The GiveWell Blog

Significant life change

If you could accomplish any of the following for the same cost, which would you choose?

(1) Prevent 100 deaths-in-infancy, knowing that in all likelihood these 100 people will grow up to have consistently low income and poor health for their ~40-year-long lives.

(2) Provide consistent, full nutrition and health care to 100 people, such that instead of growing up malnourished (leading to lower height, lower weight, lower intelligence, and other symptoms) they spend their lives relatively healthy. (For simplicity, though not accuracy, assume this doesn’t affect their actual lifespan – they still live about 40 years.)

(3) Prevent one case of relatively mild non-fatal malaria (say, a fever that lasts a few days) for each of 10,000 people, without having a significant impact on the rest of their lives.

For me, the answer is definitely #2. I am very excited by the idea of changing someone’s life in a lasting and significant way (2); I’m much less excited by the idea of a temporary, less significant life change (3), and I don’t think that the quality of a life equals the sum of the quality of the days in it. (1) excites me the least – I just don’t put that much value in “potential lives” (I think the death of a 20-year-old is more tragic than the death of an infant), and I especially don’t put much value in saving “potential lives” riddled with health problems.

I’m not interested in having a long philosophical argument about the validity of my views. I believe that different donors likely have fundamentally different values that you can’t change by throwing any number of thought experiments or philosophical abstractions at them. Our research will aim to serve as many different sorts of donors as possible, rather than holding up one philosophical value set as the “rational” one. But I am interested in what others think, and whether my attitude is common or rare.

To give a quick sense of the practical relevance of this question: programs targeted directly at under-5 mortality (including some vaccination programs and some micronutrient programs) are much more likely to get you (1)-type results; programs that distribute bednets or other health materials en masse are more likely to get you (3)-type results; an economic empowerment program (particularly focused on improved farming techniques) may aspire to (2)-type results, but I believe that these types of results are the most difficult and expensive to bring about.


  • ruby k on July 29, 2008 at 1:43 am said:

    “I think the death of a 20-year-old is more tragic than the death of an infant”
    Really? Not for the family whose baby was lost.

    Interventions that will best accomplish (1) are actually health system and capacity building (e.g. skilled attendants at childbirth, case management of pneumonia and neonatal sepsis) and not vertical bednet-type programmes so provide knock on effects greater than just the one “potential” life that you have saved.

  • Ryan on July 29, 2008 at 8:01 pm said:

    I vote #2.

    @RubyK, losing your own baby isn’t part of the question. You need to think about the real options: a 20-yr-old stranger dies or an unknown baby dies. Which do you dislike more? If you’re still stuck on the point about emotional attachment, you need to at least keep it consistent: your own baby dies or your own 20-yr-old dies (but this is less relevant for thinking about where to donate, in my opinion).

    And it’s great that there are certain procedures that are very leveragable and save lots of infants, but the question of the relative worth of saving an unknown infant vs improving the life of an unknown adult is still crucial.

  • Basti on July 31, 2008 at 5:24 pm said:

    I vote #1.

    #2 also seems pretty worthwhile but I have a hard time to even consider #3 over #1…

  • I don’t understand the point of this post/question – is it really to find out if your attitude is common or rare? If so, I would guess that it is common among some people and rare among others.

    Having worked in a developing country for several years, my guess is that your attitude is rare among people with development-related work experience from poor countries. I say this because the three alternatives, including your attitude, fail to take into account the complexities of poverty.

  • Ron Noble on August 5, 2008 at 7:13 am said:

    To me you come off as a bit to cavalier about reflecting seriously on what does more good. I think you are correct that there will be basic value disagreements, but often people can be led to change their views through serious thought.

    I suspect that your preference for #2 has something to do with the simple fact that good health is a lot better than poor health. After folks have made their choice, I’d ask that they consider it but with the following reminder: If you choose to fund #1, the 100 people you could have funded with choice #2 will lead lives in poverty and illness. If you choose to fund number #2, the 100 people you could have funded with choice #1 will die. My guess is that this will cause a lot of people to switch from choice #2 to choice #1, though rationally, they should have thought of that any so it shouldn’t have an effect.

  • Holden on August 5, 2008 at 10:06 am said:

    To clarify, the idea of this post wasn’t that this choice ever comes up as starkly as I put it. I’d expect any intervention to have many interrelated and difficult-to-predict benefits. What I’m trying to do is publish my own feelings on “what the goal is” rather than “how to get it,” using a deliberately stylized example.

    Ron: for what it’s worth, your reminder doesn’t change my mind – that’s exactly what I had in mind when I laid out the initial stylized “choice.” I agree that serious thought may lead people to change their views on questions like this, but I don’t think it’s safe to assume that all disagreements are a matter of who is thinking “most seriously” – different donors may have legitimately different values.

  • Ron Noble on August 5, 2008 at 7:50 pm said:

    Holden, I think we agree: people may have fundamentally different values, but also people may be led to reconsider when things are presented different ways. I think you’ve probably given it a lot of thought, but I think the different presentation does change a lot of minds. A classic example is the presentation of these two options, in two different ways:

    Do you prefer program A or program B?

    Program A will have a 1/3 chance of saving 600 lives, and a 2/3 chance of saving no lives. Program B will save 200 lives for certain. Which do you prefer?

    Most people prefer Program B, because it seems better to save 200 lives for certain.

    Do you prefer Program A or Program B?

    Progam A will have a 1/3 chance of no deaths, but a 2/3 chance of 600 deaths. Program B will result in 400 deaths for certain. When presented that way, most people prefer program A, because they can’t bear to condemn 400 people to certain death.

    Of course, it is simply two different ways of presenting the same scenario, but it results in dramatic shifts of people’s preferences. In a situation like that, you’d want to lead people to see that it is just a result of how you frame it, and lead them to reconsider.

    What GiveWell is trying to do is HARD, as you of course know. What is the best way to measure outcome, and why? If you don’t agree that the best outcome is measured by the summed quality of each day of life (as evidenced by your valuing the 20 year old more than the infant) then try to explicate why? What is your rationale?

    I’m just trying to provoke thought. I think what you are trying to do at GiveWell is a great thing.

  • Holden on August 5, 2008 at 10:53 pm said:

    Ron, thanks for continuing the conversation. I am familiar with the example you gave and agree that it is a good example of where someone’s first answer to a question like this might not be demonstrating deep values. However, I think the disagreement we’re discussing does run a little deeper.

    The first thing I want to clarify is that I don’t think GiveWell needs to settle questions like the one I posed above. Under our new funding model, our donors aren’t stuck with the charity we proclaim as “best”; they will choose between several charities that we will select specifically to represent a range of philosophical values and judgment calls. I think it is worthwhile to discuss these issues, so that we can get our own values out in the open and hear from others on them, but I don’t think that settling this question is necessary for what we’re doing.

    That said, I’m happy to try to explain my values further. I disagree that “the best outcome is measured by the summed quality of each day of life.” I’m not sure exactly why I disagree with this – it comes down to intuitions – but here are a few observations that seem relevant:

    • I don’t think of the quality of my own life as the summed quality of each day. It’s certainly not what I aim for. To use a somewhat classic example, I’m almost certain that I could increase this quantity for myself through a hypothetical “happiness box,” but I wouldn’t choose to. I care about things like what I accomplish in life (and not just because of the feeling I expect accomplishment to give me), which are not well captured by the sum of the quality of the days.
    • Accepting “the best outcome is measured by the summed quality of each day of life” would seem to lead to many beliefs that violate my intuitions very strongly. For example, assuming that the expected value of a life is much greater than the “zero” of nonexistence, this would imply that any time a mother decides to have one fewer child than she could is a tragedy on par with death. That would imply, in turn, that we should morally encourage people to have as many children as the planet will bear. Using a definition of “quality of life” that is more in line with my own view of the good life doesn’t seem to lead to any similar problems.

    Again, I speak only for myself, and I don’t feel that “resolution” of these questions is necessary for what we’re doing – though we do need to recognize that we’re dealing with such questions, and it seems useful to be open about where we stand on them. (And, of course, I welcome your continued thoughts; my mind is open.)

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