Though I've read everything you've said, I don't have a clear intuitive sense for where you're coming from and why this topic is important to you.

I don't want to see the human species stop doing things like e.g. Make-A-Wish does. I feel that the kind of urge that motivates people to do such things is a large part of why humanity is worth protecting in the first place. Although I agree that saving lives is typically more important than a particular other cause, and that it's usually what you should do if you have to choose, I think we should if at all possible avoid compromising high-level values -- such as by discouraging other forms of altruism -- in order to do so.

To put this in a broader context, I have a strong aversion to the mentality expressed in the second paragraph of this post. I fear that if we don't allocate some of our caring to particular humans in their individual capacities, people will come to be seen as dispensable -- and then, one day, I might be discarded, too. Since I greatly value my existence on good days and my autonomy even on the worst days, this is a nightmare scenario. I'm afraid of someone being tortured for 50 years to save 3^^^3 people the inconvenience of a dust speck. Yes, it may be the better option, if those are the only two choices, but that doesn't make it good.

Given that this is how I feel even when we're talking about existential risk -- saving the whole human species and its future -- I hope you can understand why similar-sounding arguments against small-scale fuzzy personal altruism in favor of anything less than existential risk reduction leave an especially bad taste in my mouth.

I'm the type of person who highly values fuzzies, to such an extent that I value others' valuing of fuzzies, and I don't want to push the culture in a direction toward hostility to valuing fuzzies. I think it's great if we can learn to be more rational in the pursuit of our goals, but anyone whose goals include trips to Disneyland for cancer patients doesn't have anything more to be ashamed of than someone whose goals include a new pair of shoes.