## LESSWRONGLW

I haven't read all the comments to this post, and I am new to LW generally, so if I say anything that's been gone over, bear with me.

The argument that abortion is bad due to the QALYs has certain inherent assumptions. First is that there's "room" in the system for additional people. If the addition of a new person subtracts from the quality of life of others, then that has to be factored.

Another aspect that must be factored into this analysis is somewhat more obscure. "Moral hazard". "Slippery slope" is a fallacy, however, as noted here under certain conditions, it's a caution to be taken seriously. If abortion is banned because it reduces total QALYs, then the precedent has been set for authoritative intervention in personal choices for the purpose of increasing total QALYs. it would then make sense to, for instance, ban eating beef due to the inefficiency, and health consequences of it. And etcetera, etcetera, etcetera. Depending on how the adjustment for "quality" is calculated.

And this gets into the more important question when pondering QALYs, What calculus are we using for the "Quality adjustment"? What's the coefficient adjustment for depression? How do you factor in personal differences? Is a year of the life of a man with a mean wife worth less than that of a man with a nice wife? Does "Pleasure" factor in? How? Fried food is pleasurable to many people, consuming it increases their instantaneous quality of life, but has some long-term costs in the "years".

Additionally, the quality of life hit that is suffered from banning abortion (and taking a commensurate increase in adoptions) is not just to the mother. Every human in that system takes a quality of life hit due to the chilling effect that it will likely have on the sexual climate, the additional concerns that will inevitably be present on every act of sexual congress (A full term pregnancy is a far greater consequence than an abortion). If our goal is to maximize QALY, then QALY must include all of the variables of life.

Lacking such comprehensive (and impossible) indepth, individual analysis, then it would be possible to, for instance, maximize QALY by essentially putting everyone in prison, feeding them an "optimal life extension diet" (which I assure you is not enjoyable), and keeping them away from toxins/hazards... But a population on full-time suicide watch seems suboptimal to me.

# 24

Cross-posted on my blog and the effective altruism forum with some minor tweaks; apologies if some of the formatting hasn't copied across. The article was written with an EA audience in mind but it is essentially one about rationality and consequentialism.

Summary: People frequently compartmentalize their beliefs, and avoid addressing the implications between them. Ordinarily, this is perhaps innocuous, but when the both ideas are highly morally important, their interaction is in turn important – many standard arguments on both sides of moral issues like the permissibility of abortion are significantly undermined or otherwise effected by EA considerations, especially moral uncertainty.

A long time ago, Will wrote an article about how a key part of rationality was taking ideas seriously: fully exploring ideas, seeing all their consequences, and then acting upon them. This is something most of us do not do! I for one certainly have trouble. He later partially redacted it, and Anna has an excellent article on the subject, but at the very least decompartmentalizing is a very standard part of effective altruism.

Similarly, I think people selectively apply Effective Altruist (EA) principles. People are very willing to apply them in some cases, but when those principles would cut at a core part of the person’s identity – like requiring them to dress appropriately so they seem less weird – people are much less willing to take those EA ideas to their logical conclusion.

Consider your personal views. I’ve certainly changed some of my opinions as a result of thinking about EA ideas. For example, my opinion of bednet distribution is now much higher than it once was. And I’ve learned a lot about how to think about some technical issues, like regression to the mean. Yet I realized that I had rarely done a full 180  – and I think this is true of many people:

• Many think EA ideas argue for more foreign aid – but did anyone come to this conclusion who had previously been passionately anti-aid?
• Many think EA ideas argue for vegetarianism – but did anyone come to this conclusion who had previously been passionately carnivorous?
• Many think EA ideas argue against domestic causes – but did anyone come to this conclusion who had previously been a passionate nationalist?

Yet this is quite worrying. Given the power and scope of many EA ideas, it seems that they should lead to people changing their mind on issues were they had been previously very certain, and indeed emotionally involved.

Obviously we don’t need to apply EA principles to everything – we can probably continue to brush our teeth without need for much reflection. But we probably should apply them to issues with are seen as being very important: given the importance of the issues, any implications of EA ideas would probably be important implications.

### Moral Uncertainty

In his PhD thesis, Will MacAskill argues that we should treat normative uncertainty in much the same way as ordinary positive uncertainty; we should assign credences (probabilities) to each theory, and then try to maximise the expected morality of our actions. He calls this idea ‘maximise expected choice-worthiness’, and if you’re into philosophy, I recommend reading the paper. As such, when deciding how to act we should give greater weight to the theories we consider more likely to be true, and also give more weight to theories that consider the issue to be of greater importance.

