You Can Save A Life

Yes, you.

You’re right to be skeptical. Charities are in the business of getting donations, and they’ll say any number of things to get your attention. Even generally well-regarded organizations have wasted donor money. The Red Cross raised almost half a billion dollars for earthquake relief back in 2010 and then only built 6 homes. The Wounded Warrior Project redirected millions to lavish employee retreats. A healthy dose of cynicism is worthwhile. But how can we know when charities are actually worth supporting?

Let me tell you about something cool. Back in 2007, a bunch of incredibly skeptical people got together and worked to quantify charitable impact. All they wanted to do was determine which charities were doing the most good so that they could figure out where to donate that year. Should be simple, right? So they dug into the data: randomized control trials tracking what kinds of programs saved lives; program data showing how well those programs were implemented in practice. They realized that this was a harder task than they’d initially anticipated, and found surprising results: their math suggested enormous variation between different programs at how cheaply they could save a life, from $2,000 to more than $100,000. 

They quit their jobs to do this full-time; their work became GiveWell, which has done over 300,000 hours of research into which charities are saving lives most effectively. Right now, they recommend four organizations working in sub-Saharan Africa, and they estimate that these organizations can save a life for about $5,000 through programs that distribute malaria nets or increase vaccine uptake, among others.

Look at this beautiful spreadsheet! (Screenshot from “2023 GiveWell cost-effectiveness analysis – version 4 (public)”

I trust GiveWell’s work. You can look at their spreadsheets yourself: spreadsheets with hundreds of rows and daunting phrases like “fungibility adjustments” and “serotype replacement.” This kind of work will always be uncertain because the world is inherently uncertain; this kind of work should not constitute the entirety of our charitable endeavors, because some things can’t be quantified. But I think this skeptical, quantified approach is one of the best ways to do charity.

Okay, so you can, in expectation, save a life for $5,000. What does this mean? 

In my mind, this has significant moral implications for anyone who could plausibly donate that kind of money. Nearly everyone sees directly saving a life as an unambiguously heroic and commendable action. Most folks see failing to directly save a life, when you could easily act otherwise, as unambiguously bad. But this logic is not typically extended to less direct ways of saving lives or failing to do so. 

Our brains like specificity. If you save Alice from a burning building – the gut-wrenching choice to run into danger; the sweat streaming down your face; her look of horror as you shift aside a fallen log; her sobs as you drag her back to safety; the ash beneath your feet – you receive all sorts of confirmation that your actions were directly responsible for what happened, and that you averted the death of a real, live human being. If you donate $5,000 (hypothetical example!) to a vetted charity that, I dunno, successfully advocates for fire safety codes across Nigeria, and your donation averts one death in expectation, you don’t receive much positive feedback at all. Maybe you feel nice after you hit “donate” for a bit, and then your brain moves on.

Feels pretty morally urgent (although I would not advise going into that building)

I’m going to diverge from orthodoxy a bit here: I don’t think our brains are totally wrong to treat these two cases differently. There is a meaningful difference between saving someone from a burning building and saving them through donating money to an effective charity. In the first example, you both have greater certainty and deserve more of the credit. Charities can address the former by running evidence-based programming and measuring their work, but external work will inevitably have less certainty than change you create firsthand.

Regarding the latter, when you save someone from a burning building, you get all of the credit, versus donating to a charity, whose work relies on a range of actors: the charity running the program; the aid workers running it; the people who developed the intervention; the people who rigorously evaluated it; even the evaluator recommending it! Still, many organizations doing phenomenal work are currently funding constrained: if you give them money, it will allow them to run programming that they couldn’t otherwise, and therefore save lives that they couldn’t otherwise. Donors deserve a substantial amount of credit for the impact that happens in these contexts.

Okay, so these cases are somewhat different. But I don’t think they’re that different. If I could either save 1 person from a burning building or 5 through donations, I would definitely pick the latter. Let’s put that as a lower bar, then – saving 5 lives through donations (right now, $25,000) is worth at least one burning-building rescue. That’s incredibly cheap! On most levels, the value of a human life can obviously not be quantified in a dollar amount – in fact, there’s something deeply offensive about that notion. But in order to make tough decisions about policy regulations, that’s something that the US government actually does. Various agencies ranging from FEMA to the EPA value a life at 7.4-9.6 million dollars. (By the way, the lower bound on that is 296x our conservative “burning building rescue” amount and 1,480x the GiveWell estimated amount to save a life through its recommended charities.)

