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speed ~o stay where it is. Other low-income countries are in
similar situations. By the end of the century, Ethiopia's population
is expected to rise from 49 to 66 million; Somalia's from
7 to 9 million, India's from 853 to 1041 million, Zaire's from
35 to 49 million.2
What will happen if the world population continues to grow?
It cannot do so indefinitely. It will be checked by a decline in
birth rates or a rise in death rates. Those who advocate triage
are proposing that we allow the population growth of some
countries to be checked by a rise in death rates - that is, by
increased malnutrition, and related diseases; by widespread famines;
by increased infant mortality; and by epidemics of infectious
diseases.
The consequences of triage on this scale are so horrible that
we are inclined to reject it without further argument. How could
we sit by our television sets, watching millions starve while we
do nothing? Would not that be the end of all notions of human
equality and re,spect for human life? (Those who attack the
proposals for legalising euthanasia discussed in Chapter 7, saying
that these proposals will weaken respect for human life,
would surely do better to object to the idea that we should
reduce or end our overseas aid programs, for that proposal, if
2 Ominously, in the twelve years that have passed between editions of this
book, the signs are that the situation is becoming even worse than was then
predicted. In 1979 Bangladesh had a population of 80 million and it was
predicted that by 2000 its population would reach 146 million; Ethiopia's
was only 29 million, and was predicted to reach 54 million; and India's was
620 million and predicted to reach 958 million.
237
Practical Ethics
implemented, would be responsible for a far greater loss of
human life.) Don't people have a right to our assistance, irrespective
of the consequences?
Anyone whose initial reaction to triage was not one of repugnance
would be an unpleasant sort of person. Yet initial
reactions based on strong feelings are not always reliable guides.
Advocates of triage are rightly concerned with the long-term
consequences of our actions. They say that helping the poor
and starving now merely ensures more poor and starving in the
future. When our capacity to help is finally unable to cope - as
one day it must be - the suffering will be greater than it would
be if we stopped helping now. If this is correct, there is nothing
we can do to prevent absolute starvation and poverty, in the
long run, and so we have no obligation to assist. Nor does it
seem reasonable to hold that under these circumstances people
have a right to our assistance. If we do accept such a right,
irrespective of the consequences, we are saying that, in Hardin's
metaphor, we should continue to haul the drowning into our
lifeboat until the boat sinks and we all drown.
If triage is to be rejected it must be tackled on its own ground,
within the framework of consequentialist ethics. Here it is vulnerable.
Any consequentialist ethics must take probability of
outcome into account. A course of action that will certainly
produce some benefit is to be preferred to an alternative course
that may lead to a slightly larger benefit, but is equally likely
to result in no benefit at all. Only if the greater magnitude of
the uncertain benefit outweighs its uncertainty should we
choose it. Better one certain unit of benefit than a 10 per cent
chance of five units; but better a 50 per cent chance of three
units than a single certain unit. The same principle applies when
we are trying to avoid evils.
The policy of triage involves a certain, very great evil: population
control by famine and disease. Tens of millions would
die slowly. Hundreds of millions would continue to live in absolute
poverty, at the very margin of existence. Against this
238
Rich and Poor
prospect, advocates of the policy place a possible evil that is
greater still: the same process offamine and disease, taking place
in, say, fifty years' time, when tpe world's popUlation may be
three times its present level, and the number who will die from
famine, or struggle on in absolute poverty, will be that much
greater. The question is: how probable is this forecast that continued
assistance now will lead to greater disasters in the future?
Forecasts of population growth are notoriously fallible, and
theories about the factors that affect it remain speculative. One
theory, at least as plausible as any other, is that countries pass
through a 'demographic transition' as their standard of living
rises. When people are very poor and have no access to modem
medicine their fertility is high, but population is kept in check
by high death rates. The introduction of sanitation, modem
medical techniques, and other improvements reduces the death
rate, but initially has little effect on the birth rate. Then population
grows rapidly. Some poor countries, especially in subSaharan
Africa, are now in this phase. If standards of living
continue to rise, however, couples begin to realise that to have
the same number of children surviving to maturity as in the
past, they do not need to give birth to as many children as their
parents did. The need for children to provide economic support
in old age diminishes. Improved education and the emancipation
and employment of women also reduce the birth-rate, and
so population growth begins to level off. Most rich nations have
reached this stage, and their populations are growing only very
slowly, if at all.
If this theory is right, there is an alternative to the disasters
accepted as inevitable by supporters of triage. We can assist poor
countries to raise the living standards of the poorest members
of their population. We can encourage the governments of these
countries to enact land reform measures, improve education,
and liberate women from a purely child-bearing role. We can