This is important because it means that a novel view does not have to be totally persuasive to demand our observance. Consider, for example, vegetarianism. Maybe you think there’s only a 10% chance that animal welfare is morally significant – you’re pretty sure they’re tasty for a reason. Yet if the consequences of eating meat are very bad in those 10% of cases (murder or torture, if the animal rights activists are correct), and the advantages are not very great in the other 90% (tasty, some nutritional advantages), we should not eat meat regardless. Taking into account the size of the issue at stake as well as probability of its being correct means paying more respect to ‘minority’ theories.

And this is more of an issue for EAs than for most people. Effective Altruism involves a group of novel moral premisses, like cosmopolitanism, the moral imperative for cost-effectiveness and the importance of the far future. Each of these imply that our decisions are in some way very important, so even if we assign them only a small credence, their plausibility implies radical revisions to our actions.

One issue that Will touches on in his thesis is the issue of whether fetuses morally count. In the same way that we have moral uncertainty as to whether animals, or people in the far future, count, so too we have moral uncertainty as to whether unborn children are morally significant. Yes, many people are confident they know the correct answer – but there many of these on each side of the issue. Given the degree of disagreement on the issue, among philosophers, politicians and the general public, it seems like the perfect example of an issue where moral uncertainty should be taken into account – indeed Will uses it as a canonical example.

Consider the case of a pregnant women Sarah, wondering whether it is morally permissible to abort her child1. The alternative course of action she is considering is putting the child up for adoption. In accordance with the level of social and philosophical debate on the issue, she is uncertain as to whether aborting the fetus is morally permissible. If it’s morally permissible, it’s merely permissible – it’s not obligatory. She follows the example from Normative Uncertainty and constructs the following table

In the best case scenario, abortion has nothing to recommend it, as adoption is also permissible. In the worst case, abortion is actually impermissible, whereas adoption is permissible. As such, adoption dominates abortion.

However, Sarah might not consider this representation as adequate. In particular, she thinks that now is not the best time to have a child, and would prefer to avoid it.2 She has made plans which are inconsistent with being pregnant, and prefers not to give birth at the current time. So she amends the table to take into account these preferences.

Now adoption no longer strictly dominates abortion, because she prefers abortion to adoption in the scenario where it is morally permissible. As such, she considers her credence: she considers the pro-choice arguments slightly more persuasive than the pro-life ones: she assigns a 70% credence to abortion being morally permissible, but only a 30% chance to its being morally impermissible.

Looking at the table with these numbers in mind, intuitively it seems that again it’s not worth the risk of abortion: a 70% chance of saving oneself inconvenience and temporary discomfort is not sufficient to justify a 30% chance of committing murder. But Sarah’s unsatisfied with this unscientific comparison: it doesn’t seem to have much of a theoretical basis, and she distrusts appeals to intuitions in cases like this. What is more, Sarah is something of a utilitarian; she doesn’t really believe in something being impermissible.

Fortunately, there’s a standard tool for making inter-personal welfare comparisons: QALYs. We can convert the previous table into QALYs, with the moral uncertainty now being expressed as uncertainty as to whether saving fetuses generates QALYs. If it does, then it generates a lot; supposing she’s at the end of her first trimester, if she doesn’t abort the baby it has a 98% chance of surviving to birth, at which point its life expectancy is 78.7 in the US, for 78.126 QALYs. This calculation assumes assigns no QALYs to the fetus’s 6 months of existence between now and birth. If fetuses are not worthy of ethical consideration, then it accounts for 0 QALYs.

We also need to assign QALYs to Sarah. For an upper bound, being pregnant is probably not much worse than having both your legs amputated without medication, which is 0.494 QALYs, so lets conservatively say 0.494 QALYs. She has an expected 6 months of pregnancy remaining, so we divide by 2 to get 0.247 QALYs. Women’s Health Magazine gives the odds of maternal death during childbirth at 0.03% for 2013; we’ll round up to 0.05% to take into account risk of non-death injury. Women at 25 have a remaining life expectancy of around 58 years, so thats 0.05%*58= 0.029 QALYs. In total that gives us an estimate of 0.276 QALYs. If the baby doesn’t survive to birth, however, some of these costs will not be incurred, so the truth is probably slightly lower than this. All in all a 0.276 QALYs seems like a reasonably conservative figure.

