This article was downloaded by: [State University of New York at Albany], [Lisa Fuller] On: 18 April 2012, At: 08:39 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Global Ethics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rjge20 Priority-setting in international nongovernmental organizations: it is not as easy as ABCD Lisa Fuller a a Department of Philosophy, State University of New York at Albany, Albany, NY, USA Available online: 18 Apr 2012 To cite this article: Lisa Fuller (2012): Priority-setting in international nongovernmental organizations: it is not as easy as ABCD, Journal of Global Ethics, DOI:10.1080/17449626.2012.656492 To link to this article: http://dx.doi.org/10.1080/17449626.2012.656492 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-andconditions This article may be used for research, teaching, and private study purposes. 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Priority-setting in international non-governmental organizations: it is not as easy as ABCD Lisa Fuller∗ Department of Philosophy, State University of New York at Albany, Albany, NY, USA Recently theorists have demonstrated a growing interest in the ethical aspects of resource allocation in international non-governmental humanitarian, development and human rights organizations (INGOs). This article provides an analysis of Thomas Pogge's proposal for how international human rights organizations ought to choose which projects to fund. Pogge's allocation principle states that 'an INGO should govern its decision making about candidate projects by such rules and procedures as are expected to maximize its long-run costeffectiveness, defined as the expected aggregate moral value of the projects it undertakes divided by the expected aggregate cost of these projects' (2007. Moral priorities for international human rights NGOs. In Ethics in action, ed. D. Bell and J. Coicaud, 218–56. Cambridge: Cambridge University Press, 241). I critique Pogge's argument on two fronts: (1) I demonstrate that his view is problematic on his own terms, even if we accept the costeffectiveness framework he employs. (2) I take issue with his overall approach because it generates results which can undermine the integrity of INGOs. Further, his approach mischaracterizes the nature of INGOs, and this mistake is at the root of his problematic view of INGO priority-setting. Ultimately, I argue for a conception of INGOs in which they are understood as 'organizations of principle', in the sense that they are independent moral agents and so should be permitted a fairly wide sphere of autonomy within reasonable moral constraints. Keywords: priority-setting; international non-governmental organizations; Pogge; integrity 1. Introduction International non-governmental humanitarian, development and human rights organizations (INGOs) such as Oxfam, Médecins sans Frontières (MSF) and Save the Children deliver about $7 billion worth of development and humanitarian assistance every year (UNDP 2002, 102). As such, INGOs are an important source of basic goods and services for many of the world's poorest people. They are also, on their own account, engaged in a fundamentally moral enterprise. As such, we might expect that their priority-setting decisions are made with moral criteria in mind. But which criteria are most relevant here? And which ones should take precedence when they conflict? Should these organizations (INGOs) use their considerable resources to save the most lives at the lowest cost? Or to help the worst-off? What decisionmaking processes should they use to decide between very many potential beneficiaries? Given that all INGOs operate under resource constraints, and so will not be able to help all eligible recipients, how ought they to spend their funds? This is a weighty moral question, given that choosing in favor of one project or strategy inevitably means choosing against another, and so against improving or even saving the lives of certain groups of vulnerable people. Recently, theorists have demonstrated a growing interest in the ethical aspects of resource allocation in international non-governmental humanitarian, development and human rights organizations (Pogge 2007a; Rubenstein 2007; Hurst, Mezger, and Mauron 2009; Donaghue ISSN 1744-9626 print/ISSN 1744-9634 online # 2012 Taylor & Francis http://dx.doi.org/10.1080/17449626.2012.656492 http://www.tandfonline.com ∗Email: lfuller@albany.edu Journal of Global Ethics 2012, 1–13, iFirst article D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 2010; Pogge 2011). In particular, in two recent papers, the influential political philosopher Thomas Pogge develops a broadly consequentialist principle which he argues ought to govern the moral priorities of INGOs (Pogge 2007a, 2011).1 My purpose here is to give a comprehensive analysis of his view. Pogge explains that he was moved to write on this topic when he witnessed a presentation by an INGO practitioner in which she noted that 'some of the hardest choices she has had to face in her work at Oxfam had been about abandoning a project when it becomes apparent it is doing more harm than good' (Pogge 2007b, 273). At that time, Pogge responded that 'surely even a project that does more good than harm should be abandoned when a lot more net good can be achieved with the same resources elsewhere' (Pogge 2007b, 273). He notes that this response provoked 'all but universal condemnation from INGO representatives' (Pogge 2007b, 273). Although this type of cost-effectiveness, efficiency-based analysis may not be well-received by most practitioners, it is nevertheless a type of reasoning that appeals to donors and policymakers alike. After all, no one likes waste, and often people in these positions do not fully appreciate either the real complexities of providing development and humanitarian assistance, or the multifaceted relations between donors, the culture and capacities of each INGO, and the beneficiaries they serve. In addition, donors and (inter)governmental policy-makers often focus on where 'their' money is going and in so doing pay insufficient attention to the values and principles to which their INGO 'intermediaries' are committed. The cost–benefit approach is therefore a generally appealing and pervasive oversimplification that should be guarded against. Especially when the rhetoric of many policy-makers has turned to 'eradicating poverty' as a central goal, those in the INGO sector should arm themselves with arguments that demonstrate why the imperative to put efficiency first infringes in a pernicious way on their independence and integrity. In what follows, I offer arguments of this type. The article has four main sections. In Section 2, I outline Pogge's position. In Section 3, I articulate my concern that his view may be too weak for it to constrain INGO decisionmaking in the ways Pogge himself suggests. Next, I argue that Pogge's principle is objectionable because it allows for morally impermissible trade-offs which undermine the integrity of INGOs. In Section 5, having outlined the difficulties with Pogge's view, I argue that Pogge has mis-characterized the nature of INGOs, and that this is at the root of his problematic analysis of how they ought to allocate resources. I then provide an alternative account of the nature of INGOs in which they are understood to be 'organizations of principle', in the sense that they are independent moral agents and so should be permitted a sphere of autonomy within reasonable moral constraints (as most moral agents are), rather than required to adhere to a single resource-allocation principle. 