Transcribe your podcast

Before today's episode, I have a message for our listeners, if you're listening to this podcast, you probably care about reason and evidence. If you also care about helping the world, I recommend checking out Give Weblog. They do rigorous research on which charities are actually effective. So they're not just looking at what does this charity say they do or what's the charity's budget they're looking at. OK, can we be confident that this charity's work is improving people's health or bringing them out of poverty?


And by how much? If you're curious, you can read their explanations of how they reach their conclusions at Give Weblog, or if you just want a few recommended charities to give to that you can be confident actually work. Give us. Got your back. Check them out at Give Weblog. Nothing to rationally speaking, the podcast where we explore the borderlands between reason and nonsense. I'm your host, Julia Gillard. And with me is today's guest, Dylan Matthews.


Dylan is a senior correspondent for Vox Dotcom, where he writes about politics, economics, culture and a bunch of other interesting things. I've been a fan of Dylan's writing for years, but the impetus for inviting him on the show today was actually kind of unusual. This will be like a bit of an unusual episode in that it's not about a body of work, per say, but rather about a personal choice that Dylan made last year, which is that he decided to donate one of his kidneys to a stranger.


And I'm interested in talking about this choice as kind of a case study in, first of all, how we should be thinking about our ethical obligations to people who are outside of our immediate inner circle of friends and family. And then also a case study in how we should think about risks and benefits of medical procedures, given the imperfect ness of research and evidence. So, Dylan, welcome to the show.


Thanks for having me. What was the impetus for you for deciding to donate? And this was last fall, right?


Yeah. So the surgery was August 22nd. So sort of the end of summer, beginning of fall, and then planning to do it for a while. And I've been in the process of getting evaluated for about a year.


And I think ultimate credit goes to peer pressure that anyone in particular, like was there a particular role model or just of doing it?


All the cool kids are doing well. Well, three people in particular who are friends who had done it. One is Alexander Berger, who you've probably met, who's an analyst, Kidwell, who works on a variety of topics. And definitely it is one of those cool kids. But he he donated his kidney back in 2011 when he was right out of college and and sort of could testify that it was a manageable procedure, that it wasn't unduly burdensome for him, that recovery wasn't that bad and that the benefits are substantial.


He introduced me to a guy named Josh Morrison, who runs a nonprofit called Waitlist Zero, which works specifically on living donors for other other organs as well, but mostly kidneys. And Josh had also done a non directed donation to someone you didn't know and works on, are promoting that. And Josh and I have sort of become friends in this process. But I think one of the more influential people was my friend and Stroz, who, unlike Josh and Alexander, is not sort of a self-identified effective altruist who's not someone who's sort of in a rationalist frame of mind and trying to to sort through these issues methodically.


He's he's like a guy with a job who read Larissa MacFarquhar article on this phenomenon of people doing non-direct of donations and decided that that was something he wanted to do. And I think what was influential for me is, you know, I was in awe and Josh are sort of professional do gooders. Alexander took his money from a foundation to to effective charities and foundations. Josh runs one of those effective non-profits. Ben works on Facebook. He's a great programmer and a great administrator and very talented in many ways.


But he's he's also like a normal guy and just, like, took time out of his life to do this. And and I mean, this isn't like his non disparaging way as I possibly can, but just it was like, well, if he could do it right, this isn't something that, like, weird moral saints do it right.


You know, it's something of a shaved head and a robe and live on the top of a mountain and abstain from all pleasure to have this being exactly like I drink with Ben most weeks, like getting a kidney.


And you can still go drinking with him. Exactly. Yeah, that's a common misconception. Yeah. Liver transplants are rougher for that. I, I had a beer a couple of days after I got out of the hospital, so I don't know if that's a great idea, but it felt just a reminder to all of our listeners that neither of us are doctors and we're not giving medical advice on the show.


No caveat emptor. So before we start talking about, like, how you like the calculus behind donating, what are you just give us a sense of the procedure, like how does it work? Do you meet your recipient or is it totally anonymous? How how serious or how intensive is the procedure in the recovery time, etc.?


