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Hi all! This is the inaugural post of my new blog, Julian's Blog. I hope you like it.

Six years later, we’re still in triage

One of my favourite pieces that explores the emotional side of effective altruism is Holly Elmore’s We are in triage every second of the day. This piece, which is now roughly six years old, captures the intuition that we must consciously prioritise helping others in a way that makes the most of our finite resources — like doctors, we must triage.

Triage is inevitable when helping others. Our ability to help is limited by our time and money, yet the number of people and non-human animals that could use our help is practically endless. We must make sense of this and act accordingly, even when doing so is unpleasant. We want to help everyone, but we can’t.

The idea of unpleasant opportunity costs when using our resources to benefit others rang true for effective altruists in 2016. Every malaria net is paid for with money that can’t simultaneously be sent to a single mother living in poverty or used to supplement children with vitamin A. Every dollar spent here cannot be spent there.

The stakes of cosmic triage

In 2022, these opportunity costs have gone from unpleasant to borderline agonising. As the effective altruism community’s circle of moral concern has widened, so have the stakes of the triage we are attempting. We’re not just triaging people who live in extreme poverty: we’re triaging animals who live in torturous conditions on factory farms; we’re triaging animals who suffer terrible lives in the wild; we’re triaging everyone susceptible to catastrophic risk; and we’re triaging an unfathomable number of people who aren’t even alive yet.

This moral juggling act has attracted scorn from those who think we longtermist inclined effective altruists have veered away from our once good intentions. Caring about hypothetical future people whose wellbeing could be affected by hypothetical (and oftentimes nebulous) problems like misaligned AI surely means we’ve stopped caring about those living in extreme poverty — so it goes.

People living in extreme poverty are still important

I understand why some people have formed this view, but I think it arrives at the wrong conclusion. The same principles, reasoning, and desire to reduce others’ suffering that led the effective altruism community to care about poverty in the first place remain at the forefront of our thinking. But now our moral circle has expanded, and with this comes new challenges and opportunities to do good that we are trying to make sense of as we go.

Perhaps those folks think we are bringing the wrong moral patients into our circles of concern. Fine. Expanding on the reasoning behind caring about the welfare of non-human animals, and the moral status of future generations, is outside of the scope of this piece. What I will say is that the burden to argue that non-human animals and future people do not deserve moral consideration falls upon those critiquing longtermist prioritisation. And crucially, so long as we continue to be convinced that these groups are worthy of moral concern, we must triage.

Triaging 700 million people in poverty, trillions of non-human animals living in horrid conditions, and the future of humanity is a gut-wrenching affair. We are still working in the same metaphorical hospital we were in 2016. Yet now, the hospital is on fire, sick animals have started wandering around the halls, and trillions of yet-to-be-born people are progressively lining up at the door. Plus every few months, Brian Tomasik writes an essay about a new swathe of patients we ought to consider admitting. And to his credit, he usually has some damn good points.

Where we’re at, and where we’ll go

This situation is scary. Understandably, it comes with a tremendous amount of responsibility. Perfectly triaging between trillions of moral patients isn’t an easy task. But we’re trying to make sense of this the best we can, and we really do care about all of the patients — especially the ones we can’t help.

The effective altruism community will need to continue triaging to do the most good it can. The exciting part, however, is that we can learn (and indeed have learned) to triage more effectively. New insights will lead us to patients we had once not considered, but these insights will go hand in hand with discoveries that improve our ability to effectively help. Rigorous truth-seeking can help us make sense of the chaos, and we can build this knowledge cumulatively over time. As the number of people practising effective altruism grows, we can combine our skills and expertise to fill gaps that had previously dampened the community’s ability to fully achieve its ambitious goals.

As Holly concluded, we are always in triage. And while this triage has only gotten more complicated, I believe we will find a way to navigate it more effectively as time goes on.

A widened moral circle presents uncharted territory for us to navigate. While the effective altruism community’s focus has shifted, our desire to help rid others of suffering has not. I hope one day we will move past the point of triage. But until then, we will have to embrace gruelling opportunity costs as we try to do the most good we can.

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Caring about hypothetical future people whose wellbeing could be affected by hypothetical (and oftentimes nebulous) problems like misaligned AI surely means we’ve stopped caring about those living in extreme poverty — so it goes.


If the future people are not hypothetical, but people that you believe will exist, then I think your triage approach is virtuous. That is a lot of people to care about, but like you say, your moral circle has widened. Widening it to non-human animals is a conceptual challenge as well. For now, I consider dolphins, whales, primates, some smaller mammals, farm animals, and squid as deserving moral status comparable to humans. I'm curious where you draw the line.

 Your write-up is inspiring. I would still shrink from the challenge you face by adding in far-future people, but I consider them to be hypothetical: I don't believe that they will necessarily exist. That doesn't stop me from making up my own ideas of what makes a good long-term future for humanity.

It is very hard to deal with the reality of suffering that we must tolerate given resource limitations. Seeing the big picture allows us to do the most good, but also exposes us to countless nightmares we have to walk away from.

This is why we also need to be thinking about how to expand the resources we can direct to effective charities... My nonprofit, the Consumer Power Initiative, is looking to leverage the general economy to benefit effective charities. With global net profits in the trillions, I believe we can get a larger piece of the global pie working for well-being and justice so that there are far less nightmares we need to tolerate.

If you're interested in learning more, check out our most recent newsletter, linked below, and feel free to reach out to me at Brad@consumerpowerinitiative.org


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