We are in triage every second of every day

The most common critique of effective altruism that I encounter is the following: it’s not fair to choose. Many people see a fundamental unfairness in prioritizing the needs of some over the needs of others. Such critics ask: who are we to decide whose need is most urgent? I hear this critique from some on the left who prefer mutual aid or a giving-when-asked approach; from some who prefer to give locally; and from some who are simply uneasy about the idea of choosing. 

To this, I inevitably reply that we are always choosing. When we give money only to those who ask as we walk down the street, we are choosing to prioritize their needs over the needs of those whose calls for help cannot or will not reach us. The choice not to choose is really a choice to leave the decision to external factors.

Resources are limited. We must choose. The question is how, and this is the role of effective altruism.

This post articulates an essential component of effective altruism in an elegant way. It provides a simple metaphor that is helpful both for adherents of the movement to reflect on what effective altruism involves and to communicate with the public about the ideas that undergird the movement. This simple, powerful metaphor renders this post deserving of lasting attention. 

The post itself could be stronger; I think there’s a reasonable argument that the post would be equally strong or stronger without the central example. An abbreviated version of the piece, consisting of the first full paragraph in conjunction with the final four, could serve as a brief overview of this sharp idea. However, that’s something of a quibble: the piece is well-written, and explores a brilliant idea. I'm grateful that I had the chance to read it, and I would highly recommend that others give it a read.

I just wanted to say that this essay was really important for me getting into EA a few years ago, it really resonated with me emotionally in a way that little else did. So wanted to thank you for writing this. 

I know this is not how EA is defined for most people, but I often think of EA as recognizing that we are always doing triage. 

Really resonated with me emotionally

Thanks for sharing this, Holly!

To anyone who liked the essay, I also recommend Julia Wise's "No One is a Statistic", which makes a similar argument.

Thanks for posting this here. I think it makes an important point as to why EA is important.

Btw, you might want to consider spacing out posting your old blog posts here just a little more :) I'm glad to see more good content here, but it feels a little spammy to me at the moment.

We are making decisions every single day, however a lot less frequently than every second.*

An additional consideration for the benefits of Triage is to address decision fatigue. Triage is a methodology and can be considered a logical, sequential system of prioritization to prevent the overwhelm of making a decision on a decision. Triage is a way of weighing options quickly and consistently. I believe most of us here have the privilege of making gradual decisions, especially in everyday life. 

Triage is to maintain calm in chaotic and emotional environments of immediate and obvious human suffering. Many of us, especially Earn to Give, are often shielded from those environments. The media we have access to understand tropical diseases or other high-impact, low-cost is not necessarily personal or visceral. Every choice we make takes considerable energy, from breakfast to whether to acknowledge a human we see in clear distress with a cardboard sign requesting assistance. 

I get frustrated when I see charity organizations pushing images of suffering as it often portrays an image of inferiority of recipient below the giver rather than equal. I believe the reality of the living conditions of our fellow man needs to be transparent, but presented in a context where people have space to understand the systems that create these disparities in the first place. Poor people deserve privacy in their lives as much as those with an semblance of wealth. However, whether an intimate knowledge of someones life conditions is necessary to provide effective support is a discussion for another space. 

For triage to be conducted in the context of Effective Altruism, there need to be explicit and accessible guidelines and best practices to of how to process the information about various sources on how to prioritize recipients of abundance. I am at the beginning of this journey, so I ask for your understanding as I continue to learn through the resources provided and contribute my reflections along the way.

Holly, I absolutely adore this essay, this has to be my favourite EA text ever right after On Caring! Thank you so much for writing this. I came back to it a couple of times over those 2 years and I've sent it to someone quite recently.

I'd rather you space out your older essays too, so that people may be more likely to read them!

I heard this episode of RadioLab and I don't think it reinforced any fantasies about traige: I think it was pointing out that triage itself relies on the fantasy that life is a zero-sum game. The reality was that when a weaker person was given an advocate, it turned out the worst outcome of triage was avoided without any harm to anyone else. Nathalie's experimental treatment did not take anything away from anyone; had the doctor not spent time on her, he might have taken a smoke break or a nap, or spent his time with a patient who didn't end up needing immediate treatment, or who didn't end up surviving the day for some other reason. 

The fact that the doctor was pushed to think beyond the simplistic concept of triage could even be a net benefit--the next time he sees a patient with Nathalie's symptoms, he now knows how to treat them without using limited oxygen that could be used for other patients, meaning he can now save more lives with the same amount of resources and can teach other doctors to do the same. This is the strongest critique of the concept of triage: while it's a necessary last resort, offering it as an option too soon can limit creative problem-solving that could be beneficial for future crises over the longer-term. A lot of medical best practices are developed in resource-rich and lawsuit-prone environments, and medicine is therefore quite risk-averse and wasteful. In a true emergency, there are probably many solutions a smart doctor could try before giving up on patients altogether in the name of triage. The whole point of technological progress is that we don't live in the dark ages anymore, and innovation means that life and health are no longer automatically a zero-sum game.

This post (and also chapter 2 of Doing Good Better, but especially this post) added "we're in triage" to my mental toolbox of ways to frame aspects of situations. Internalizing this tool is an excellent psychological way to overcome forces like status quo bias (when triage is correct), and sometimes an excellent way to get people to understand why we sometimes really ought to prioritize doing good over making our hands feel clean.

I would guess that this post would be even better if it was more independent of the podcast episode.

I used to be more utilitarian about this but eventually I started to believe it is quite important to be 'extra' nice to the people closest to us as it brings the benefit of cooperation which has in turn allowed us to be so effective as humans at all.

This strikes right at the heart of trolleyology for me. And in some cases, seems like a scarcity problem rather than a moral problem. 

Hi! thank you for this essay. I fully agree with the idea of triage and that we are all responsible for the choices we make, and don't make. Consciously and unconsciously.

I felt quite a strong shaming tone at the end of the article which I don't believe is necessary to home in your point. 

I do appreciate the underlying message and the necessity to say it clearly.

Thanks