This is an image of people protesting Peter Singer. Two people in wheelchairs are holding signs. One of the signs says, "I was a disabled baby." A third person in the foreground is signing a petition.

Effective Altruism and Disability Rights are Incompatible

Earlier this month, members of the University of Victoria Effective Altruism Club were surprised to find themselves a target of protest as they hosted a talk from celebrity philosophy professor Peter Singer. After all, Singer is known worldwide for his views on animal rights and charitable giving. He was lecturing on the effective altruist movement, his effort to make charitable giving more effective by measuring impact and encouraging donors to shift their contributions to specific interventions in the developing world believed to have the lowest cost per life saved.

And yet, for much of his career, Singer has been known for another reason: As the philosopher making the case for legalizing the murder of disabled infants.

Throughout his career, Singer has been a critic of laws designed to protect disabled people. In his 1979 book, Practical Ethics, he made the case for allowing parents to kill children with spina bifida and other disabilities shortly after birth, stating his belief that disabled infants should not be permitted a right to life until “a week or a month after birth… [allowing] parents, in consultation with their doctors, to choose [life or death for the child] on the basis of far greater knowledge.” Singer’s argument rests on the idea that not all human beings are persons, allowing the conclusion that “killing a disabled infant is not morally equivalent to killing a person. Very often it is not wrong at all.”

Four years later, Singer bemoaned federal disability law prohibiting clinicians receiving federal funds from withholding appropriate lifesaving care from disabled infants that would have been provided to non-disabled ones, arguing that this placed doctors in the “absurd situation of having to keep alive the most grossly defective infants.” The Princeton philosopher has long criticized disability rights laws for requiring clinicians to provide people with disabilities equal access to care.

During the 2009 debate over health reform, Singer made the case for rationing care away from people with disabilities of all ages. Writing in the New York Times Magazine, Singer made the case that the United States should allocate resources utilizing Quality Adjusted Life Year (QALY) calculations, a cost-effectiveness measure used in the UK and elsewhere that assigns a precise percentage a disabled life is worth as compared to a non-disabled one. Funding for care is then allocated with the goal of QALY maximization  This results in care to disabled patients being disadvantaged, since extending disabled life provides for a smaller QALY return than extending non-disabled life for the same period.

Putting forward a hypothetical estimate that a year in the life of a person with quadriplegia would have one half the value of a year in the life of a non-disabled person, Singer concluded that “a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics.” Thus, all other things being equal, the non-disabled should be given precedence over the disabled in accessing lifesaving care.

Singer has returned frequently to the issue of disability over the course of his career, both as an area of focus and as a point of reference in discussing other topics. In his much celebrated Animal Liberation, he decries as hypocrites those who distinguish “sharply between human beings and other animals…[but] allow no distinctions to be made within our own species, objecting to the killing of the severely retarded and the hopelessly senile as strongly as they object to the killing of normal adults.”

In Practical Ethics, he elaborates, stating that, “Some members of other species are persons: some members of our own species are not. No objective assessment can support the view that it is always worse to kill members of our species who are not persons than members of other species who are. On the contrary, as we have seen there are strong arguments for thinking that to take the lives of persons is, in itself, more serious than taking the lives of non-persons. So it seems that killing, say, a chimpanzee is worse than the killing of a human being who, because of a congenital intellectual disability, is not and never can be a person.”

Though he is forthright with his views, the Princeton philosopher has complained bitterly about protests against him, once taking to the New York Review of Books to compare dealing with German disability activists protesting his lectures to “what it must have been like to attempt to reason against the rising tide of Nazism in the declining days of the Weimar Republic”. His critics would no doubt find this accusation profoundly ironic.

The people who come to hear Singer lecture on effective altruism generally do not come for these views. Many object to the protest at the University of Victoria and similar efforts by disability rights activists, contending Singer’s effective altruism has little in common with his support for infanticide. They argue that Singer is merely a flawed visionary whose unrelated good work is marred by an irrelevant blind spot when it comes to disability. In the words of one effective altruist, Ozy Brennan, “When I think about Peter Singer, I find myself thinking about the civil rights movement. The civil rights movement was sexist in many respects…Silencing the sexist leaders of the civil rights movement would not have helped to further the goals of the Civil Rights movement…And so with Peter Singer and Effective Altruism.”

