Contra Schiller on Neoliberal Brainworms

Effective Altruism ≠ Effective Capitalism

An infant covered by an insecticide-treated bed net (image source)

I recently read an interview with political philosopher Amy Schiller titled “The Problems of Modern Philanthropy.” The interview put into words some things I’ve felt in the past but never articulated (I thought Schiller’s phrase “the exchange rate for generosity” was a particularly smart coinage), and I have no doubt her book is a fascinating read.

But there was one answer that really rubbed me the wrong way. Specifically, Schiller’s argument against the common philanthropic metric “Quality-Adjusted Life Years” (QALYs):

Effective Altruists evaluate charities with very utilitarian metrics: their impact has to be quantifiable, and it has to strive for volume over depth. If more people get a minimal improvement, that’s far better than fewer people getting a deeper, more holistic benefit.

One of these metrics is QALY[s], “quality-adjusted life years.” It’s used in a lot of public health and other settings, but in Effective Altruism it becomes a kind of absolutist lens through which all human benefit is defined as whether a person gains more healthy and economically productive years of life.

That’s why I consider Effective Altruism to be more like “global labor force and population management.” Its “altruism” only seeks to maximize the number of economically productive actors in the world. So the idea of “return on investment” is at its full expression here — human beings need to provide the best bang for the buck, the best return on an up-front benefit (say, a bed net to prevent malaria that then means you don’t die from that disease and can keep working). Keeping people alive and economically productive is not an act of love for their humanity — it’s instrumentalizing people the way capitalism always does, defining our value by our future economic potential. [emphasis mine]

The first claim here is true: EA does rely primarily on utilitarian metrics, and QALYs are one of those metrics.

But the second part—the part about how modern philanthropy isn’t really motivated by a love of humanity—is a total straw-man.¹ This is a line of attack that amounts to little more than “Effective Altruism rhymes with Effective CAPITALISM, gotcha.”²

Wikipedia defines QALY as “a measure of the value of health outcomes to the people who experience them. It combines two different benefits of treatment—length of life and quality of life—into a single number that can be compared across different types of treatments.” Nowhere does the article say that the goal of maximizing QALYs is to stimulate productivity or economic growth.³ That particular motive is a leap Schiller seems to have made on her own.

Here’s the fuller truth Schiller doesn’t acknowledge: Yes, healthy people are able to work more—but providing malaria bed nets is worthwhile not simply so people “don’t die from that disease and can keep working.” It’s also worthwhile so they don’t die and can produce art, or play sports, or spend time with the people they love; because not only may the next Bill Gates or Sundar Pichai be living in extreme poverty but so too may the next Frida Kahlo or Bob Dylan or Toni Morrison. In fact, improving people’s basic health and livelihood is the prerequisite for “deeper, more holistic” benefits—not a Trojan Horse for investment capital.

Do QALYs capture everything that makes life worth living? No, obviously not. Is utilitarianism a totally airtight moral philosophy? No; it’s easy to find edge cases and repugnant conclusions. Personally, I find utilitarianism less helpful than commonsensical morality for working through individual, everyday dilemmas. But when you need to make decisions as megadonor or a foundation or a government agency—when you’re distributing huge amounts of money, and need to aggregate a lot of different viewpoints and tradeoffs—QALYs seem like a necessary and sensible metric to use.

I find it telling, too, that Schiller’s go-to positive examples are building schools and libraries. I like schools and libraries! If I had billions of dollars, I’d probably throw a few million to these kinds of cultural institutions. Yet note what her primary justifications for them are: that their donors are “human and grounded and connected to deep emotional experiences,” and that they are “beautiful spaces that confer a sense of dignity to everyone who enters them.”

I wholeheartedly agree.

But what does this logic say about those who stand to gain the most QALYs from modern philanthropy? Are they not human too? Might not their net-protected spaces—the spaces where they sleep and love, the spaces where they dream—also confer to all a sense of dignity and beauty?

1. (Or at best, a tin-man.)

2. Actually, it doesn’t…? And even if it did, it's ok for things we like to have some overlap with things we don't like. Everything has some overlap with everything!

3. The closest the article comes is a line that one measure of health quality is “standard descriptive systems such as the EuroQol Group’s EQ-5D questionnaire, which categorises health states according to five dimensions: mobility, self-care, usual activities (e.g. work, study, homework or leisure activities), pain/discomfort and anxiety/depression.” In other words, for just one method of calculating QALYs, “work” is a sub-category of a category.