2. Pogge's view In order to keep my exposition of Pogge's view reasonably brief, I will begin by introducing the final version of his resource-allocation principle, and then explain its various components in more detail. Pogge proposes that the following general principle should guide INGO choices: (ABCD∗) Other things being equal, an INGO should govern its decision making about candidate projects by such rules and procedures as are expected to maximize its long-run cost effectiveness, defined as the expected aggregate moral value of the projects it undertakes divided by the expected aggregate cost of these projects. Here aggregate moral value, or harm protection, is the sum of the moral values of harm reductions (and increases) these projects bring about for the individual persons they affect. (Pogge 2007a, 241; 2011, 58–59). The principle (as indicated by its name) is made up of four key components. Pogge argues for each of these elements independently, and so I will try to give a short summary of his reasons for 2 L. Fuller D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 adopting them. His larger strategy takes the form of introducing relatively uncontroversial moral considerations, demonstrating why they are significant, and then integrating them into a single principle. Proposition or consideration (A) simply states that all other things being equal, 'it is morally more important to protect people from greater serious harm than from lesser' (Pogge 2007a, 222; 2011, 48). Serious harm is defined as 'shortfalls persons suffer in their health, civic status (civil and political rights, respect in their community) or standard of living relative to the ordinary needs and requirements of human beings' (Pogge 2007a, 222; 2011, 48). This idea has a threshold built-in to it, such that anyone whose standard of living rises above the threshold for minimal sufficiency cannot be said to suffer serious harm. Further, Proposition (A) points to the diminishing marginal significance of resources, in that the worse-off someone is relative to the threshold for an adequate standard of living, the more a given amount of resources can protect her from harm. In effect, someone living on $30 per month gains more harm protection by receiving aid equivalent to another $30, than someone living on $60 per month would gain from the same amount of aid. Proposition (B) instructs us to give some priority to the worse-off. This is meant to take account of the fact that it is morally more important to help someone the worse-off he is, as contrasted with the earlier assertion that the same amount of resources can help people more the worse-off they are. Pogge himself calls this the distinction between the magnitude of a given harm reduction and its moral value or importance (Pogge 2007a, 224; 2011, 50). He uses the following example to demonstrate the chief implication of (B): [C]onsider an INGO that supplies poor households with a smart fuel-efficient stove that greatly reduces hazardous indoor air pollution and time spent gathering firewood. . . . [T]he INGO must choose whether to supply the stoves to one rural area inhabited by extremely poor people or to another inhabited by merely poor people. People in both groups would realize equal harm reductions . . . Even though the two groups thus do not differ in achievable harm reduction, Proposition (B) directs the INGO to decide in favor of the extremely poor (Pogge 2007a, 224; 2011, 50). A further implication of (B) is that an INGO ought to prefer harm reductions that are smaller but morally more valuable over those that are greater in magnitude but less valuable. The essence of Proposition (C) is that 'the numbers count'. Here, Pogge is pointing out that we commonly consider it to be morally more important to achieve the same harm protection for more people than for fewer. He develops this intuition by specifying that 'aggregate harm protection is a linear function of the number of persons protected' and that 'the moral value of several harm reductions is the sum of their moral values' (Pogge 2007a, 227; 2011, 51). This last point is intended to commensurate different harm protections, such that improvements in medical care and clean water implemented by a given project yield a single result in terms of harm protection, which can then be compared to the harm protections yielded by another project concerned with, say, defending the civil rights of women and minorities. Finally, Proposition (D) merely states that, everything else being equal, cheaper projects are more choiceworthy than more expensive ones. Basically, if harm protection of the same moral value can be achieved for $10,000 in Project X and $15,000 in Project Y, then an INGO ought to prefer the former, since its resources are scarce. Pogge notes that by choosing to implement cheaper projects, INGOs 'can then achieve more of what is morally important' (Pogge 2007a, 228; 2011, 52). Those are the four basic elements of his view. However, several other facets of Pogge's position warrant additional explanation. Importantly, the principle does not allow sacrifices of costeffectiveness for the sake of fairness. So we ought not to read the 'other things being equal' clause to allow trade-offs in favor of either an equalization of chances among eligible beneficiaries (as in deciding by lottery among appropriate recipients) or a 'proportionate distribution of Journal of Global Ethics 3 D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 harm reduction across countries or other collectivities' (Pogge 2007a, 237; 2011, 56). This means that no departures from maximum cost-effectiveness are permitted for the sake of, say, equalizing the distribution of aid among urban versus rural populations or among those populations that