Yet, it is more difficult to separate out Singer’s views on disability and his effective altruist project than one might first think. The truth is that disabled people have reason to be profoundly concerned by the broad scope of Singer’s work. Efforts to atomize Singer’s writing and pretend it does not emerge from a single consistent intellectual whole do both him and his critics a disservice.

Most supporters of the effective altruist movement are attracted to it with the best of intentions, seeking to improve conditions in the developing world and move away from wasteful and publicity-focused charitable efforts that seem more about glorifying the giver than assisting the recipient.

In this respect, effective altruists join other analysts of charitable giving to make well-justified criticisms of contributions to things like university endowments, arts centers, or expensive “Make-A-Wish” projects with little long term impact. Well before effective altruism came on the scene, many observers felt a greater emphasis on effectiveness was worthwhile and necessary to make sure that scarce donor dollars are used appropriately.

Unfortunately, effective altruists take this a step further, arguing that impact is the only appropriate factor to consider in charitable contributions, with considerations like a community’s responsibility to its members discounted as illegitimate. Effective altruism does not just teach that it is better to contribute to malaria nets in Africa than to arts funding at home, a reasonable conclusion to most. Instead, the ideology goes a step further, arguing that one should invest in interventions in the developing world rather than things like homeless shelters or social services for low-income Americans in one’s own community. Anything less is unethical favoritism, since charitable dollars spent in one’s local communities require greater investment per life saved than those in more impoverished parts of the world.

In his recent bestseller The Most Good You Can Do, Singer points out, “All impoverished Americans have access to safe drinking water, free schooling for their children, free health care through Medicaid and, in many cases, subsidized public housing.” That this is not consistently true – Flint, Michigan and recent proposed Medicaid cuts both come to mind – is immaterial to Singer and the effective altruist community. Investing in improvements to the American safety net is more resource-intensive than malaria nets and other comparable interventions for the global poor. Therefore, under a strictly utilitarian worldview, it cannot be justified.

This approach bears a deep similarity to Singer’s efforts to ration healthcare, which seek to yield the maximum “quality of life” impact for each dollar spent on care. Such a system will inevitably disadvantage those who have more intensive support needs, since they will require more resources to maintain basic survival, let alone quality of life. In an ethical framework that allows for no weight to be given to communal obligations, this is a worldview that dooms disabled people and other “high-cost” individuals to go without support, at least until those who can more ‘efficiently’ absorb assistance have all been helped.

It is not an accident that effective altruists have borrowed the QALY system that causes disabled people such concern in healthcare contexts. Effective altruism and Singer’s views on how to ration healthcare use the same utilitarian ethics and tools. As a result, the promotion of effective altruism can serve as an effective “gateway philosophy” into support for the kind of healthcare rationing disabled people so rightly fear.

After all, from Singer’s utilitarian perspective there is no meaningful moral distinction to be made between charitable donations and social services like healthcare. Both are commitments a society makes to improving the conditions of its less fortunate. It would be illogical to argue for perfect efficiency in voluntary contributions and not with taxpayer funds. As Singer makes clear in his views on health policy, utilitarian thinking belongs in government just as much as it does in philanthropy.

By what right should the government fund wheelchairs when these funds might be more efficiently spent on paralysis prevention or cure research? How can we justify vocational rehabilitation services, which spend considerable sums helping disabled adults find employment, when non-disabled people might achieve similar outcomes for a fraction of the cost? If resources should always flow to their area of greatest efficiency, there is little hope for people with significant disabilities, a notoriously resource-intensive group to assist.

Indeed, the very idea of a welfare state comes under threat in this kind of moral calculus. Since effective altruism allows for no greater moral weight to be given to those in one’s own family or community, it becomes hard to justify expensive programs like housing assistance or in-home care for seniors and people with disabilities, which can cost tens of thousands of dollars per a person, when malaria net charities can save lives elsewhere at a fraction of the cost.

