It is reasonable to ask the question, “you may be able to save a life in Africa, but will the child child you save from malaria likely die from something else soon after?" The question here is simply how many life-years will a given amount of money actually save?
Indeed, this is a very real, non-hypothetical question in health care within the developed world today, particularly for the old and infirm. We have gone so far in the direction of heroic and expensive interventions to preserve life, that many patients and people who fear they may become patients are actively advocating for the right to refuse treatment and die with dignity. This has led to the development of living wills, for example. Much of this may be due to other factors such as an insanely inefficient and irrational (1) health care system and the reluctance of doctors to provide sufficient pain relief out of misplaced concerns about addiction and demonization of effective narcotics.
Even taking these into account, it is certainly reasonable to account for other likely causes of death when calculating the lives saved for dollar. If X dollars are sufficient to save the life of a five year old with a 65-year life expectancy or a 70-year old with a 10 year life expectancy, and X dollars are all you have to spend, then by all means save the five year old. This is an emotionally difficult choice, one I hope never to face, but it's not especially controversial or challenging.
However, I find it morally repugnant to go from there to the incredibly patronizing position that a year of life for a poor person in the developing world is worth less than a year of life of a rich person in the developed world. I take as one of my fundamental moral principals that "All men are created equal." (2)
I am frankly astonished that people would suggest that "an average year of life in the developing world is no more than 3x lower than the value of an average year of life in the developed world." (I am, of course, not surprised that people would act as if this were true, but most folks are far too polite to say it. I doubt most folks are even consciously aware of this preference.) Have people really suggested this to you? Is this really an expressed concern of donors? The ethnocentrism of such a position is staggering.
In my own moral system, the only approach I accept is that every currently existing (3) person's year of life is worth as much as every other currently existing person's year of life, no more, no less. One criterion I have for where to direct my charity dollars is that the organizations I donate to act as if that were true, which as has been pointed out many times before by GiveWell and others means that most of my donations are directed toward work in the developing world because the same money goes further there. I do not accept that a life in the Congo is worth less than a life in Paris, even if one is on average more pleasant than the other.
(1) In the economic, not LessWrong sense of the word "rational"
(2) I include the usual modern explication of this phrase to include people of both genders in "men", and the understanding that this means "that they are endowed ...with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness", not that everyone is identical. Boring, well-known, straw man caricatures of the meaning of "equals" in this context will be ignored.
I have the impression that you're reading "no more than 3x lower than X" as meaning "<= X/3" when in fact I'm almost certain ">= X/3" is intended. In other words, the argument JonahSinick is making is: "You may consider that saving lives in the developing world is less valuable than saving lives in the developed world, because the extra years you provide that way are more pleasant ones; but even if so, it doesn't seem credible that there's more than a 3x difference, and even if we assume that developed-world years a...
In my last post I wrote about how Peter Singer’s implicit past claim that [one can save a child’s life for the cost of a pair of shoes] is misleading.
Having said that, it’s important to highlight that if one ignores indirect effects, funding bed net distribution to save lives is an extremely good opportunity for people in the developed world to increase the number of valuable years of life that people experience.
The situation is probably completely different when one considers indirect effects. I’ll postpone discussion of indirect effects to a later date.
Consider the question of what the quality of life is in the developing world. The GiveWell blog post Quality of life in the developing world reads:
The reader can draw his or her own conclusion from this. It seems likely to me that the average life in the developing world is worth living, and that the value of an average year of life in the developing world is no more than 3x lower than the value of an average year of life in the developed world.
In my last post, I wrote about how the explicit estimate for Against Malaria Foundation’s marginal cost per life saved is $2k, and the fact that the actual cost could be significantly higher owing to Bayesian regression.
Note: I formerly worked as a research analyst at GiveWell. All views are my own.