are more expensive to help due to a higher local exchange rate and those that are cheaper in this respect.2 The view also specifies how INGO decision-makers ought to address the uncertainty and risk they typically face. In situations where there is some amount of risk, decision-makers are meant to assign probabilities to various outcomes and to their associated costs with the information available to them. Then their probability-weighted expected moral value can be divided by their probability-weighted expected cost and a single value for each possible project can be arrived at as before.3 Obviously, these types of calculations are not strictly possible under uncertainty, but Pogge suggests that nevertheless INGOs ought to manage risk and uncertainty in such a way that they 'maximize [the] expected long-run costeffectiveness' of all their projects taken together (Pogge 2007a, 241; 2011, 58). At first glance, Pogge's clear ranking of the most cost-effective realization of moral value over all other options might seem too demanding, in that it rules out too many potential projects that would ordinarily be considered suitably worthwhile. For example, it looks like (ABCD∗) would exclude a project which focused on providing grief counseling for the families of AIDS victims, since it is not likely that this is the most valuable harm reduction that could be obtained with those funds. Or perhaps, it might also rule out more traditional projects that provide food or medical care, but that happen to be located in very remote regions where the logistical costs of operating are very high. Joseph Carens makes precisely this type of objection (Carens 2007). However, as Pogge points out, he has left several significant features of the principle unspecified. These 'open parameters' allow INGOs to answer key questions in a variety of different ways and so to generate diverse sets of results from principle (ABCD∗). Consider Proposition (A), which allows INGOs to determine for themselves 'what should count as harm and what weight should be attached to harm of different types' (Pogge 2007a, 223; 2011, 49).4 This seems to indicate that INGOs can outline their own notion of harm and can also determine how to differentially weight various types of harm, such as persecution suffered as a result of gender, race or ethnicity, food insecurity, lack of medical care or illiteracy. Further, it is up to INGOs to decide how to integrate the views of beneficiaries themselves into their determination of what counts as harm and how to weight each type. In effect, Pogge's view seems to allow each INGO to decide how much paternalism (if any) is acceptable for the purposes of determining the kind and extent of the harms suffered by various groups. In addition, Proposition (B) leaves open the question of how much priority to give to the worse-off. This means that for one INGO, the moral value of a particular project might turn out to be much greater than it is for another INGO (holding the cost of the proposed project constant), despite the fact that both INGOs have applied principle (ABCD∗). Purely because they have answered the priority question differently, it seems that virtually identical projects could show up as more choiceworthy for some INGOs and as less choiceworthy for others. Finally, Propositions (A) and (B) do not specify whether an INGO ought to count all the harms and benefits a person has and will have experienced over the course of her whole life, or only some subset of these. The time period over which harms to a single person are aggregated will have an impact on both the expected magnitude of various harm reductions, and the judgment of how badly off certain potential recipients are as compared with other eligible candidates. Thus, these open parameters can be 'filled in' in several different ways, which allows INGOs a degree of freedom with respect to the activities they can ultimately undertake. Pogge himself remarks that '(ABCD∗) is not nearly strong enough to permit a precise ranking of all possible INGO projects' (Pogge 2007b, 274). 4 L. Fuller D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 3. Not strong enough? At this point, Pogge's principle does not look unacceptably strong (Pogge 2007b, 275). In fact, it appears to suffer from precisely the opposite difficulty, namely, that it is too weak to do the work Pogge wants it to do. In effect, the open parameters of (ABCD∗) leave too much open – so much so that it cannot constrain INGO choices in the ways Pogge suggests it can. Once we begin to imagine the diverse ways in which the open parameters might be filled in, it begins to look as if all that an INGO needs to do is figure out what answer they want the principle to generate, and then figure out which 'inputs' will get them what they want. Perhaps the calculations required by (ABCD∗) could not generate any conceivable answer, but it seems to allow for too many possible results, including some that we might well think it ought to exclude. Naturally, Pogge argues that his principle does rule out the types of projects that are unjustifiable. He maintains that (ABCD∗) has several concrete implications that direct INGOs to refrain from instituting projects in certain places and under certain conditions. For example, he suggests that projects in countries where government control is precarious (or perhaps non-existent) are excluded from consideration. This is because the likelihood of misappropriation of resources and extortion by criminals and political factions makes funding projects in these countries too costly. However, we can see that if an INGO was to include in its definition of harm 'living without rule of law or under the regular threat of violence from criminals or political factions', and then to weight being badly off in this type of way very heavily, then projects in these countries would be eligible again. Pogge lists as another implication of his view that it favors projects where 'many poor people live in geographic proximity' (Pogge 2007a, 231). This requirement arises from the fact that stationary projects (such as clean water facilities or hospitals) can help more people in heavily populated areas than they can in sparsely populated ones, and mobile projects can spend less money on traveling to beneficiaries and so more on actually improving their wellbeing. Again, we can see that although increased numbers will certainly incline INGOs toward working in places where there are many people, they could dramatically weaken the importance of sheer numbers by choosing to define harm as partially constituted by isolation from medical services or supplementary food sources. This type of definition