EA - The elephant in the bednet: the importance of philosophy when choosing between extending and improving lives by MichaelPlant

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: The elephant in the bednet: the importance of philosophy when choosing between extending and improving lives, published by MichaelPlant on November 18, 2022 on The Effective Altruism Forum.Michael Plant, Joel McGuire, and Samuel DupretSummaryHow should we compare the value of extending lives to improving lives? Doing so requires us to make various philosophical assumptions, either implicitly or explicitly. But these choices are rarely acknowledged or discussed by decision-makers, all of them are controversial, and they have significant implications for how resources should be distributed.We set out two crucial philosophical issues: (A) an account of the badness of death, how to determine the relative value of deaths at different ages, and (B) locating the neutral point, the place on the wellbeing scale at which life is neither good nor bad for someone. We then illustrate how different choices for (A) and (B) alter the cost-effectiveness of three charities which operate in low-income countries, provide different interventions, and are considered to be some of the most cost-effective ways to help others: Against Malaria Foundation (insecticide-treated nets), GiveDirectly (cash transfers), and StrongMinds (group therapy for depression). We assess all three in terms of wellbeing-adjusted life years (WELLBYs) and explain why we do not, and cannot, use standard health metrics (QALYs and DALYs) for this purpose. We show how much cost-effectiveness changes by shifting from one extreme of (reasonable) opinion to the other. At one end, AMF is 1.3x better than StrongMinds.At the other, StrongMinds is 12x better than AMF. We do not advocate for any particular view. Our aim is simply to show that these philosophical choices are decision-relevant and merit further discussion.Our results are displayed in the chart below, which plots the cost-effectiveness of the three charities in WELLBYs/$1,000.StrongMinds and GiveDirectly are represented with flat, dashed lines because their cost-effectiveness does not change under the different assumptions. The changes in AMF’s cost-effectiveness are a result of two varying factors. One is using different accounts of the badness of death, that is, ways to assign value to saving lives at different ages; these three accounts go by unintuitive names in the philosophical literature, so we’ve put a slogan in brackets after each one to clarify their differences: deprivationism (prioritise the youngest), the time-relative interest account (prioritise older children over infants), and Epicureanism (death isn’t bad for anyone – prioritise living well, not living long). We also consider including two variants of the time-relative interest account (TRIA); on these, life has a maximum value at the ages of either 5 or 25.The other factor is where to locate the neutral point, the place at which someone has overall zero wellbeing, on a 0-10 life satisfaction scale; we assess that as being at each location between 0/10 and 5/10. As you can see, AMF’s cost-effectiveness changes a lot. It is only more cost-effective than StrongMinds if you adopt deprivationism and place the neutral point below 1.1. IntroductionHow should we compare the value of extending lives to improving lives? Let’s focus our minds with a real choice. On current estimates, for around $4,500, you can expect to save one child’s life by providing insecticide-treated nets (ITNs). Alternatively, that sum could provide a $1,000 cash transfer to four-and-a-half families living in extreme poverty ($1,000 is about a year’s household income). The cost of both choices is the same, but the outcomes differ. Which one will do the most good?This is a difficult and discomforting ethical question. How might we answer it? And how much would different answers change the priorities?There are various m...