Tuesday, November 18, 2014

Health Improvement vs. Treatment

Appeals to quality-adjusted life-years (QALYs) in medical resource allocation decisions are naturally supported by a broadly utilitarian view of the role of health institutions, i.e. as having the purpose of improving social welfare (via health improvement) as much as possible.  But is that the right view to have? My colleague Mary recently pressed me on an intuitive alternative conception of healthcare as aiming at treating localized health problems rather than yielding global health benefits to patients.  Might that be a better view?

Monday, November 17, 2014

Kidney-Equivalent Donations

There's an interesting post over at the EA forums advocating live kidney donation as an effective way to do a lot of good.  The authors estimate that kidney donation to start a donor 'chain' could be expected to yield a benefit of approximately 14 quality-adjusted life-years (QALYs), with risks to the donor being much smaller than you might expect.  So that's cool.  Not something I'm inclined to do myself, but definitely a cool thing for those who are willing to follow the authors (and GiveWell's Alexander Berger) and go under the knife for their moral beliefs!

One thing that really struck me while reading this, though (and that also emerges in the comments to their post) is just how easy it is to do an equal amount of good through well-targeted financial donations.  Though GiveWell caution against putting too much weight on rough quantitative estimates, their top-rated charities appear to work at around $50 per QALY (see, e.g., these unofficial deworming estimates, and their estimate of bednets as costing at the margin around $3200 per life saved).  So perhaps we can think of each $700 (or £450) donated to GiveWell-recommended charities as a "kidney-equivalent donation".

Tuesday, November 04, 2014

Is There a Moral Duty to Cut Taxes?

So claims David Cameron (ungated version here):
It is morally right that the rich pay their fair share in tax; and right that those who are able to contribute to our public services and safety nets do so.
But what is morally wrong is government spending money as if it grows on trees. Every single pound of public money started as private earning. Every million in the Treasury represents a huge amount of hard work: early morning alarms, long commutes, hours spent on the factory floor, the office, the hospital ward or the classroom. [...]
No one should doubt my position: with every spending commitment we must be mindful of who picks up the bill. It's easy for governments to trumpet what they spend money on - and claim a moral victory for it - but on the other side of the coin are those who work hard, many on low incomes, who would desperately like to spend more money on their family. The government has a moral duty to think of these people in any decisions made on tax and spending.

Cameron is surely right that governments should not waste money (e.g. fighting harmful and unnecessary wars).  I'm also sympathetic to the thought that individual citizens -- especially those with low incomes -- will often be able to make better use of money than the government does. But this is no reason for tax breaks that disproportionately benefit the wealthy.  A better option would be to disburse the wealth as an unconditional basic income or fixed lump sum payment to each citizen.

Monday, October 27, 2014

Implicit Bias in Academic Service Expectations

I recently came across Brian Weatherson's excellent post from earlier in the year on "very junior [female] faculty doing demanding administrative tasks [...] at the level of workload of being a chair of a search committee."  He continues:
It is possible in principle that these faculty could be getting enough teaching relief that they have as much time for research as any other junior faculty. Even if so, I think it would be better to be teaching than doing admin. Teaching advanced courses is good for research, teaching lower level courses gives you re-usable teaching materials, and generally teaching is good training for teaching. No one cares how well you administrate; they do care how well you teach. In short, generous teaching reductions would make these administrative assignments less horrible, but wouldn’t I think make them acceptable.

There has been a growing awareness in recent years of the harms done by gendered implicit bias in academic hiring/recruitment. It would be good to see this awareness extend further in scope, to encompass the (all-too-familiar to many) harms of gendered implicit bias in service expectations and workloads.

Friday, October 17, 2014

Good Lives and Procreative Duties

Many philosophers seem inclined to accept
(Procreative Axiological Asymmetry): While it would be bad, or undesirable, to bring a miserable life into existence, it isn't good, or desirable, to bring an awesome life into existence.

in order to secure
(Procreative Deontic Asymmetry): While we are obliged to not bring miserable lives into existence, we are not obliged to bring awesome lives into existence.

Friday, September 26, 2014

Where QALYs Go Wrong

My paper 'Against "Saving Lives": Equal Concern and Differential Impact' defends the use of QALYs (Quality-Adjusted Life Years) in medical resource allocation against several traditional objections. But along the way, I note several respects in which (it seems to me) not all life years -- even in perfect health -- are equal, and hence a straightforward QALY-maximization approach falls short.  I'll briefly outline them below, and invite readers to suggest any further examples I may have missed...

Wednesday, September 24, 2014

Bostrom's Superintelligence - Does AI constitute an Existential Risk?

The folks at OUP kindly sent me a review copy of Nick Bostrom's new book Superintelligence, exploring AI risk.  It's a topic that lends itself to eyerolls and easy mockery ("Computers taking over the world? No thanks, I already saw that movie.") -- but I don't think that's quite fair.  So long as you accept that there's a non-trivial chance of an Artificial General Intelligence eventually being designed that surpasses human-level general intelligence, then Bostrom's cautionary discussion is surely one well worth having.  For he makes the case that imperfectly implemented AGI constitutes an existential risk more dangerous than asteroids or nuclear war. To mitigate that risk, we need to work out in advance if/how humanity could safely constrain or control an AGI more intelligent than we are.

Thursday, September 18, 2014

The "Double Jeopardy" Objection to QALYs

I've previously discussed Harris (1987)'s famous objection that the use of Quality-Adjusted Life Years (QALYs) in medical resource allocation is unjustly "discriminatory". Harris' second objection is that the use of QALYs gives rise to an unfair kind of “double jeopardy” (p.190):
QALYs dictate that because an individual is unfortunate, because she has once become a victim of disaster, we are required to visit upon her a second and perhaps graver misfortune. The first disaster leaves her with a poor quality of life and QALYs then require that in virtue of this she be ruled out as a candidate for lifesaving treatment, or at best, that she be given little or no chance of benefiting from what little amelioration her condition admits of. Her first disaster leaves her with a poor quality of life and when she presents herself for help, along come QALYs and finish her off!

Sunday, September 07, 2014

An Obligation to Abort? Moral Guidance vs. Reaction

Dawkins was widely condemned for his tweet a couple of weeks ago claiming that it would be "immoral" not to abort a fetus with Down Syndrome. The claim seems pretty implausible on its face if we read "immoral" in the "reactive" sense indicating blameworthiness or moral criticizability. But if we instead address the question of 1st-personal moral guidance -- if faced with this situation, what should I do? -- Dawkins' response strikes me as more defensible. (Dawkins' own elaboration seems to indicate that something more in this vicinity was indeed his intended meaning.)

Sunday, August 10, 2014

Normative Concepts

How do we get to have normative concepts?  What does it take for a concept to be the concept of ought, or of good, say?

It seems neither necessary nor sufficient that one be disposed to apply the concept to just the things that are actually good. On the one hand, you could be mistaken about what things are good whilst still possessing the concept.  On the other hand, you could have a non-normative concept which picks out the good items under some other, non-normative guise. (Suppose hedonism is true: the concept pleasure then picks out all the good things, but that doesn't make it the concept good.)