Thanks for this. I find it very strange that fetal anesthesia isnāt standard here: unless thereās some countervailing medical reason (risk to the mother?) or very significant expense involved, it seems like a clear moral improvement.
...see whether advocacy for fetal anesthesia is cost-effective enough to be competitive with leading global health interventions.
fwiw, I think a better comparison would be leading animal welfare interventions. Those seem more similarly targeted at raw suffering-reduction, whereas most āglobal health interventionsā serve to increase global productive capacity and so have positive expected flow-through effects that pure suffering-reduction does not. I grant that this is āhumanā rather than ānon-humanā, so I get where youāre coming from; Iām just suggesting that this isnāt actually the morally relevant distinction between the two cause areas.
(I should probably write a full post someday about why I think the standard breakdown of EA cause buckets isnāt well-conceived, even though it works well enough in practice because itās very close to something that I do think makes sense.)
I very much agree that itās a clear moral improvement unless thereās some strong countervailing consideration. I would guess the greatest practical difficulty would be the interventionās adjacency to politically contentious issues, which might make it intractable.
fwiw, I think a better comparison would be leading animal welfare interventions
I agree that there are many similarities between this proposal and animal welfare interventions. However, since I think the best animal welfare interventions are orders of magnitude more effective than GHD, Iād far rather GHD funding be diverted to this than animal welfare funding. I also just donāt think this intervention would be anywhere near the animal welfare cost-effectiveness bar, though it could conceivably pass the global health bar.
In the US, abortion is often a private-pay surgery, and so keeping costs low is seen as more of a concern than with procedures for which insurance is usually footing the bulk of the bill.
Iām not sure how difficult fetal anesthesia isāa skim suggests IM fetanyl might be used here. Injecting into the wrong area by accident seems easier than for a newborn, especially where the anesthesia is not performed by an experienced fetal surgeon.
I think the comparison group should be based on principle, rather than pragmatic considerations of which bucket youād rather divert funds from!
If itās true that GHD funds should be diverted to AW funds, then they should be diverted to AW funds, not to a very poor substitute for an AW cause.
I personally think it isnāt obvious that GHD funds should be so diverted, precisely because of their greater potential for flow-through effects. But of course if that is the basis for GHD funding having a lower ābarā than AW funding, it cannot justify applying the low (GHD) bar to this cause (which lacks potential flow-through benefits).
It might be that the strongest reason to prioritize GHD is because of flow-through effects, as youāve suggested. But I donāt think that those who prioritize GHD generally actually do so for that reason. They care about saving and improving peopleās lives in the near term, and the units they use (QALYs, income doublings, WELLBYs) and stories they tell (the drowning child) reflect that.
If GHD was trying to optimize for robustly increasing long-term human capacity, I think the GHD portfolio of interventions would look very different. It might include certain longtermist cause areas such as improving institutional decisionmaking. It would be surprising if the best interventions when optimizing for longterm flow-through effects were also the best when optimizing for immediate effects on individuals. If youāre optimizing for flow-through effects, I agree that itās non-obvious whether GHD or AW is better, but I think you probably shouldnāt be donating to either of those!
I think GHD donors choose GHD over AW simply because they care overwhelmingly more about humans than nonhuman animals. Thatās also why they usually ignore animal effects in their cost-effectiveness analyses, even though those effects would swamp the effects on humans for many GHD interventions. If they were trying to impartially help others in the near term, they would choose AW.
Hereās a classification of GHD/āAW which I think is more relevant to neartermistsā revealed preferences: The best impartial neartermist interventions are AW. The best neartermist interventions ignoring nonhuman animals are GHD. Under that classification, fetal welfare would be GHD.
I agree that most GHD donors donāt consciously conceive of things as Iāve suggested. But I think the most coherent idealization of their preferences would lead in the direction Iām suggesting. Itās even possible that they are subconsciously (and imperfectly) tracking something like my suggestion. It would be interesting to see whether most accept or reject the idea that fetal anesthesia or (say) elder care are ārelevantly similarā to saving children. Since metrics like QALYs (esp. for young people) and income-doublings correlate strongly with capacity growth, I donāt take them to be evidence either way.
I also agree that my suggested reconceptualization could lead to some broader changes to the GHD portfolio, though itās important not to forget the ārobustā part of it. If you have a pessimistic prior about narrowly-targeted attempts to improve the long-term future, general improvements to human health, education, and economic growth seem like a pretty natural alternative to me.
But Iām afraid Iāve gotten pretty far astray from the topic of your original post! Iāve drafted up an attempt to explain my views on EA ācause bucketsā more fully, and will aim to post it tomorrow. [Update: here!] Thanks again for the stimulating discussion.