So the first thing to say is that I'm really unusual and the three people I just mentioned are very unusual, too, and that the vast majority of kidney donations are to some. You know, already usually a family member, sometimes a friend, and and so we're talking about a small subset where someone is donating without a specific recipient in mind. And so some of those happen through actual sort of almost like dating websites that exist that you can that people will post profiles saying they're looking for a kidney, people will scroll through them and pick someone.


OK, that's not a race.


It's not a I was uncomfortable with that for a number of reasons. One, it's like there's there's something vaguely distasteful about people who need what I think of as a necessary basic medical procedure, sort of begging for that. But that seems sort of like something you shouldn't have to do. And also the other reason is that it doesn't enable what I think is one of the coolest things about non-direct a donation, which is donor Chanes. So a big problem in in kidney donation is that oftentimes people will have a loved one or friend who wants to donate to them, but medically can't.


Different blood types is one issue, but you have tons of antibodies in your body that come into play when you're taking an organ from your body and trying to make it not reject in another person's body. And it's very, very, very common, even if you have the same blood type for it just to not work. And so it used to be that if you didn't match, you did match. But some smart economists and doctors, Alvin Roth is one of them who works in Stanford and got the Nobel a few years ago.


Dorry Segev at Johns Hopkins has worked on this as well, have developed algorithms for matching. So do the simplest one would be a pair trade. So if there's one diad of people would be donor and it would be recipient who would want to donate but cancer. And then another one and the first dyads donor is compatible with the second dyads recipient and vice versa. Then they can just swap. And Chanes let you do that kind of a process, sort of on an interactive basis.


The difficulty is if everyone in the chain needs a kidney back, it's very, very difficult to set that up. It gets sort of I not good enough about to know what adverb is correct for how fast it grows, but it's computationally, much more difficult. The bigger you get it. But one way around that is if someone in the process doesn't need a kidney back. And so if someone like me donate a kidney to a recipient and then they have a friend or a loved one to donate, that they can donate it forward to the next person can donate it forward, and it either terminates at some point or it can just be left open ended.


There is one chain that opened a few years ago I think is now closed, but that had 30 donors and 30 recipients. Wow. That these can go on for a very, very long time just because you don't have to be put back around.


Interesting thing like this is such an interesting way to do a large amount of good. It's basically like injecting some liquidity into a system to allow all this, like, good stuff to happen. That couldn't happen. Just exactly. A bit of liquidity.


Yeah, it's sort of solving the liquidity problem. And yeah. And it's an interesting case of application of very abstract, like matching fees that I think Alvin Roth early in his career did a lot of sort of theorizing on on this and then found that it was very relevant to the kidney machine and very relevant to matching people for medical residencies, which is something else he's worked on.


I kind of want someone who worked on like Uber Cool or Lyft line to create an algorithm that, like, finds the ideal pairs people in for non-direct donation. The ideal way, the same way like the apple. Just figure out exactly like, you know, which driver should pick up which passengers to minimize the total amount of travel time.


Right. And there are some more impressive algorithms than that. This is the general field from the topic. But but Uber and Lyft, my understanding that's the driver still has to accept the suggestion that suggest to you you should also pick up, but they have to go along with it. Right. There is this this now defunct startup called Split in DC that had used this this algorithm that I think that the Finnish computer scientists had developed that did it with no drive for choice.


So, like, you pick up the people that tells you to pick up no matter what. And it was. Their claim was that it was vastly faster and enabled more shared rides than the new proposal or flying. I mean, it's their corporate PR line taken with a grain of salt. But but, yeah, there are a lot of interesting problems in that in that vein.


Yes, I think I've used the phrase it's like Uber, but for kidney donation, which is always fun. Exactly.


So then we could get money for it, right?


Exactly where I live. Yeah. Yeah. We get a little less of that here in D.C.. But but yeah.


So that was that was a major motivation for me. And I did my surgery at Johns Hopkins, which has been a pioneer in doing things like that. And and so I went in not knowing anything about who is going to get it. And up until pretty late in the process and they needed to match me against people I was I was compatible with. But then which one of them got my my kidney had to do with when their loved one was free to donate, when I was free to donate.


But there are a lot of variables and and ultimately I got put into a chain that had four kidneys in it. So it's closed. Now, the final recipient didn't have a family member or friend who wanted to donate further, but that all happened simultaneously on the same day that I I had my kidney taken out very early in the morning. It was flown to Cincinnati where my recipient lives. It was implanted there. And at that same time, his friend or family member was getting their kidney out and shipped.


