thousand dollars I donated today isn’t a trivial amount,^[2] but it’s much more trivial than a human life. Modern economies of abundance should have ensured that it costs me more than a new car I don’t need to make the difference between a kid dying before their fifth birthday and that kid meeting their grandkids. Yet here I am, sitting on my couch, holding a life I cannot see – but that exists as so much more than an abstraction – in my hands.

Please, I think, as I walk by people with expensive cars and watches, and picture a little girl celebrating her birthday, please don’t tell yourself you deserve it.

. . .

Oh, and about that taboo of not talking about donations: fuck that. Imagine if sharing how I feel about donating could inspire at least one other person to join the project of giving what we can, but I stayed quiet because of worries that I would come across as self-righteous or self-centered. I worry much more about the self-centeredness I would be expressing in that silence.^[3]

^{^}
I’m not that different from the people who I expect to read this post. See how you compare to the rest of the world here.
^{^}
Does $5,000 seem like a lot? Find out why the instagram ads telling you you can save a life for less aren’t telling the whole truth.
^{^}
If someone ever saves my life, the first thing I’ll ask is whether they “did it for the right reasons.”

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NickLaingAug 7 202336

Love this - strong upvote.

Not a big thing, but I would be a bit careful with comments like this, could maybe be considered a tiny bit stereotyping or patronising - especially if you are going for a wider public audience.

"Maybe playing with other kids in their village. Maybe seeking shade with his or her siblings, trying to escape the sub-Saharan African heat. Maybe being held by their mother or grandmother, nurtured."

Perhaps even a slight change to something like.

"Maybe they were playing with their friends at school. Maybe studying towards their dream of becoming a doctor. Maybe lounging on their grandma's lap, soaking up her love and wisdom."

Or it might be completely fine, feel free to ignore.

Nice one again, love the simplicity and bluntness.

michelAug 7 202316

Thanks Nick! Really appreciate you flagging this. I didn't intend it that way and hope the edit helps:

Maybe playing with their friends in the schoolyard, maybe spending time with their grandma, or maybe just kicking rocks, alone.

NickLaingAug 8 20238

Nice one yeah that's great - if it was me I would perhaps even change kicking rocks to kicking a football ;).

DzoldzayaAug 15 202315

NickLaingAug 15 202347

I disagree with fairly high confidence with this comment. "it's shitty being a poor person in the poorest countries in the world."

For a start, your comment here is misleading "When you ask them how happy they are on a life satisfaction/ happiness scale, they'll give you around 4/10" - they were not asked how happy they are, what they were asked was this.

“Please imagine a ladder, with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder representsthe worst possible life for you. On which step of the ladder would you say you personally feelyou stand at this time?" - The answers they give make perfect sense - of course there are far better counterfactual lives for them, especially when they compare themselves with other people from higher income countries, but this doesn't mean they aren't happy.

In Burkina Faso the next graphic shows that 80% of people from Burkina Faso said they were either very happy, or rather happy - which should answer the happiness question.

https://ourworldindata.org/happiness-and-life-satisfaction

Besides that, the examples you gave that I agree are "Likely" in Burkina Faso are FGM and your school comment which I think is very accurate and actually underappreciated. All the others (child marriage, stunting, mental illness) I would not consider "likely", as their prevalence is well below 50%.

To answer your comment "you have to work out whether you think this life you've saved is more likely or not to be net positive. " - We have worked it out, and the answer YES, a resounding yes.

Yes your life might be worse than for people in richer countries, that's why us global health people do what we do, but that doesn't mean that people's lives are "shitty", nor that we should not talk with great care and dignity when we conside hypothetical people's in low income countries.

Vincent van der HolstAug 15 20236

I would quickly add to what Nick said by saying that donating to charities that save kids' lives (e.g. AMF) likely improves all of your bullets.
- Families become happier if they receive the health interventions they need (and they almost certainly don't rate themselves 4/10 on the happiness scale, your quoting the wrong thing as Nick mentioned)
- I think it's also unfair to single out the Burkina Faso alone, when you donate to these effective charities they cover dozens of countries, most with far lower FGM rates
- You say they will spend their lives in 'extreme boredom', but your link doesn't really state any evidence for that

It's true that the lives we can save might still be ones full of hardship, but the evidence suggests that they will be happier and healthier lives. The counterfactual is death, and even in your bullets (that seem a bunch of pick and choose to bolster your argument) I don't see strong evidence that suggests we shouldn't be funding these charities.

DzoldzayaAug 16 20231

As I said on my final para, I do see global health interventions as probably being net positive, despite potentially saving more net negative lives, so my argument definitely wasn't to "defund GiveWell". It was more that "saving lives" is a bad metric and bad thing to feel good about.

