Reading time: 11-15 minutes

When we think about doing good, saving lives is at the top of the list. Doctors, firefighters and Batmen are regarded as heroes because they save lives. We give soldiers medals for rescuing wounded comrades. As far as I know, we don’t award medals for ‘really brightening up someone’s day’. And if any more evidence was needed Peter Singer’s latest book is called The Life You Can Save not The Happiness You Can Increase.

Against this conventional wisdom I’m going to argue that while saving lives is often good, its remarkably less good that we think it is. I’ll offer three arguments for this. The first is that saving lives is impossible. The second is that, according to total utilitarianism, many deaths aren’t very bad because they cause lives. I call this the replacement problem and point out in replacement cases the badness of deaths consists solely in the sadness felt by the living, rather than, as we’d normally think, in both the sadness felt by the living and the loss for the deceased. The third argument is that alternatives to total utilitarianism are either implausible or also entail the badness of deaths consists just in the suffering of the living. The conclusion I draw is we should think less about saving lives and more about helping the living live better lives, although I leave what we should focus on instead of saving lives for another essay.

Argument 1: You can never really save a life

If you’re asked to choose between saving a life or making someone happier, you obviously save the life. Compared to saving a life, increasing happiness looks trivial. However, the phrase ‘to save a life’ is misleading. It implies that if you don’t act, the person will die. But that’s only half-true: whatever you do, the person will die. If you don’t act they’ll just die sooner.

Really then, I think we should talk about ‘lengthening lives’ or ‘delaying deaths.’ Rhetorically, these seem a lot less powerful. It’s somehow deflating to think when you rushed into the burning building to save the old lady you didn’t save her, as it were, for all time. You just bought her more time.

Put this way, the moral choice is between trying to give people more time to live, or helping them enjoy their time more whilst they are alive. If the trade-off of is intensity or duration, it’s no longer clear duration should always win.

Argument 2:  The replacement problem: many deaths aren’t very bad because they cause lives

Imagine the following scenario. A couple want to have a family. A child, Adam, is born. A year later, Adam dies from a preventable disease such as malaria. How important would it have been to save Adam’s life?

On the face of it, quite important. We should count the loss for Adam and his parents separately. We might say this is a tragedy for Adam because he misses out on another 69 years of good life. It’s obviously very sad for the parents too, maybe equal to each of them getting a bout a moderate depression. Let’s generously estimate this depression is equivalent to the parents losing a whole year of happy life each. So we might say 71 years of happy life has been lost.

However, suppose the parents were planning to have a one child family and they decide to conceive again. Around what would have been Adam’s 2nd birthday, Ben is born. Ben goes on to live a happy 70-year life. How important should we have consider saving Adam’s life knowing the parents would have tried to have another child?

How you answer this question will turn on whether you think creating people can be a good thing. Suppose you adopt the total utilitarian view. This holds the best outcome is the one with the most happiness and means we can increase happiness both by making existing people happier, or by creating new happy people. What I say will apply to any view which holds it can be good to create people although alternatives might have slightly different calculations.

If you do think creating people can be good, you should think saving Adam’s life is much less important if you knew he was going to be ‘replaced’ by Ben. We can call this the ‘replacement problem’. Simply, Adam’s loss is Ben’s gain, so those two are going to roughly cancel out. One loses 69 years of life, another gains 70 years of life. Obviously the cost of Adam’s death for the parents still remains. So the total number of happy year lost when we consider Ben replaces Adam is -69 (Adam’s loss) + 70 (Ben’s gain) – 2 (parents’ sadness) = -1 overall. Just 1 year of happy life has been lost if Ben replaces Adam, which means the death is 1/71th as bad as we would have thought on our original total utilitarian calculation.