And they do these all simultaneously so that there's no chance of backing out. So it wouldn't be like I gave my kidney and the person's friend was like, well, we got ours. I know. And it sort of enforces credibility in a certain way, but it's a huge logistical challenge. And I was just consistently impressed throughout the process and their ability to pull it off and to pull it off down to specific things like chartering flights at the last minute to get the organ over.


That is really impressive. And how long was your recovery after that? So I'll put it this way. There are two or three days that are really exceedingly unpleasant. I don't want to say it's it's the worst pain you all have until like you're elderly because half of your listener base might deliver training at some point. But I think for men, it certainly would be one of one of the more painful experiences like it is major surgery. You're taking out an organ, you're making major incisions into your abdomen, and that takes time to heal.


And and I think also it's done laparoscopically, which makes it less invasive that they have sort of what I mean, oh, sorry, laparoscopic surgery. It's the sort of surgical technique that's become really popular in recent decades because it lets you do smaller incisions. So I had three incisions. One was sort of like just big enough to fit a kidney out of around my belly button. And then the other two were for scalpel and light slash camera. And so the addition of the camera and and sort of putting the instruments in through a tiny pore lets them sort of see what's happening and make the cuts they need to make without opening up your whole abdomen, which is the way they used to do it, which would leave you with a scar all the way up up to your chest.


And so it's a great technology. The difficulty in recovering is just so they can see sort of the lay of the land in the abdomen. They pump your stomach full of CO2. So they they it sort of lifts the skin up. They can see around, see what's happening. And it turns out that getting CO2 reabsorbed into your skin is super painful. I have not fully been briefed on that. And and the hardest part is just having it around in your system.


Since gas gas rises, it will ensure I think it's a I forget which nerve it is, but it's a nerve that goes from your diaphragm up to your shoulders. And so, weirdly, I had this piercing shoulder pain that's not treatable by opioids due to gas activity lower. In my opinion, the bodies are weird and complex. So, yeah, my my main memory from the hospital is I hacked my hospital bed so that I was like Backwords and so the gas would flow downwards.


Yeah, I figured that out a little bit.


And so, yeah, I spent most of my time sort of upside down watching Family Feud on the game show.


Or do you now have like traumatic associations, the family feud?


Oh, not really. I mean, it was it was like it was a comfort and compared to getting getting catheters put in and taking out and sort of the various indignities of hospital stays in there. So, yeah. So I was in the hospital for three nights. I went in on Monday morning and was discharged on a Thursday. And after that, the recovery really is rapid, that it starts really bad, but it gets better while we better each day.


And you hit a point about three or four weeks after where you just feel normal again. And I was told this would happen and it seemed totally unbelievable in the immediate aftermath of the surgery just because I was so uncomfortable and so for about sorts. But it really does happen remarkably fast. And so I wound up only taking two weeks off work. I had originally planned to work from home for my first week back and I didn't wind up having to, which was really nice since I'm more productive in the office.


And yeah, it was it was a much easier recovery than than I had feared in sort of the grand scope of things. It's hard for a little bit, but but a lot easier if you zoom out.


And this is probably a good time to talk about how you evaluated the risks. Like just naively, you know, before looking at any of the evidence, one might assume, you know, giving up a major organ is probably bad for you or makes you more vulnerable. But I. I imagine you looked at the literature. What was your conclusion? So my conclusion is that it's pretty safe. I mean, it's major surgery, no surgery is risk free.


There are two big risks that I think you need to think about in evaluating this. One is the very near term chance of death or serious injury in surgery, and that just isn't very high at all. If you don't have high blood pressure, the risk of death in surgery is by about one point three out of ten thousand, according to the literature I've seen. That's about the same as childbirth in the US. Childbirth is not a risk free procedure either.


But there's a reason we congratulate mothers for being happy and healthy after the process. But it's also something that, you know, it's a risk that people are really accepting and give some sort of standard of comparison. And and so I was not super worried about that. It's also, I believe, the homicide rate for DC.


I don't know whether I should feel confident by that, but.


