[Cross-posted from the original in Spanish on my blog]

It's estimated that between 2015 and 2021 Amancio Ortega donated around 600–700 million euros in total to Spanish healthcare, specifically for early detection and cancer therapies and for advanced proton therapy equipment, through programmes with several regional health systems and individual hospitals.

Unfortunately, there are no public estimates of the number of lives expected to be saved by these gifts; only qualitative assessments exist. According to the Amancio Ortega Foundation itself (original in Spanish),

"[it will be possible to] save hundreds of lives each year that are currently cut short, and to offer thousands of patients a path to recovery with shorter, far less aggressive treatments and a substantial improvement in their quality of life. [It will be possible to] increase the hope and wellbeing of thousands of patients and their families."

In any case, one needn't be an expert to reasonably expect that this deployment of resources will keep alive, every year, dozens or even hundreds of Spaniards who would have died in the counterfactual scenario. In Spain, the statistical value of life (the marginal cost of preventing a person's death) was estimated, two decades ago, at between 2 and 2.7 million euros (paper in Spanish). Rounding the value of a life up (€3,000,000) and the donation amount down (€600,000,000) to keep the estimate conservative, we can reckon that the resources donated by the businessman will prevent the deaths of at least two hundred patients.

Let's imagine that all the benefiting hospitals kept meticulous records, over the years, of every patient who used this equipment — including their prognoses, their progress over time, and the outcome that would most likely have occurred without these resources. Let's also imagine that Amancio Ortega lived long enough to see the bulk of his donation's impact (this seems unlikely; he is ninety years old). Finally, let's imagine that towards the end of Ortega's life, the hospitals got in touch with the specific people still alive thanks to the donated equipment, and invited them to an event with him. Amancio Ortega could shake the hands of those two hundred people.

Would it be fair and accurate to say that "Amancio Ortega, through his personal decisions and his own resources, indirectly saved the lives of some two hundred people"?

Now let's imagine an alternate universe in which the philanthropist died the day after signing the last of these health programmes, in 2021. The same two hundred people gather, years later, at an event (this time, a posthumous tribute). The only difference is that this time their benefactor never got to learn their names, nor can he shake their hands.

Would it still be true that "Amancio Ortega, through his personal decisions and his own resources, indirectly saved the lives of some two hundred people"?

In another alternate universe, Amancio Ortega lives for many more years, but for some reason the list of two hundred names is never compiled. Perhaps the hospitals don't keep good records, or perhaps the Amancio Ortega Foundation declines to have access to that information. So that gathering of saved patients never takes place. The same two hundred people go on living, scattered across Spain, but no one ever finds out exactly how many there are or who they are.

Would we then say that "Amancio Ortega, through his personal decisions and his own resources, indirectly saved the lives of some two hundred people"?

In the next parallel universe, the only difference is that for some reason the Amancio Ortega Foundation decided to invest those 600 million euros in New Zealand's hospitals. As New Zealand is a country with a standard of living similar to Spain's, let's imagine that about two hundred New Zealanders likewise avoid death from cancer, or significantly extend their life expectancy, thanks to these donations. In this other universe, not only does Amancio Ortega never learn the exact number or the names of those who benefited, but he never sets foot in New Zealand and knows almost nothing about the country, having delegated all the work to his foundation's staff.

Would we accept that "Amancio Ortega, through his personal decisions and his own resources, indirectly saved the lives of some two hundred people"?

In yet another possible universe, it isn't the Amancio Ortega Foundation but a different non-profit organisation that donates those €600,000,000 to the same cause. This organisation is funded entirely by wealthy private donors; specifically, it was two hundred wealthy individuals, contributing three million euros each, who made these health programmes possible. Berta was one of them.

Would it be correct to state that "Berta, through her personal decisions and her own resources, indirectly saved the life of one person"?

In another universe, this same organisation decides to donate the same amount, but there, where the statistical value of life is lower and the cause more urgent. They find that in several African countries, 3,500 euros spent on antimalarial medication statistically manages to save one life (often a child's). With the same expenditure as before, around 171,000 people are saved. Berta donated the same three million euros.

Now, would it be true that "Berta, through her personal decisions and her own resources, indirectly saved the lives of some 855 people"?

In alternate universe 769.1B/3Z (which, as it happens, is precisely our own), the same philanthropic organisation secures many small donors. Marco is a middle-class Spaniard accustomed to taking two family holidays a year. After reflecting on the opportunity cost of those leisure trips, he decides to travel only once a year from now on, or else to travel to closer destinations and book cheaper activities. Thanks to that change, over the course of two decades Marco and his family save 70,000 euros, and donate it to the best available vitamin A supplementation campaign for young children. With that money, more than 7,000 children receive adequate vitamin A during their first five years of life. The problem of vitamin A deficiency is so acute in some African countries, and its consequences so severe, that, statistically, this treatment will save the lives of about twenty children.

Would it be fair and accurate to say that "Marco and his family, through their personal decisions and their own resources, indirectly saved the lives of about twenty people"?

If you agreed with the first statement about Amancio Ortega and the impact of his donations, but disagree with this last statement about Marco, at what point in this chain of fictional scenarios do you think the equivalence between the different situations described breaks down, and why?