Ask yourself, why is it that you want to do medicine? Is it for recognition? Fortune? Or, as is likely the case, a feeling of need to do altruistic good in the world? To this end you may have been told that medicine is a noble career where you will save lives, comfort those at their lowest ebb and keep the world turning. This is all very satisfying and deserving of praise. But if your goal in life is to do objective good, then medicine is frankly - not good enough.
The reason it is not good enough, is that it is neither objectively efficient nor effective. More specifically, it is not as efficient, nor as effective as you have the potential to be. This is about the concept of Effective Altruism.
At its heart, effective altruism is about getting the most bang for your buck. $100 given to a struggling first year university student - living out of home and subsisting on a meagre diet of Mi Goreng and the wide-eyed hope that they may, one day, be just like Fred Hollows - is going to go a whole lot further than put towards an attempt to secure the position of Prime Minister for yourself.
An example of something that is typically agreed to be effective is the provision of guide dogs for the blind. This can have a profound impact on a person’s quality of life for a great number of years. To train a guide dog and an individual to produce an effective therapeutic relationship may cost up to $40,000.
Compare this to preventative treatment for trachoma in the third world, which can cost from $20-$50 per cure. For the same amount it would cost to train a guide dog and its owner, in return for the dog’s life span worth of improved quality of life, it is possible to prevent lifetime blindness in 800 people. Anyone can see the more objectively effective choice here.
Peter Singer is the father of effective altruism. A graduate of the University of Melbourne and a post-graduate of Oxford University, he is a philosopher primarily concerned with applied ethics and it is from him that most of the following programs derived.
You may wonder how it is possible for any individual to assess the efficacy of a given course of action or a cause for donation. Altruistic organisations are almost universally plagued by impenetrable bureaucracy and you are just one individual in a first world country with a limited skill set and no access to organisational data.
Fortunately, effective altruism has attracted a whole swathe of high-functioning academic- types in the form of mathematicians, philosophers and economists from the Ivory Towers of Oxbridge, and possessing the analytical skills to quantifiably assess the world’s charitable organisations for efficacy. Their work can be explored on the
Give Well website.
I do know however, that there is a subset of you out there who know this is not for you. Your EQ is off the charts and you know the reason you wanted to do medicine all along was to help those most impoverished and disadvantaged in the world with your own hands. You have the skills and the intelligence. You are going to get your degree, do your specialist training (in a field of high need) and then hightail it to the third world to make the difference. To you I must apologise. The work you want to do is truly phenomenal and I have utmost respect for you. However, it is not the most effective use of your abilities or your time. Compared to your work in the field, the neuro-surgeon living lavishly and locally with philanthropic leanings who can still afford (and is willing) to make five-figure donations, will single-handedly triple or quadruple your efficacy in the third world annually by any measure.
Again, these things are difficult to assess from our position of lack of inclination or access to metadata. Luckily, again, there are people who have made the effective use of qualification, time and money their job. 80,000 hours is the estimated time a person will spend in their career over a lifetime (admittedly somewhat more for some in the medical professions) that is 80,000 hours you can effectively be improving our world. And the people at
80,000 hours want to help you achieve precisely that. Their work, including career guides, can be found on their website.
The way to determine efficacy is to apply reason to empathy.
- Measure the good. The quantification of good may be complex (so leave it to the mathematicians) but it is essential for the comparison of efficacy.
- Think on the margin. Higher popular investment means diminishing returns for a given investment. $1000 will be a drop in the ocean to breast cancer awareness, but may produce a ground shaking breakthrough in the management of Crohn’s disease in sea urchins (or buying mosquito nets for malaria plagued communities.)
- Apply counterfactuals. What good would actually be achieved if you were to act? Could you perhaps actually accomplish more good by your inaction, thus allowing someone more qualified to act? It may be the case that you are not always the most effective person for the job. An example of the poor application of counterfactuals can be seen when Tony Abbott allocated himself the role of minister for women. Far greater good could have been accomplished by his inaction, therefore allowing someone more competent to take the role – for example, a woman.
- Assess expected value. Probability of positive effect x benefit of action = expected value of action.
- Focus on the best. When taking all of these into consideration you must find most effective project with the biggest net benefit per unit of action - this is your cause.
Whilst this paradigm will appeal rationally, no matter your ethical beliefs, it can raise some questions. The biggest threats we face to welfare currently are far and away diseases such as malaria. To tackle these is essential - however, can it truly be said to be doing the greatest good for the greatest number? In terms of humanity as a whole, are we not obligated to give moral consideration to the members of our species (and other species, this applies to non-humans too) that will follow us in the future? In the simplest sense, our children; in the broadest sense every individual that could exist until the death of the human species. In light of this consideration, can we justify acting against the present day threats in the face of existential threats such as climate change and multi-antibiotic resistant tuberculosis which have the potential to annihilate our species, effectively snuffing out the entire potential population that could come after us until the end of time?
These are the questions you must examine when deciding your life’s purpose. Even if you don’t follow these values in their most extreme form, it is always worthy to think about how you can be most effective – even when just treating the patient in front of you.
