Successes of international aid and effective development charities: global health

Does aid work? Some authors argue yes, and we should give more. Others argue that it has been ineffective, or even hindered development of poor countries. It’s clear that some charities are much more effective than others, and certain forms of government-financed aid can sometimes exacerbate corruption within a country. But there are also examples where aid seems to have been rather effective, particularly in the area of health. Here are some of its successes, along with some recommended charities to donate to if you want to contribute to ongoing achievements.

1. The Marshall Plan. 

No, this wasn’t a health-based aid project, and in terms of effectiveness this is probably the least empirically justified out of the whole list.  I provide it first because many opponents of aid in the UK seem to have forgotten how the UK and Europe as a whole were recipients of large amounts of aid not too long ago. After World War II, European countries benefitted from a substantial financial gift from the United States in order to rebuild their devastated infrastructure.

In today’s currency, a Marshall Plan would be worth more than $740bn.

2. Eradication of small pox.

Small pox used to kill millions of people every year. In the 1960s a plan was announced to provide sufficient vaccinations to completely eliminate the virus within a decade. It was successful; the last case of smallpox was in 1977. About a third of the funding was provided by ‘international assistance’.

3. Near-eradication of polio. 

Infection by poliovirus lead to the paralysis of tens of thousands of people each year in the early-mid 20th century.  In 1988 the World Health Organisation (WHO) resolved to eradicate polio worldwide. That year, there were an estimated 350,000 cases globally. By 2012 this had fallen to just a few hundred cases. The WHO is funded by governments of the United Nations. Members of the organisation Rotary International have also raised and donated huge sums (over $1bn) to help fund provision of the polio vaccine.

4. Near-eradication of Guinea-Worm disease.

Guinea-worm disease is caused by a parasitic worm caught by drinking contaminated water. Symptoms include “intense pain…fever, nausea, and vomiting.“ 

Unlike polio and smallpox, there is no vaccine. But the Carter Center, an NGO established by former US President Jimmy Carter, has helped almost completely eradicate it, working alongside the WHO, UNICEF and other groups to prevent contamination and infection:

“In 1986, the disease afflicted an estimated 3.5 million people a year in 21 countries in Africa and Asia. Today, thanks to the work of The Carter Center and its partners — including the countries themselves — the incidence of Guinea worm has been reduced by more than 99 percent….In 2012, there were 542 cases reported in South Sudan, Mali, Ethiopia, and Chad.”

5. Big decline in deaths and suffering from malaria.

Malaria causes illness in hundreds of millions of people each year, and kills thousands (mostly children) every day. But since 2000, these numbers have fallen by 25% globally, and 33% in Sub-Saharan Africa. Much of this is because of the mass-distribution and use of insecticide-treated bednets, which charity-evaluator GiveWell describe as ‘among the most cost-effective ways to save lives‘. These bednets have primarily been funded by the governments of wealthy nations via The Global Fund. The UK’s Department for International Development, for example, has funded tens of millions of nets.

–The Against Malaria Foundation. Private donations have also helped buy bednets. Bill Gates is a notable contributor to the Global Fund. For those of us who aren’t billionaires, the Against Malaria Foundation is a highly recommended charity that spends all of its donations on bednets. So far, over 475,000 people have donated more than $18m to buy more than 5 million nets, showing that everyone can make an important contribution. The Life You Can Save, GiveWell and Giving What We Can currently rate the AMF as the top charity to support for private donors; this means their work has demonstrated very high cost-effectiveness and high transparency/accountability. You can donate to them here.

6. Near-eradication of River Blindness (onchocerciasis) in West Africa. 

The OCP, a 30-year program lead by WHO and United Nations Development Program, ended in 2002 “after virtually stopping the transmission of the disease“ in the 11 West African countries covered by the program. This “reopened to farming 60 million acres of land once abandoned to the disease, and protected the sight of an estimated 30 million people at risk for blindness”.

A new program, the APOC, is now seeking to control and then eliminate it from the remaining endemic Africa countries over the next 2 decades. It is funded by a number of countries, including the UK and USA.

7.  Measles vaccination success

In 2011 around 158 000 people, many children, died of measles. But the World Health Organisation reports that, because of vaccination, there has been a 71% global decline of measles since 2000. This vaccination campaign has been supported by the WHO, UNICEF, the American Red Cross, and the United States Centers for Disease Control and Prevention.

Other vaccination campaigns include:

8. Hepatitis B

In China, hundreds of thousands of people die each year from the consequences of hepatitis B infection, in the form of liver cancer and cirrhosis. But the GAVI Alliance has worked alongside the Chinese government and co-funded over 25 million vaccines to newborns, signficantly reducing Hep B infection. Given the huge population of China, deaths from Hep B are still widespread, but the Chinese government is now working on expanding the program across the whole country.

9. Pneumonia

Pneumonia is a leading cause of childhood mortality, killing 18% of the 6.9 million under-5s that died in 2011. The type-b strain of the Haemophilus influenzae bacteria (Hib) is one the main causes of such pneumonia, along with Streptococcus pneumoniae, which it interacts with.

In the 1990s, only one low-income country offered the vaccine to Hib. GAVI, a partnership that promotes vaccinations, then campaigned and presented strong evidence as to the benefits of the vaccine. Governments responded: “By 2011, nearly all GAVI-eligible countries had introduced Hib vaccines with GAVI support, immunising a cumulative 124 million children and preventing an estimated 697,000 future deaths.”