Obviously you could refine these numbers a lot (for example, years of old age are likely to be at lower quality of life, there are some medical risks to the mother from aborting a fetus, etc.) but they’re plausibly in the right ballpark. They would also change if we used inherent temporal discounting, but probably we shouldn’t.

We can then take into account her moral uncertainty directly, and calculate the expected QALYs of each action:

• If she aborts the fetus, our expected QALYs are 70%x0 + 30%(-78.126) = -23.138
• If she carries the baby to term and puts it up for adoption, our expected QALYs are 70%(-0.247) + 30%(-0.247) = -0.247

Which again suggests that the moral thing to do is to not abort the baby. Indeed, the life expectancy is so long at birth that it quite easily dominates the calculation: Sarah would have to be extremely confident in rejecting the value of the fetus to justify aborting it. So, mindful of overconfidence bias, she decides to carry the child to term.

Indeed, we can show just how confident in the lack of moral significance of the fetuses one would have to be to justify aborting one. Here is a sensitivity table, showing credence in moral significance of fetuses on the y axis, and the direct QALY cost of pregnancy on the x axis for a wide range of possible values. The direct QALY cost of pregnancy is obviously bounded above by its limited duration. As is immediately apparent, one has to be very confident in fetuses lacking moral significance, and pregnancy has to be very bad, before aborting a fetus becomes even slightly QALY-positive. For moderate values, it is extremely QALY-negative.

### Other EA concepts and their applications to this issue

Of course, moral uncertainty is not the only EA principle that could have bearing on the issue, and given that the theme of this blogging carnival, and this post, is things we’re overlooking, it would be remiss not to give at least a broad overview of some of the others. Here, I don’t intend to judge how persuasive any given argument is – as we discussed above, this is a debate that has been going without settlement for thousands of years – but merely to show the ways that common EA arguments affect the plausibility of the different arguments. This is a section about the directionality of EA concerns, not on the overall magnitudes.

#### Not really people

One of the most important arguments for the permissibility of abortion is that fetuses are in some important sense ‘not really people’. In many ways this argument resembles the anti-animal rights argument that animals are also ‘not really people’. We already covered above the way that considerations of moral uncertainty undermine both these arguments, but it’s also noteworthy that in general it seems that the two views are mutually supporting (or mutually undermining, if both are false). Animal-rights advocates often appeal to the idea of an ‘expanding circle’ of moral concern. I’m skeptical of such an argument, but it seems clear that the larger your sphere, the more likely fetuses are to end up on the inside. The fact that, in the US at least, animal activists tend to be pro-abortion seems to be more of a historical accident than anything else. We could imagine alternative-universe political coalitions, where a “Defend the Weak; They’re morally valuable too” party faced off against a “Exploit the Weak; They just don’t count” party. In general, to the extent that EAs care about animal suffering (even insect suffering ), EAs should tend to be concerned about the welfare of the unborn.

#### Not people yet

A slightly different common argument is that while fetuses will eventually be people, they’re not people yet. Since they’re not people right now, we don’t have to pay any attention to their rights or welfare right now. Indeed, many people make short sighted decisions that implicitly assign very little value to the futures of people currently alive, or even to their own futures – through self-destructive drug habits, or simply failing to save for retirement. If we don’t assign much value to our own futures, it seems very sensible to disregard the futures of those not even born. And even if people who disregarded their own futures were simply negligent, we might still be concerned about things like the non-identity problem.

Yet it seems that EAs are almost uniquely unsuited to this response. EAs do tend to care explicitly about future generations. We put considerable resources into investigating how to help them, whether through addressing climate change or existential risks. And yet these people have far less of a claim to current personhood than fetuses, who at least have current physical form, even if it is diminutive. So again to the extent that EAs care about future welfare, EAs should tend to be concerned about the welfare of the unborn.

#### Replaceability

Another important EA idea is that of replaceability. Typically this arises in contexts of career choice, but there is a different application here. The QALYs associated with aborted children might not be so bad if the mother will go on to have another child instead. If she does, the net QALY loss is much lower than the gross QALY loss. Of course, the benefits of aborting the fetus are equivalently much smaller – if she has a child later on instead, she will have to bear the costs of pregnancy eventually anyway. This resembles concerns that maybe saving children in Africa doesn’t make much difference, because their parents adjust their subsequent fertility.