Here’s another way of putting this surprising result. Suppose we want to help more people live happy lives and we’re choosing between saving Adam or curing another person, Charlie, from some debilitating but non-life threatening disease. When we should we be indifferent between saving Adam and curing Charlie? Just when we can give Charlie a benefit equivalent to one more year of good life. Maybe Charlie is blind, we think curing his blindness is worth 1/10th of a happy year each year, and Charlie lives another 15 years. So curing Charlie is would be worth 1.5 happy years and it would be better to treat Charlie than save Adam’s life.

You might think this sounds like a strange, unusual scenario we can ignore. However, my concern is that this applies to many of the real-world cases where we would have thought saving lives was extremely pressing. For example, the Against Malaria Foundation is often touted as the world’s most effective charity by members of the Effective Altruism movement. Why? Because it provides insecticide-treated bed nets for $5 that can stop young children in the poorest parts of world being bitten by mosquitos and dying from malaria. The reason GiveWell, a charity evaluator, likes it so much is because the children it saves are really young, often under-5, which means we could expect to live many years of good life. They estimate the charity saves a statistical life for every $3,500.

However, these are exactly the sort of age children who are most likely to be ‘replaced’ if they die young. This assumes that parents will have a maximum family size they’re aiming for. It also assumes that parents can and do replace young children (say, under 10s) but not older children either because the woman reaches menopause by that stage or because the parents decide they don’t want to. Hence it’s not clear donors of the Against Malaria Foundation really bring about 65-70 years more human life for every life you ‘save’ because the death of that child might cause another to be born. If you are of a total utilitarian mindset, you might wonder how much good your money really does. And you might have the strange thought that the Against Malaria Foundation would be more effective if it got it recipients to agree not to ‘replace’     yone who dies from malaria. Alternatively, you might also think this whole conjecture is ludicrous because we don’t think it’s good to create people. Hold onto that thought, I’ll come to it next.

The replacement problem will appear whenever a population is at its maximum and the death of one makes room for another. The examples so far have been internally-imposed restrictions: the parents have their own limit to how many children they will have. But you can find externally-imposed restrictions, such as China’s famous one-child policy.

Suppose there’s a deadly virus that wipes out 10 million Chinese people. On the face it this is a massive loss. However, suppose the Government decides to relax the one-child policy temporarily allows 10 million more people to be born, and 10 million families leap at the chance. Similarly to the Adam and Ben case, the loss from the virus consists in the suffering felt by the living because the badness of the deaths of the 10 million is cancelled out by the goodness of the lives 10 million who replace.

We might think replacement cases are reasonably common in states of nature where a given environment supports a maximum population size. If a large part of a certain species (human or non-human) dies from a plague, then there are suddenly more spare resources. In response, members of the species will reproduce more, causing those spare resources to dwindle, until the population reaches its maximum again. So the deaths lost to plague are not as bad as we might have thought because it causes new life.

The conclusions I draw is that, for those with total utilitarian sympathies, the badness of deaths that occur in replacement cases is much lower than we might have expected. In such cases the net loss is the sadness the living feel; the badness causes by the death and goodness of the life it creates are of roughly equal value. Total utilitarians should not consider saving lives in replacement cases very valuable and should look at other ways to increase happiness, either by making the living happier, or by finding ways to create new happy people.

Argument 3: Alternatives to total utilitarianism are either problematic or entail that the badness of deaths consists only in the suffering of the living

Reading the above, you might think the mistake I’m making is wrongly assuming the total utilitarian view that it’s good to create happy people. Instead, you could think that while it’s bad if people die – either because they miss out on life (a ‘person-affecting’ deprivation view) or because it’s a shame there are fewer happy people in the world (an ‘impersonal’ view) – there’s nothing good about bringing new people into existence. After examining this view I’ll turn to two views on which death is not considered a loss for the person who dies.

This view does let you rescue the idea that Adam’s death is bad even if it directly causes Ben to exist. We count the badness of the loss to Adam and the suffering of his parents, but don’t think Ben’s birth was good. So even if Ben gets born we’re back to the original estimate of 71 years of happy life lost and Adam’s death being a tragedy worth preventing.