10. pertussis (whooping cough), 11. pneumococcal disease/pneumonia, 12. rotavirus diarrhoea, 13. yellow fever

Vaccines/treatment of these have all been significantly funded by the GAVI Alliance, which is supported by government aid (including the UK) and private philanthropists. It raises funds by selling long-term bonds backed by donor governments, meaning money is immediately provided by investors in those bonds.

14. Reduction in burden of Schistosomiasis (and other parasitic worms)

Schistosomiasis is a parasitic worm estimated to kill up to 280,000 people due to organ damage, though it probably kills closer to 40,000. It also contributes to malnutrition and causes pain, fever and anaemia. Schistosomiasis is still widespread, infecting several hundred million people globally. But there is a cheap and effective treatment, and given the success of reducing the burden of other parasites such as guinea-worm disease (see above), it is plausible that the coming decades will see a large decline and perhaps eradication of schistomiasis and other tropical parasitic worms.

Deworming drugs cost around half a dollar (~£0.30) per person treated, according to GiveWell. Studies in Burkina Faso, Niger, Uganda, and Burundi by the Schistosomiasis Control Initiative (SCI) report significant declines in parasite prevalence and intensity after treatment with these drugs. There is also evidence from Kenya that deworming is by far the most cost-effective way to increase primary school attendance. In Rwanda, recent reports state that the prevalance of schistosomiasis infection has fallen by over 80%.

-The Schistomiasis Control Initiative, run from Imperial College London, has received significant funds from the Gates Foundation, as well as the US and UK governments. But private donations have also made important contributions. And for good reason; the SCI is another highly-recommended charity according to GiveWell and Giving What We Can, demonstrating its cost-effectiveness, commitment to transparency, and ability to properly use any additional funds it receives. You can donate to the SCI here.

But what about overpopulation?

A very common concern is that by reducing mortality, these efforts are simply contributing to overpopulation. There are two key points in response to this:

Firstly, as this World Bank article highlights, probably the biggest influence on fertility rates (how many children a woman has) is childhood mortality. If you reduce child mortality, adults have fewer children (see box 2 on page 11 of the article for a summary). And the wonderfully enthusiastic Hans Rosling presents this 3-minute video showing how fertility rates and childhood mortality rates have changed since the 1960s.

There are of course other important influences on fertility rates, including education and access to family planning/contraception, but childhood mortality appears to be more influential than each of these. But the second point is that these diseases don’t just kill: they often also cause serious physical weakness, mental exhaustion and disability. This makes it much harder for children to receive good education in the first place; children can’t access school or are unable to properly concentrate once there, or the teachers themselves have the same problem.

Continuing to reduce the burden of disease should therefore speed up a ‘demographic transition’ whereby fewer children are born in the first place.

Furthermore, these diseases impact the economy both in the short-term (seriously reducing the amount and quality of work that can be done) and in the long-term (i.e reducing quality of education and hence ability to grow businesses successfully when the children grow up).

The University of York’s RAG international charities: a good choice?

Background

Each year universities across the UK take part in RAG events. RAG is a ‘backronym’ of  ‘raising and giving’. Students engage in a range of activities and adventures in order to make as much money as they can for selected charities. Last year, the University of York RAG campaign raised a very impressive £80,000 which will be distributed to the charities selected by the student body.

This selection process initially involves charities applying to receive funding. The applications are then reduced to a short-list by the RAG team, before all students have the opportunity to vote for the charities they prefer from this short-list. This year, 2 local, 1 national, and 2 international charities were selected to receive funding.

I am skeptical about the process used to select these charities. And given the amount of money involved, having an adequate selection process could potentially be the difference between life and death for many people.

It’s understandable that the University wants to donate to local and national charities, as these are ones that will benefit the University’s standing in the local community, and will engage students on issues that may affect their own lives, or their friends and families. But when creating a short-list of international charities, clear and precise criteria must be used to ensure a worthy choice is presented to the students to select the winners from.

What Criteria Should We Use?

The first and most prominent criterion should be cost-effectiveness. As Giving What We Can point out, some charities can be as much as 1000 times as effective as others. So if RAG donated £100 to one charity, this could have as great an impact as donating £100,000 to another. Given that each charity can expect to receive £5-10k, it’s easy to see the importance of intelligent, targeted donations. Other important criteria for charities should be transparency and accountability (i.e. willing to share information about their expenditure ) and room for more funding. (i.e. actually have goals that can benefit from extra finances). These are the criteria used by GiveWell to rank the charities they review.

WaterAid and Medecins Sans Frontieres

This year’s international charities selected by the University of York are Water Aid and Medecins Sans Frontieres (MSF). So, how well do they meet the above criteria?

GiveWell has recommended MSF for their disaster-relief efforts. They are also described as being “unusually transparent”. However, despite this positive view of MSF, GiveWell do not consider them to be cost-effective overall, at least not compared to their top charities. 

GiveWell contacted WaterAid with the intent to thoroughly review them. However, they have now been ‘deprioritized‘. This means that subsequent investigations revealed the charity was unlikely to meet the criteria to be one of their top charities, possibly because WaterAid were unwilling/too slow in providing responses to their queries, or because they were unable to provide strong enough independent evidence of the effectiveness of their work.