Right, right. I mostly like major surgery. But the bigger thing is long term risk of of chronic kidney disease. And this is something that we actually learned a lot about in recent years. So it used to be that no one thought there was there was much risk of increased kidney failure. That has changed that the earlier studies have compared people who don't need it to the general population. And you have about a third of the risk of developing kidney failure as the general population.


But I think it's about a point nine percent lifetime risk if you've donated.


So you're sorry. You're saying the risk of kidney problems. If you if you have only one kidney because you donated one is a third the risk of of of the average American.


But here's the caveat. The caveat is that to donate, you are selected for a variety of health. Right. And so the relevant comparison is not to the general population, which does look very good. It looks like you're actually better off. It's to what you would be if you didn't donate. And so more careful studies that have compared people who donated to people with equivalent kidney function, pre surgery, who didn't donate shows that your risk goes up about eight fold.


Now, from what it's still from about zero point one four percent, two point nine percent kidney failure or a.


Yeah, of kidney failure. So you have about a little under one percent chance of kidney failure at some point in your life if you donate a kidney, whereas you would have about a ninety nine point nine percent chance of not getting it if you if you hadn't donated to the absolute risk is still small.


I did read about one study, so I was I had thought about the confounding problem of like, well, if you're just comparing donors to non donors, then, yeah, those aren't the same group. And so I was aware of that. And then I came across a study that seemed like I mean, if it were well conducted, I'm not really sure, but it seemed like it would get around the confounding issue that looked at World War Two soldiers who had sustained an injury to one of their kidneys.


So that's like, you know, you could consider that random unless you think that, you know, with better health are more likely to get shot in the kidney. I don't know.


I don't think Nazi murderers and their long term outcomes, I think they were just looking at life expectancy actually were comparable to people who had not gotten injured in one kidney. So that was interesting. I don't I really don't know how much to update from a single study, which is actually something I want to talk to you about.


But had you come across that, I had I had seen the World War to study. My sense is that the literature on mortality is much more sanguine than than the rest of the literature on kidney failure. But I don't think that the I think there was like one Norwegian study that had a poor research methodology a few years ago that claimed a modest reduction in life expectancy. But that's the only one out of a much broader literature and that the general consensus is that there's not an increased mortality risk sort of once you get out of the immediate post or.


Right. So so, yeah, I worry much less about long term life expectancy. And in any case, I think even if there was an effect on life expectancy, it would be totally swamped by like, how much sugar do you eat? How much do you exercise? Like compared to other behavioral modifications? It's just sort of a drop in the bucket.


And do you just to like, frame this process of evaluating the medical literature? The procedure that I usually go through and I haven't done anything quite like this, but in general is that I will like because the medical studies are really hard to do well enough that we can just be confident. And the result, like as I'm sure you know, there's medical reversal that happens all the time where we have a study that seems really good or even an emerging consensus, and then it gets reversed 10 years later.


It turns out actually, you know, it's like stents don't do what we thought they did, et cetera. So given that fact, what I tend to do is I start with a kind of common sense prior about like, well, what would I expect to be the case here, given just my understanding of how the world works? Like sort of like what I said at the beginning of this thread, but like, well, probably taking out an organ isn't good for you.


And then I look at the evidence and depending on how strong it is, I update, you know, upwards or downwards from my prior to some extent. But I don't fully abandon the prior. And I'm wondering if you had a similar way of thinking about it or if you think that makes sense.


Yeah, I think I'm a less methodical Baynton than you are.


Yeah. Like, I hope to be a better one, but I don't think I a sort of explicitly laid out my prior in doing I mean I don't think I would define it.


I didn't mean to imply that. Sure. Not that I know. Yeah. But I think sort of one thing that was helpful for me and thinking this through is sort of the stuff that you are and aren't allowed to do once you've donated. So I think a decent estimate is, is that your you lose half your kidney capacity immediately once you donate, but that your remaining kidney grows a bit to make up for that. And so a decent estimate is you have about 60 to 70 percent of your prior kidney capacity.


And the striking thing, talking to my own doctors and looking through the research was just how few things that rules out for you that that it really does seem like humans have evolved to have somewhat excess capacity. And and so I think the only things I heard about that that affect my life at all based on this are most troops over the counter. Pain meds are overly taxing on the kidney. And so I have to take Tylenol or acetaminophen from now on.


