The messy morals of donating to medical crowdfunding campaigns

What do we get when we give?
What do we get when we give?
Image: AP Photo/Michael Dwyer
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In a tale titled Légende du Beau Pécopin et de la Belle Bauldour, Victor Hugo writes about a meeting between the devil and a group of saints. The devil needs help. But the saints decline to give it, for a variety of reasons. Saint Autremoine has the most peculiar: “I regret that I can’t help you, my friend; I would consider that to be a good action, and since good actions have the inconvenience of pushing the vanity of those who make them, I refrain from doing it to preserve my humility,” the saint says.

The story underlines the complexity of altruism. Do people give to one another because it’s good, or because it makes them feel good? Is altruistic giving ever actually altruistic? Are some forms of generosity morally higher than others? And, does it even matter?

What brings people to give, and what kind of giving is most ethical, are two aspects of generosity that play a big role in understanding why medical crowdfunding is so effective at encouraging people to help others, yet at the same time so incapable of improving equal access to healthcare.

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What you get when you give

Giving is not a purely altruistic act. It is instead, experts say, motivated by a range of factors, from the very tangible to the purely intangible.

“It is important to realize that you can actually gain private benefit from a donation,” says Pamela Paxton, a professor of sociology at the University of Texas, Austin.

Think about someone who donates a large sum of money to a school, for instance. The school might name a building after them, or it might offer their children (and grandchildren) free schooling. Or, they might get public acclaim and gain social capital. This kind of personal gain can be a nice side effect of our altruistic behavior, or its main driver—and it’s likely people will donate differently depending on what they are seeking.

In some cases, the motivation is purely one of personal wellbeing. “You feel good when you are giving,” Pamala Wiepking, a professor of philanthropic studies at Indiana University, tells Quartz. Engaging in generous behavior, she says, activates the same areas of the brain that are responsible for pleasure. This, she notes, is why generosity exists across cultures, and has played an important role in the evolution of societies.

Wiepking says that it is only a matter of perspective to see generosity as self-serving. Another way to look at it is there is an innate generous component to human nature. This is supported, for instance, by evidence collected in situations of emergency: One might expect that in times of crisis people would restrict the network of people they give to. In reality, the opposite is true.

In fact, acts of generosity in themselves give people a “warm glow,” regardless of whether they can benefit, or even be involved in them. “Neurological studies [have shown] the same neural pathways are activated when people are seeing a charity receive money, and when they’re donating money to that charity themselves,” says Paxton.

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Why we give to medical crowdfunding

The motivations of giving play a role in medical crowdfunding, too. People may donate, perhaps unconsciously, to pay it forward—hoping that their good actions will be repaid in kind, should they ever need. Or, they could just do so because it feels right.

But giving is also a social and community act, which is the element that crowdfunding campaigns are able to tap into arguably more than any other form of charitable fundraising.

“One of the most important things we know from research on giving is that the most proximate cause of a charitable gift is being asked to give,” Paxton says. That is precisely what a crowdfunding campaign does: It brings a need to the attention of a network and potential donor within it, and asks that they help to address it.

Being part of a community that encourages giving, too, is key, so it is especially effective that crowdfunding happens through networks. “It’s really about to what extent a person is in a network or is exposed to organizations that put them in a position to be asked more often,” Paxton says.

There is another element of our behavior around giving that crowdfunding optimizes: the effect of seeing others give. “We know that donors do compare themselves with other donors when they’re deciding whether to give and how much to give,” Paxton says. “And so if you tell people, for example, that a high proportion of people like them have already donated, they’re more likely to donate.”

This mechanism is even more powerful among those who share certain characteristics—like gender or age or profession—because we tend to want to match the generosity of people similar to ourselves.

Not only that: In this case, people tend to match the dollar amount that others donate. So the way crowdfunding is set up, where people can often see who is giving and how much, transforms the modeling of good behavior into a chain reaction.

Giving to a medical crowdfunding campaign on a digital platform ultimately combines all the incentives to giving: There is a call to action, the moral driver, and the behavior of peers on which one can model their own. Plus, the good deed is only a click away.

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The better ways to give

While crowdfunding healthcare has achieved some commendable results, it hasn’t rectified the existing inequalities in access to treatment that plague many societies. In fact, it may make them worse. “The kind of reputational or network chain effects that could occur ultimately are more beneficial to [members of a network] in a way that creates inequality,” Paxton says.

For instance, unlike charities, which may raise money from one group of people in order to address the issues of another, crowdfunding largely provides support within peer groups.

Does this make it a less worthy charitable act, then? That depends on who you ask.

According to a philosophical movement known as “effective altruism,” the value of an act of generosity should be judged purely based on its effects. “Effective altruists have on the whole argued that it is our moral duty to give in the way that does the most good,” Paul Woodruff, a professor of philosophy at the University of Texas, tells Quartz.

To achieve this goal, effective altruists believe it is essential to be dispassionate and “cause neutral.” Donors don’t need to care about the cause they donate to, they believe, but select it purely based on its potential impact. Under this understanding of giving, then, donating to the medical campaign of a neighbor in a rich country is ineffective because the same donation would impact many more lives in a poor country. So it would be a lesser act of altruism.

On the other side of this debate, however, are those who think intentions are how an act of altruism should be judged. People may ultimately be acting out of self interest when they are giving, but that doesn’t make their intentions less worthy.

“When we’re talking about ethics, we’re talking about our aims and moral ambitions,” Woodruff says. “We are obviously imperfect beings and we’ll never fully exemplify the kind of goodness that we strive for.” Yet, he says: “We still ought to be striving for that.”

This is a kind of altruism that is driven by passion, and its proponents suggest that while it might have a smaller immediate impact than effective altruism, it is more likely to generate the kind of emotional reward that will lead to repeat behavior, adding up to a sustained effort of generosity.

But judging from intentions has its limits, too. “People want to believe that they’re good morally, even when they’re doing terrible things they persuade themselves that they’re really doing something good,” Woodruff says.