Giving What We Can are also skeptical about the cost-effectiveness of water-related construction programs generally (building “boreholes, stand posts and dug wells, or infrastructure that improves sanitary conditions, such as sewerage, septic tanks and latrines”). They claim that “their cost-effectiveness has been estimated as less than a tenth that of some other ways of promoting health”. However, they are much more optimistic about programs that seek to improve behaviour regarding sanitation and hygiene. Perhaps WaterAid will eventually show that their work in this area is as cost-effectiveness as the top recommended charities. They do not yet appear to have done so.

Conclusion

Though WaterAid and MSF have undoubtedly made improvements to the living standards of a large number of people, the top-rated charities would likely have aided many more, and to a greater extent. Whilst the University of York international charity recipients of RAG aid should not be determined entirely by the criteria I have discussed in this article (York may have long-established links to particular communities or causes), such criteria must surely play a large part.

I would therefore encourage the RAG team to clearly publish the criteria they use, and the weightings for each one, in order to apply pressure onto charities to demonstrate their evidence of effectiveness, their accountability and their costs. Ultimately this will help us determine what form of charity works well and what doesn’t, and hence allow us to improve as many lives as possible.

The killing of police officers is not an act of ‘pure evil’, Mr Cameron.

Prime Minister David Cameron has described the murder of 2 policewomen today as an act of ‘pure evil’.

Clearly, he could do nothing other than seriously condemn the shootings. Yet whilst the use of the phrase ‘pure evil’ may solely be intended to demonstrate how seriously he takes the situation, it is also not particularly helpful.

Why? Because it encourages and promotes ‘good vs evil’, black-and-white thinking. It ignores any attempt at understanding why such crimes are committed, and how they can be prevented. After all, if someone is pure evil, then there is nothing that can be done to change their behaviour. Education and poverty reduction can’t combat pure evil. Only the mystical Forces of Good can.

But the reality is we know that crimes are committed for reasons. Lack of hope for the future, anger, depression, hatred. Even because of boredom and for personal pleasure. Committing murder because of boredom might sound like pure evil, but again, there will be deeper reasons as to why someone decides to relieve their boredom by killing, rather than seeking an alternative. Psychopathy/lack of empathy for others, for example. This in turn has genetic and environmental roots such as certain gene variants (e.g. the monoamine oxidase A gene) combined with serious neglect during childhood.

Dismissing even the worst perpetrators as ‘pure evil’ does not encourage people to think about the causes and reasons behind actions, and fails to acknowledge that behind every murderer there is a person, and behind every person, there is, in the right circumstances, a murderer.

Riding a horse is as dangerous as taking heroin

What’s wrong with the following argument?

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P1. In the UK, heroin is a Class A drug.

P2. Ecstasy is also a Class A drug.

P3. The classification of a drug represents the level of harm it causes to individuals and society.

P4. Horse riding causes at least as much harm as ecstasy.

C. Therefore, horse riding is as harmful as heroin.

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Suddenly, I have a new-found respect for Britain’s successful Olympic horse-dancing team. Who knew they were taking such risks?

The problem with the above argument is at premise 3.  The classification of a drug is supposed to represent the level of harm it causes, but in practice it doesn’t. Why not? Primarily because politicians ignore scientific evidence on drugs. They prefer to appear tough on drugs, in order to please the tabloids. The tabloids in turn significantly under-report deaths from drugs such as paracetemol (reporting approx 1 in every 250 deaths) compared to ones like ecstasy (reporting almost every single death).

This means the classification of a drug loses any value as a signal as to how harmful it is. You might as well take a Class A drug, because being Class A says nothing about how harmful it is.

Some people argue that no matter how harmful something is, as long as people are aware of the risks, then we should be allowed do whatever we want to our own bodies. This is a view I am sympathetic towards. However, as long as governments take the view that they should tell us what we can or cannot put in our bodies because of the harm it causes, at the very least they have a duty to ensure the law is consistent with such harm.

GM Crops: ban them, but only if you also want to ban peanuts…

…and milk and eggs and seeds and soy, wheat, fish, shellfish, fruits, vegetables.

Actually, ban any food with any non-human protein in. It all has the potential to cause a serious allergy. Whether it is genetically modified or not.

The ‘health risks’ argument that is used to oppose each and every GM crop is, for the most part, absurd. Yes, there is a small possibility of them causing health problems. I would be surprised if no one ever develops a health problem in response to consuming a GM food. But the point is that we must see this in the context of the health problems and risks of non-GM foods that we already widely consume on a daily basis and that already cause problems to a small number of people

Now, this is not to say that other factors associated with certain GM technologies can’t contribute to health problems. A commonly suspected factor is the use of pesticides and herbicides. The most famous example is Monsanto’s ‘Roundup’ weedkiller. By modifying crops to be resistant to Roundup, farmers can apply it in greater doses, knowing that it won’t harm the crop. There are debates over whether this has actually increased or decreased overall herbicide use (use of more ecologically harmful herbicides than Roundup may have actually fallen as a consequence) and whether Roundup can have detrimental health effects.

There is also a genuine issue about consumers being able to avoid GM products for known allergies. Say, for example, a gene for a peanut protein that causes allergic reactions in some people could be inserted into wheat. If products were adequately labelled, one would think that consumers could easily avoid wheat products that contained such a protein. The concern is that crops would cross-pollinate, meaning that even the wheat that was not modified with the hypothetical peanut protein could acquire it.