makes it look as if rural or nomadic populations will typically be much worse off than those in urban settings (where there are usually some services of this kind although they may be insufficient) and so each unit of harm reduction for those groups will be weighted much more heavily. Further, we might wonder if the relative weighting of different types of harm would not end up allowing projects which seem inconsistent with what I take to be the general thrust of (ABCD∗). For instance, many INGOs are involved in empowerment activities, which include consciousness-raising among oppressed groups, and support for 'expanding and strengthening established [local] organizations so that they are better able to safeguard the interests of their members' (Degnbol-Martinussen and Engberg-Pedersen 2003, 154). Conceivably then, an INGO very concerned with empowerment might weight this type of harm reduction as more important than more obvious kinds such as provision of clean water or free medical care.5 I do not mean to suggest that these are not worthwhile activities. My point is, rather, that the implications Pogge draws from his own principle do not seem to bring to mind these types of activities. Instead, his examples tend to be specified in terms of saving people from homelessness, malnutrition, avoidable disease and death. Indeed, he begins both articles on INGO priority-setting with a discussion of how much it would cost to eradicate poverty (Pogge 2007a, 219; 2011, 47). This is why the principle is focused on maximizing harm reduction or harm protection. INGOs may well be involved in activities such as empowerment projects, advocacy on behalf of prisoners of war and political prisoners, or even projects devoted to say, the provision Journal of Global Ethics 5 D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 of organized sports activities for youth in refugee camps, and on the above reading, his principle does not seem to absolutely rule these out. But these types of activities clearly do not fit with Pogge's understanding of his own view, since they do not seem to straightforwardly maximize the moral value generated by the harm protection provided. They certainly do not seem to fit well with these additional efficiency-based allocation guidelines which he indicates are implied by his view: (1) concentrating resources in the poorest countries (namely, Ethiopia, Uganda and India) (2) choosing only populations in well-governed countries and (3) choosing projects in places where prices, compared at market exchange rates, are lower (Pogge 2007a, 230; 2011, 52). As we might expect, Pogge has a response to the charge that (ABCD∗) is so weak that it allows INGOs to justify almost any project. By way of reply, he notes that This suggestion may have some truth with regard to any one project viewed in isolation. An INGO must justify its projects together, however, as designed according to a single plausible strategy. It must not, for example, specify the open parameters of (ABCD∗) in one way to justify one project choice in one country and then specify the same parameters in another way to justify a project choice in some other country . . . [T]he specific strategy in place greatly reduces the possible projects that can be chosen [my emphasis]. (Pogge 2007b, 275) It seems that in rejecting the argument from weakness, Pogge may be conceding that his view is more restrictive than he previously admitted. This may be because he does not envision his 'open parameters' to be especially wide-open. And there may be good reason for this. For example, there is reason to suppose that even a consistently applied set of parameters generated in line with (ABCD∗) could generate results that are seriously objectionable. For reasons of space, I will only discuss one such objection in the hope that it will serve to illustrate my broader worry. The open parameter I want to discuss is the one which allows INGOs to judge for themselves 'how much of persons' lives we should consider for determining how badly off they are' (Pogge 2007a, 226). If INGOs want to maximize the moral value of the harm reductions they undertake, then they need to know who is now the most badly off. However, in order to determine this, first they must specify the relevant time period. Should they count all the harms and benefits a person has experienced to date? Should they also count those she is likely to experience in the future? Or perhaps only the harms a person is currently experiencing are relevant here? How they decide this question will have a considerable impact on the results of any calculations they make about the relative worth of various potential projects. But surely some answers to this question should not be allowable. In particular, it does not seem reasonable for an INGO to take the view that they ought to count all the harms that a population has experienced in the past as part of the overall measure of how badly off they are – and therefore as an indication of the choiceworthiness of projects designed to help them. Dennis McKerlie points out what is wrong with this view by means of the following example: [S]uppose we must choose between helping someone who is very badly off and helping someone who used to be miserable but is now happy. Because of past suffering, the second person might have the worse lifetime. Nevertheless, I think we might feel a pull towards helping the person who is in misery now. (McKerlie 2001, 275) In the context of international aid, we might wonder how it is at all relevant to the task of choosing populations for aid that the people in Village 1 used to be very prosperous, while the inhabitants of neighboring Village 2 (who are in roughly the same current circumstances) did not. On a whole-life view of welfare, the former group could easily be ruled out because they have had better lives on the whole. But this judgment relies on the questionable idea that having been well-off in the past somehow 'makes up' for their current suffering. Now, there might well be some amount of variability with respect to the reasonable time period over which the welfare of eligible populations might be measured and compared, but 6 L. Fuller D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 surely any sensible answer to this question is going to specify the period as quite short. An INGO that considered how well-off a group of potential recipients were 10 years ago to be relevant to whether that group should take priority in the present is making a mistake. Even if they applied their method of measurement consistently, it does not seem to me that they could justify their specification of this parameter to, say, the people of Village 