It is not a surprise that Singer’s utilitarianism clashes so frequently with disability rights activism. The work of the disability rights movement, which seeks to enshrine legal and social equality for those who do need more to accomplish the same outcome, has long been a major obstacle to the utilitarian project. Previous efforts to introduce QALY calculations into US health policy have been stymied due to the Americans with Disabilities Act.

In 1992, federal officials blocked a request by Oregon to adopt QALYs within the state’s Medicaid program as part of an effort to expand coverage by limiting certain kinds of care to the disabled. More recently, acting in part at the request of disability rights groups, Congress wrote into the Affordable Care Act a statutory prohibition against the use of QALYs by the Patient-Centered Outcomes Research Institute, a new taxpayer funded research body created by the ACA to fund comparative effectiveness research. Disability rights activists and utilitarians are natural opponents and for people with disabilities, it is an existential fight.

This is not a purely academic debate. The University of Victoria protestors came to Singer’s lecture directly from a vigil organized as part of the annual Disability Day of Mourning, an annual disability community gathering across dozens of cities where activists remember disabled people murdered by their family members. Such efforts began five years ago, motivated by lax responses from law enforcement and media narratives that preached sympathy for the killer for the burden of having to deal with the victim.

It is precisely this type of action that Singer’s writing explicitly condones. His advocacy for the legalization of infanticide is itself consistent with similar efforts by the early 20th century eugenics movement. Then, as now, efforts to devalue disabled life were explicitly framed in terms of the inevitability of disabled suffering, the benefit doing so would bring to society at large, and desire to ensure that people with disabilities did not take up resources utilitarians wished to place elsewhere.

Similarly, at a time when “healthcare as a human right” has become more politically viable than ever before, it should concern us to see a growing movement that tells those with the greatest level of need to go to the back of the line. Singerian healthcare ethics open the prospect that, as we move away from rationing care based on income, our society may instead decide to do so based on disability status. This would be a profoundly unfortunate outcome, especially only a few years after the US finally ended pre-existing condition discrimination in the commercial insurance market.

All of this is not to say that advocating for more effective philanthropy is not a worthwhile cause. In fact, it is sufficiently worthwhile as to be the focus of many of the leading global foundations for many years, largely independent of Peter Singer or effective altruism.

One might reasonably argue that these efforts are more likely to be effective without the baggage associated with the charismatic Princeton philosopher building arguments on the backs of people with disabilities. This is likely true. However, while efforts to improve charitable giving might be better off without attacking disabled people, Peter Singer almost certainly wouldn’t enjoy his current status without of his controversial views. There is little fame in arguing to save the lives of disabled people. Anyone can do that.

By removing the attacks on disabled people, Singer’s ideas become milquetoast, almost mainstream liberal platitudes about being nice to animals and using data in decision-making. To put it another way, in so far as effective altruism is compatible with disability rights, it offers nothing new. And in so far as it is new, it is not compatible.

This may well be why Singer so frequently uses disabled people as examples when advocating for animal rights or effective altruism. To say that one should care about impact in charitable giving is banal, barely worthy of a book deal, let alone a career as a celebrity philosopher. Even advocating against arts funding or for limits on animal testing could be dismissed as mere tinkering, not worthy of the attention and admiration upon which Singer has made his career. It is only with the additional element of taking away from people with disabilities that these ideas become revolutionary. To kill is to show that one means it. For Singer, attacking disabled personhood is the proof of his sincerity and the “secret sauce” for his academic superstardom. And as Singer seeks to bring his utilitarianism to new audiences, disabled activists have every reason to step up their protests.

5 thoughts on “Effective Altruism and Disability Rights are Incompatible”

  1. I think the big issue here, is that back in the thirties and forties we got scared, and started marketing dangerous impractical products like nuclear power, medications, toxic food additives and eugenics. The wasteful products drain funding , increase the likelihood of disability, damage the environment, and lead to the suppression of valid research. It’s like on Batman Returns Max Shrek’s power sucking power plant pollutes the environment, but is so “profitable” because of promotion, it takes away, the funding leaving nothing for it’s victims.

