Repugnant Interventions - Doublethink in Global Prioritization Outline: 1) Global prioritisation: child mortality, family planning and the cancellation worry 2) Making it quantitative: the benefit-cost approach 3) CBA for child mortality reduction 3.1) Arguments for not counting ‘knock-on effects’ 3.2) Critique of the CBA 4) CBA for family planning 4.1) An excursion into population axiology 4.2) Critique of the CBA 5) Conclusions Summary / Conclusions: • Child mortality and family planning are both (fairly) frequently cited as ‘top picks’ in global prioritisation. • This is prima facie curious, since the most-obvious effect of the second intervention is precisely to undo the most-obvious effect of the first. • Benefit-cost analyses (indeed) only manage to make both interventions simultaneously come out as ‘top picks’ by engaging in ‘doublethink’: making inconsistent decisions as to which effects (‘direct’ vs ‘indirect’) to count vs disregard, across the two interventions. • Analyses of mortality-reduction projects neglect indirect (e.g. economic) effects. • There may be a case for ignoring such effects in some contexts (e.g. doctor-patient relationships), but not at the level of global prioritisation. • Analyses of family planning programs ignore the (‘direct’) ‘value of lives not born’, counting only the ‘indirect’ effects on others. • This presupposes a person-affecting and/or an average-utilitarian approach to population ethics. Those approaches are initially intuitive, but ultimately indefensible. • There is a resulting danger that we are currently wasting billions of dollars per year, by doing and then undoing good. • To fix this: More sophisticated analysis, including serious attempts to put neo-Malthusianism and the value of individual additional lives in dialogue with one another, is required. Video of talk: https://www.youtube.com/watch?v=QCoYq7kzcH0 Hilary Greaves is Associate Professor in Philosophy at the University of Oxford, specializing in moral philosophy. She is currently particularly interested in what moral philosophy has to say about actions that affect the number of people who will live, and in connecting abstract theoretical work in this area to real-world issues that are relevant to public policy and philanthropic intervention. Oxford Bio: users.ox.ac.uk/~mert2255/

1. Population ethics meets
cause prioritisation
Hilary Greaves
Philosophy, Oxford

2. Outline
1) Global prioritisation: child mortality, family planning and the
cancellation worry
2) Making it quantitative: the benefit-cost approach
3) The relevance of ‘population ethics’: the ‘neutrality
intuition’ vs ‘total utilitarianism’
4) Benefit-cost analysis through the lens of total utilitarianism

3. Two top priorities? Child
mortality and family planning
• The big question of global prioritisation: How best to improve
the world?
• Difficult issues surrounding
• Which improvements can (reliably) be made
• How to trade off different types of benefit against one another
• Tough choices: not everything that is good is a top priority
• Two ‘top picks’:
• Reducing child mortality (e.g. GiveWell/GWWC’s
recommendation of AMF)
• Family planning (e.g. the 2012 Copenhagen Consensus)
• Highly regarded esp. by ‘neo-Malthusians’, concerned about
overpopulation

4. The cancellation worry
• The net effect of
funding both child
mortality reduction
and family planning,
is to prevent some
short lives.
• Not really: to ‘save’
life-years
• And not: to reduce
the instantaneous
population size
• This may well be
good to some extent.
But how good? (Still a
‘top pick’?)
No
intervention
Life-saving
intervention
alone
Both
interventions
together
Family
planning
intervention
alone

5. Making it quantitative: prioritisation
via cost-benefit analysis (CBA)
• The quantitative question: Granted that Intervention X is
good, how good is it, and how much does it cost?
• The top-priority interventions are those with the highest
benefit:cost ratio.
• Existing CBAs for child mortality reduction count only the
‘direct’ effect of saving the child’s life (i.e., more life-years for
that child).
• And not: any negative effects of ‘increased overpopulation’ on
others.
• Existing CBAs for family planning count only the ‘indirect’
effects of preventing a birth: e.g., the resource-depletion and
economic-growth effects for the rest of society.
• And not: the loss of the intrinsic value that the ‘averted life’
would itself have contained.

6. Populationethics:The ‘intuition of neutrality’
• Natural thought:
• What’s bad is if there are people who lose most of their lives due to
death in childhood. It’s not that ‘non-births’ are tragic, on account of
the ‘loss’ of life that is not a loss that befalls any actual person.
• Adding an extra person is in itself neutral. (‘Intuition of neutrality’)
• This intuition is extremely natural, but ultimately incoherent.
A:
‘Status
quo’
A1: Status quo +
extra person at well-
being level 5?
?
?
A2: Status quo +
extra person at
well-being level 100
• ‘The Principle of Neutrality’:
Adding an extra person (others’
well-being levels being held
fixed) leads to a world that is
equally as good as the status
quo.
• This principle is the relevant
expression of the neutrality
idea (the point is to make the
world as good as possible), but
it cannot be true.

7. Beyondthe intuitionof neutrality: CBA
reassessedin the light of total utilitarianism
• A different proposal (total utilitarianism): the best state of affairs is
the one with the most total well-being, summed over all sentient
creatures.
• The key question then is just: Which of the following quantities is
bigger than the other? (And is either massively bigger?)
• (A) The intrinsic value of years (say) 5-65 of a person’s life.
• (B) The adverse net negative consequences of an additional life on
other people, due to ‘neo-Malthusian’ overpopulation-type effects
(resource depletion, depressed economic growth, political
instability…).
• If A>>B, then the current calculations for child mortality reduction
are roughly accurate. If B>>A, then the current calculations for
family planning are roughly accurate. But it’s hard to see how one
could agree with both simultaneously. This is doublethink.

8. Summary and conclusions
• Child mortality and family planning are both (fairly) frequently
cited as ‘top picks’ in global prioritisation.
• This is prima facie curious (“the cancellation worry”).
• Benefit-cost analyses (indeed) only manage to make both
interventions simultaneously come out as ‘top picks’ by
engaging in ‘doublethink’ (methodological inconsistency).
• This is explained (but not vindicated) by confusion over
population axiology.
• To fix this: More sophisticated analysis is required. (We need
more researchers!)
• We ignore this at our peril: the consequence could be that
billions of dollars of EA money get wasted on (mostly)
mutually counterproductive intervention-pairs.