The Millennium Ethical Fallacy: Why Ignore Future Children?

(Photo: Sanjoy Ghosh)

(Photo: Sanjoy Ghosh)

Economist Jeffrey Sachs, the force behind the Millennium Villages Project, is in the news as a book chronicling his efforts is released – Nina Munk’s The Idealist: Jeffrey Sachs and the Quest to End Poverty.  You can read about it in the Wall Street Journal, or read excerpts in the Huffington Post.  Sachs’s project is a major effort at a new way to fight poverty in Africa, as Joe Nocera, writing in The New York Times, explains:

The quest began in 2005, when Sachs, who directs the Earth Institute at Columbia University, started an ambitious program called the Millennium Villages Project. He and his team chose a handful of sub-Saharan African villages, where they imposed a series of “interventions” in such areas as agriculture, health and education. The idea was that these villages would show Africa — and the world — how the continent could loosen the grip that extreme poverty had on so many of its people.

Sachs admirably raised millions, drew attention to efforts to alleviate poverty around the world, and launched Millennium Villages in several countries. However, the reviewers hone in on the book’s discussion of many of the difficulties, such as drought, disease, locals who resisted the idea of selling their prized camels at the new markets set up for them, or locals who used the anti-malarial bednets on their goats rather than their children.

These are powerful (negative) stories. Advocates of Millennium Villages tell powerful stories, too. How can we get past stories, and get to answers? One frustrating fact is that for all the money spent, it is difficult to know how much better off the beneficiaries in these select group of villages are. As Nocera points out:

It has soaked up large sums of money — the original seed money was $120 million — which its critics believe could have been better used on more targeted, less grandiose forms of aid. Because Sachs, for years, refused — on ethical grounds, he said — to rigorously compare the results at his villages with villages that didn’t get the same kind of help, development experts complained that there was no way of knowing if the project was making a difference.

Sachs elaborates on his objection in a response to Nocera’s column: he specifically opposes the scientifically rigorous method of evaluation, the randomized control trial. Randomized control trials, just like those used in medicine, involve having a control group that doesn’t get the treatment, or gets an alternative treatment (or maybe a placebo). It’s helpful to have control groups nearby for reasons documented in the book – if people are no better off after the millions invested, was it the failure of the village’s new livestock market or the regional drought that affected all the villages in the area? Maybe people were worse off, but would have been even more worse off had it not been for the Millennium Villages?

Sachs’s response, however is that: “The ethical reasons are that ‘controls’ in a trial should not be denied basic, proven lifesaving interventions.”

In this case, I would argue that ethics demands a randomized control trial, not the other way around.

What Sachs succumbs to is natural and human. An analogy by Princeton philosopher Peter Singer, often used to motivate giving to poverty causes on the premise of utilitarian ethics, illuminates my point. The Singer analogy asks “If a child is drowning in a lake and you are walking by, even if doing so will cost you $300 (perhaps in ruined clothing, or a missed meeting), do you have an ethical obligation to jump in the lake and save the child?” Most will say yes. Then, when asked “If sending $300 to an organization (such as Millennium Villages) that is working to help the impoverished would save a life, do you have an ethical obligation to do so?,” most will say no (or say yes, but cringe). (You can see Singer posing these questions to Stephen Colbert here.)

Why the different perception of ethics for these two scenarios? Two commonly heard retorts:

  1. But I can see the child in the lake, I cannot see the child in Uganda. This is hardly an argument of ethics, but rather captures the psychology behind how and why we do make the judgments we make, as humans. And here, we see the same psychology behind Sachs’s argument against randomized control trials. He can see the child in the control group, and does not want to hold back giving that child a bednet. But there are many more “unseen” children in the world. We cannot, with current resources, give them all a bednet. Tough choices must be made. And, here is my main point, there are countless more “unseen” children in tomorrow’s world, and we need to know what to do for them with our scarce resources. So Sachs, under the guise of ethics, is unintentionally doing harm (by not doing the best that we can) to future “unseen” children, simply because they do not have the luxury of being within eyesight of one his Millennium Villages. This does not imply that any randomized trial is ethical: one has to trade off the knowledge gap that is hopefully to be (partially) filled with alternative use of the research money (specifically, in this example, the bednets that could be bought, if money were not spent on research).
  2. What if the money sent to the international aid charity won’t actually save a life? Maybe the idea is bad. Maybe the organization won’t implement it well. This is where evaluation can make important headways — in reducing this uncertainty. This is, again, an ethical call to do more rigorous research, such as randomized control trials, in order to convince the skeptical altruist to support effective programs. And to help the active altruist make the best choices. 

NPW

At the extremes are 1) Doing nothing or 2) Saving every child in the world from everything. I believe that 1 is immoral and 2 is impossible. Having established that the limits are not the solution, I chose where I believe that my ability and means intersects with maximum good.

This process is called adult reasoning.

Singer’s analogy is without merit.

Voice of Reason

I propose another answer (this may go against conventional assumptions and morals, but the logic is sound):

It is unethical to give any starving people in Africa money or food. If you prolong their life expectancy, they will just reproduce, and bring more unneeded children into the country that will have terrible lives and starve. So, by feeding them now, you create 5x as many starving and unhappy people in the long-run.

Use that money on Starbucks or a new TV and sleep easy at night.

Bart Doorneweert

I think your statement that evaluation will improve implementation is still very much a hypothesis. Yes, it is better than the no-rigor-to-evaluation, a la Sachs, we had before. But, come on, evaluation is pretty much still an academic publishing exercise, and provides little feedback into new project definition and design. Evaluation only focuses on the particular project that is being evaluated, it doesn't reveal any generalizable patterns that prevent other projects from ignoring the same false assumptions. No learning takes place, and little development. Evaluation, and particularly the RCT is an ivory tower ideal, churning out smart discussions on blogs like these.

Swami

Interesting. The Drowning Child analogy misses a key point.
We know the outcome. Singer specifically assumed the outcome and the cost are known.

But then Sachs does a spin: he implies that the outcome in his Village Child analogy are equally known, even though he has, for "ethical reasons", denied himself access to this information!

How do we know we the facts in Singer's story? We presume the narration is true. Is it? If the situation was real, we'd have to weigh all sorts of factors- how dangerous are the conditions? The narration says we are walking by and we see it. And seeing, we can decide: is the child really drowning? Maybe he's faking? Are there sharks? Can I swim well enough to accomplish the rescue? And then, we decide, not because the narrator told us the story, but because we are aware of, or at least capable of estimating, all the relevant factors.

But Sachs has decided he does not wish to know the relevant factors. Assuming them is good enough.

To make the Analogy more accurate, both should be placed on an "equal information" footing. Perhaps this:

A child may drown while swimming in a lake, somewhere far away, and a stranger asks you for $300 dollars to pay lifeguards for a day to ensure this does not happen. The stranger tells you there is no other source of money for lifeguards, and it is probable that if you do not pay, a child will drown. The stranger refuses to measure the actual statistical impact of lifeguards, as that would force him to gather data on lakes without lifeguards, which he does not wish to do. But he is certain that your $300 will save a life.

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