Thanks for this. I find it very strange that fetal anesthesia isnāt standard here: unless thereās some countervailing medical reason (risk to the mother?) or very significant expense involved, it seems like a clear moral improvement.
fwiw, I think a better comparison would be leading animal welfare interventions. Those seem more similarly targeted at raw suffering-reduction, whereas most āglobal health interventionsā serve to increase global productive capacity and so have positive expected flow-through effects that pure suffering-reduction does not. I grant that this is āhumanā rather than ānon-humanā, so I get where youāre coming from; Iām just suggesting that this isnāt actually the morally relevant distinction between the two cause areas.
(I should probably write a full post someday about why I think the standard breakdown of EA cause buckets isnāt well-conceived, even though it works well enough in practice because itās very close to something that I do think makes sense.)
I very much agree that itās a clear moral improvement unless thereās some strong countervailing consideration. I would guess the greatest practical difficulty would be the interventionās adjacency to politically contentious issues, which might make it intractable.
I agree that there are many similarities between this proposal and animal welfare interventions. However, since I think the best animal welfare interventions are orders of magnitude more effective than GHD, Iād far rather GHD funding be diverted to this than animal welfare funding. I also just donāt think this intervention would be anywhere near the animal welfare cost-effectiveness bar, though it could conceivably pass the global health bar.
In the US, abortion is often a private-pay surgery, and so keeping costs low is seen as more of a concern than with procedures for which insurance is usually footing the bulk of the bill.
Iām not sure how difficult fetal anesthesia isāa skim suggests IM fetanyl might be used here. Injecting into the wrong area by accident seems easier than for a newborn, especially where the anesthesia is not performed by an experienced fetal surgeon.
I think the comparison group should be based on principle, rather than pragmatic considerations of which bucket youād rather divert funds from!
If itās true that GHD funds should be diverted to AW funds, then they should be diverted to AW funds, not to a very poor substitute for an AW cause.
I personally think it isnāt obvious that GHD funds should be so diverted, precisely because of their greater potential for flow-through effects. But of course if that is the basis for GHD funding having a lower ābarā than AW funding, it cannot justify applying the low (GHD) bar to this cause (which lacks potential flow-through benefits).
It might be that the strongest reason to prioritize GHD is because of flow-through effects, as youāve suggested. But I donāt think that those who prioritize GHD generally actually do so for that reason. They care about saving and improving peopleās lives in the near term, and the units they use (QALYs, income doublings, WELLBYs) and stories they tell (the drowning child) reflect that.
If GHD was trying to optimize for robustly increasing long-term human capacity, I think the GHD portfolio of interventions would look very different. It might include certain longtermist cause areas such as improving institutional decisionmaking. It would be surprising if the best interventions when optimizing for longterm flow-through effects were also the best when optimizing for immediate effects on individuals. If youāre optimizing for flow-through effects, I agree that itās non-obvious whether GHD or AW is better, but I think you probably shouldnāt be donating to either of those!
I think GHD donors choose GHD over AW simply because they care overwhelmingly more about humans than nonhuman animals. Thatās also why they usually ignore animal effects in their cost-effectiveness analyses, even though those effects would swamp the effects on humans for many GHD interventions. If they were trying to impartially help others in the near term, they would choose AW.
Hereās a classification of GHD/āAW which I think is more relevant to neartermistsā revealed preferences: The best impartial neartermist interventions are AW. The best neartermist interventions ignoring nonhuman animals are GHD. Under that classification, fetal welfare would be GHD.
Thanks, this has been a helpful discussion.
I agree that most GHD donors donāt consciously conceive of things as Iāve suggested. But I think the most coherent idealization of their preferences would lead in the direction Iām suggesting. Itās even possible that they are subconsciously (and imperfectly) tracking something like my suggestion. It would be interesting to see whether most accept or reject the idea that fetal anesthesia or (say) elder care are ārelevantly similarā to saving children. Since metrics like QALYs (esp. for young people) and income-doublings correlate strongly with capacity growth, I donāt take them to be evidence either way.
I also agree that my suggested reconceptualization could lead to some broader changes to the GHD portfolio, though itās important not to forget the ārobustā part of it. If you have a pessimistic prior about narrowly-targeted attempts to improve the long-term future, general improvements to human health, education, and economic growth seem like a pretty natural alternative to me.
But Iām afraid Iāve gotten pretty far astray from the topic of your original post! Iāve drafted up an attempt to explain my views on EA ācause bucketsā more fully, and will aim to post it tomorrow. [Update: here!] Thanks again for the stimulating discussion.