1. If your general purpose is harm reduction for people in poverty, there is going to be a limit to the kinds of comparisons you can legitimately use as the basis for ruling some people out. Their good (or bad) fortune in the distant past does not seem to be such a basis. I am not suggesting that there is a single right way to answer this question. Rather, I am trying to point out that there are some answers that are unacceptable, and (ABCD∗) would be improved if it closed them off as eligible specifications. Pogge himself suggests that there will be 'reasonable disagreement' around how to specify the open parameters (Pogge 2011, 51). However, from my perspective, pointing this out is merely a way of side-stepping the central issue, since exactly what we want to know is which specifications are going to count as reasonable and which ones are not. My more general point is that (ABCD∗) is underspecified with respect to some of the most significant issues at stake here, and this considerably weakens the overall attractiveness of Pogge's view. Indeed, these open questions are often considered to be some of the most controversial issues in the philosophical literature on priority-setting.6 When we are engaged in assessing an INGO's priorities, in large part this assessment will be based on how it answers those questions left unanswered by the open parameters of (ABCD∗). And it seems to me that there is a limited range of answers that will be acceptable, both from a moral point of view and from the point of view of legitimate political practice. In sum, Pogge's view requires INGOs to allocate all their resources according to a single version of (ABCD∗), the details of which they would specify themselves. The specifications of the open parameters Pogge himself seems to have in mind – as indicated by the implications he takes his view to have – appear very restrictive. However, his particular version of (ABCD∗) is not strictly entailed by the view, and so (ABCD∗) on its own is too weak to generate the results he takes it to generate. The view is as a whole is too underspecified to serve as a meaningful resource-allocation policy. And it is worth noting that these difficulties arise for the view even if we concede that, in general, a cost-effectiveness approach that maximizes expected moral value is the right type of allocation strategy. However, we also have good reason to think that this general approach is flawed. 4. Trade-offs – integrity But suppose that the open parameters were to be spelled out in a generally defensible manner. Would (ABCD∗) then be an unproblematic principle for guiding INGO project choices? One example Pogge raises suggests a different worry about the implications of adopting (ABCD∗). This worry concerns the kinds of trade-offs INGOs are permitted to make in their efforts to maximize harm reduction. The worry is that such trade-offs are morally impermissible and so accepting them as a matter of course would undermine their integrity. The example is as follows: 'Suppose the affluent people giving money to INGOs are mostly white and somewhat racist: projects that protect from harm badly off white people elicit much greater [overall] contributions per dollar expended than projects that protect equally badly off persons of color' (Pogge 2007a, 246; 2011, 62). Hence, choosing a project that protects white children from harm will generate more money and will enable the INGO to maximize harm protection. Pogge admits that 'combating racist attitudes among contributors' and 'not allowing oneself to become an instrument of racism' are moral reasons that should be given at least some Journal of Global Ethics 7 D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 weight in deciding how to proceed. However, consistent with (ABCD∗), he ultimately wants to know how many extra deaths 'this "standing up for principle" can justify' (Pogge 2007a, 247; 2011, 63). He asks: 'What is the correct exchange rate between racism spurned and additional lives saved?' (Pogge 2007a, 247; 2011, 63). He notes that as standing up against racism becomes very costly in terms of harm protection, he finds the principled stance less and less plausible. Bernard Williams points out that once we concede to frame certain questions in this way, then we have already implicitly accepted the view of our interlocutor (Williams 1973, 102– 3). Accordingly, I suggest that it is a mistake to frame this question in terms of 'exchanges' or 'trade-offs' in the first place. This is because how INGOs go about implementing harm protection is a matter of rather more significance than this approach will allow. INGOs do not work in a context unconstrained by the ordinary requirements of morality or of the principles and values to which they are deeply committed. It would undermine their general commitment to justice to knowingly harm people in the course of their activities, or to accept discrimination as a legitimate basis for the choice of recipients.7 Any recommendation for how they ought to make decisions cannot therefore ask them to accept actions or policies that betray their convictions for the sake of better results. An INGO, if it were to allow itself to contradict its own principles in this way, would cease to be the sort of moral agent that is appropriately designated to handle this type of work, since by its actions it has become alienated from its central purpose. Indeed, I would argue that the essence of INGOs is to be organizations of principle rather than instruments for harm reduction. To be fair, I should point out that Pogge recognizes that INGOs are to some extent actors in their own right, as well as trustees charged with carrying out the moral duties of contributors (Pogge 2007a, 222; 2011, 48). But he does not seem to appreciate the implications of either their principled nature or their independent moral agency for how they ought to allocate resources. As actors in their own right, INGOs are collective moral agents. Each one is also a unique historical, organizational entity made up of members committed to its specific mission. The principles and values that make up an INGO's mission are at the core of what makes it a distinct organization or movement, rather than simply a machine for generating welfare improvements. These are also what attract members and supporters over time, and what shape the work each INGO does such that it is oriented toward eliminating distinct kinds of injustices and implementing distinct kinds of harm reduction efforts. These principles and values are also what allow an INGO to survive and thrive over time in a unified way. The principles and values of an INGO inform and influence what activities it