But all too often anti-GM protestors take concern about one particular crop, such as Monsanto’s GM soy, and use it to accuse all GM products of having similar issues. Creating a herbicide/pesticide resistant crop is only one type of genetic modification. And risks of cross-pollination are dependent on the species involved and its method of dispersing pollen, so should be considered on a case-by-case basis rather than supporting a blanket ban on GM. This is particularly true given some of the potential benefits of GM crops. Here are a few upcoming GM products that involve traits other than increased herbicide and pesticide resistance:

1. Golden Rice.

~200 million people suffer from vitamin A deficiency around the world, and each year hundreds of thousands of children are estimated to die or become blind because of it.  This rice is genetically modified to produce beta-carotene, which is converted to vitamin A in the body. The rice can provide a significant proportion of the recommended daily intake, possibly 100%. The genes that have been introduced come from a soil bacteria and from maize/corn.

Interestingly, the intellectual property rights involved in creating Golden Rice have been waived for subsistence farmers, meaning they can earn up to $10,000 without paying royalties for growing the rice.

2. Wheat with a peppermint gene.

Globally, pests cause huge damage to crops; with estimates of 25-40% loss for many common crops. In the UK, aphids would cause a loss of ~£100m without the use of pesticides. Recent trials are looking at whether GM wheat, with a gene from the peppermint plant inserted, could deter aphids, possibly resulting in reduced pesticide use. The gene leads to production of a pheromone that plants already use in the wild to deter aphids. It also attracts a natural predator of aphids to further reduce their impact. It won’t, however, result in mint-flavoured bread.

3. Drought-tolerant corn.

This year’s droughts across America led to the loss of huge amounts of corn. This GM drought-tolerant corn could help reduce future impact of droughts; though probably not when they are as severe as this year’s. Future versions may have improved tolerance.

On a similar theme, a flood-resistant form of rice has been developed using non-GM methods by hybridisation of different strains of rice.  Although not GM per se, it did use some clever genetic technology in order to cross the strains. And one of the developers of this rice hybrid believes that GM technology will “give us a lot of tools for further improving rice, that we do not have now….[it]will give us a way to do that much quicker and much easier”.

What about corporate control of food?

Finally, many anti-GM protestors are concerned about the monopoly/private control of biotechnology and IP patents. There are some genuine issues about this, but what I say to them is this: support state-funded research.

This ensures relevant information remains in the public domain and is available for any entrepreneur to use. More research being publicly funded means less likelihood of a particular discovery or technology being patented. And the more biotechnology companies there are, the less likely anyone of them will have a monopoly on the market and be able to dictate the terms of use. Just don’t oppose the technology as a whole, and remember to consider the likely costs of not using it.

Are some countries more genetically inclined towards capitalism than others?

Claiming that there is a link between genetics and the economic system of a country will no doubt strike you as a preposterous hypothesis*.

I admit I’m skeptical about the following argument. But even if it’s wrong, at least it’s interesting. Here goes:

1) People who are more likely to support business and a capitalist system – entrepreneurs, inventors, investors and company CEOs – are deluded. They think the chances of their business, invention and investment being successful are much higher than they actually statistically are. They are overconfident and overoptimistic. They are willing to take more risks than is rationally justified. It’s probably a good thing some people are like this, otherwise the pace of technological creation and innovation would likely be much slower. But overoptimism also contributed to the housing bubble that contributed to the current economic crisis.

The thing is, most people are overly optimistic and overestimate their own abilities. One famous example is an American study where 90% of drivers believed their driving skills were ‘above average’. (See here and here for more examples, and buy Daniel Kahneman’s excellent book which covers a whole range of topics on human (ir)rationality and behavioural economics). But people who are more overoptimistic are more likely to become entrepreneurs.

2) Variation in how optimistic someone is, is significantly influenced by genetics; one study of Australian twins puts the genetic contribution at 36%. So environmental factors have an influence of around 64%.

3) Immigrants, given that they are taking a risk to move from one country to another, must be reasonably optimistic that they can make a success for themselves in a new country. They’re taking a risk by giving up everything that they know for a new culture (and possibly new language). This risk-taking certainly seems indicative of a mind-set similar to those of entrepreneurs, and there is strong evidence (see here and here) that many immigrants are indeed the entrepreneurial (genetic?) type, at least in America.

4) This implies that there is a genetic inclination towards capitalistic behaviour accumulating in certain countries. Perhaps countries such as America, which were founded by immigrants relatively recently, and continue to welcome them, have capitalism in their blood.

There are of course problems with this. It’s possible to find polls that purport to show that Americans are generally more optimistic than Europeans, but this is more easily explained by environmental rather than genetic factors (it might simply be that Americans feel cultural pressure to tell people, including pollsters, that they believe their life is improving, even if they secretly don’t believe this). Until there are more studies that look at genetic differences, this argument will have to remain a mere hypothesis.

If evidence for the link between genetics and inclination towards a particular economic system strengthens, and if it becomes possible for parents to select which genes they want their child to have, then one day we may find parents imposing their economic beliefs on their children not just by controlling the environment they grow up in, but also by controlling their genetics.

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* Did Steve tell you that, perchance?

The Eugenic Self-Extinction of Social Conservatism

A recent book by Chris Mooney argues that there is a neurological basis as to why many supporters of the American Republican Party seem to “believe more wrong things; appear more likely than Democrats to oppose new ideas and less likely to change their beliefs in the face of new facts; and sometimes respond to compelling evidence by doubling down on their current beliefs.”

I have not yet read this book. As such, I may be misrepresenting the views of the author, but based on the book description, it seems to me that his arguments are primarily targetted at the social conservatives in the Republican Party, rather the economic conservatives whose concern is limiting the size of the state (i.e what those outside the US would call supporters of economic liberalism).

This distinction is important. Economics is not a science; it is an art. There is no clear consensus on what is the best economic theory, partly because what one considers ‘best’ depends on your values. But even if one shares the same values, one can disagree with the means of promoting them. Strong rational arguments can be put forward for both reducing state investment and increasing it, if your agreed aim is promote economic growth. But interpretation of economic evidence is often confounded by too many variables to support one economic theory over another, at least not with the same level of confidence as one would need to reasonably support a scientific theory.

Mooney’s arguments may extend to more extreme economic theories. The book description claims he considers “why Republicans reject the widely accepted findings of mainstream science, economics, and history”. But non-mainstream economic theories exist at both ends of the economic-political spectrum. I suspect many Marxists are “less likely to change their beliefs in the face of new facts” just as much as many libertarians. (Though it should be said that someone adhering to non-mainstream economic theories does not necessarily mean they dogmatically ignore new facts. They could be right, and it’s actually the mainstream who have overlooked/ignored some essential facts).

Eugenics then. Where does this come into it? Well, let’s assume that Mooney is correct in claiming that there is a neurological/psychological basis for our political beliefs. Apparently “people more wedded to certainty tend to become conservatives; people craving novelty, liberals”. If one’s neurology influences one’s political outlook, it seems reasonable to infer there is also a genetic influence of one’s political outlook. I am not suggesting that anyone is born a Tory, Democrat, Liberal, Republican, Socialist etc. Clearly, one’s education, experience and upbringing play a hugely significant role. But genes will play a part too. [UPDATE: On his blog, Mooney does indeed list studies that suggest a varying degree of genetic influence on political preference]

Over the next few decades, it is possible that parents will, to an extent, be able to choose certain characteristics of their children. This could be done by using pre-implantation genetic screening of IVF embryos and selecting those embryos with the desired traits. Or it could be done by genetically engineering one embryo and inserting the genes for the traits the parents desire, rather than selecting from a group of embryos.

Social liberals are, apparently, more likely to “crave novelty”. Social conservatives are more likely to be “wedded to certainty”*. Historically, this can especially been seen with regards to changing attitudes towards sexuality and new reproductive technologies: consider the different stances on contraception, homosexuality, IVF, abortion. Thus, it seems likely that most social conservatives will strongly oppose using genetic engineering or embryo selection. Social liberals may be more willing to use it. If so, and they are able to select traits that they find valuable, they may seek to select genes that will encourage a socially liberal outlook. This could involve selecting genes that boost intelligence, since it appears that low intelligence, mediated via socially conservative ideology, predicts greater racism. But it could also mean selecting genes that directly influence one’s political leanings. Perhaps the genes involved in ‘craving novelty’ or being ‘wedded to uncertainty’ are related to having an appropriate development of fear responses; i.e not fearing someone merely because they belong to a new group whose clothes/language/culture/sexuality is unknown to you.

If this sort of selection occurs, then social liberals will essentially be self-promoting, and will thus increase their way of thinking within the population by having kids that are genetically inclined to think their way. Social conservatives, who won’t select for traits they desire because they generally have more ‘fear/distrust’ of the technology, will not enhance the social conservative genetic mindset. Any children they have will not deliberately be selected for conservative thinking. Thus, such children may grow up in a society that is increasingly overwhelmingly socially liberal. The liberal mindset will become the new social norm and any such children of conservatives will increasingly accept the liberal ‘status quo’; including the use of genetic technologies, perpetuating the selection of liberal ideals. Social conservatism as we know it will be extinct.

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*Socially conservative attitudes can occur across the economic political spectrum. For example, I suspect there are a number of socialists who would oppose any reform or reduction of the welfare state or (in the UK) of the privatisation of the National Health Service, even if there was strong evidence that such reform would benefit those who use such services.  This can be considered socially conservative just as much as those who consider themselves to be politically right-wing and are socially conservative in a religious or cultural sense.

Artificial wombs, infanticide and the implications for abortion

Infanticide and Personhood

A recent article published in the Journal of Medical Ethics has caused a veritable shitstorm (a technical term in philosophy) for the authors and the editors of the journal. Briefly, the article argues that in some cases infanticide is justified since there is no moral difference between a foetus just before birth, and a newborn infant. Hence, if it’s ok to abort a late-stage foetus, it should be ok to kill the newborn. They claim it is ok to do both on the grounds that neither a foetus or the newborn has yet developed necessary characteristics for personhood (such as self-awareness), and therefore should not be entitled to a moral or legal “right to life”.

Legally, in the UK, personhood only begins at birth. Yet the foetus is not entirely unprotected before this. In the UK (apart from Northern Ireland), obtaining an abortion is legal before 24 weeks of pregnancy. After 24 weeks, abortion is only legal if there is evidence that the foetus is likely to be severely disabled, if the woman’s life is at risk, or to avoid severe physical or mental harm to the woman (in practice, interpretation of ‘severe physical or mental harm’ is probably rather lax). This implies it is not considered ok to abort a late-stage foetus merely on the grounds that it is not yet a person, and infanticide is therefore also not justified merely on the grounds that it is not yet a person.

