International Triage: The Morality of Charity

Bouguereau's Charity

Charity is big business, but not all charities are created equal, and not all charities, despite the best intentions, actually end up doing good. Yet most people want to help out in some way: we empathize with the pain of others, we sympathize with the unfortunate positions they have been put in, but very few actually do anything about it.

Sure we might feel bad, but rarely does that translate into action, and even when it does, the actions we take are rarely the most effective. But then, the real motivation for many people is to make that feeling go away, to feel as if they have done something, but not to look too closely into what has actually been achieved, because trying to confront such a terrible, insurmountable problem is quite a task to set before yourself.

So we do the little things: we recycle, we turn off lights, we send some money to an organization. It lets us think of ourselves good people, it alleviates the guilt we feel when we see the late night commercial with the starving African children, but these techniques are often marketed to do just that: to make us feel complacent, as if we have already done something good.

Yet, when we feel good, that is when we are least likely to actually do good. Studies have shown that when we talk about our goals, it makes us less likely to actually work on them, because to the brain, talking about something gives us the same feeling as we'd get from actually doing it. It's something we can all recognize inherently, because when we talk about our goals, it makes us feel good, it makes us feel like we're on track, and that nagging feeling that we ought to be working on it right now just goes away.

We've all seen it: the guy who refers to himself as a writer and always wants to talk about his latest idea, despite the fact that he has failed to finish any of his previous projects. Yet, he sees no conflict in defining himself as 'a writer' despite never having completed a book.

Well, now I actually have to finish it.

My ex's mother collected business self-help books which she would read whenever she felt stressed out or depressed, because they made her feel like financial independence was only six to eight months of hard work away--all she needed was to put her nose to the grindstone, a few hours a day, and all the financial woes that kept her up at night would disappear. She'd come bustling out of her office smiling, and she might even complete Step One of the book's ten step plan. And then, since she felt good, and like she'd done some work, she'd reward herself with some well-deserved rest and leisure.

Real Estate Guru

This would last until the next personal financial crisis, when she'd suddenly remember that she was no nearer to any of her goals and had never gone on to Step Two, at which point she's get depressed and start the cycle over again. In the end, it was just her escape--her drug that she claimed was helping her when really, all it did was enable her own destructive pattern.

This type of pattern is terribly useful if you want to control people and make them complacent. So, when the American public started to attack industry for being wasteful and destructive, they brilliantly turned it around and set us on each other. We get messages about how we're supposed to turn off the water when we brush our teeth, despite the fact that in high-income countries, more potable water is used by industry than by domestic and agriculture combined. We're reminded over and over to turn off the lights when we leave a room, but we drive by supermarkets and office buildings that keep their lights on all night, whether they are closed or not. We happily buy 'Fair Trade' coffee despite the fact that it has a larger markup, produces bigger profits, and often pays less to the actual farmer than non-'Fair Trade'. We buy anything with 'Organic' on the label even if it means that we're buying a product that is more wasteful and pollutative (and more likely to contain fecal bacterial contamination).

The Triskelion of Guilt

It's a very clever branding shift: making the average person blame themselves for the small role they play, all in order to distract them from blaming industry for the lion's share--especially since, even if we all reduced our personal water and electric requirements today, that little bit we saved will just be used up by industry tomorrow. It is not a solution and it does not address the problem at hand, all it does is allow us to ignore our guilt and pat ourselves on the back for 'helping' in ways that are ultimately pointless.

So, what can we do? Well, it's tempting to think about charities--and though that's a very literal way to 'pass the buck', it doesn't mean it can't be effective. Indeed, one of the strengths of a large society is specialization. If I make shoes all day and trade them to people who make food or buildings or clothing all day, then everyone will get what they want, and each individual is probably going to end up being pretty damn good at what they do. I'll certainly get better food, clothes, and shelter that way than if I tried to split my time and make it all myself. It's one of the reasons that extreme couponing isn't worth it: you'd make more than you end up saving if you spent the same number of hours at work as you would have to clipping coupons.