undertakes, including those that may not maximize longterm harm reduction. For example, MSF may choose to stay in a war-torn area assisting displaced persons when it would be more cost effective to work somewhere more peaceful. They may do this because they believe that it is morally important to stand in solidarity with vulnerable populations, and/or as a symbolic reminder to the international population that 'these people are still here', that is, that these people matter even though they are no longer in the news. This is because it is part of their mission and organizational identity that they choose to speak out about atrocities and injustices, and that they value maintaining proximity to vulnerable populations.8 Now, it seems to me that Pogge's view would require MSF to abandon vulnerable populations and so undermine their commitments to advocacy and solidarity wherever this is not cost effective. But this is tantamount to changing them into a different organization. He would certainly reject this characterization, claiming, that he is merely advocating a shift away from any 'symbolic' or 'principled' allocation decisions and toward more cost-effective ones within their domain of emergency health care, particularly, since their ability to fundraise would no doubt diminish if they were to completely change.9 But this response misses 8 L. Fuller D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 the point, which is that INGOs are moral agents with their own commitments – commitments that constrain their ability to maximize harm reduction in every instance. Further, it is exactly these kinds of commitments that turn out to be cases in which it is necessary to 'stand up for principle' in order to maintain the moral integrity of the organization. To return to the racism example, we can see that INGOs are also constrained by normative standards – both moral and professional. For instance, they cannot use unjust means to pursue their ends, or 'wrong some in order to help others'. They likewise cannot allow themselves to become instruments of racism and discrimination for the greater good any more than they can allow their workers to have sexual relations with beneficiaries even where all parties are consenting. They are professional organizations required to live up to certain normative standards specific to their field.10 One might reasonably suppose that one such standard (among others) requires them to refrain from making invidious distinctions between beneficiaries who are already vulnerable and who must trust these organizations to look after their welfare. Another, mentioned by Pogge himself, might be that INGOs must not betray the trust of their donors by merely seeming to implement morally important projects, while concealing their true activities (Pogge 2011, 47). In my view, the reason that Pogge rejects standing up for principle in the racism example has to do with his conception of INGOs as agents. An INGO is, on his account 'not merely an actor in its own right; it is also an agent and a trustee for its contributors. It must then reflect not merely on its own moral responsibilities, but also on its contributors' moral responsibilities which [they] entrust it with discharging' (Pogge 2011, 48). And he has (now famously) argued that donors, as members of affluent societies, are not merely helping the badly off through donations to INGOs but are instead engaged in the 'mitigation of wrongs from which [they] profit and in the production of which [they] participate' (Pogge 2007a, 247; 2011, 65). He notes then that he does not see 'INGOs as venues for "helping" but as instruments for undoing a fraction of the vast harms the affluent countries are inflicting on the poor and marginalized in the so-called developing world' (Pogge 2007b, 277). Perhaps many INGO practitioners are, in their private capacities, implicated in causing similar harm to that caused by their affluent contributors. Nevertheless, these organizations on the whole are not so implicated, and only act as trustees for contributors as part of their overall missions. Each organization is, in fact, oriented first and foremost toward the fulfillment of its mission, to which donors have subscribed when they contribute their funds. I would argue that Pogge does not genuinely take seriously either the moral agency or the principled nature of INGOs, but rather takes them to be primarily instruments for the fulfillment of others' obligations, with no right to independent commitments of their own. On such a view, there would be little need for an organization to act in order to maintain its moral integrity and/or unique mission except to the extent that not doing so would negatively impact fundraising. He evidently holds this view since not even Oxfam sets as its sole commitment to eradicate poverty, and yet that is the primary goal Pogge would set for all INGOs, without regard for their concrete histories and their long-standing commitments to certain principles and values. Pogge denies that his view requires all INGOs to focus on poverty eradication in just three states, and so would create a 'dreary monoculture' or vast homogenization of the INGO sector. He appeals to the various specifications of the open parameters that INGOs would be permitted to choose from, as well as the general uncertainty about what will, in fact maximize long-run cost-effectiveness to suggest that a diverse range of projects would remain eligible (Pogge 2007b, 274). He claims that (ABCD∗) does not thereby 'require all INGOs to choose from a narrow set of possible projects' (Pogge 2007b, 274). But again, here he misses the larger point, which is that the latitude provided by the open parameters and the uncertainty within which INGOs work is radically insufficient in terms of providing for real choices between Journal of Global Ethics 9 D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 priorities, when those priorities involve matters of principle that are incompatible with even their most-favored version of (ABCD∗). There are other moral considerations that INGOs may well want to bring into play here, and they will need to balance these other concerns against their concern for cost-effective harm reduction when they consider both their overall strategy for allocating funds, and whether or not a specific project or other activity fits within that strategy. 