Picture a hospital, bringing in thousands of people every day who suffer from a host of different ailments, many of them contagious. If you go there for one reason, there is a risk you will end up suffering from something else by the time you leave: a complex medical procedure could go wrong, or – more likely – you could end up catching something from a fellow patient or a visitor. Working there puts you in an equally dangerous situation, as you spend your days alongside seriously ill people. A hospital, in short, has a “negative baseline” of secondary effects that must be overcome for it to be beneficial to the community it serves. Yet very few people would be bold enough to suggest we would be better off without hospitals.
This is development economist Paul Collier’s (2006, p. 1485) defence of development aid. I believe it strikes at the heart of a common misconception about aid. And it matters when it comes to the philosophical question of what we owe to others.