What does it mean to save a life? Or at least, what do we mean by it?
The first thing we need to do is stop and think a bit about causation. Causation, notorious in philosopher’s circles, is not normally the best way to make a clear definition. But here we are talking about a psychological interpretation of cause, as in how do we cause this or cause that, and so it is sufficient to suggest a loose picture of causation that we can accept. A very popular interpretation is, ‘if I had not done this, then that would not have happened.’ Now, beset with problems, I believe this is roughly how we each think about when we have caused and outcome, more especially when we have not caused it.
Next we need to be explicit about what we mean by ‘a life’. This is tricky because we probably don’t mean a couple of hours but we also don’t mean living until 74. There is some middle ground and I think that it is defined by our action: ‘life’ is what you get when the immediate risk to your life is removed by someone who has saved it. For example, if a nurse delivers nutrients to a child who would have died of starvation then that is a ‘life saved’ and we don’t wonder how much longer that child does actually live. You have ‘saved a life’ when in the counter factual case the person would have died but instead the person does not die from the cause of death you intervened on.
What is clear, is that it isn’t actually that clear what it really means to ‘save a life’. But I think that there is a type of apparent clarity that is associated with humanitarian work that is not found in say vaccine delivery. The psychological effect of delivering aid is to feel like you are saving lives. There is immediacy and contrast between the results of action and non-action. If you were not there, if we didn’t send food, then people would die. Saving lives, therefore, is just a matter of delivering aid. With vaccines you need to appreciate a population level effect. You might not be saving this child, or the next child, from measles but there is a vague counter factual world where more children die for lack of vaccination. There is no immediacy and no certainty of the results of your actions.
This psychology is found in all areas of reactionary care. This sense of cause and effect is motivation for working in the humanitarian industry; getting ‘out there’ and saving lives.
“Help the needy in a humanitarian crisis,” is a moral position that stubbornly resists scrutiny.
Over the next three weeks I want to explore the foundations of this position, its implications and unintended ramifications. I am not saying that no-one opposes humanitarian aid, many do, but when people oppose it they are often doing so on xenophobic, nationalistic, racist or ignorant grounds without framing their opposition in a coherent ethical framework that could be applied in all places. What I intend to do – and I don’t know for sure where it will lead – is to critique humanitarian aid and place it into a system of priorities that applies to all of our other ethical decisions. In the book Dead Aid, Dambisa Mayo argues that development aid is exacerbating Africa’s problems. She is one of the most controversial and outspoken critic of foreign aid but even she ring-fences humanitarian aid for natural and man-made disasters. Now, I don’t know about her original thesis but I am interested in this distinction: what is special about disasters?
I will look at the outcomes of humanitarian assistance and how they are measured. I will consider that there is a moral hazard in place that works for the agencies and their donors while excluding the people they are trying to help. I will look at the psychology of the aid worker, how our ideas about causation and limitations in understanding statistics might be holding us back from rational progress. I will think about the psychological effect of a disaster, who the death/disease is affecting, and the tyranny of present perception. Finally I will make the contention that humanitarian aid is not only weak within itself but that so long as it is inefficient and opaque the opportunity costs are extra people dead/diseased that we could have helped.
What I am not going to do is a Crisis Caravan style exposition of humanitarian workers in specific contexts. Not only do I lack the experience to do so, I don’t think that is the point. Individual actions/inactions are not the problem, nor are agency level actions/inactions. I am exploring the state of the system and how it came to be like it is.
With a crisis of immense scale unfolding in the Horn of Africa I appreciate that this is a sensitive time. But there are many crises, albeit slow/sporadic/spread-out ones, that are happening right now; and humanitarian aid is not helping them, perhaps even, the reverse.