5. Moral agency – integrity To be clear, I am not arguing for the view that it is permissible for INGOs to set their priorities however they see fit, and to operate in an inconsistent or ad hoc manner should they so desire. As noted above, INGOs are not unconstrained. They clearly must operate within the constraints of ordinary morality, as well as within the requirements of professional ethics, and in ways consistent with the values and principles upon which their organizations are grounded. They have to fulfill their obligations, refrain from harming others, and demonstrate respect for persons as free beings with their own interests and projects. That said, it is important to understand INGOs first and foremost as moral agents in their own right, and only to a much lesser extent as trustees for donors, that is, as mechanisms for mitigating the harms members of affluent societies are inflicting on the badly off in the developing world.11 The maximizing strategy that Pogge proposes seems driven by their role as trustees, or put more bluntly, their role as the means for affluent individuals to carry out their duties. And since members of affluent countries have done a lot of harm, as much harm as possible should be averted on their behalf. But people who have founded, and who continue to work for, INGOs do not typically come together to act as a means in this way. Normally, INGOs are made up of people with certain types of expertise who passionately reject certain types of injustice and feel a deep empathy for individuals in certain kinds of difficult circumstances. It is philosophers who have cast them in the role of means-to-the-end-oferadicating-poverty.12 And I see no reason why, as independent moral agents dedicated to certain causes, values and principles INGOs should accept this role, and hence, Pogge's principle (ABCD∗). Rather, if we conceive of INGOs as moral agents in their own right, then we can appeal to a certain ideal of moral agents in which they have, as Liam Murphy puts it, 'broad space for individual decision within limited constraints' (Murphy 2000, 30). Pogge's single principle, even if specified in the way an INGO most prefers, does not fit this model. Instead, it seems to eliminate an important aspect of moral agency – the ability to determine which goods are worth pursuing. Many goods are certainly valuable but take considerable resources to promote, and very many of these seem all but ruled out once (ABCD∗) has been specified. For instance, it might be the case that an INGO very much values promoting the autonomy of beneficiaries, and so it spends quite a lot of resources on subsistence farming projects, when the same amount of money could provide food directly to more people for quite a long time, and without the associated risk of crop failure. The point of such a project may not be that helping people to set up farms is in the long run, more cost effective than direct food aid. It may be that the farms do not flourish over the long term in any case. The INGO, knowing this, might nevertheless be committed to giving people opportunities to work both for themselves and their communities, since they regard this as important for its own sake. Or, it may be that an INGO is deeply committed to the education of women and girls, even in places where this is very dangerous, and so very costly to implement safely. Such an INGO may want to prioritize the principle that women and girls deserve to be educated over considerations of cost-effectiveness. This may be paired with another commitment of theirs, say, not to be intimidated by forces of patriarchy in their efforts to help women in need, and therefore they might 10 L. Fuller D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 choose to work in locations in which the force of patriarchy is very strong, and so where they will necessarily face opposition and its associated setbacks. These examples are meant to show that to be a genuine moral agent is to be able to decide which things are valuable and pursue them within reasonable constraints. And I would emphasize that the things most agents will choose will be various rather than singular. There are very many important aspects of injustice that must be combated, and so it should not be surprising that most INGOs are committed to multiple approaches and concerns. With Pogge, I would suggest that one such concern should be preventing deaths from poverty-related causes, such as malnutrition and lack of access to basic medicines and clean water. But there is no reason to suppose that this should be their only priority, since they can share this work with other INGOs, governments and intergovernmental organizations. At least some INGOs can, and should, take on a reasonable share of responsibility for 'fixing' this problem while retaining a significant feature of their moral autonomy – their ability to pursue goods of their choice. But they should not take on this responsibility because they are primarily instruments for eradicating poverty. Instead, they should do this for the same reasons we all should do our share to help alleviate poverty-related suffering and death, namely, because alleviating suffering is one of the most valuable things we can do as human beings. Likewise, INGOs must be concerned with cost-effectiveness (within reason), since they are agents with goals and commitments to doing good in the world, and it is apparent that wastefulness undermines the pursuit of these goals. Nevertheless, I would argue that as organizations of principle they ought not to compromise their long-standing commitments and values for the sake of cost-effectiveness, as is sometimes called for on Pogge's view, since this undermines their integrity as an organization and calls into question their basic moral commitments. 6. Conclusion I have argued that Pogge's program for INGO priority-setting is problematic both on its own terms and when considered in light of my conception of INGOs as independent moral agents. On its own terms, the view is underspecified – it does not answer the hard questions that are most controversial and so fails to give adequate guidance even if one accepts the kind of consequentialist analysis Pogge prefers. It does not tell us how to understand what constitutes harm, the time-span we ought to consider relevant when comparing the well-being of different populations, or how heavily to weight smaller benefits for worse-off people versus greater benefits for people who are somewhat better-off. In addition, even as the view leaves these critical questions open to interpretation, Pogge seems to favor an overly demanding interpretation of his principle, as demonstrated by the kinds of concrete programmatic suggestions he makes. More importantly, however, his overall approach focuses almost exclusively on cost-effectiveness, and is based on a view of INGOs as instruments for carrying out the duties of affluent states and individuals. The combination of these two assumptions makes invisible