And they can't do ibuprofen or aspirin, which I'm fine with. And the other one is I lowered my Wellbutrin dose a little bit that I think that also can serve up to another SSRI to compensate. So it's very specific, weird stuff that that if if you're not taking specific medications, there's not a whole lot that's Taxin or Chiney and requiring sort of 100 percent of your your original kidney capacity. And so I think sort of thinking through that made it make more sense to me why there wouldn't be a huge mortality rate.




I'm kind of tempted to say going out into the like ethical how you thought about the ethics of kidney donation, but just to make sure, did you have anything else you wanted to make sure to mention about the like risks or procedure or anything before we move on? No, I think we covered that pretty well. Yeah, I think so, too. So I guess my first question would be, do you like is part of why you made this decision because you think of it as in some sense morally obligatory in the sense of like, you know, how can I justify keeping this kidney for myself, which I don't totally need when someone's life is at stake?


Was that was there a sense of moral obligation for you?


I think obligation is not quite the right word. So I, I like to think of myself as a scalar consequentialist and not a binary consequentialist.


I like that. We're going to explain what that is. And that's not my term. That Alister Norcross is a utilitarian philosopher. A Colorado Boulder has a paper called Skalak Consequentialism where you have this idea. And the basic concept is that once you get outside of Judeo-Christian or Canadian sense that what you want to do is distinguish between good actions and bad actions and more the good actions and don't choose bad actions. And and if you think that morality is in some sense of telling exercise exercises, I think most consequentialist would have to concede that consumption like telling you against the harms and the goods against the harms and thinking through the consequences of your actions that once you do that, drawing a bright line.


Across the scale and saying is above, this is good, below this is bad is in some sense arbitrary. It might make sense sometimes to do that. But I think we we have drawn a bright line about murder that seems collectively useful and leads to better outcomes in the medium and long run. But but there's no sort of deep, principled reason why that line should be one place rather than another.


For example, why the line should be between causing harm versus failing to prevent harm is the right or intuitive way that people draw the line.


Right, exactly. And it also sort of prevents you from drawing a line not between good and bad, but between good, but not obligatory and good and obligatory.


The term that philosophers sometimes use for that is super rogatory like as opposed to obligatory, where super arbitrary is like you're not a bad person if you don't do it. But if you do it, you get like extra credit there, like moral bonus points. Right.


And I think some of this is Sam Shuffler wrote a book about this called The Protection of Consequentialism that gets into this in an interesting way where his views are responding to the idea that utilitarianism is too demanding, that it asks too much of you, and and that his response was that you need to make the separation between things that are obligatory and things are rogatory. And I think both consequentialism becomes more plausible and it becomes easier to think of things like, should I donate a kidney if you just stop thinking in those binaries that I don't think anyone is morally obliged to give a kidney.


I do think it's better to do it than to not do it. And and I am fully aware that because I am a human with with biases and flaws and any imperfect information, that I'm never going to do all the things that it would be better to do than to not do. And and I'm going to make some poor choices. But my goal is to get higher on the scale rather than to cross some threshold.


Yeah, I think the way that I've been intuitively thinking about this, I like scalar consequentialism and I might have to look into that. But the way that I've been thinking about it is in terms of obligation versus opportunity where like what we talked about, the obligation, framing of morality. And the canonical example of that would be Peter Singer's child drowning in the pool, our thought experiment, where like, you know, if you would feel obliged to jump in and save a drowning child, even at the expense of ruining your, you know, thousand dollar suit, then you know that if that's your intuition there, that shows that you should also feel obliged to, you know, donate a thousand dollars if it could save the life of a child who doesn't happen to be right in front of you, but is instead, you know, dying of malaria in a country across the world.


And that kind of experiment, that kind of thought experiment, I think underlies a lot of the sense of obligation that a lot of people, especially in the effective altruism community, have, but an alternate conception of doing good, which is also relatively popular among. Yes. Is that of opportunity that you're not really obliged to do any of these good things. I mean, you're obliged to, like, not murder and, you know, not like short term harm to your immediate social fabric.


But as you go around the world, you will sort of encounter various opportunities to do good. And you can ask yourself, like, do I feel excited about this opportunity? And one reason that you might feel excited is if it happens to involve a low amount of sacrifice on your part or expense relative to the amount of good it does or it has some other sort of feature that makes it makes it kind of a good deal, really. And so I find that I often feel very motivated to do good when it feels like this is a good opportunity, especially for me or especially for this particular case.