If I could save a loved one from dying, there’s no monetary price that would feel too high. I’m sure the same is true for those who die of hunger or poverty or malaria: many of their loved ones would pay any price to help. They’re usually not in the position to do so, beset themselves by similar issues. But you are.

I want you to stop reading for a minute and reflect on that fact: you can save someone's life.

No, actually; take a minute.

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If I saved someone from a burning building, that would feel like one of the most meaningful actions of my entire life. I would feel fantastic! And I would also probably get lots of social credit. Flattering news articles; maybe some sort of town award. We give way less than 20% of the internal psychological credit or external social credit to people who save lives through donations rather than their direct actions, and this actively leads folks astray in their decision-making. It’s certainly affected my own decision making.

Making a donation can feel bloodless, but there are real humans being affected on the other end

Look, talking about donations is awkward. Effective altruism is really important to me, but I didn’t talk to many of my close friends about it for over five (!) years because I felt uncomfortable bringing it up. It’s difficult to talk about ethics in a way that doesn’t sound like you’re shaming those who disagree. Last week was the first time I’ve ever posted on social media about my donations; I’m nervous about posting this essay. I don’t think we should be excessive about this – donations mean money, and many people have complex money situations, and people certainly shouldn’t feel pressured to make choices that are bad for them. But I also don’t think we should be nearly as shy as we currently are.

Look, most people in the world do not have a spare $5,000 to save a life. But many people in high-income countries do, however, at least over the course of several years. It’s easy to underestimate the scope of income inequality globally. If you make more than $19,000/year (post-tax), you’re in the top 10% of global incomes. More than $60,000/year – you are the global 1%. In America, mentioning the 1% typically invokes images of folks in tuxes drinking champagne; when you take a global perspective, things look different. In fact, a huge chunk of Americans are in the top 1-5% of global income.

This is what the (global) 1% looks like

I don’t know your financial situation. Many people are tight on money. If you don’t have enough to take care of yourself or your family, you certainly shouldn’t stress about charitable donations. But if it’s possible for you, it’s worth joining those who make conscious choices to spend less money so that they can donate more. Some folks eat out less; spend less on vacation; or emphasize free rather than paid sources of entertainment. Honestly, a lot of the EAs who reduce their spending in order to donate more still live comparatively lavish lifestyles (e.g. living in expensive places like Cambridge/London/SF; buying organic food; etc.) – often it’s a matter of optimizing spending, and the image of folks eating rice and beans to donate more for malaria nets is rarely true.

Everyone will make different moral choices. But from where I stand, it’s worth making some personal financial sacrifices in order to help others. Absolutely take care of your needs, and the needs of those who depend on you. Satisfy many of your wants. But not all of them. Eat out some of the time, sure, but occasionally stay home instead. Take a vacation – but not the most expensive one you can afford. And then take the money you saved and use it on one of the most meaningful things you can do with your life: genuinely save someone’s life.

Our brains and our social norms push us to see those we save from burning buildings as real people, while those we help from afar are merely numbers. But the people we are helping from afar are just as human, even if we cannot see their faces. Their lives are just as worthy of dignity; their deaths are as much of an unspeakable tragedy.

There’s a girl named Fatima. She lives in a small village in rural Nigeria. She’s going to get malaria in a few weeks, and it’s going to kill her. Malaria Consortium is planning to distribute medication to treat malaria in nearby townships next month, but they won’t reach Fatima, because her village is slightly below the cost-effectiveness “bar” established by evaluators. If they get additional funding, they can reach her village, and it will save her life. 

I made up that example, but it’s a decently representative evocation of how these things work. Your money could potentially be saving lives right now; you have chosen to act otherwise. At this exact moment, you are walking by a burning building. We all are. You can’t see it, but it’s there, and the people who are dying are just as real as you or me. 

You have an opportunity. You can be the hero; you can sprint into the burning building and save someone’s life – maybe even many someones. No smoke inhalation required. 

All you have to do is sit down and decide to shift some of your donations to more effective charities, ones recommended by evaluators like GiveWell or The Life You Can Save, or decide to spend less money on some areas and redirect it to those donations, or decide that donating isn’t possible right now, but maybe it is in the future, or maybe it never will be but you can tell a friend.

You can save a life. Yes, you.