The plausibility behind this idea comes from the idea that, at least in the US, most families have a certain ideal number of children in mind, and basically achieve this goal. As such, missing an opportunity to have an early child simply results in having another later on.

If this were fully true, utilitarians might decide that abortion actually has no QALY impact at all – all it does is change the timing of events. On the other hand, fertility declines with age, so many couples planning to have a replacement child later may be unable to do so. Also, some people do not have ideal family size plans.

Additionally, this does not really seem to hold when the alternative is adoption; presumably a woman putting a child up for adoption does not consider it as part of her family, so her future childbearing would be unaffected. This argument might hold if raising the child yourself was the only alternative, but given that adoption services are available, it does not seem to go through.

#### Autonomy

Sometimes people argue for the permissibility of abortion through autonomy arguments. “It is my body”, such an argument would go, “therefore I may do whatever I want with it.” To a certain extent this argument is addressed by pointing out that one’s bodily rights presumably do not extent to killing others, so if the anti-abortion side are correct, or even have a non-trivial probability of being correct, autonomy would be insufficient. It seems that if the autonomy argument is to work, it must be because a different argument has established the non-personhood of fetuses – in which case the autonomy argument is redundant. Yet even putting this aside, this argument is less appealing to EAs than to non-EAs, because EAs often hold a distinctly non-libertarian account of personal ethics. We believe it is actually good to help people (and avoid hurting them), and perhaps that it is bad to avoid doing so. And many EAs are utilitarians, for whom helping/not-hurting is not merely laud-worthy but actually compulsory. EAs are generally not very impressed with Ayn Rand style autonomy arguments for rejecting charity, so again EAs should tend to be unsympathetic to autonomy arguments for the permissibility of abortion.

Indeed, some EAs even think we should be legally obliged to act in good ways, whether through laws against factory farming or tax-funded foreign aid.

#### Deontology

An argument often used on the opposite side  – that is, an argument used to oppose abortion, is that abortion is murder, and murder is simply always wrong. Whether because God commanded it or Kant derived it, we should place the utmost importance of never murdering. I’m not sure that any EA principle directly pulls against this, but nonetheless most EAs are consequentialists, who believe that all values can be compared. If aborting one child would save a million others, most EAs would probably endorse the abortion. So I think this is one case where a common EA view pulls in favor of the permissibility of abortion.

#### I didn’t ask for this

Another argument often used for the permissibility of abortion is that the situation is in some sense unfair. If one did not intend to become pregnant – perhaps even took precautions to avoid becoming so – but nonetheless ends up pregnant, you’re in some way not responsible for becoming pregnant. And since you’re not responsible for it you have no obligations concerning it – so may permissible abort the fetus.

However, once again this runs counter to a major strand of EA thought. Most of us did not ask to be born in rich countries, or to be intelligent, or hardworking. Perhaps it was simply luck. Yet being in such a position nonetheless means we have certain opportunities and obligations. Specifically, we have the opportunity to use of wealth to significantly aid those less fortunate than ourselves in the developing world, and many EAs would agree the obligation. So EAs seem to reject the general idea that not intending a situation relieves one of the responsibilities of that situation.

#### Infanticide is okay too

A frequent argument against the permissibility of aborting fetuses is by analogy to infanticide. In general it is hard to produce a coherent criteria that permits the killing of babies before birth but forbids it after birth. For most people, this is a reasonably compelling objection: murdering innocent babies is clearly evil! Yet some EAs actually endorse infanticide. If you were one of those people, this particular argument would have little sway over you.

#### Moral Universalism

A common implicit premise in many moral discussion is that the same moral principles apply to everyone. When Sarah did her QALY calculation, she counted the baby’s QALYs as equally important to her own in the scenario where they counted at all. Similarly, both sides of the debate assume that whatever the answer is, it will apply fairly broadly. Perhaps permissibility varies by age of the fetus – maybe ending when viability hits – but the same answer will apply to rich and poor, Christian and Jew, etc.

This is something some EAs might reject. Yes, saving the baby produces many more QALYs than Sarah loses through the pregnancy, and that would be the end of the story if Sarah were simply an ordinary person. But Sarah is an EA, and so has a much higher opportunity cost for her time. Becoming pregnant will undermine her career as an investment banker, the argument would go, which in turn prevents her from donating to AMF and saving a great many lives. Because of this, Sarah is in a special position – it is permissible for her, but it would not be permissible for someone who wasn’t saving many lives a year.