I agree that neither a foetus or a newborn has the characteristics required to be considered a person, yet pragmatically the clear-cut dividing line of birth seems to be the only real option for legal personhood, and the rights such legal recognition entails. If it is set at a later date of development, such that infanticide of newborns is allowed, then there is no obvious point where to stop. Setting it at an earlier date could be plausible for some point late in pregnancy, but then there will inevitably medical emergencies whereby a doctor may have to commit what would be legally defined as murder in order to save the life of the woman involved. This would in all likelihood lead to doctors refusing to treat heavily pregnant women, leading to deaths of both woman and child.

The purpose of this post is not to rehash the current debate on abortion. Rather, it is to discuss out how a possible future technology, an external artificial womb, is likely to confuse the situation even further, if that is at all possible.

Artificial Wombs: why bother?

What would be the point of developing an artificial womb? The primary motives currently include:

(a)enhancing the survival chances of premature infants

(b)rescuing sick foetuses

(c)the possibility of genetically-related children for women with reproductive diseases (e.g. womb and ovarian cancer) without the need for a surrogate

(d)scientific curiosity regarding human prenatal development; and

(e)enhancing equality in society, as argued by some feminists such as Shulamith Firestone, by allowing reproduction without imposing all the risks and harms of pregnancy on women. Firestone has also argued that natural pregnancy leads to inequality and divisive hierarchies in society as a consequence of favouring one child over another merely on the basis of genetic and gestational connections to the parents

Their development may also be supported by certain bioconservatives, who would traditionally otherwise oppose major technological changes relating to sex and reproduction. This is because of the perceived potential to eliminate foetal deaths that occur in abortion.

Artificial wombs will likely come about as ‘merging’ of IVF and human embryo research with neonatal incubators. In the UK, research is allowed on human embryos up to 14 days old. As far as we know, such embryos develop in vitro fairly normally. If it were legal, it seems highly likely that it would already be possible for them to develop a bit further. There would have to be some means to replicate the tasks of the placenta, such as gas exchange and nutrition, and ultimately control of hormones and antibodies. Whilst exactly how these tasks are achieved by the placenta is exceedingly complex, back in the 1990s researchers in Japan successfully kept alive goat foetuses in an artificial womb, some for up to ten days, suggesting it is not beyond the realms of possibility of understanding. And in 2002, human embryos were implanted into the wall of a tissue grown from cells from the inner membrane of the uterus.

Babies born after 24 weeks of pregnancy currently have approximately a 50% chance of survival outside the mother thanks to modern neonatal intensive care units (NICUs), though rare cases have been documented of survival of newborns as young as 21/22 weeks. This viability of 24 weeks is the reason for having the UK legal limit of abortion where it is.

Artificial wombs: the end of foetal death from abortion?

If artificial wombs are developed, then the reason for having the 24-week deadline becomes void; embryos that successfully grow in artificial wombs will by definition be viable from IVF to whenever the foetus is considered ‘born’. So should abortions from ‘natural’ pregnancies still be allowed? Since it may be possible to transfer an embryo from a mother’s (real) womb and place it in an artificial womb, there may well be pressure on mothers to undergo surgery to ‘rescue’ the embryo, rather than abort it*. What stage of development, if any, is an acceptable limit for terminating a ‘pregnancy’ using an artificial womb? When should the embryo/foetus obtain rights of personhood? The two main factors that currently provide answers to these questions, foetal viability and birth, would not apply to artificial wombs. At least, birth would no longer exist for foetuses grown in artificial wombs in the sense we currently understand it: seperation of foetus from the woman’s body and entry into the external world.

It would seem rather inconsistent to grant legal protection to foetuses of a particular age that develop in an artificial womb but not grant the same protection to those that develop in a natural womb. Of course, the latter must consider the rights of the woman. However, granting greater protection for artificial-womb-foetuses than natural-womb-foetuses could lead to women being pressured into only having children via artificial wombs. This pressure would be enhanced by the risk of miscarriage in natural pregnancy, and the fact that artificial wombs would conceivably allow greater opportunity to repair foetal defects, via surgery or gene therapy.

The very technology that some feminists view as potentially extremely liberating, would in fact be restricting for women who wish to experience natural pregnancy. The possibility of such technology also demonstrates why it is essential to consider, in advance, the rights of embryos and foetuses. Even if one believes that the current debate on abortion ends with the woman having the absolute right to abort a foetus of any stage of development, this position says little of relevance as to how we should treat embryos and foetuses in the context of a world with artificial wombs.

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*A significant practical argument against this saving of would-be abortions is the shear number of new infants that would be brought into existence, and the financial cost imposed on social services. One estimate is that one year’s worth of saved embryos and foetuses in America could be in excess of $150 trillion dollars (over an average of 22 years before a child becomes self-sufficient).

A free-market or government-regulated approach to genetic enhancement?

The Potential

Within the last few months, a couple of studies by researchers at UCL have been released demonstrating the potential benefits of gene therapy. Six patients with Hemophilia B were treated; four of whom no longer need their usual treatment. And 14 out of 16 children with two different immune system disorders have been successfully treated. These, and a number of other studies, demonstrate that gene therapy is likely to help treat a wide range of diseases over the coming decades. Faulty genes will be replaced with functional ones, many being delivered to us using nature’s very own cell-invasion specialists: viruses.

