# Giving: Like heroin, but more expensive

I’m right sick of all the jabber about all the wonderful things that giving does for the giver.

Don’t get me wrong. I think that giving is beautiful. Yet, as soon as that becomes the reason you give, it becomes about 10x less beautiful to me. I think that giving because of what it does for you – whether you call it happiness or fulfillment or what – is crass and misguided and yuck.

And generally, this kind of giving looks very different from the kind I prefer. When the donor gives in order to achieve happiness or fulfillment or any other feeling, the donor is probably giving to his own town, or his own “people” (ethnicity, nationality), or whatever random disease has affected him personally. And making sure the gift is restricted so he can have the illusion that every dollar pays for heartwarming things like food instead of unsexy things like rent. And doing a lot of pointless/unhelpful volunteering and other interaction with the fundraisers and the beneficiaries and the site so that he can see and feel his dollars at work. And definitely, definitely not doing something boring and nerdy like picking apart the methodology used to examine the actual effectiveness of what he’s funding.

This kind of giving is still better than nothing, I guess, but it’s worse than a good cheeseburger.

Loud and clear: good giving is NOT about the donor. It’s about the people in need. Remember them?

• What about the fundraisers behind this type of giving? The articles you give as examples backhandedly illustrate that fundraisers know they’re often appealing to whatever will get the check written (this gift will improve your psychological AND physical health!) rather than promoting the strength of their programs and the needs of the people those programs serve, and that they have a general cognitive dissonance about doing so.

I understand there is a hugely important emotional aspect to giving, as well there should be, but should that be the focus of fundraising efforts? And does that kind of fundraising often promote inefficiency in organizations by enabling, even encouraging, irresponsible (albeit unknowingly so) giving? Or is it really all about the bottom line in development offices?

Appealing to donors’ emotional needs might raise money but it won’t necessarily advance the cause, at least not efficiently.

• Agreed. There’s always been a chicken-and-egg problem in my mind about the relationship between fundraisers and donors. My intuition is that donors (the egg) are more to blame for the current state of fundraising: fundraisers will ultimately tell us what we want to hear, and I believe that if we demanded real information instead of snow jobs, we’d get it.

On the other hand, fundraisers are presumably the more “socially conscious” people, having chosen careers in this area – it’d be nice to see more of them stepping up and leading with the right message, treating the donor as a partner rather than a customer who is “always right.”

• Interesting posts and interesting site. I’ve been poking around here for a little while and noticed that three out of five of Clear Fund’s causes serve people in New York City. So how does that square with the last two posts–your thoughts on the tragedy of dying from diarrhea & your disdain for donors who like to the feeling they get by giving where they live?

• Nick – good question. The answer is that we just had to narrow our scope to avoid biting off more than we could chew. When dealing with these developed-world causes, you have to get to know the job markets, the education and legal systems, etc. – wouldn’t be feasible to do more than one city at once. (Arguably it’s equally stupid to be doing all of Africa at once, but we didn’t have much choice there – most large international charities are that broad in their focus.)

There’s a lot of money, a lot of need, and a lot of charity in New York, and there are also concrete advantages to focusing where I live: (a) it makes site visits easy; (b) most of our donors in the early phase will be from the area, and they may care more about locality than I do. So, knowing we had to pick one city, we picked this one. In the future I hope we get to do more. I can tell you that if I become convinced that Houston has greater needs and therefore greater opportunities to change people’s lives, I’ll personally prefer giving there.

• Gillian on October 8, 2007 at 7:41 pm said:

Holden,

Yeah, OK, so you think there is too much emphasis on donor’s needs. That doesn’t mean you should chuck them out altogether. Every donor has to consider their own needs AS WELL AS the needs of the intended recipients.

As far as individuals are concerned, good giving is about both. If a charity is going to treat donors as ‘partners’, they’re going to have to consider their donor’s personal preferences.

Given that so much needed, it doesn’t really matter that you choose to give to palliative care for AIDS sufferers or a soup kitchen for the homeless, or measles vaccination in Africa. I agree with you, however, that even the most personally driven donor should check out the effectiveness of service deliverers. You want your money to arrive at the destination and not be diverted or wasted.

Holden, you sound a bit irrational in this post.

Perhaps you could allow the donor to be personal in choosing New York over Houston, but emphasise the need for rigour in selecting an efficient service provider.

• Holden on October 9, 2007 at 5:26 am said:

Gillian: first off, it’s important to distinguish between our blog (personal, unfiltered opinions) and our project. As a matter of policy, GiveWell is committed to accommodating donors’ personal preferences. That’s why we divide charities into causes and compare them only within (not between) causes, exactly as you imply. I believe in picking our battles and I am not advocating that donors’ personal preferences be ignored.

That said: there is a lot at stake here, much more than you imply. I really can’t understand a statement like this:

“it doesn’t really matter that you choose to give to palliative care for AIDS sufferers or a soup kitchen for the homeless, or measles vaccination in Africa.”

It seems to me that this matters about as much as anything in the world can matter. The interventions you describe don’t cost the same, nor are they equally effective in changing people’s lives, nor is there any reason to think it’s close. That means choosing one or the other can be the difference between helping more people and helping fewer. If getting less myopic about giving helps you save even one more life … that’s a life we’re talking about. A person. How can you say that “doesn’t really matter?”

