Effective altruists recommend that we give large sums to charity, but by far their more central message is that we give effectively, i.e., to whatever charities would do the most good per dollar donated. In this paper, I’ll assume that it’s not wrong not to give bigger, but will explore to what extent it may well nonetheless be wrong not to give better. The main claim I’ll argue for here is that in many cases it would be wrong of you (...) to give a sum of money to charities that do less good than others you could have given to instead, even if it would not have been wrong of you not to give the money to any charity at all. I assume that all the charities under discussion here do positive good overall, do not cause harm, do not infringe rights, etc. What makes my main claim here particularly interesting is that it is inconsistent with what appears to be a fairly common assumption in the ethics of giving, according to which if it is not wrong of you to keep some sum of money for yourself, then it is likewise not wrong of you to donate it to any particular charity you choose. Roughly: if it’s up to you whether to donate the money, it’s also up to you where to donate the money. I challenge this common assumption. (shrink)

There are many cases in which, by making some great sacrifice, you could bring about either a good outcome or a very good outcome. In some of these cases, it seems wrong for you to bring about the good outcome, since you could bring about the very good outcome with no additional sacrifice. It also seems permissible for you not to make the sacrifice, and bring about neither outcome. But together, these claims seem to imply that you ought to bring (...) about neither outcome rather than the good outcome. And that seems very counterintuitive. In this paper, I develop this problem, propose a solution, and then draw out some implications both for how we should understand supererogation and for how we should approach charitable giving. (shrink)

ABSTRACT In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting‐list and receives in exchange a postmortal kidney, usually an O‐kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate directly or to participate in a paired kidney exchange because of blood group incompatibility or a positive cross‐match. Each donation within an LDLE program makes an (...) additional organ available for transplantation. But because most of the pairs making use of the program will be A/o incompatible, it will also tend to increase the waiting time for patients with blood group O, who already have the longest waiting time. It has therefore been objected that the program is materially unjust, because it further disadvantages the least advantaged. This objection appeals to John Rawls’ difference principle. However, the context for which Rawls proposed that difference principle, is significantly different from the present one. Applying the principle here amounts to a lop‐sided trade‐off between considerations of need and considerations of overall utility. Considerations of formal justice, however, may lead to a stronger objection to LDLE programs. Such a program means that one O‐patient on the waiting list is exempted from the application of the general criteria used in constructing the list because he has a special bargaining advantage. This objection is spelled out and weighed against the obvious attraction of LDLE in a situation of (extreme) organ scarcity. (shrink)

Living-donor kidney transplantation is the “gold standard” treatment for many individuals with end-stage renal failure. Superior outcomes for the graft and the transplant recipient have prompted the implementation of new strategies promoting living-donor kidney transplantation, and the number of such transplants has increased considerably over recent years. Living donors are undoubtedly exposed to risk. In his editorial “underestimating the risk in living kidney donation”, Walter Glannon suggests that more data on long-term outcomes for living donors are needed to determine whether (...) this risk is permissible and the extent to which physicians and transplant surgeons should promote living-donor kidney transplantation.1 In this paper I argue that it is not clear that medical professionals have underestimated this risk, nor is it clear that more data on long-term outcomes are needed in order to determine whether it is permissible for individual autonomous agents to expose themselves to this or, indeed, any risk. The global shortage of organs available for transplantation ultimately means that every year thousands of individuals who value their life die needlessly. This is an unacceptable loss of human life. Saving life is one of the most wonderful things an individual can do for another. Promoting any strategy that will assist in saving life and preventing human suffering within acceptable moral limits is legitimate. (shrink)