And so in practice, it seems to work pretty well. I don't I think it's kind of a tricky question whether that frame leads to more good being done than the obligation frame. But it seems to function basically. Yeah, I think that's a really interesting question. And something someone who knows more about the social psychology literature than I do might have interesting observations on since. Yeah, it's a choice between sort of shame and guilt as a motivator and and and sort of excitement and excitement and and intrigue and and I don't know, like you, I don't have a strong prioress which can be more effective.




Nor do I. And so an absence of power, I feel totally free to do the one that I like better rationality works. Right, because that's all.


Kids, what do you how do you feel about the argument that, you know, donating a kidney does involve a fair amount of personal sacrifice, not just in terms of the pain or the risk that you're taking on, but also in terms of like the lost wages, like you could have. You know, you. To two weeks of work, like I you know, not to get into, like how much you earn, but like for four different people sacrificing different amounts of wages, I can certainly imagine for many of them that, like, there could be a lot of money that they could donate instead of taking the time off to to donate a kidney.


And that, you know, depending on what assumptions you want to make about how much like how many lives you can save per thousand dollars, it's plausible that you could, like, save more lives just by donating the money that you would have lost by donating a kidney. What do you think about. Right. I think it's it's important to say in my case that I did not forego any wages for this degree of a very liberal medical leave policy.


We also have unlimited vacation. So the distinction between medical leave and vacation becomes very arbitrary. But I was on paid leave for those two weeks and and Fox media was very supportive of that and points to. Yeah. Of us for that and points to I think a lot of white collar employers have policies like that. Interestingly, the main concern they had was if I ever wrote about it, they didn't want the company to be seen as compensating now for having donated an organ.


Does this count? You're not writing, but I don't think it counts.


I did sign a lot of paperwork saying it didn't count. That I think helps immunize the company. But the US has a lot of very stringent and not super consistent or well thought through laws about about kidney compensation. And so we just wanted to be on the right side of that. So that was the last wage issue is, I think, a totally fair point. I do think there's sometimes a tendency among effective altruists to treat sort of donations to effective charities as kind of like buying indulgences, that to do it as sort of an offset to not doing so.


Some other thing. And and I think we're all moved by that bullet, actually. I think they might. Yeah, but I like you can you can both donate some money and do this. And and I think especially in cases like mine where there isn't a trade off between wages and and giving, it gets murkier. Now, there were some out-of-pocket costs, like my dad came down from New Hampshire and stayed at a hotel in Baltimore and looked after me.


And that plane ticket and hotel room were not free. And I think it would be a very common sense policy to have hospitals compensate people for costs like that. But I think the total there is still to do well under whatever a dollar equivalent you could estimate for for the number of quality or delivery qualities being quality adjusted life years.


So, like, exactly yours. I don't know how down with the lingo I was borderline.


I bet a lot of our listeners revalues. I know they're if they haven't learned it by now, they haven't been listening to three weeks.


But if you don't know now, you know. So I mean, the lost wages argument is kind of a special case of a general argument that that, like donating a kidney may just not be the most cost effective way to help the world. And so even if, like, even if you're not losing wages, someone could say, well, it's still like very like effortful and and maybe painful for you. Like, do you actually prefer it if you could save the same number of colleagues by donating money, like, is there a reason to donate the money?


This is sort of an awkward thing to talk about in that I think people have a bunch of hangups about this that don't make very much sense. But I think there are a lot of selfish reasons to give away or to go on. And there are there are more and less corporations invest. If you want to be hyper cynical, like you gain a great deal of social esteem and prestige, do you still gain the EU and prestige if you admit that you are gaining steam in pursuits?


I don't know how this works.


I think that does cut against it. And I should be clear that I'm denying on the record that God played me doing this.


I some other person who's not you, some other hypothetical person who isn't. Yeah, but I think the less cynical version of that is it's a really emotionally meaningful thing to do. And we sometimes have a hard time talking in terms of of emotions and the effect. About tourism world, but like I feel a sort of concrete connection to the person who got can in a way that I don't to the specific people who got benefits from money I donated to the Against Malaria Foundation.


