Nick Beckstead

In this chapter, Nick Beckstead argues that the best available interventions gain most of their expected value via the effects that they have on the long-run future, rather than via their more immediate effects. Because of the vastness of humanity’s possible future, this line of argument tends to favour actions that reduce risks of premature extinction, and actions that increase probabilities of other significantly beneficial “trajectory changes” to the course of humanity’s long-run future, even where the change in probabilities that we are able to bring about is very small.

Over the last forty years, it has become standard to rank publicly-funded health interventions in terms of how many Quality-Adjusted Life-Years (QALYs) they produce for a fixed amount of money. Some proponents of this metric favor ranking health interventions in terms of how many QALYs they produce for a fixed sum of money, and then funding the most cost-effective interventions first. The QALY-maximizing approach has been attacked by disability-rights advocates, policy-makers, and ethicists on the grounds that it unjustly discriminates against the disabled. The main complaint is that the QALY-maximizing approach implies a seemingly unsatisfactory conclusion: other things being equal, we should direct life-saving treatment to the healthy rather than the disabled. This argument pays insufficient attention to the downsides of the potential alternatives. We show that this sort of discrimination is one of four unpalatable consequences that any approach to priority setting in health care must face. Given the alternatives, it is far from clear that we should revise the QALY-maximizing approach in response to this objection.

We begin by showing that every theory of the value of uncertain prospects must have one of three unpalatable properties. Reckless theories recommend giving up a sure thing, no matter how good, for an arbitrarily tiny chance of enormous gain; timid theories permit passing up an arbitrarily large potential gain to prevent a tiny increase in risk; non‐transitive theories deny the principle that, if A$A$ is better than B$B$ and B$B$ is better than C$C$, then A$A$ must be better than C$C$. Having set up this trilemma, we study its horns. Non‐transitivity has been much discussed; we focus on drawing out the costs and benefits of recklessness and timidity when it comes to axiology, decision theory, and normative uncertainty.

We begin by showing that every theory of the value of uncertain prospects must have one of three unpalatable properties. _Reckless_ theories recommend giving up a sure thing, no matter how good, for an arbitrarily tiny chance of enormous gain; _timid_ theories permit passing up an arbitrarily large potential gain to prevent a tiny increase in risk; _non-transitive_ theories deny the principle that, if A is better than B and B is better than C, then A must be better than C. Having set up this trilemma, we study its horns. Non-transitivity has been much discussed; we focus on drawing out the costs and benefits of recklessness and timidity when it comes to axiology, decision theory, and normative uncertainty.

It is common to allocate scarce health care resources by maximizing QALYs per dollar. This approach has been attacked by disability-rights advocates, policy-makers, and ethicists on the grounds that it unjustly discriminates against the disabled. The main complaint is that the QALY-maximizing approach implies a seemingly unsatisfactory conclusion: other things being equal, we should direct life-saving treatment to the healthy rather than the disabled. This argument pays insufficient attention to the downsides of the potential alternatives. We show that this sort of discrimination is one of four unpalatable consequences that any approach to priority setting in health care must face. We argue that, given the alternatives, it is far from clear that we should revise the QALY-maximizing approach in response to this objection.

In slogan form, the thesis of this dissertation is that shaping the far future is overwhelmingly important. More precisely, I argue that: Main Thesis: From a global perspective, what matters most is that we do what is best for the general trajectory along which our descendants develop over the coming millions, billions, and trillions of years. The first chapter introduces some key concepts, clarifies the main thesis, and outlines what follows in later chapters. Some of the key concepts include: existential risk, the world's development trajectory, proximate benefits and ripple effects, speeding up development, trajectory changes, and the distinction between broad and targeted attempts to shape the far future. The second chapter is a defense of some methodological assumptions for developing normative theories which makes my thesis more plausible. In the third chapter, I introduce and begin to defend some key empirical and normative assumptions which, if true, strongly support my main thesis. In the fourth and fifth chapters, I argue against two of the strongest objections to my arguments. These objections come from population ethics, and are based on Person-Affecting Views and views according to which additional lives have diminishing marginal value. I argue that these views face extreme difficulties and cannot plausibly be used to rebut my arguments. In the sixth and seventh chapters, I discuss a decision-theoretic paradox which is relevant to my arguments. The simplest plausible theoretical assumptions which support my main thesis imply a view I call fanaticism, according to which any non-zero probability of an infinitely good outcome, no matter how small, is better than any probability of a finitely good outcome. I argue that denying fanaticism is inconsistent with other normative principles that seem very obvious, so that we are faced with a paradox. I have no solution to the paradox; I instead argue that we should continue to use our inconsistent principles, but we should use them tastefully. We should do this because, currently, we know of no consistent set of principles which does better.