Chapter 4
Organizers and Campaigners
People with special talents and determination can maximize their impact by starting organizations that create entirely new benefits. Unlike taking existing jobs where impact equals only the marginal difference between your contribution and the next candidate's, founding organizations can create tremendous good. Janina Ochojska founded Polish Humanitarian Action, transforming Poland from aid recipient to provider. Buddhist nun Cheng Yen built Tzu Chi into a seven-million-member organization that has rebuilt hundreds of schools after disasters. Four Harvard and MIT students created GiveDirectly, pioneering direct cash transfers to the extreme poor. While starting impactful organizations is challenging, these examples show the extraordinary good one determined person can accomplish.
The career that allows you to do the most good depends on your unique interests, talents, and character. What matters isn't following a prescribed path but finding where your particular strengths can create the greatest positive impact in the world.
When Chris Croy donated a kidney to a stranger, he initiated a chain allowing four people to receive kidneys. Despite friends thinking it was a "crazy act of self-sacrifice," he discovered kidney donation has minimal long-term health risks while providing enormous benefits to recipients. Similarly, Alexander Berger donated a kidney at age 21, initiating a chain of six transplants.
What's striking is how Chris compared his kidney donation to monetary giving, suggesting that donating $5,000 to anti-malaria efforts might save more lives than his kidney donation. This calculation reflects the core of effective altruism-quantifying impact across different forms of giving to maximize good.
While blood and bone marrow donations are now routine life-saving procedures, non-directed organ donation demonstrates profound altruism that requires no financial resources. The practice is growing rapidly-in the US, anonymous organ donations increased from just 1 in 1988 to 174 in 2013, with the UK showing even higher per-capita donation rates after legalizing the practice in 2006.
These donations represent effective altruism in its most literal form-giving a part of yourself to create the greatest possible benefit for others. They challenge us to reconsider what true generosity means and what we're capable of giving.
What motivates effective altruists? It's not conformity to social norms, as they go far beyond conventional expectations. While universal love might seem the obvious answer, philosopher David Hume observed there's "no such passion in human minds as the love of mankind, merely as such." Evolutionary theory supports this view-we evolved to love kin and those in mutually beneficial relationships, not strangers.
Empathy too has limitations as an explanation. Studies show emotional empathy works strongest with identifiable individuals rather than groups. When shown photos of one child versus eight children needing the same life-saving drug, people donate more to help the single child-a response effective altruists would find absurd, as they prioritize saving the most lives possible.
Research on trolley problem dilemmas reveals that those making utilitarian judgments (similar to effective altruists' reasoning) actually show lower levels of empathic concern than others. Rather than emotional empathy, effective altruists appear motivated by rational recognition that "the lives of distant strangers have the same value as the lives of those we love" and a sensitivity to the numbers of people they can help.
Neuroscientist Joshua Greene's dual-process theory of moral judgment suggests we have two modes of moral thinking: an intuitive "point-and-shoot" mode that evolved for tribal group survival and gives quick emotional responses, and a "manual mode" that engages conscious reasoning. Brain imaging studies show increased cognitive activity before utilitarian judgments but not before non-utilitarian ones. When subjects experience "cognitive loading" (like memorizing complex sequences), they make fewer utilitarian judgments, suggesting reasoning is required for consequentialist thinking.
Despite this reasoning foundation, effective altruists aren't coldly calculating machines. Holden Karnofsky of GiveWell emphasizes that effective altruism itself is what excites him-the idea of maximizing impact drives his passion. Yet when asked if he would leave GiveWell for soup kitchen work if his passions changed, he acknowledged it would be a "tough decision," revealing how reason still guides his choices.
Interestingly, human reasoning abilities have measurably improved over the past century (the Flynn effect), with IQ scores rising approximately 3 points per decade. This improvement in abstract reasoning may have enhanced our capacity for impartial moral thinking-what Steven Pinker calls a "moral Flynn effect."
Contrary to common perception, effective altruists rarely view their choices as sacrifices. Studies of organ donors confirm this-one study of non-directed donors found they rated their donation experience 9.8 out of 10 on average, and all gave a perfect 10 when asked about their willingness to donate again if they could. Sue Rabbitt Roff reports that "every study of live kidney donors from Turkey to Scotland has reported enhanced self-esteem among the donors," with serious health complications being very rare.