And is that arbitrary and morally kind of arbitrary? Sure. And I think it's a factor of students have been studying the evidence work and tearing down some of the feel good assumptions about that, but still real. And and I still feel sort of proud and happy that I went through that experience, even just just thinking about myself and my own well-being.


Yeah, yeah. I think I've thought a fair amount about this. And it seems to me there are a couple of ways to to justify using personal sacrifice as a reason to prioritize an act of of doing good as opposed to a reason to, like, undermine that act of doing good thing. It involves personal sacrifice. One potential argument I'm very unsure how I feel about this. Just to be clear about thinking through, I guess, you know, for this position, you could say that like in the long run, I expect that I will do more good if I cultivate a character of someone who is willing to make personal sacrifices and that even if, like in this case, I didn't have to make a personal sacrifice to do good, I like want to generally like like reinforce this virtue in myself, this like this personality trait of being willing to do this.


A different audience is is more of a social it's like social influence as opposed to influence on yourself that like maybe it's easy for me to donate 5000 dollars to charity and save a life or two. But if we if like, I want to ask other people to to help the world, it's not always going to be easy for them. And maybe I want to show that I'm willing to do something that's hard for me in order to, like, set a societal standard that people in general should be willing to do things that are hard for them or something.


I don't know.


Yeah, I think there's value to that. And I think also and this is less and the costs column and more on the benefits column that I think it's important to include the social effects of donating that I wouldn't have donated if if three people I knew had never donated before me and hadn't served. And that's an example. I don't know what the marginal increase in the number of future donors is from one person donating and telling people about it. But one reason I'm working on a piece about this for and we're working on the video with our video team is that I think part of the benefit of doing it is it's increasing awareness of this and maybe getting other people interested in doing it.


And and yeah. So there's there's a benefit of serving as a personal example in a way that is harder to do just for donating just because donating is the last public act.


Right. Right. And less vivid and sort of salient and compelling as well. Right. Right. Well, do you want to recommend any like if listeners are interested in learning more about this, is there any place they should go in particular that you'd recommend?


I think the best compendium of basic facts and figures about this is we've lost zero zero togged, which is it's Josh Markson's group. They they do great work walking people through the process. If you're interested in donating, I encourage you to reach out to me and join that box dot com or to Josh. And neither of us are happy to talk to people considering this. I also want to recommend a post that Josh and Thomas Kelly wrote for a fact about tourism dot com going through sort of the effective altruism argument for donating.


It's the non flashy title is Kidney Donation is a reasonable choice for Effective Altruism.


That's a flashy title for effective altruism because those those are fighting words. Yeah, we can reasonable choice.


We are going to serve. But I think that's very helpful in summarizing the risks and benefits.


Well, that's probably a good place to break or just to close. Do you want to give you kind of just give a recommendation, but do you have another recommendation that you want to make your rationally speaking pick of the episode that influenced your thinking in some way?


This might be something that the previous guests have mentioned as well. But as we're speaking, it's a couple of weeks after Derek Parfit passed away and he was probably the single philosopher who influenced the way I think about ethics more than any other. And his book, Reasons and Persons in Particular, which is is very technical and detailed, read and might be tough for people without philosophy training, but really rewarding is is really eloquent on on this kind of point.


And it is sort of adds up to an argument that our distance from other people is not as great as we might think and that that our relationship with our future selves is sort of like our relationship with other people existing with us at the same time. And that an implication of this is, is that selfishness makes a lot less sense than it might seem to. And and altruism makes a lot more. And so that was really influential and foundational for me, interested in philosophy and consequentialism.


And and I think it's befitting in memory of Derek if more people went out and read it.


Yeah, I totally agree. It was very influential on me as well, especially the second half of the book that you were talking about and very timely. Thanks. Very timely. Thanks so much for coming on the show. It's been great having you. Yeah, no, thank you for having me. This concludes another episode of Rationally Speaking. Join us next time for more explorations on the borderlands between reason and nonsense. If you enjoy listening to the rationally speaking podcast, consider donating a few dollars to help support us using the donate button on our website, rationally speaking podcast Dog, we're all volunteers here, but we do have a few monthly expenses, such as getting the podcast transcribed and anything you can give to help.


That would be greatly appreciated. Thank you.