INGOs standing as autonomous moral agents and established members of global civil society, capable of choosing which values to pursue and which principles to use for guidance in priority-setting. Sometimes, the values that make up an INGOs mission will be in tension with requirements of cost-effectiveness, and in cases of 'standing up for principle' they may well be over-riding. Efficiency and fiscal responsibility, while important, must be balanced against the goals and commitments that make any given INGO what it is. These values and commitments are what generate the political will and willingness to serve that are needed to sustain such organizations. But finally, much of the work done by INGOs is worthwhile in ways that simply cannot be captured by a cost-effectiveness analysis, and these aspects of their work ought to be protected from Journal of Global Ethics 11 D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 theory and policy frameworks that would reduce the practices of the INGO community to something less richly meaningful than they are. Acknowledgements I would like to thank Thomas Pogge for his comments, as well as the audience at the 'Pogge and his Critics' conference at the University of Newcastle for feedback on an early version of this paper. I would also like to thank Leif Wenar, who was working closely with me at the time the paper was originally drafted. Finally, special thanks to the members of my group at the Mentoring Project at University of Massachusetts Amherst for their excellent feedback on the revised version. This paper was made possible in part by a postdoctoral fellowship granted by the Social Sciences and Humanities Council of Canada. Notes on contributor Dr Lisa Fuller is an Assistant Professor in the Philosophy Department at the State University of New York at Albany. Her main areas of research interest are political philosophy (especially global justice), applied ethics and feminism. Having worked closely with Médecins Sans Frontières (Doctors Without Borders) Holland, much of her work has focused on issues related to global poverty and international aid. Her most recent work has concentrated on problems within non-ideal theory. Fuller has published in journals including: Ethical Theory and Moral Practice, Journal of Moral Philosophy and Developing World Bioethics. Notes 1. The newer paper is essentially a shorter version of the older one, and the view remains essentially the same. Therefore, where necessary, I have supplemented the newer version with material from the original version, since it provides more detailed argument, and is accompanied by a response to criticisms. 2. I have argued elsewhere that fairness across populations is an important consideration in resource allocation decisions, especially as against ongoing commitments, however, I cannot include that argument here for reasons of space. See Fuller (2006). 3. This is just the standard way to address risk in expected utility theory. 4. There is some ambiguity here concerning whether or not INGOs are permitted to leave out certain types of harm altogether when they are determining what should count as harm, or if they must include all conditions they think are harmful in their weighting scheme. For my purposes here, I assume that they cannot arbitrarily exclude certain types of harm but that they can adopt distinct interpretations of what it is and can also weight those harms in their primary areas of concern very heavily. 5. Of course, this would depend on the expected aggregate cost-effectiveness of this strategy vis-à-vis the expected amount of weighted harm protection. But if the weights are very high, and there is some even small gains, this type of project could turn out to be acceptable on (ABCD∗). 6. See for instance Daniels (2004). 7. Pogge suggests at one point that even if it were known that certain children were more likely to die from a vaccination than be saved by it, 'In special cases, when excluding them would greatly reduce the aggregate harm protection achieved by the project, these children may nonetheless be included – but only if the moral value of the expected increase in harm imposed on them is greatly outweighed by the expected moral value of the additional harm reduction achieved for the rest of the population' (Pogge 2007a, 251). He argues that while any harm the INGO itself causes must be assigned greater weight, he does not appear to rule out deliberately harming some to save others; a clear violation of basic moral principle if ever there was one. 8. For more information on MSF's mission, see http://www.doctorswithoutborders.org/aboutus/?ref= main-menu, and Bedell and Ford (2001). To take another example, Habitat for Humanity originated from the moral insight that housing is a vital human need which should be fulfilled based on the Christian moral commitments of its members (Carens 2007, 261). Oxfam's mission statement can be found here: http://www.oxfam.org/en/about/what/mission, and includes commitments to fighting gender injustice and to working in an environmentally sustainable fashion. 9. He makes an argument of this type at Pogge (2007b, 276). 12 L. Fuller D ow nl oa de d by [ St at e U ni ve rs ity o f N ew Y or k at A lb an y] , [ L is a Fu lle r] a t 0 8: 39 1 8 A pr il 20 12 10. See, for example, the Global Accountability Charter for the Non-Profit Sector, to which very many INGOs have signed on: http://www.oxfam.org/sites/www.oxfam.org/files/INGO_accountability_ charter_0606_0.pdf. 11. This is Pogge's view of the relationship between individual affluent donors and INGOs. It is controversial, but I do not have space to dispute it here. 12. Of course, this trend began long before Pogge's work on INGOs, with Peter Singer's famous 1972 article (Singer 1972). References Bedell, R., and N. Ford, eds. 2001. Justice in MSF operational choices. Amsterdam: Médecins sans Frontières-Holland Report. Carens, J. 2007. The problem of doing good in a world that isn't: Reflections on the ethical challenges facing INGOs. In Ethics in action, ed. D. Bell and J. Coicaud, 257–72. Cambridge: Cambridge University Press. Daniels, N. 1994. Four unsolved rationing problems. Hastings Center Report 24, no. 4: 27–9. Degnbol-Martinussen, J., and P. Engberg-Pedersen. 2003. Aid: Understanding international development cooperation. New York: Zed Books. Donaghue, K. 2010. Human rights, development NGOs and priorities for action. In Ethical questions and international NGOs, ed. K. Horton and C. Roche, 39–63. Dordrecht: Springer. Fuller, Lisa. 2006. Allocating aid: Justification, fairness and deliberation in international aid organizations. 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