There are quite a few problems with what I’ll called the ‘asymmetric’ view on deaths though. One challenge is trying to give a plausible justification for the asymmetry. Whatever the reason is we give for saying Adam’s death is bad – e.g. he misses out or there are fewer happy people – why can’t we use that same reason to say Ben’s birth is good – e.g. he gets a chance at life or there are more happy people? It looks like the view is in danger of being inconsistent.

A possible way of trying to avoid this inconsistency is by saying Adam’s death meant he wasn’t able to build on the interests, experiences or projects he had developed whilst alive (the so-called “time relative interest account”, which I admit seems strange to use in the case of a one year old, but let’s stick with it). In contrast, if Adam had never existed he would never have had such interests to miss out on.

However, this could just as easily be argued the other way. It seems it’s just as bad, if not worse, for someone not to be born and never be able to have any interests or experiences at all.

The view has some other puzzling consequences too. For one, it means we can’t differentiate between the scenario when Ben gets born and when he doesn’t: we treat them both as being equally bad even though an additional person exists in one outcome.

More problematically, if you don’t think it’s good to bring people into existence, it also implies you’d be quite happy if this was the last generation of the human race. On this view there’s nothing good about creating any of those future lives. That may not be a bullet you want to bite.

You might try to get around this by saying you don’t care about humans in particular, but you don’t want humanity to die out. This won’t work either. Suppose Adam’s parents were the last humans. Then you probably do think it’s good that Ben gets created because he keeps humanity going. In which case you actually do think it can be good to bring people into existence.

All in all, the asymmetric view doesn’t look very promising. It’s here I want to point out there are two alternatives to the total utilitarian view and the asymmetric view. However, neither view allows you to say that badness of Adam’s death doesn’t consist in the misery it causes his parents. To explain, when we are considering  how good or bad it is when someone is born or dies (and we are looking just at the value related just to them rather than how it might affect their friends and family), there are four positions we could hold. I’ve represented these in the two by two grid.

The total view holds deaths can be good/bad and births can be good/bad. The asymmetric view holds that deaths can be good/bad but that births can’t be.

This leaves two more positions. The Epicurean view, named after the Greek philosopher Epicurus, holds that births can’t be good/bad but neither can deaths be good/bad. The Epicurean rationale is that someone needs to exist to say anything can be good or bad for them, and no one exists either once they’re dead or before being born.

The fourth and final position I’ve called the ‘reverse asymmetric’ view holds that deaths can’t be good/bad (the Epicurean line on deaths) but that births can be good/bad (the total utilitarian view on births). I don’t think anyone actually holds the reverse asymmetric view because it so implausible – it considers it better than Adam dies and is replaced by Ben than if Adam never dies(!) –  but I’ve put it there for completeness.

However, whilst total utilitarians can place great value on saving lives (outside replacement cases) neither the Epicurean view or the reverse asymmetric view place much value on saving lives in any circumstances. They don’t think it’s a loss for the deceased, so the badness of deaths only ever consists in the suffering of the living. That’s obviously a reason to prevent deaths, but it suggests there might be many better ways to make the living happier than stopping their friends and family dying, particularly given how infrequently this actually happens.

Conclusion

In this essay I’ve argued that saving lives might have a lot less importance that we often assume, particularly in cases where failing to save lives causes other people to be born. I’ve noted that the replacement problem is not merely a theoretical one. It appears whenever there is an internally or externally imposed population maximum. Perhaps surprisingly, one of the most obvious real-world cases of the replacement problem is saving the lives of children in the developing world, something effective altruists (and others) would typically consider a highly effective way to do good. I then went on to show the replacement problem can be avoided by dropping the assumption that creating people can be good, although such a view is not particularly plausible. I showed there are alternative views about the value of life and death one might take, but these positions hold that badness of deaths consists entirely in the suffering of the living. As a result, I think ethics should shift its focus from delaying deaths to reducing the suffering and increasing happiness.

As legendary philosophy Jean Razak once asked, I think rhetorically in relation to this question: