# Guest post from Jason Fehr

This is a guest post from Jason Fehr about how he decided what charity to support for his most recent donation. We requested this post along the lines of earlier posts by Ian Turner and Dario Amodei.

Before proceeding, I’d like to thank Dario Amodei and Ian Turner for their excellent guest posts earlier this year regarding their own decision making. I stumbled upon GiveWell in early 2010, as part of a lifelong search for the optimal way to benefit humanity. I’ve been so impressed with the rigor of their logic and the quality of their research that I’ve decided to make GiveWell my primary resource to guide all my charitable giving. Rather than simply rehash what has already been eloquently stated by the staff and friends of GiveWell, I’d like to take a step back and explain a bit of the philosophy that led me to my current state of mind regarding charity.

Whenever I pose the fundamental question of what general life objectives one should have, i.e. what metric to use to determine whether a life has been well lived, I always come back to the same two basic goals: first, to enjoy one’s own life to the fullest, and second, to improve the human condition as much as possible given one’s means and talents. This may seem trite to the subset of people likely to be reading this post, but I think it’s worth stating up front. Some people are motivated by money, fame, power, etc., but I’m writing the rest of this post under the assumption that the “goal” here is to try to use the time and resources we have to make a positive impact on the world.

How do you measure how much good an individual has done? This can be very difficult when you’re dealing with intangibles and vastly differing commodities: how do you compare the impact of Mozart with that of Einstein? Which provides more good: an art gallery or a soup kitchen? So, I decided that impact can be broken down into two categories: elimination of negatives (reduction in death/suffering), and introduction of positives (providing entertainment, emotional fulfillment, etc.). I thought that the first was far easier to measure, less ambiguous, and more universal: only a small sliver of the population might appreciate a beautiful work of art, but I think it’s safe to say just about everyone would prefer not to die or lose their loved ones prematurely, or to feel great pain. For these reasons, I decided to make the elimination of death and suffering the focus of my efforts.

I settled on a straightforward equation by which I would measure my impact: how many people will live healthy, normal lives because I was here who would have suffered or died had I not been here? For most people, this number is probably zero. This is not a criticism; it’s hard to find opportunities to save a life within the realm of most professions. Most people will never encounter a situation where they alone are in a position to save a drowning person or pull someone from a burning building. Additionally, I don’t count a life having been saved if the person who would have replaced you would have done the same thing. For example, I don’t consider a paramedic to be saving several lives a day just because the victims would have died without help. Had that paramedic decided to become a brush salesman instead of a paramedic, a different paramedic would have taken that job and driven the ambulance that day.

So, I consider a life saved/suffering averted only if you achieved something that would not have been achieved had you been replaced by the average person in that position. Using the paramedic example above, let’s say a victim has been shot in the face, and the average paramedic would not have been able to get him to the hospital alive. But, luckily for our victim, today an especially skilled paramedic is on duty; this paramedic has skills that the average paramedic does not, which allows him to get our victim to the hospital safely for definitive treatment. By my calculus, this paramedic has just saved a life.

I work as an anesthesiologist, and I (like most physicians I’m sure) am constantly learning and self-evaluating to ensure I am always providing optimal care for the patients. However, in any profession, there will always be individuals who are more skilled than others. I keep a mental tally of the patients that (in my estimation) are alive and well who would have suffered unnecessarily or died had I been replaced by a less well-trained anesthesiologist. In the three and a half years since I began practice, I think my number is up to about eight, or around one every six months. This mentality also constantly motivates me to be the best practitioner I can be; if I’m not doing a better job than the guy who would have replaced me had I not been there, I need to push myself to be better!

Now turning to giving, I tried to apply the same moral calculus to the world of philanthropy: if I can make a small difference by doing my job well (better than the person I might be replacing), I can make a huge difference by providing something via charity that otherwise wouldn’t have been provided at all. In other words, I think people can make a much bigger difference through careful charitable contributions than they ever can in their everyday lives, virtually no matter what their professions may be.

