I perceive a weakness in GiveWell and EA in general that it seems to prioritise saving lives over improving quality of life. The standard Disability Adjusted Life Year measure often cited is a pretty blunt instrument. To take one example, if you give someone three years of life but you know they will live it in "overwhelming, constant sadness [to the point they] cannot function in daily life" that's still "equivalent" to giving them one more year of full functional life using the DALY. The disability adjustment weight can reduce the value of an added period of life but not to zero (or to a negative value).
If, to use another example, you save the life of a child but leave it dependent on daily intensive care so that its family is reduced to bare subsistence, this is also considered a net benefit. (I note that hunger or lack of shelter, not being diseases, are not factored into DALY calculations).
It seems that there are many key interventions (improving access to pain relief, preventing or curing Trachoma/river blindness, preventing tertiary syphilis) which may not be costly, where not many lives are saved or lengthened but life quality is greatly enhanced.
The idea of a disability adjustment weight seems broadly useful - I assume it's carefully measured using some kind of rigorous evidence - but the "utility" numbers themselves that result from their application are questionable.
Can I suggest it might be useful to attempt to take these adjustment weights and re-interpret them (perhaps allowing for negative values in some cases?), supplementing them with other quality of life metrics and use the resulting numbers as more nuanced but still evidence-based means of prioritising resource allocation? Perhaps give donors and others a means to adjust their own preferences before calculating the best result?
My apologies if this is an issue which has already been grappled with in detail - in that case I would be grateful if someone could point me to the relevant literature on this point.