liv: cast iron sign showing etiolated couple drinking tea together (argument)
[personal profile] liv
[personal profile] wildeabandon posted something thoughtful about giving to charity a while ago, and it made me realize just why I am uncomfortable with the idea currently fashionable among my friends of trying to maximize the efficiency of charitable giving. Unfortunately I started getting into a debate based on my new insight just a few days before I got married, so didn't really have time to follow up.

This is going to be an unpopular opinion, certainly, but I don't really agree with the principle that there's a moral imperative to use your money to save as many lives as possible. On the face of it that's a seductive idea, because saving lives is obviously a good thing, so saving more lives is obviously better, right? Also using resources efficiently is obviously better than wasting money. What kind of twisted person would disagree with that?

I think part of my issue is that I am not by nature a utilitarian. There was a discussion at Veizla recently where someone I don't know was claiming that utilitarianism is the only "rational" moral system. IJ pointed out that utilitarianism fails to take into account the possibility that one may have a stronger moral obligation to people one is more connected with. That felt like a succinct summary of where I'm coming from morally. It's tricky, because it's easy to use the idea of connectedness carrying moral weight to justify untenable positions like "rich, white, English people like me have more value than poor brown foreign people". That's not my belief at all; I believe I have more obligation to my family, my close friends, my local community, and to some extent my region and country than to random strangers. But I don't believe that my family and friends are inherently superior to anyone else.

OK, that's a little abstract. Let's talk about practical details. I'm aware that the efficient giving approach can be extremely nuanced, and I don't want to argue against a complete straw man version of it. But in a lot of cases it pretty much boils down to, give as much as you can reasonably afford to charities which spend the money efficiently on treating easily curable childhood diseases in resource-poor countries. The thing is, if your calculus is based on how many lives you can save for a fixed amount, that particular kind of giving is pretty much always going to come out on top. I'm not against doing that, but I don't think it's the only possible moral thing to do. Partly because I do believe that people also have specific moral obligations to themselves and the people they immediately interact with, not just to humanity in the abstract.

But also partly because I am just not convinced by the concept of "efficiency" in this sense. Efficiency might be trying to ensure that the largest possible number of people live for the longest possible amount of time. If you have one choice between saving a child and saving an older person, there's a case to be made for saving the child as you have potentially provided them with more years of life. But if you always prioritize children over adults and working adults over the elderly, well, it's easy to see the problems with that. And if you always prioritize financially efficient saving the lives of children dying of dysentery now over expensive long-term goals like building infrastructure to provide clean water so future children don't get dysentery, you're kind of making the wrong calculus. I am aware that many people who think seriously about efficient giving do think about long-term and infrastructure issues, not just how many lives can be saved right now. But once you start considering those factors, there isn't a simple, linear measure of what counts as "efficiency".

And now we come to the nub of the issue, for me. You can save more lives for the same amount of money if you spend it on basic medicines for simple, acute conditions, and calories for people who are right now in danger of starving to death. But particularly, you can save more lives for the same amount of money if you spend it in resource-poor countries, and even more in some ways if you spend it in war-torn countries in the throes of humanitarian disasters. And that's where I really have a moral problem. I mean, there's a fundamental unfairness about the fact that some countries have no functional economy and no rule of law, while our country has generally excellent infrastructure including high-quality healthcare and a functioning if less than ideal welfare state. This didn't "just happen" by chance, it was caused by colonialism and continues to be exacerbated by unfair international trade practices etc. It's bad enough that we benefit from cheap consumer goods produced by people in countries with terrible wages and terrible labour practices. And in turn it's that unfairness that means that people like me have plenty of spare cash (and time!) to even be having philosophical debates about how to use it most "efficiently" for humanitarian purposes. But I really can't stomach the idea that I get cheap humanitarian benefit by spending my money in the developing world rather than at home.

