The Lives We Can Save

And the lives we must save

I work as a Resident Assistant at my college. Last year, only a few weeks into me starting, I was called at night to come help with a drunk student. I didn’t actually help very much, and probably didn’t have to be there. I didn’t even have to write up the report at the end. At one point I went outside to let medical services into the building, but mostly I just stood in a hallway.

The person in question was so drunk they couldn’t move. They had puked in the bathroom and were lying in the hallway crying. They could barely talk. When Campus Safety arrived they kneeled down next to this person and helped them drink water, while asking the normal slew of questions about the person’s evening.

They asked this person, whose name I can’t even remember, why they had been drinking so much. They said, in between hiccups and sobs, “friend doesn’t want to be friend anymore.”

How do you describe that feeling? I don’t think transcription can convey the misery and the drunkenness and the awful situation that had led to this awful situation. Someone drank so much that they could barely move, was lying curled in a hallway where all the other residents could and were watching, and was only able to muster out “friend doesn’t want to be friend anymore” as they cried.

Should I only care because I happened to be standing in that hallway on a late September evening? Had I remained in my room, laughing with my friends, would this person’s struggle have been worth nothing?

—Max Alexander (this whole post is very worth reading)!

It’s sometimes hard to be motivated to help the world. The trip you forego, the fun you could have had with a friend, the nice things you could have bought are instead sent straight into the coffers of some charity that you’ve read about. It can feel sort of alienating when you think just of the number of people you have saved. Instead of thinking of numbers, think of stories. The people who make up the numbers—who make up the hundreds of thousands of lives saved by effective charities—are real, flesh-and-blood people, who matter just as much as you and I. We may not look into the gaunt faces of those who would have otherwise starved to death, we may not see their suffering with our eyes, but we know it is real. People are dying in ways that we can prevent. GiveWell top charities can save lives for only a few thousand dollars.

It’s hard to get your mind around that. I have a friend who has raised over 50,000 dollars for effective charities. 10 lives. 10 people. 10 people, many of them children, who will be able to live out a full life, rather than being snuffed out at a young age by a horrible painful disease. They will not have to lie in bed, with a fever of 105, slowly dying of malaria when they are five. They will have the chance to grow up.

Who are these people? I do not know. But I can imagine their stories. I can imagine their stories because I can hear the stories of other people like this, people who are about to die. For example, on this Reddit thread, you can find the stories of lots of people who are about to die. Stories like these:

Stage IV colon cancer here. Age 35. I'm a single mum to a 1-year-old and there is a 94% chance I'll be dead in 4 years. But there is still a wee bit of hope, so I try to hold onto that (hard to do most days). My days are filled with spending time with my baby and hoping that I live long enough that she'll remember me. She's pretty awesome and makes me laugh every day, so there is a lot of happiness in this life of mine.

Reading these stories causes me to tear up. I think a lot of people have a similar response. They’re so tragic—entire lives being snuffed out. The line “My days are filled with spending time with my baby and hoping that I live long enough that she'll remember me,” is one of the saddest things I’ve ever read. These are probably people who cannot be helped. But there are so many others who can be helped, at minimal personal cost, who each of us can help. People like this:

I have cystic fibrosis. I'm trying to achieve so many things normal people have, but are harder because of my CF. I want a boyfriend, and to eventually get married before I'm too ill. I just got my first post graduate school job, after moving across the world. I'm very, very afraid of the future, but I have some truly wonderful friends I can vent to, and my parents are very supportive. There's a lot of fear in my life- I've never pretended to be one of those patients who sets out to be a role model and an inspiration. I have break downs a lot. I struggle mentally and physically every day, and I may move back home soon, as my lung function has declined a lot in the past few months, but at least home has video games.

Somehow, a single paragraph of explanation can transform someone from nameless and faceless to someone that I deeply care about. When I hear this person’s story, I feel willing to give up a nice vacation or two to help them. I feel willing to take a different job to help avert this person’s misery, to enable them to live a healthy life. And I think most people feel that way too.

When framed in these terms, the conclusion that you should use the opportunity you have, as one of the richest sliver of people to ever live, even if you’re at well below middle-class income, to save the lives of people like this doesn’t seem like a counterintuitive proposal. It’s not the kind of thing that you have to be argued into believing, by way of ponds and abstruse philosophical arguments about distance. You don’t need a philosophical argument to realize that you should spend 4,000 dollars to save him:

I will die a slow, painful death.

I have CML, will progress to AML eventually, and then to death unless some miracle drug comes out in the next few years.

With the medication I take, the results are still relatively young - Gleevec has only been around for a short time, so it's still hit or miss on how people will take to the medication, how long it will take them to build a resistance to the medication, etc.

I should have been dead a few years ago, CML progressing to AML usually only takes a year or two give or take, and then it's a quick road down the painful death at the end.

I live my life rather slovenly, I quit working a few months ago as I kept getting sick, kept getting shit from work from being sick all the time, was tired of having to explain to people how somebody with cancer could appear to be so healthy i.e. not skinny frail and miserable all the time.

So now I spend my time at home, playing housemaid while my wife works. I read a lot, I play video games, I browse the internet for long periods of time, honestly pretty boring, but I'm just killing time as there really isn't much else I could be doing.