  2. A few conditions must be met before Singer’s notions can be taken seriously.

    1) Human life, all human life, including that of the seriously crippled, is holy from birth to natural death.
    2) Just as we willingly spend a million dollars to save a cute puppy in a deep well, we must allocate money to save troubled humans.
    3) No human life is inherently worth more than any other.

    These must be accepted a priori.

    1. Hi Ed,

      “Crippled” is generally not the preferred nomenclature. I try not to be an asshole about language, but you should know that it is considered offensive by many disabled people. There are some disabled people who have chosen to reclaim it, like the LGBT community has done with the word “queer,” but that doesn’t seem to be the context you’re using.

      – The Management

  3. Replicating /u/UmamiSalami’s comment from reddit that I found relevant:

    Title aside, this is actually a fairly reasonable piece which doesn’t strawman in any obvious way.
    But as strange as it may sound, effective altruists didn’t suck money out of the world and create lots of scarcity. There wasn’t enough money and healthcare to go around before we existed either. So when we have some money and want to provide some healthcare, and we decide where it’s going to go, we decide that it’s better to save the lives of 12 non-disabled people than the lives of 9 disabled people. I don’t think that’s very controversial.
    So maybe we take effective altruism into the government and we decide that healthcare should be allocated on the basis of cost-effectiveness, and that means that last year’s budget gets shifted so that we treat 9 fewer disabled people in exchange for treating 12 more non-disabled people.
    People see this and they think that nine people at stake have been “harmed” in some robust way while the twelve others have merely been benefited in some vague, supererogatory way. But this is simply the wrong reaction. If we assume from the outset that there isn’t enough care to go around, then some people will be treated and some people will be neglected. The fact that a previous generation or cohort of individuals had their care assigned in a particular way isn’t relevant; it doesn’t make sense to say that it’s super-duper-extra important that 5 million contra 4 million disabled people born in 2005 get healthcare while it’s kinda-but-not-extremely-important that 51 million contra 50 million able people born in 2005 get healthcare merely because 5 million of disabled people born in 2004 got healthcare whereas only 50 million able people born in 2004 got healthcare. This is conflating population sizes, trendlines, and policies – which can fluctuate up and down, year to year, without ever being “harmed” or having any “rights” to be violated – with what really matters, individuals.
    And here the EA policy is quite simple – save as many individuals as you can. And it doesn’t violate any rights if you can’t save them all and therefore do so as efficiently as possible. That’s like saying that a shrewd lifeboat operator prioritizing thin people and children on a sinking ship is incompatible with fat people’s rights. Sorry, but the fat passengers have exactly and only as much right to be saved as the thin people, and in such a situation we’re just going to protect as many people’s rights as possible. If I’m incompatible with disability rights because of this, then I and lots of other people all over the world (outside EA) are also incompatible with fat people rights, people standing on the wrong side of the trolley tracks’ rights, casualties in the wrong triage zone rights, free range farm animals’ rights, and a shit ton of other rights depending on the situation. When you apply this understanding of rights (that “you have to help these people with just as much effort as you help other people) consistently, it falls apart. Clearly rights are the wrong way to look at it.
    The world sucks and EA hasn’t had time to grow too much, so that means some people get left out. Just like people who live in one village get left out because it doesn’t have mobile phone service, or people in one country get left out because local warlords are hostile to aid workers, and so on. We don’t get accused of being incompatible with the rights of any of those people. Likewise, effective altruism isn’t incompatible with disability rights at all. In fact, you can even believe that we should help disabled people just as much as able people and be an effective altruist. Yup! You don’t have to believe everything about utilitarianism to be an effective altruist. (But do remember that utilitarianism was founded by an aspie, Bentham.) It should especially go without saying that nothing in EA implies Singer’s views on after-birth abortion, though some of us share those views nonetheless. They are serious philosophical arguments, after all.

  4. So it appears Singer, and some of the other commentators, would take the position that Stephen Hawking isn’t worth whatever medical expenses he has cost the world, because he is surely disabled.

Leave a Reply

Your email address will not be published. Required fields are marked *