Thanks, Toby! I think we’ve always interpreted our mission—questioning existing norms in medicine, science, and public health—pretty broadly. This episode is less closely tied to bioethics than most (though heavier on the norm questioning), with the link being that longtermism and David’s work have significant implications for priority setting in research and global health (eg, pandemic vs malaria prevention).
Leah Pierson
Karma: 159
Speaking only for myself, not co-authors: I think the concept of personhood has become highly politicized in the US, due largely to abortion laws that attempt to limit reproductive rights by conferring legal personhood on fetuses. Medical organizations have come out strongly against this, e.g.:
The American College of Obstetricians and Gynecologists (ACOG) opposes any proposals, laws, or policies that attempt to confer “personhood” to a fertilized egg, embryo, or fetus. These laws and policies are used to limit, restrict, or outright prohibit access to care for women and people seeking reproductive health care, including those who are pregnant, those who are trying to prevent pregnancy, and those who are trying to become pregnant, and they have been used as the basis of surveillance and prosecution of pregnant people.
Our results suggest that US bioethicists overwhelmingly believe that abortion is ethically permissible, and it’s thus possible that their responses to the “A being becomes a person...” question were influenced by their views on the permissibility of abortion and wariness about how concepts of personhood are being used to restrict access to reproductive care.
(Separately, you may also be interested in this recent paper.)
Feel free to DM me your email; I can send you a PDF!
Speaking only for myself (not coauthors), I agree it’s a surprising result! That said, I think their position may be more nuanced than is evidenced by their responses to this question alone, because their responses to a related question are as follows:
When deciding which patients are eligible for an expensive treatment, it is permissible to consider:
The patient’s expected post-treatment quality and length of life (71%)
The patient’s expected post-treatment quality but not length of life (8%)
The patient’s expected post-treatment length but not quality of life (9%)
Neither the patient’s expected post-treatment quality nor length of life (12%)
I think the apparent discrepancy between respondents’ answers to these two similar questions may be partly explained by the fact that people found it difficult to choose between, e.g., a 25-, 10-, and 1-year-old, and so basically treated “equally important” as “unsure.” To put this slightly differently, I suspect if we had asked “Is preventing a death equally important irrespective of age?” and had given “yes” and “no” as answer choices, a much larger percentage would have said “no.”
We asked David about longtermists’ responses to his work in the podcast episode we did with him. Here’s the (rough, automatically generated) transcript, but you can listen to the relevant section here; it starts at ~33:50.
David: I think to contextualize that, let me use the word I’m going to use in my book, namely a strategy of shedding zeros. So, longtermists say, look, the axiological case for longtermism is 10 orders of magnitude or 15 orders of magnitude better than the case for competing short-termist interventions.
So, therefore, unless you are radically non-consequentialist, longtermism is going to win at the level. And I want to chip away a lot of zeros in those value estimates, and then maybe do some other deontic things too. And so if the longtermist is just in one swoop gonna hand me five or ten or twenty zeros, I think there’s two things to say. The first is they might run out of zeros just there.
5, 10, 20 orders of magnitude is a lot. But the second is this isn’t the only time I’m gonna ask them for some orders of magnitude back. And this thing that they do, which is correct, is they point at every single argument I make and they say “I can afford to pay that cost and that cost and that cost.” But the question is whether they can afford to pay them all together, and I think, at least as the line of the argument in my book, that if we’re really tossing orders of magnitude around that freely, we’re probably going to run out of orders of magnitude quite quickly.
Leah: Got it. Okay. And, I just want to follow up on the last thing you said. So has that been the response of the people who are writing on these issues? Like, do they read your work and say, yeah, I concede that?
David: I get, well, sometimes it’s concessive, sometimes it’s not, but almost always, somebody raised their hand, they say, David, couldn’t I believe that, and still be a longtermist? So I had to rewrite some of the demographics section in my paper. They said, look, aren’t you uncertain about demographics?
Maybe there’s a 10 to the 8th probability I’m right about demographics, so maybe I lose eight orders of magnitude, and the response there is, okay, maybe you do. And then they’ll say about the time of perils, maybe there’s a 10 to the 9th chance I’m right about the time of perils, maybe I lose nine orders of magnitude, and okay, you do.
Obviously, we have a disagreement about how many orders of magnitude are lost each time, but I think it’s a response I see in isolation every time I give a paper, and I’d like people to see it as a response that works in isolation, but can’t just keep being repeated.