Self-esteem is a key component of happiness. Philosopher Richard Keshen developed a concept of "reasonable self-esteem" that aligns well with effective altruists' mindset. A reasonable person seeks evidence-based beliefs and defensible values, recognizing that others' well-being matters equally to their own. The most solid basis for self-esteem is living ethically by contributing to making the world better.
This raises the question of whether effective altruists are truly altruistic if they aren't sacrificing. We can redefine altruism based not on self-sacrifice but on having interests that include strong concern for others. What matters isn't whether helping others involves personal loss, but whether one's happiness includes increasing others' well-being.
As animal welfare campaigner Henry Spira said before his death: "When I go, I want to look back and say: 'I made this world a better place for others.' But it's not a sense of duty, rather, this is what I want to do."
Doing the most good requires difficult judgments about which causes are most effective. Many philanthropic advisors avoid these comparative questions, treating all charitable causes as equally worthy. Rockefeller Philanthropy Advisors, which advises on over $200 million in annual giving, exemplifies this error by failing to distinguish between domestic and international giving-a critical distinction that determines whether donors help those already among the world's wealthiest third or those far worse off.
The cost differences between domestic and international aid are staggering. While separating conjoined twins at a Palo Alto hospital costs between $1-2 million, vaccinating a child against measles in developing countries costs just $1, with an estimated cost per life saved of about $80. Similarly, providing one guide dog in the United States costs around $40,000, while preventing blindness from trachoma in developing countries costs just $20-$100-meaning the same donation could either help one person with a guide dog or prevent 400-2,000 cases of blindness.
Poverty in the United States differs dramatically from poverty in developing countries. The U.S. poverty threshold of $23,850 for a family of four translates to $16.34 per person per day-far above the World Bank's extreme poverty line of $1.53 per day (in 2014 dollars, adjusted for purchasing power). Americans in poverty have access to safe drinking water, free schooling, emergency healthcare, and food assistance programs like SNAP that provide about $4 per day. Hundreds of millions in developing countries lack these basic necessities.
The gulf between American poverty and extreme global poverty means charitable dollars go much further overseas. GiveDirectly's one-off cash grants of $1,000 to extremely poor African families can represent six months to a year's income, allowing recipients to replace leaky roofs or start small businesses. The same $1,000 given to a poor American family might represent just one month's income with less transformative impact.
Robert Wiblin calls this difference "altruistic arbitrage"-the opportunity to do vastly more good per dollar by targeting neglected causes. His advice: "Target groups you care about that other people mostly don't, and take advantage of strategies other people are biased against using."
While there are objective answers to "What is the best cause?", determining those answers isn't always possible. How do we compare preventing blindness in 1,000 people versus feeding starving people, rescuing abused animals, protecting women from rape, or keeping glaciers frozen?
Health economics offers some frameworks for comparing different health outcomes. The quality-adjusted life-year (QALY) concept used by the UK's National Institute for Health and Care Excellence helps determine which treatments provide the best value. Similarly, the World Health Organization uses Disability-Adjusted Life-Years (DALYs) to compare different health conditions. For blindness, WHO research indicates a discount of 0.2, meaning one year of blindness equals 0.8 years of healthy life.
Using these metrics with hypothetical figures ($100,000 to cure 1,000 people of blindness versus saving 500 lives), we could calculate that untreated blindness causes the loss of 200 DALYs per year, while starvation threatens 500 DALYs-suggesting we should feed the starving.
However, these methods remain controversial. Should we ask healthy people or those with the condition to evaluate health states? GiveWell's Holden Karnofsky questions whether quality of life can be reduced to simple metrics, noting that given the choice between preventing 100 infant deaths, providing full nutrition to 100 people, or preventing mild malaria in 10,000 people, different people would choose differently based on their values.
When comparing across domains-like animal welfare versus human welfare-the challenges multiply. While some believe we cannot objectively compare animal rescue with other causes, there's a straightforward reason not to prioritize pet rescue charities: the suffering of abused pets represents a tiny fraction of animal suffering overall. The 164 million owned dogs and cats in the US (2012) are dwarfed by the 9.1 billion animals slaughtered annually for food. Factory-farmed animals endure far more severe suffering than typical pets, and in numbers 55 times greater.