• Gillian on October 9, 2007 at 4:28 pm said:

Hi Holden… ‘helps you save even one more life’…

Hmmm… but what if I’m not driven to save the maximum? What if I’m happy to do a bit? Or to do a lot?

In addition, ‘saving even one more life’ seems to ignore another worthwhile goal – that of reducing suffering. Palliative care doesn’t save lives, but it reduces suffering.

If saving/changing lives and having maximum impact are the only goals, we’d never do anything for people over 50 years, cos you’ll always get bigger gains by helping kids over helping older folks.

In that case you’re right – palliative care for the dying is not as important as measles vaccinations. But that doesn’t mean that I’ll disparage those people who choose to support that cause, even if they choose it cos they get a buzz out of sitting with dying people to ease their passing.

Holden, it’s often true that we are blind to suffering until it touches our lives. Breast cancer is ‘over there’ till it comes right up close. My gripe about this kind of giving is that so many newly-aware donors seem to feel the need to set up yet another small foundation that does much the same as others. Surely it would be more effective to contribute to funds that already exist? It must be something to do with branding, having control, or keeping busy. It’s certainly more about the donor needs than the recipient needs.

You want to see that poor kids in Africa grow up literate? You don’t have to start a school – just send a couple of million  to the School of St Jude – Africa’s best education project.

Thanks for the forum Holden. And your patience with us!

• Holden on October 9, 2007 at 4:35 pm said:

I didn’t mean to imply that saving a life is the only worthwhile goal. There are philosophical issues here, and issues on which intelligent people will disagree … but there are also non-philosophical issues.

If you choose to provide palliative care rather than save a 5-year-old, when costs are in the same ballpark, I won’t complain. If you choose to provide palliative care to one person when that same money could have saved 10 lives, I’d at least like you to step back and realize the sacrifice you’re making, and ask whether this is really about your philosophical preferences, or whether it’s about your vanity. If you choose to save an African life from AIDS, when you could have saved 10 from diarrhea, because you enjoyed Rent, I really start having a problem.

The point is, no matter what your priority – education, palliative care, saving lives – doing what “feels” good can mean doing less. And doing less is a serious, serious thing, when you realize that it could make a difference the size of a person.

I agree with you that people shouldn’t unnecessarily duplicate efforts. GiveWell isn’t about trying to reinvent the wheel, it’s about trying to make it less necessary for others to reinvent the wheel, by getting the information we haven’t been able to find (including, at least conceptually if not this year, how St. Jude compares to charities with similar aims).

• Gillian on October 10, 2007 at 1:36 am said:

Regarding reinventing the wheel, I wasn’t suggesting that GiveWell does that. I am fairly clear that you seem to be looking for organisations that already exist and can demonstrate what they do, and you’re sending funds their way.

Mine was just a general rant.

Effectiveness depends to some extent on the timeframe. I deliberately chose an education project cos it has the potential to change society as well as changing individual lives, whereas health projects often seem to focus at the individual level.

An excellent project in Ethiopia is a Fistula Hospital which has been run for three decades
by two Australian doctors. In that time they have saved literally thousands of women from lives ruined by serious physical damage during childbirth. The trouble is, the same proportion of women still suffer this damage today. The underlying causes have not been addressed. I wonder how many wonderfully worthy and effective medical services are like this? In a sense, they almost perpetuate the problem because they repair the damage and no one has to try to implement the major social changes that are required to prevent it (e.g. end Female Genital Mutilation, teach birth control, implement village level health care).

At least measles vaccination programs have the potential to help lower infant mortality and hence reduce the birthrate.

I just thought it would be simpler to support an education project rather than try to sort out which health projects might be addressing the system as well as the individual lives.

Plus, I like education. It’s my thing! So maybe I’m in the donor-vanity project category!

• michael vassar on October 10, 2007 at 6:43 am said:

Things fall apart. Entropy rises. When things seem to hold together it is because of continuous work like in Fistula Hospital. Most of the time we can’t address the “underlying” problems, because they are things like being biological creatures who need food and water, but we can and do continuously make a huge effect on the world via many many small efforts. Feed the hungry and they will still get cancer. Cure cancer and they will still get old. Imperfect, but better than starving.
The problem with Fistula Hospital is, primarily, that there are too few of it.

• Holden on October 11, 2007 at 5:48 am said:

Gillian – I have the same tendency to like education because it’s simultaneously short- and long-term, at least in theory. The one issue is that given how tricky and complicated this issue is (for example, the US education system appears to have gotten worse over the last 50 years), it seems even more possible than usual to throw unlimited amounts of money at it without helping a single person. Developing-world education may be simpler to improve; I hope we get a chance to look at it next year.

I think your analysis of the fistula problem is way off, though. It’s important to distinguish between:

(1) Alleviating symptoms without addressing the root cause

(2) Alleviating symptoms and thus actually making the root cause worse

I think (2) is pretty rare, and I really don’t think it applies to fistula. You think people are less likely to fight the conditions that lead to fistula, just because the women who get it suffer a lot instead of suffering a ton? Having to get an operation is still horrible; the overall conditions and power structure are still horrible; if anything, I’d expect people to fight these things harder when the women who have been most affected are at least a little more empowered, and a little more capable of doing something with their lives.

Generally, I think that if direct aid is done well, it should empower people to do more good, fighting the things that have held them down. That ought to easily outweigh any bizarre logic that “We don’t have to fix this problem because we have hospitals to save those affected from utter ruin.” More on this here.