In a democratic society, the social rules are imposed by all upon each. As “recipients” of the rules, we tend to think that they should be designed to engender the best attainable distribution of goods and ills or quality of life. We are inclined to assess social institutions by how they affect their participants. But there is another, oft-neglected perspective which the topic of health equity raises with special clarity: As imposers of the rules, we are inclined to think that (...) harms we inflict through the rules have greater moral weight than like harms we merely fail to prevent or to mitigate. What matters morally is not merely how we affect people, but how we treat them through the rules we impose. While current (consequentialist and Rawlsian) theorizing is dominated by the first perspective and thus supports purely recipient-oriented moral conceptions, an adequate approach to social justice requires a balancing of both. Such balancing results in a relational conception of justice, which distinguishes various ways in which an institutional scheme may causally affect the quality of life of its participants.This essay argues that the strength of our moral reason to prevent or mitigate particular medical conditions depends not only on what one might call distributional factors, such as how badly off the people affected by these conditions are in absolute and relative terms, how costly prevention or treatment would be, and how much patients would benefit from given treatment. Rather, it depends also on relational factors, that is, on how we are related to the medical conditions they suffer. It then discusses some implications of this view for understanding responsibilities for international health outcomes. (shrink)

For several decades, there has been a debate in the philosophical literature concerning whether those of us who live in developed countries are morally required to give some of our money to aid agencies. Many contributors to this debate have apparently taken it that one may simply assume that the effects of the work such agencies do are overwhelmingly positive. If one turns to the literature on such agencies that has emerged in recent decades, however, one finds a number of (...) concerns about such agencies and the work they do that put that assumption in serious doubt. This situation raises a number of pressing questions, many of which have received little or no attention from philosophers. After articulating a number of those questions, I focus mainly on what I call the ‘Epistemic Question (for potential contributors to aid agencies)’: How can those of us who are not experts in international aid arrive at an estimate concerning the effects of the work aid agencies do that we have at least some good reason to believe accurate? (shrink)

Effective altruism is a philosophy and a social movement that aims to revolutionise the way we do philanthropy. It encourages individuals to do as much good as possible, typically by contributing money to the best-performing aid and development organisations. Surprisingly, this approach has met with considerable resistance among activists and aid providers who argue that effective altruism is insensitive to justice insofar as it overlooks the value of equality, urgency and rights. They also hold that the movement suffers from methodological (...) bias, reaching mistaken conclusions about how best to act for that reason. Finally, concerns have been raised about the ability of effective altruism to achieve systemic change. This article weighs the force of each objection in turn, and looks at responses to the challenge they pose. (shrink)

Once upon a time, I attempted to create a web-based one-stop-shop for global poverty relief called the Maximin Project. Drawing on aspects of that experience, I show that although some existing ways of rating and recommending charities are significantly better than others, there remain certain challenges that need to be overcome. Specifically, I argue that the emerging Effective Altruism movement, with its emphasis on measurable effectiveness, runs the risk of neglecting a whole range of projects that are necessary for a (...) well-rounded approach to human development. I briefly model an alternative virtue-based approach that calls on the personal insight of individual researchers and practitioners in addition to the more directly experimental approach of organizations like GiveWell. (shrink)