When I find it hard to intuitively be willing to make personal sacrifices to help faraway strangers, I imagine the sacrifices I’d want faraway strangers to make for me, or for my friends. If one of my friends was dying, and a stranger could save her life but instead decided to go on vacation, I’d feel she’d have a duty to forego the vacation and save my friends life. And yet we are those strangers who can save lives. Who can make it so that one fewer child has to sit in bed with a fever of 105, their brain becoming damaged, chills racking their body, until their heart eventually stops.

I heard a story recently about a young boy named Abdul. He was only five or so years of age. He was sick frequently—going to the hospital multiple times per month. And when it went dark outside, he went blind.

Imagine how terrifying it is to be five years old and to go blind whenever the sun goes down.

I remember I used to be scared of the dark. And I didn’t go blind whenever it was dark. It’s hard to imagine just how terrifying this is—to be sick constantly, to be blind at night, to have terrified parents who don’t know how to help you, but who want to help you, more than anything. Parents who try to comfort you but are themselves terrified.

Abdul did get help. He got help because of one of the most effective charities in the world—Helen Keller International. He was deficient in Vitamin A. Vitamin A allows us to see in the dark, and so Abdul couldn’t do that when it went dark. Vitamin A deficiency leads to a weakened immune system, leading to often fatal disease. It also leads to blindness in millions of people. HKI notes:

1 in every 7 people worldwide are living with vision loss because they lack access to care.

Some 43 million of them are blind. Yet many of them didn’t have to lose their sight. A staggering 90% of all vision loss is preventable or treatable.

It costs only a few thousand dollars to save a life if the money is given to HKI. It costs $1.10 cents to distribute a Vitamin A capsule. $1.10! It costs so little to avert such an extreme cause of misery.

My grandfather died before I turned 13. He was one of the kindest people I ever knew. I think about him rather often. He just embodied decency and virtue and love and kindness and all the other virtues. I’ve heard multiple people describe him as the best man they ever knew, and I think he’s probably the most morally upright person I’ve ever met.

He was an intellectual. I recently read his master’s thesis about Matthew Arnold. He’d have loved to discuss it with me, just as he liked to discuss many intellectual matters.

He loved to talk to strangers. I remember one time, as we were standing in line at El Pollo Loco, he noticed a stranger who had multiple sets of car keys. The guy looked intimidating—he was ripped and had tattoos. Most people would have been frightened to talk to him. Not my grandfather, however; he went up to him and asked why he had multiple keys. They had a lengthy conversation about it—I think the guy collected cars.

I often think about my grandfather. I wonder what he’d think about effective altruism, for instance. I think he’d be a fan. I wish I could have seen him at my bar Mitzvah, and my cousins’ Bar Mitzvah. I wish I could call him, hug him, tell him about the things I’ve learned in college, discuss things with him, figure out what he thinks about anything that happened after 2016.

In the end, there was nothing anyone could do for him. Nothing could stop his cancer. But if there was something people could do, if someone could have prevented his death for minimal cost but chose not to, then if they failed to do so, that would be unforgivable. But how is that different from what most of us do, when we spend thousands of dollars on a nice car, when that money could have saved multiple lives?

When I think about my grandfather, and what I or any member of my family would give to have just one more day with him, to give him the opportunity to see my cousins’ upcoming Bar Mitzvah, it becomes obvious that it’s worth making costs to save lives. The life of a person, however far away is worth more than a few thousand dollars, is worth more than a cheap car.

When I think about my grandfather, it becomes clear that donating lots of money to charities that demonstrably save lives is morally required. If you live on more income than almost all people ever, and you’re not willing to give even 10% of it to save hundreds of lives, then I think you are failing in your duty. If you have the opportunity to save dozens of lives, but prefer to slightly elevate your standard of living, then I think you are doing something wrong.

So please, friends, sign the giving pledge or at least the one for the world pledge. These pledges are automatic. They make it so that you can save hundreds of lives while taking a minor haircut—of either 10% of your income or 1%. Surely 1% of your income is less valuable than many lives. Do it for the people who will die if you don’t, people like Abdul and my grandfather and the various people whose deaths cannot be averted, who lament their tragic fates on reddit. Do it for the people hoping they won’t die, hoping that they’ll live long enough so that their child remembers them.

This minor haircut to your income won’t significantly undermine your ability to engage in valuable activities. But even if it does, even if you can’t go on the vacations you’d want to because of the donations, don’t think of that as a sacrifice. Because the life of an ENTIRE. LIVING. CHILD is much more valuable than whatever else you would have spent it on. A human full of hopes and dreams and aspirations, who can live a full life, who, if you fail to act, will be just as regretful as the people on reddit, pining about the tragedy of their upcoming demise can be saved by you. Don’t just think of your donations as going into the void—think of the concrete person, like you or me, who you can save. And when one does that, giving becomes easier. It’s impossible to empathize with a number, but easy to empathize with a terrified and sick adorable five-year-old child, who just wants to play, but instead must lie in bed as his organs fail, experiencing more pain than you or I ever will.

Let me close with a quote by Derek Thompson, written after the death of his mother, explains why he gives to prevent malaria deaths:

Malaria is not merely the greatest killer of children in the world, but also it is the greatest killer of pregnant women. The disease plunders motherhood from both sides of the equation. The loss of a mother must be quantifiable by some measure of creative accounting, but in my experience it is immeasurable. This much I knew: There is the thing that I want, I cannot have it, but I can give it to somebody else.