The annual delivery of Superbowl loser shirts

So, if we could pool our money and give it all to someone that was really good at doing charitable work, that would be fairly productive--but unfortunately, finding a good charity isn't always easy. There are lots of useless charities out there, where much of the money goes to bureaucracy, and even for the ones where a large amount of money, goods, and services actually reaches the needy, that doesn't mean that those goods or services are actually productive. For instance, there are quite a few charities devoted to sending clothing and shoes to Africa, despite the fact that Africa is fairly warm and there just isn't a big demand for either. More than that, flooding the African markets with surplus shoes and clothes makes it impossible for any Africans to make a living as tailors or cobblers, so this kind of 'giving' just weakens their economy.

Then there are charities that are even more harmful, such as the Catholic Church, the single largest charitable organization in the world, which has continually rejected the use of condoms in Africa, where many of its charitable branches are, promoting continuing rates of infection and death among millions of Africans over decades. Or one can look at Mother Teresa, who raked in millions in donations from corrupt South American dictators, but none of that money ever went to building schools and hospitals. Instead, she built shrines to suffering, where the poor were allowed to stay until they died, in conditions which Medical journal The Lancet criticized for doing nothing to heal patients, and even making some worse by needle sharing and poor hygienic practices. And when I say 'shrines to suffering', I mean that very literally, as the philosophy of her order, in Teresa's own words was:

"'the most beautiful gift for a person that he can participate in the sufferings of Christ."

Which meant that all patients were denied painkillers on principle, even those on whom surgery was performed. So, the desire to help is simply not enough--there must also be an effective system by which that help is administered such that it actually does good. Then there are the charities which are just wholly scams. The '50 Worst Charities in America' raised 1.4 billion dollars over the last ten years, 970 million of which went to CEOs, consulting firms, and other fees.

'Triage' is a system by which medical professionals decide which patients to treat, and in what order. So, for example, if an EMT arrives at the location of an accident to find two men, one with a crushed trachea and the other with a broken arm, triage dictates that he go to the first man and perform a tracheotomy and deal with the other man later, since an arm can be set and splinted hours after the injury, but a crushed throat means a quick death. Indeed, we might say that allowing the first man to die when you could have prevented it is amoral, even if you were spending that time helping the other man.

Tags Color-Coded for Marking the Wounded

Or say our EMT comes across seven wounded people, all of whom are wounded severely and will die without care. He sees that to save one man would take two hours of surgical intervention, while to save the six others would take 20-30 minutes of surgery each. In this case, triage would dictate that he try to save the six and let the one die, since saving six people is a better use of time than saving just one. Again, we might say that it is immoral to let six die to save one.

So, if there is a moral imperative to do the most good to the most number of people, why not extend this to charity? Just because we move from a handful of people to millions doesn't mean we change the fundamental underpinnings of our morality. So we must look at the world, at the disaster there--the sick, starving, injured, and imperiled--and ask ourselves: who comes first? Who is in the greatest danger? If we are going to spend a million dollars or a million man hours, then where will they do the most good, where will they save the most lives?

Determining the priorities of 'international triage' is the whole point of the Copenhagen Consensus--explained more fully here--and it's a controversial position to take, since it usually involves saying that there are certain problems we should stop throwing money at, because there's just not much we can do about them, and it's money we could have spent doing something productive. After all, if it's amoral to let six die to save one, is it not equally amoral to let six million day to save one million? What about letting a million die because the money and manpower goes into donating shirts, or building schoolhouses where there are no teachers, or buildings where old nuns pray reverentially over the sacred suffering of people who could be cured, or supporting charities that are inefficient and bloated with bureaucracy? Shouldn't the truly controversial choice be spending so much money and time on white elephants?

If you feel sympathy for these people and upset at the state of the world, if you feel a moral obligation to do something to make a difference, then make it more than a gesture--don't get into this to make yourself feel better, because your narcissism is not going to help anyone. And really, throwing money or time at the problem shouldn't make you feel better, because you don't know if it's doing any good at all. Your little feel-good gesture might even end up making things worse.