That's not just a moral squick. It's also the fact that injecting cash from rich countries where its value is relatively little into countries where its value is relatively great perpetuates inequality. That is to say, the very fact that I can spend 50p on a bar of chocolate over here (or lose it down the back of the sofa and not really notice the difference), but the same money buys enough medicine to cure several sick children in a different country, well, that's very nice in the sense that I managed to save several children's lives for a trivial sum of money. But it's probably long-term bad for the recipient country because it's so much easier to buy the medicine with my casual, almost valueless donation than it is for local people who might have to do a whole day's labour or more to be able to afford the same medicine. And that just contributes to the cycle where people in resource-poor countries are aid dependent and basically never have a chance to build up their own economies.

My belief that people are entitled to fair compensation for their labour still applies when that labour is directed towards humanitarian ends. Medicine in resource-poor countries is cheap because fuel is cheap, which means that the people who extract it and distribute it are underpaid, and because the people who maintain the roads and transport the medicines are underpaid and because most of the people who build, clean and work in the clinics are underpaid (even if the actual doctors and nurses are volunteers from richer parts of the world.) And the marginal costs of treating additional sick children are tiny because the people doing the treating have access to all the infrastructure of former colonial powers, factories to produce medicines and vehicles to transport them in, education to produce the kind of skilled workers needed to handle the logistics (let alone the doctors, nurses, educators etc who are going to be part of any aid programme). Maybe the benefit of saving children's lives outweighs all these disadvantages, but it's not a straightforward calculus.

I don't think it's necessarily morally wrong to give some money to support this kind of aid; I just don't think it should be everybody's priority to make sure as much of their income as they can possibly afford goes to this kind of cause. In particular, I think it's right to give some or all of your charitable money to local causes, even though it's relatively expensive to help someone who lives in the UK. Perhaps even more controversially, I also think it's right to give some or all of your charitable money to causes that are inherently "inefficient" in terms of return on investment: political lobbying, where most of the money gets spent on things like fancy dinners for politicians who may or may not have any influence, and scientific research.

Yes, research. I'm aware that part of the reason why I react negatively to the efficient giving style of thinking is that I'm a professional cancer researcher. And cancer research is the Big Bad in the minds of the efficient giving people. I'm quite aware that it's inherently going to cost a lot of money; after all I've spent the last three years desperately trying to raise funds to run a very small cancer project. Just think how much rehydration therapy could have been provided for children with diarrhoea in resource-poor countries for £70,000! That's barely the minimum threshold needed to carry out the smallest possible experiments for three years. Cancer research is carried out in fancy labs, using a lot of high-tech equipment and extremely expensive biochemicals, and it's done by highly trained personnel who may earn less than some professionals but are still paid fairly generous salaries even by the standards of a rich country. The great majority of it doesn't lead directly or at all to life-saving treatments. Even when it does, those treatments are themselves extremely expensive, partly because of drug patents but also partly because pharmaceutical and medical tech companies have to recoup the extremely high costs of research, and because doctors are highly paid and the infrastructure costs of running hospitals are astronomical, and cancer treatment takes a long time and takes up a lot of medical resources. Further, most people with cancer are elderly, so you're only saving them a few years of life anyway!

I have still chosen to devote my life to this, rather than earning five times as much in a city finance job and giving away most of my salary to cost-efficient development charities. That's partly because I am somewhat selfish and care about my own quality of life and job satisfaction and so on. But also because I think cancer research is a genuinely worthwhile thing to be doing, even if it's not financially efficient. I believe increasing human knowledge is a morally valid goal in its own right. I also believe that a lot of these inefficient ways of spending money contribute are efficient if you think on the right scale. It's similar to my argument that spending money on clean water infrastructure, or political action to ensure better trade arrangements between the developed and developing world, or working to prevent and mitigate the conflicts that lead to large numbers of people depending on pocket-money amounts of foreign aid to have the basic necessities are efficient in the long term in the sense of improving overall quality of life and tackling the root causes of the satisfyingly cheap to treat problems. In the same way, high-tech medical research is efficient on the long term scale because the aim of development charities is (or should be, in my opinion!) to do something about the situation where half the people in the world are barely subsisting, so eventually we get to a situation where everybody lives to 60 or more in relatively good health, which means that everybody is going to need treatment for the diseases that currently primarily affect rich, elderly westerners.