I wanted to be as sure as possible that any gift I made was being used optimally to improve the human condition. For the reasons I stated earlier, I’ve always tended to gravitate towards charities that aim to reduce suffering and death. Although I didn’t have the means to make a substantial donation until recently, I had been trying for years to determine how to optimally give money to make as great a difference as possible. It seemed that there simply was no consensus of expert opinion; I remember an article in Slate from 2006 in which they asked various writers and academics to whom they would donate a million dollars if they had the chance (there was very little overlap in their answers.)

Since I have a medical background as well as some experience working in the third world, I came to suspect that the lowest hanging fruits would most likely be in nations with the fewest resources. Examples seemed too numerous to count; in school I heard lectures by physicians who had worked in India or Africa, where children would die of diarrhea for want of a simple electrolyte solution, where hospitals would reuse needles since they didn’t have enough disposables, where children were still dying of measles and other vaccine-preventable illnesses (it doesn’t get much more preventable than measles!) It seemed that even a few dollars put into the right hands in the right way could save a life.

When I was young, I was convinced that Africa remained poor because the first world just didn’t care about them. Over the past several years, however, after reading (among others) popular books by economists William Easterly and Paul Collier, I’ve learned that tremendous resources have already been invested in third world development, frequently with little or nothing to show for it. While Easterly has a very cynical viewpoint (he essentially believes that foreign aid has never facilitated third world development), Collier feels that it’s more a matter of certain interventions being effective and others ineffective. I still have an unfinished email in my Gmail account from a year ago that I was composing to Collier asking him where he thought my charity dollars would do the most good. Before I had the chance to send it, I stumbled upon GiveWell.

I promised myself long ago that I would never give to charity just to assuage feelings of guilt or to help convince myself that I wasn’t being selfish walking past homeless people to buy $4 cups of coffee. I had looked into several possibilities prior to finding GiveWell (the Gates Foundation, Africare, disaster relief) but simply wasn’t satisfied with these choices for a number of reasons. In fact, it seemed to me that virtually every cause had a chorus of detractors claiming that the cause was doing more harm than good. I decided to wait and research this further before giving; I actually made no donations at all until 2010 when I found GiveWell. I actually found GiveWell by accident while searching for more research by the economists I mentioned earlier. As I read through GiveWell the first time, I realized that I had found kindred spirits in philanthropy: the staff of GiveWell started with all the same frustrations that I had felt over the years, but they had found some success in seeking out the answers. I was very excited to read through GiveWell’s philosophy and mission; it seemed that, finally, someone was saying exactly what needed to be said. I looked through their research with my usual skeptical eye, trying to find some fatal flaw in reasoning and analysis. As I read further, I found that every issue that needed to be addressed had already been addressed and evaluated thoroughly. At this point, I found the analysis on VillageReach, currently GiveWell’s #1 recommended charity. It seemed VillageReach’s approach was having a well-documented impact that was extraordinarily cost-effective. For the first time in my life, I felt comfortable enough with an organization to make regular substantial donations. I have continued to do so over the past year on a monthly basis (I elected to make a recurring monthly donation rather than a single annual donation; this approach allows myself greater flexibility in case new data were to suddenly become available that would cause me to change charities.) In my own mind, I add the lives saved as a result of my support of Villagereach to my personal total. Although I agree completely with GiveWell that attempting to quantify the cost per life saved requires many assumptions and is at best a rough estimate, I find it exciting to think about the sheer numbers one person can save with precisely the right donation. I’ve started with regular donations of$1000/month. Using GiveWell’s estimate of \$545 per life saved by VillageReach, this would be one child death averted every two weeks solely attributable to my contribution (remember, as a comparison, I would estimate that I am “saving” at best one person every six months through my work!) Although it’s impossible to ever have a guarantee in the world of charity, this is the most confident I have ever been. I intend to continue to use GiveWell to guide my giving, and I thank the GiveWell staff for providing me with the tools I need to make an informed choice.