But why stop at disease? If one views medicine as something that should be concerned with maintaining or increasing our well-being and not merely about fighting disease (for example, by providing access to abortion and providing palliative care), then we should be using genetic engineering for enhancement, as well as therapeutic, purposes. Indeed, if one is concerned about well-being, then there is no clear dividing line between enhancement and therapy.

As well as limiting genetic disease, it will become possible to create designer babies with genetically-enhanced intelligence, strength, beauty, even happiness and (arguably) moral virtues (or at least an increased potential for empathy). In fact, designer babies already exist to an extent: whenever a woman has an abortion on grounds of a foetal genetic disability or disease, she is choosing not to accept the non-intentional ‘design’ nature has provided her baby with. The same is true of IVF, where embryos can be selected on grounds of expression of certain genes. Whether these forms of selection can be considered ethical depend on both the traits being selected for/against, and the attitude of the parent(s). Genetic technology could be used to enhance beneficial traits or fix defective traits without requiring selection of ‘good’ embryos and the associated death of those embryos not selected.

Consent?

It can be argued that genetic engineering should be restricted to individuals who consent: embryos and gametes cannot consent, therefore we should not attempt to enhance them. Under this view, genetic engineering becomes just another tool alongside other forms of enhancement for individuals to use if they desire once they are old enough to be capable of autonomous decisions. These other forms of enhancement include already-existent drugs (e.g. Modafinil, caffeine, ritalin, steroids) and ones not yet developed. Computer devices that directly interact with the brain, allowing improved memory and intelligence, are a possible future form of enhancement. Arguably current calculators, phones and computers are a form of ‘extended cognition’ and therefore a form of cognitive enhancement.

However, by relegating genetic engineering to consenting individuals, we would be severely limiting the benefits of it both to society, and to the individual, who may well have consented to his enhancement before his birth had he been able to. Certainly, it seems unlikely many people would object to being created as more intelligent, healthier and happier. Enhancement of consenting adults would likely be far more costly and carry more risks than enhancement of an IVF embryo. I shall take it as given that most people would support genetic enhancement of embryos for these general traits (even if intelligence, health and happiness are not easy to define).

Parental Choice

But when you look at specific traits, it is far less clear whether people would support being selected according to the wishes of their parents in a sort of ‘genetic supermarket’ (as Robert Nozick puts it). It could lead to children being used solely as a means to their parents end. Perhaps the parents really want their child to be a professional athlete. So they select genes that will lead to a physically stronger, more muscular, child than if left to chance. Yet what if the child rejects this, and grows up wishing to be a violinist, but finds the type of physical strength imposed upon him actually limits his ability to perform the instrument? It seems that letting parents choose particular traits will remove or limit what some philosophers have called ‘the child’s right to an open future’, and what Habermas calls being ‘an author of one’s own life’*.

Allowing parents to choose could lead to traits being selected purely based on cultural norms, leading to generations of genetically-similar babies, depending on what is in fashion at that time. It could lead to the selection of traits, that whilst being beneficial to an individual if few others possess that trait, becomes pointless or even detrimental if enhanced on a society-wide scale. Any advantage of being taller is pointless (and a waste of resources) if everyone is taller by the same degree (the benefits of height relative to others is a ‘positional good‘). If everyone was made more competitive rather than accepting/cooperative, it would arguably reduce quality of life and lead to increasing conflicts across society. There are also issues of distributive justice; could only rich parents afford to shop at such a supermarket, leading to greater social inequality as the rich reap the benefits of enhancement, maintaining their privileged position?**

State Regulation

These problems with letting parents choose imply there should be some level of state regulation. Yet excessive regulation would likely lead to the creation of a black-market. Allowing the state to dictate which traits are acceptable or not to enhance implies it has a better or more valid conception of a ‘good life’ than individual parents. Certainly there will be some parents out there capable of making ethical choices that may be superior to that sanctioned by the state, whose choices would be lost in such a system. It would also instigate fears of a slippery-slope towards a Nazi-esque eugenics policy where traits are unjustifiably selected against, or where certain nationalism-promoting traits are selected for (though I feel this is highly unlikely to occur within a stable existing liberal democracy and is merely unhelpful scaremongering).

Given the potential problems with both a free-market and a government-regulated approach to genetic enhancement, it is tempting to argue we should stop all forms of genetic engineering in humans. But this would likely lead to even bigger black-market and the associated criminality, with parents trying to hide their genetically enhanced children from the law etc. And it would mean abandoning the massive benefits genetic enhancement could bring across society. It seems we must accept some forms of genetic enhancement. But what forms? And is there a particular system we could set up to minimise the potential harms of both parental and governmental selection of traits, whilst maximising the benefits?

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* Given that the child would arguably not exist (as psychologically the same person) without the parents making this selection means it is difficult to claim that the child has been harmed by the parents, unless the parents deliberately select a trait that causes such severe suffering that death/non-existence would be preferable to experiencing life with that suffering. However, a child that does come into existence solely as a consequence of parental choices could be seen to have a better or worse existence than one that would have come into existence had the parents made other choices.

The fact that parents already often seek to impose their wishes on their children does not justify extending this to genetics. It is equally wrong to impose excessive social pressure, for example, in the form of unwanted athletics coaching…though just because a child doesn’t want something doesn’t mean it is always wrong to impose it upon them!.