I do agree with many of the principles of efficient giving. I mean, once you've chosen which cause matters to you, it's a good idea to do research to find out which charities are actually putting most of their donations into actually tackling that cause, and which are using most of it on the salaries of overpaid directors or unsuitable interventions which feel good to donors but don't have much benefit (or are actively harmful) on the ground. If you care about breast cancer, it's almost certainly right to give money to Breakthrough Breast Cancer rather than some company that sells tacky pink shit and donates a few pennies out of their profit to vaguely cancer-related causes. Should you prefer Breakthrough Breast Cancer, who fund cancer research, over the kinds of organizations that provide emotional support to people going through cancer? Really hard to argue on "efficiency" grounds; emotional support is vastly, almost immeasurably cheaper, but the benefits are nebulous and hard to measure too, and are unlikely to save many lives. Emotional support helps pretty much everyone with breast cancer; most scientific research produces only negative results (that would be why it's research rather than "stuff we know already!"). Or should you bypass charitable giving altogether, and lobby politically for the government to assign more tax money to breast-cancer related causes?

However, when you're choosing which causes to support with your charitable donations, I don't think it's morally right to always gravitate towards the cheapest causes. Particularly if they're cheap because of systematic inequalities, rather than because they're actually cheap (eg treating a child with diarrhoea in the UK through our high-tech medical infrastructure with doctors, nurses and other health professionals involved in their care, versus treating hundreds of children with diarrhoea in resource-poor countries with marginal costs of pennies per case for oral rehydration salts and boiled water to make them up with.) But even if you're comparing dealing with something inherently expensive to tackle with something inherently cheap within the same economic context, I'm very wary of making it a moral absolute to prefer the cheaper problems. Because it's very easy to slide from that to start valuing financial efficiency over actual people; for example, quite reputable moral philosophers have argued not just for healthcare rationing, but for actual euthanasia, for people with severe disabilities. Not just on the grounds that all the money spent on their care and needed adaptations could help hundreds or thousands of starving children in resource poor countries, though that's bad enough, but because living with a major disability means that your quality of life is going to be too low to be worth it no matter how much money is poured in. I reject that view completely, though I'm aware that it's not shared by all proponents of efficient giving.

There's also the issue of how much of your money should go to humanitarian causes. I think most people agree there's a sensible balance between spending every spare penny on efficient charity, and always prioritizing fun toys and entertainment over worthwhile causes; other than teenagers who have just discovered utilitarianism, everybody understands that this is a nuanced issue. Still, efficiency alone can't be the only criterion; for example, where should the balance be between paying tax, which includes giving some of your income to things that are generally good for society and even these days some foreign aid, and buying things which directly effect the happiness of yourself and the people who depend on you, and spending money on officially charitable causes? Where's the balance between spending your time earning the highest possible hourly rate which can then be used to support worthwhile causes, and spending your time actually doing practically beneficial things for other people? Some charitable efficiency people argue that highly paid professionals should basically never do volunteer work, because it's always more efficient to work longer hours and use the extra cash for cost-efficient causes. I disagree with that, because I think volunteering has benefits beyond the merely practical; again, this is tied up with my view that people have moral obligations towards those they are personally connected to.

Where I do agree with the efficiency people is that it's far better to actually make positive decisions about which charities you want to support, and how much you can afford, and make a regular donation to your chosen cause, than to just give money randomly whenever you happen to encounter a moving appeal. Partly because just giving on a whim almost always means giving less, and if you can afford more and morally think it's right to give more, then you should set yourself up to do so, not set yourself up to forget because you're not in the habit or because you saw a shiny thing which took up all your spare money this month. Partly because haphazard giving rewards causes that spend a whole bunch of money on advertising and chuggers and generally encouraging people to importune you in order to pick up your haphazard donations. I do agree that it's better to support charities that spend their money on the actual problem, not superfluous stuff.

I wonder how many people I've mortally offended with this post...
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