Despite this imbalance, thousands of organizations help dogs and cats while relatively few work for farmed animals. Animal Charity Evaluators (ACE) concludes that advocating for farm animals is far more cost-effective, as animal rescue costs tens or hundreds of dollars per animal saved, while changing consumption habits saves animals at a fraction of that cost.
Even if we assume farm animals experience only one-tenth the suffering capacity of humans, organizations promoting vegetarianism or veganism remain extremely cost-effective compared to human-focused charities. ACE estimates the cost per year of animal suffering averted at $0.63 through leafleting and $0.47 through online ads.
Could we suffer the same fate as the dinosaurs? The extinction of humanity would be catastrophic, eliminating not just current lives but potentially trillions of future lives. While NASA tracks near-Earth objects that might collide with our planet, we lack the technical capacity to deflect extinction-level threats.
Nick Bostrom defines "existential risk" as situations that would annihilate Earth-originating intelligent life or drastically curtail its potential. Major risks include asteroid collisions, nuclear war (with 17,000 warheads still in existence), natural or engineered pandemics, runaway global warming, nanotech accidents creating "gray goo," physics research producing hyperdense "strange matter," and superintelligent unfriendly artificial intelligence that might eliminate humans.
Philosopher Derek Parfit argues that the difference between 99% and 100% human extinction is vastly greater than between peace and 99% extinction, because what's at stake is not just current lives but potentially billions of years of future civilization. If Earth remains habitable for another billion years and could sustain a billion people, that's 10^18 human life-years at stake. Bostrom goes further, suggesting the potential for space colonization and digital consciousness could yield 10^58 possible mind-lives-making even tiny reductions in extinction risk overwhelmingly valuable in expected utility calculations.
Why has existential risk received so little attention? Bostrom notes several reasons: no historical precedent, association with "doom-mongers," lack of identifiable victims, and diffusion of responsibility. The philosophical question hinges on whether future potential lives matter equally to existing ones. Utilitarians like Sidgwick argued for maximizing total happiness, including potential future people. The alternative "prior existence view" holds we should make existing lives good but have no obligation to create new lives.
A major obstacle to prioritizing existential risk reduction is that we often lack clear solutions. While we know how to prevent asteroid collisions, we're less certain about bioterrorism prevention. When scientists synthesized a polio virus and published their methods in Science, did they reduce risk by warning of dangers or increase it by providing a blueprint?
The most promising approach is pursuing strategies that both reduce extinction risk and benefit existing beings-like reducing animal product consumption (which benefits animals, reduces emissions, and decreases pandemic risks) or empowering women (potentially reducing nuclear war risk while improving lives today).
Despite headlines dominated by violence and conflict, the world is actually becoming less violent. For any randomly selected person today, the chances of dying violently are lower than ever before in human history. More importantly, significant progress is being made in reducing suffering. Since 2009, the number of children dying annually from poverty-related causes has dropped from nearly 10 million to 6.3 million-meaning 10,000 fewer children die each day.
While effective altruism may seem extreme when highlighting those who donate half their income or a kidney to strangers, most effective altruists give around one-tenth of their income and continue in their planned careers. The movement represents an advance in ethical behavior and practical reasoning that will spread more rapidly once it reaches critical mass and people realize how easy it is to do significant good while feeling better about their lives.
What makes effective altruism revolutionary isn't just its emphasis on evidence and effectiveness, but its fundamental challenge to how we think about our obligations to others. It asks us to consider not just whether we're doing good, but whether we're doing the most good possible with our resources.
This shift in perspective-from "Am I helping?" to "How can I help the most?"-transforms charity from an occasional act of generosity into an ongoing ethical commitment. It moves us from emotional giving to strategic impact. And perhaps most importantly, it shows that living ethically and living happily aren't in conflict-in fact, they may be two sides of the same coin.
Whether this moral revolution continues to spread depends on people's readiness to embrace a new ethical ideal: doing the most good they can. The evidence so far suggests that many are ready for precisely this challenge.