All my life, I had been looking for “the answer”, the low-hanging fruit: if we have so many capable, talented individuals with the means and desire to improve the human condition, why does progress seem so slow in so many sectors throughout the world? I do believe that the answer may simply be misallocation of resources, often despite the best of intentions. What if we could redirect all charitable efforts towards the interventions that actually work, and stop wasting resources on the ineffective ones? What if we could change the culture of the nonprofit sector from one of competition for fundraising to one of competition for the most effective solutions? This, to me, may be the start of a revolution in the world of charity, the start of a movement that changes everything. I, for one, am thrilled to be a part of it.

• Nick Beckstead on December 24, 2010 at 11:46 pm said:

This is a great story to hear. Very few people seem to recognize the importance of asking the counterfactual question: “Who would have happened if I had not done this?”. I’m going to refer them to this post in the future.

• Boris Yakubchik on December 25, 2010 at 12:09 am said:

Thanks Jason for this post. I like your approach to counting lives saved. If you happen to be donating 10% or more of your income – you should join http://www.givingwhatwecan.org/

• Robert Daoust on December 27, 2010 at 1:53 pm said:

Excellent, Jason, that’s the way to go, I believe. Hopefully, with more people of the same mind, a large scale solution to our most pressing problems will come into being.

• Brian Geistwhite on January 3, 2011 at 10:24 pm said:

Jason, thanks for writing this post! It must have taken a lot of courage to discuss your values so publicly like this.

I also have a particular personal interest in your “what would have happened if not for this particular person in this particular job” kind of analysis. Issues related to this idea are important and touch a lot of people. How much does having an additional doctor really help people? Should a worker at a chemical weapons plant feel guilty, if someone else would take his job if he left? You might encounter this kind of question in a philosophy class, but I’ve always been disappointed that I can’t seem to find any high-quality research that addresses this kind of issue.

I have the strong intuition that someone could do rigorous research to figure out how much a person helps society by becoming a doctor. An economist might call it the “marginal impact” of someone choosing to be a doctor, rather than take up an alternative career. If anyone has any information about good research on this subject, I’d love to hear about it.

You talk about the difference between how good a job you would do and how good a job the guy who’d be replacing you would do. This seems to be a good way to start on the problem, in my opinion. However, it *might* also be appropriate to consider how you’re increasing the total job competitiveness in the field of anesthesiology, potentially bumping up the quality of others’ work as well. Here’s something to consider, based on my very amateur economic tinkering:

For any particular (paid) type of job, the employers for those jobs are going to have something very much like a cumulative demand curve for employees who do that kind of work. The sum willingness of all the potential employees for these kinds of positions makes up something very much like a cumulative supply curve. Your personal decision to take a particular job pushes up that supply curve just a little bit — your willingness to do that kind of job is a small fraction of the total willingness of every person to do that job. So, if you personally choose instead to be jobless, that supply curve shifts down, and there should be a small change in the equilibrium point in the market for that kind of job. Wages for that kind of job should increase just a bit, and the total amount of “employee-ing” that is supplied in this field decreases just a little.

I think this little decrease in “employee-ing” represents, in some way, the lower quality of work that’s going to be done for that type of job. So it could tell us about the difference in the quality of the work that would be done in that kind of job if you weren’t there.

So if we knew a little about the elasticity of demand for anesthesiologists, and a little about the elasticity of supply for anesthesiologists, a skilled economist might be able to tell us a little about the total impact that your decision to become an anesthesiologists is making on people’s lives!

Wouldn’t that be neat? It would at least be a lot better than our current situation — where everyone who cares about the quantitative impact they’re making in their jobs is left to do the analysis themselves, as best they can!

• Brenton Mayer on June 29, 2012 at 9:22 am said:

Hi Brian, not too sure if there’s a way to email you to make sure you get this reply, but I’ve heard of a group 80 000 hours which tries to calculate the sort of thing you’re getting at. http://www.80000hours.org is their website, and http://www.youtube.com/watch?v=myRQq8dYnLI is a talk by the philosopher Toby Ord, who founded GWWC on the topics they’re interested in. It might be worth checking out 🙂