I think this is a pretty repugnant attitude in general, and a particularly objectionable instance of it, but I include it here for completeness.

### May we discuss this?

Now we’ve considered these arguments, it appears that applying general EA principles to the issue in general tends to make abortion look less morally permissible, though there were one or two exceptions. But there is also a second order issue that we should perhaps address – is it permissible to discuss this issue at all?

#### Nothing to do with you

A frequently seen argument on this issue is to claim that the speaker has no right to opine on the issue. If it doesn’t personally affect you, you cannot discuss it – especially if you’re privileged. As many (a majority?) of EAs are male, and of the women many are not pregnant, this would curtail dramatically the ability of EAs to discuss abortion. This is not so much an argument on one side or other of the issue as an argument for silence.

Leaving aside the inherent virtues and vices of this argument, it is not very suitable for EAs. Because EAs have many many opinions on topics that don’t directly affect them:

• EAs have opinions on disease in Africa, yet most have never been to Africa, and never will
• EAs have opinions on (non-human) animal suffering, yet most are not non-human animals
• EAs have opinions on the far future, yet live in the present

Indeed, EAs seem more qualified to comment on abortion – as we all were once fetuses, and many of us will become pregnant. If taken seriously this argument would call foul on virtually ever EA activity! And this is no idle fantasy – there are certainly some people who think that Westerns cannot usefully contribute to solving African poverty.

#### Too controversial

We can safely say this is a somewhat controversial issue. Perhaps it is too controversial – maybe it is bad for the movement to discuss. One might accept the arguments above – that EA principles generally undermine the traditional reasons for thinking abortion is morally permissible – yet think we should not talk about it. The controversy might divide the community and undermine trust. Perhaps it might deter newcomers. I’m somewhat sympathetic to this argument – I take the virtue of silence seriously, though eventually my boyfriend persuaded me it was worth publishing.

Note that the controversial nature is evidence against abortion’s moral permissibility, due to moral uncertainty.

However, the EA movement is no stranger to controversy.

• There is a semi-official EA position on immigration, which is about as controversial as abortion in the US at the moment, and the EA position is such an extreme position that essentially no mainstream politicians hold it.
• There is a semi-official EA position on vegetarianism, which is pretty controversial too, as it involves implying that the majority of Americans are complicit in murder every day.

#### Not worthy of discussion

Finally, another objection to discussing this is it simply it’s an EA idea. There are many disagreements in the world, yet there is no need for an EA view on each. Conflict between the Lilliputians and Blefuscudians notwithstanding, there is no need for an EA perspective on which end of the egg to break first. And we should be especially careful of heated, emotional topics with less avenue to pull the rope sideways. As such, even though the object-level arguments given above are correct, we should simply decline to discuss it.

However, it seems that if abortion is a moral issue, it is a very large one. In the same way that the sheer number of QALYs lost makes abortion worse than adoption even if our credence in fetuses having moral significance was very low, the large number of abortions occurring each year make the issue as a whole of high significance. In 2011 there were over 1 million babies were aborted in the US. I’ve seen a wide range of global estimates, including around 10 million to over 40 million. By contrast, the WHO estimates there are fewer than 1 million malaria deaths worldwide each year. Abortion deaths also cause a higher loss of QALYs due to the young age at which they occur. On the other hand, we should discount them for the uncertainty that they are morally significant. And perhaps there is an even larger closely related moral issue. The size of the issue is not the only factor in estimating the cost-effectiveness of interventions, but it is the most easily estimable. On the other hand, I have little idea how many dollars of donations it takes to save a fetus – it seems like an excellent example of some low-hanging fruit research.

### Conclusion

People frequently compartmentalize their beliefs, and avoid addressing the implications between them. Ordinarily, this is perhaps innocuous, but when the both ideas are highly morally important, their interaction is in turn important. In this post we the implications of common EA beliefs on the permissibility of abortion. Taking into account moral uncertainty makes aborting a fetus seem far less permissible, as the high counterfactual life expectancy of the baby tends to dominate other factors. Many other EA views are also significant to the issue, making various standard arguments on each side less plausible.

1. There doesn’t seem to be any neutral language one can use here, so I’m just going to switch back and forth between ‘fetus’ and ‘child’ or ‘baby’ in a vain attempt at terminological neutrality.
2. I chose this reason because it is the most frequently cited main motivation for aborting a fetus according to the Guttmacher Institute.