Sunday 4 October 2015

To Do Good

I think I'd be correct in stating with confidence that "all readers of The Blob desire to do good".  Even if the grandson of Josef Mengele is tuning in from his fastness in the Paraguayan jungle, a case could be made that Opa Josi firmly believed he was carrying out important medical research.  If we're going to Good, there's no point in piffling about at the fringes; we should aspire to do the most good possible with the resources that are available to us. A smart young chap called William MacAskill is making waves in plunging towards this goal of quantifying altruism. He's got his own website and and is now a Fellow at Emmanuel College Cambridge and also an associate professor at Lincoln College, Oxford.  He's just published a book Doing Good Better: Effective Altruism and a Radical New Way to Make a Difference, which is comprehensively reviewed by Amia Srinivasan in the LRB. You should read it, ideas are developed there that I don't touch on here.  MacAskill, is a disciple of Peter Singer an experimental ethicist who has forced us to think about the utility of compassion. Singer is fond of pointing out that we would happily ruin a $700 suit wading into a muddy pond to save a drowning child but won't shell out $7 to immunize one on the other side of the Third World.

Last Summer I confessed to being a Naive Utilitarian, with similar trepidation as people who admit to supporting a rubbish soccer team (Arsenal springs to mind) or liking the music of Blur. I've also filled The Blob with examples of quantification and statistical analysis with no more existential justification than that if numbers are there then they deserve to be analysed. Therefore I am predisposed to like an attempt to quantify or optimise an ethical issue like altruism or effective giving.  But I also know that ethics is hard (having failed the Ethics Quiz) and that a superficial analysis of altruism is going to be annoying. Worse than annoying, because it's going to queer the pitch for other would-be rationalists.

Amia Srinivasan has digested enough of MacAskill's book so that I don't feel a burning need to run off and buy it.  But if any close family member is stuck coming up to Christmas ...?  MacAskill and another Oxbridge philosopher Toby Ord have pledged to cap their income (at about £20K) and give the rest to charity for their entire working life.  Ord has founded Giving What We Can while MacAskill has launched 80,000 Hours which is about what your paid working life will be if you survive to 65.  GWWC has apparently raised $400 million in pledges since its launch six years ago. But we all know that some charities deliver more of your cash to the deserving than do others. When Sinclair Lewis won the Nobel Prize for Literature in 1930 he pledged to donate the money to “a well-known young American author and his family, to enable him to continue writing” [himself].  You can check out a number of meta-charities like Give Well to see who has the fewest 4x4 vehicles and desk-bound fund-raising VPs.  Forbes sorts US charities on the basis of charitable commitment [how much of your $$$ goes to Africa] and fundraising efficiency [how much it costs to get your $$$].  So that's one element of efficient giving.

But the impact of your $$$ can also be quantified. All your money can be given to ensure that every child in Africa has a pencil with which to get educated OR you can stop any child ever again being infected with hookworm Ancylostoma duodenale. You're too late to do that for smallpox, we've done smallpox.  This is where QALYs quality-adjusted life years come in.  I mentioned the idea in connexion with hepatitis back in July. QALYs are useful for allocated resources among competing claims on a finite cash-pot. Is it better to make triple-bypass heart-surgery available to all at government expense or build gyms in every school in the country (and ban the sale of cream-cakes)?  You can do research to find out how much the quality of life is improved over how many years by these two alternative interventions and then make an informed allocation at budget time.  The example in the LRB review says that life with AIDS is so grim [with constant infection and weird tumours popping up every third Thursday] that your QALY is 0.5 compared to happy healthy me with a QALY 1.0. Giving antiretroviral therapy can a) extend life expectancy but also b) crank up that QALY to 0.9. There are all sorts of problems with QALY - like having to ask Jo[e] Patient how s/he feels having contracted condition X rather than using an objective criterion. For example, people actually on dialysis rate their well-being higher than people who merely imagine being in the hospital getting filtered twice a week. Having established your QALYs, scaling up to the whole population is only elementary maths.

What we want to avoid is decisions being made, consciously or unconsciously, by fat old white men who want to get re-elected. We also want to avoid damn-fool ideas like buying expensive/glamorous pieces of kit or opening [requires Minister, ribbon, scissors, constituents and the press] new state-of-the art centres-of-excellence rather than dribbling out the money in unsexy but highly effective initiatives . . . like breakfast clubs for dirt-poor children.  I think QALYs work if you are an uncorrupt government whose brief is to maximise the well-being of The People.  It is pure greatest good for the greatest number utilitarianism in the tradition of Jeremy Bentham and John Stuart Mill.  But it requires The Man to be as sternly uncompromising as any stoic Roman consul ordering the death of his own son.

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