My cherry picking of negative phenomena was in response to the cherry picking of the original post. I think boring/ useless school (I didn't quote anything but... most African rural schools are boring and useless...), unpleasant labour, hunger/ stunting and poor mental health are very relevant variables, as they define a lot of the waking hours of the poorest people in the world.

FGM and child marriage are probably less representative of general welfare - I was responding to the "first kiss" idea in the post.

I chose Burkina Faso at random. For central African countries I might have stressed sexual violence, which seems to be lower in Burkina Faso.

DzoldzayaAug 16 20232

Thanks for responding.

I accept your point about life satisfaction vs happiness measures not being equivalent. But if GiveWell recipients think that their life is significantly closer to the worst possible life than the best possible life, this still makes my point pretty well. Doesn't seem obvious to judge the net welfare of someone who is, say, 3/10 for life satisfaction and 'rather happy'. I haven't seen good studies on GiveWell recipients' happiness or moment-to-moment well being (using ESM etc.), or other ways of measuring what we care about, but I would appreciate better info on that.

My (implicit) estimates for child marriage, stunting and mental illness should be adjusted for the fact that average GiveWell charity recipients in Burkina Faso have worse lives than the average citizen, but I acknowledge my language was imprecise. Stunting might plausibly cross the 50% threshold in that category, but might be under. The median marriage age for Burkinabe girls is 17, and is probably lower in the GiveWell pop. Some orgs define child marriage as <18.

Mental illness thresholds seem to vary a lot, but this https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164790 article is a good example of how bad mental health is for 'ultra-poor' kids in Burkina Faso. My thinking would be that 20-30% of the kids in this study have lives clearly on the net-negative side, which I think would be unlikely to be outweighed by the more neutral/ positive lives. Don't know exactly how this would match with a typical GiveWell population.

"To answer your comment "you have to work out whether you think this life you've saved is more likely or not to be net positive. " - We have worked it out, and the answer YES, a resounding yes"

I consider this just obviously false. I just don't believe that you/ global health people have disproven negative-leaning utilitarian or suffering-focused ethical stances. You might have come to a tentative conclusion based on a specific ethical framework, limited evidence and personal intuitions (as I have).

I'd say that there's probably a fairly fundamental uncertainty about whether any lives are net positive. There's definitely not a consensus within the EA community or elsewhere. It depends on stuff like suffering happiness assymetry and the extent to which you think pain and pleasure are logarithmic (https://qri.org/blog/log-scales).

Most of us will acknowledge that at least some lives are net negative, some extremely so, and that these lives are far more likely to be saved by GiveWell charities. I suspect any attempt to model exactly where to draw the line will be very sensitive to subtle differences in assumptions, but my current model leans towards the average GiveWell life being net negative in the medium term, for the reasons I've mentioned.

In terms of language, I think "great care and dignity" are suitable for most contexts, but I think that it's important that the EA forum is a safe space for blunt language on this topic.

michelAug 17 20238

I think your arguments are plausible, and I agree with the comment you make elsewhere that the EA Forum should be a place for such (relatively) unfiltered push back.

But in the absence of any inside view on this topic and the fair push back Nick made, I still feel solid about holding the outside view that donation to GiveWell top charity = good. Neither the specifics of GiveWell charities nor subjective well-being in LMICs are my areas of expertise, so I‘m mostly deferring to GiveWell. But I also think most lives are worth living, and I’m weary (although I could be wrong) about “lives not worth living” lines of reasoning in countries and cultures I don’t understand well.

AdriansSkaparsAug 16 20231

Would current use of QALYs factor in some of the features you mentioned? I suppose the focus on lives saved is a criticism of the post not of GiveWells method in general?

DzoldzayaAug 22 20233

GraceAdams🔸Aug 10 20237

A lovely post Michel! Do you mind if we share it on the GWWC social media?

michelAug 17 20234

Thanks Grace! Feel free to share.

Denis Aug 10 20236

How can we get more posts like this on more people's social media feeds?

I just don't think people realise how much impact they can have with a donation. Or they don't make the connection that the kid whose life they save is just the same as their own kid, or the kid from down the road, for whom they probably wouldn't think twice before donating to save their life if they had that option.

Your post has a "click-bait" potential (in a positive sense) that a lot of EA posts lack for a general audience. You've written it very well, with a kind of "teaser" element to it which encourages further reading.

If we could get it out there, it feels like we might encourage a lot of people to consider a donation.

JoanMM🔹Aug 7 20231

Nice! Thanks for sharing it :)

I think I caught a typo:

but I stayed quite because of worries…

Shouldn’t it be “quiet”?

michelAug 7 20231

It totally should be. Fixed, thanks :)

Igor ScaldiniAug 8 20230

Thank you for this article, Michel!