**I do not view unequal access to be a serious problem, provided steps are taken to ensure access is opened up to all. Most new technologies are expensive when they first come out, but that is not a reason to oppose them. We do not oppose the development of cars, computers or expensive chemotherapy just because poor people in other countries cannot afford them. Many technologies experience a rapid fall in cost after originally only being available to the richest few, ultimately benefitting the whole of society.

Vegetarianism (and preventing climate change): who actually benefits from it?

I’ve been vegetarian for 4 to 5 years now.  If someone ask why I’m vegetarian, I have a basic default response of  “It’s better for (a) animals (b) the environment (and therefore other people), and (c) one’s health”.  However, each of these points can be challenged. I will explain how a philosophical problem called the ‘Non-identity problem’ demonstrates that it is not obviously clear that as many people or animals actually benefit from vegetarianism as many vegetarians argue.

Point (c) is most easily challenged. Vegetarianism may well be healthier than the average Western diet. Excessive consumption of (especially red) meat may contribute to increased risk of various cancer and other diseases. However, similar health benefits could be obtained simply by significantly cutting down on meat consumption, rather than completely eliminating it.

The same argument applies to (b). Environmental benefits could be obtained from cutting down on meat consumption, rather than completely eliminating it. However, unlike with health, continued reductions in meat consumption should noticeably benefit the environment, so that completely eliminating meat consumption is the environmentally optimum position. This is because of (i) the vast amount of land and water required to farm meat which could have otherwise been left as rainforest or woodland or used to grow crops straight for human consumption, (ii) the large amounts of greenhouses gases produced (iii) the amount of effluent produced etc. Of course, one might feel we have a duty to protect the environment for its own sake, but I think generally people want to protect it for the sake of the sentient beings that require ecosystems to be protected: humans and other animals.

So, unless you think the environment should be protected for its own sake, the environmental benefits of vegetarianism should actually fall under (a), as being something that is better for animals (including human-animals).  Some of these benefits are obvious. Reducing pollution will immediately benefit existing people who suffer from it. Reducing the amount of land used to grow crops to feed animals could allow for more crops to be grown and thus help reduce world hunger (though it should be noted that economic factors play an important part in this; it is not necessarily true that there is not already enough food, it’s just that it is too expensive for many poor people). Reducing the impact of climate change will benefit existent young people who are likely to suffer the worst consequences of it.

How about other benefits? Environmentally, cutting down on greenhouse gas emissions should benefit future individuals by reducing the impact of climate change. And not eating animals should benefit the animals that would otherwise have been born into factory farms and inflicted with pain and suffering in their slaughter. But these 2 claims have a problem. They are both making claims about future people and animals, rather than those who already exist.

In the case of the animals (let’s assume they’re chickens), that would have been born into a factory farm, how can we say that they have benefitted by not being brought into existence? And in the case of the future individuals who have benefitted from the reduced impact of climate change, how can we say that they have benefitted by being brought into existence? This point of this latter question may not be obvious. But think about it: every action that we do or do not do will ultimately affect who is brought into existence, by way of interacting with different people and changing their behaviour ever so slightly, and thus ultimately changing which egg or sperm is involved in creating a new person, and therefore result in a person with a different identity being born.

The issue is: how (for the people) can existence be considered better than non-existence, or (for the chickens), how can non-existence be considered better than existence? This is at the core of Derek Parfit’s non-identity problem, which considers whether an act can be moral or immoral, even if no individual benefits or is harmed by the act.

Let’s focus on the people. Assume we do nothing about climate change, and as a consequence in the year 2040 an individual called John is born. John has to cope with the serious consequences of climate change, which dramatically harm his well-being. Out of 10, John has a well-being of 2. So it seems that John’s well-being is harmed by climate change. But by preventing climate change, John wouldn’t have existed; perhaps his parents never met, or they had a child, Paul, at a different time formed from a different egg and sperm, and Paul had a well-being of 7. What is John’s well-being in this case? Nothing. This does not mean John has a well-being of zero out of ten. If our ‘well-being’ scale goes from -10 to +10, with the extremes representing intense suffering and intense pleasure then a zero would be in the middle. If the scale goes from 0-10, then zero would represent intense suffering. So someone who exists could have  zero well-being. But John doesn’t exist. It makes no sense to rank his well-being on the scale, because his well-being is non-existent. Similarly, in the scenario where John does exist, it makes no sense to say his well-being is ‘better’ than his well-being if he doesn’t.

This argument applies to everyone who has not yet been born (or at least not yet been conceived) who is supposed to benefit from averting climate change. And it applies to animals who are supposed to benefit by not being eaten. But it seems that none of these people or animals will actually benefit.

Is there a way around this problem? The most obvious argument is to point out that even if no future individual benefits from vegetarianism, future generations clearly do. So rather than comparing John’s well-being with his non-existent self, you compare him to Paul. Even though no-one is harmed or benefitted by preventing climate change, if we do so, then Paul will exist. And his well-being is higher than John’s, and therefore it is better that he exists than John does, and therefore it is better to adopt a vegetarian diet to prevent climate change. Problem solved.

However… the way we have solved the problem, by looking at it from the perspective of generational, impersonal benefits, is an essentially utilitarian approach. Which comes with a whole bunch of its own major problems. And unless we are going to keep them as pets instead, it doesn’t say why we shouldn’t eat chickens.