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On How To!, a listener, Mary, wants to give her mom a kidney, but she’s still struggling with the decision. So host Charles Duhigg asks Larissa MacFarquhar, author of Strangers Drowning: Impossible Idealism, Drastic Choices, and the Urge to Help, a book about extreme altruists, to explain how people decide to do good. This transcript of their conversation has been condensed and edited for clarity.
Charles Duhigg: Mary is like most of us. She’s hesitating, and she’s asking herself questions and having doubts, and that’s totally normal. One of the ways we can help Mary is by figuring out: Are her doubts and questions legitimate, or is she overthinking things? Researchers who study situations like this have found that there are ways, methods, that people can use to help us figure out when we should listen to our hesitations and when we should ignore them. One of those systems is something called time frame thinking. For instance, Mary has been really concerned about the short-term impact the surgery might have on her ability to take care of her kids. But what if instead of focusing on the short-term time frame, the immediate impacts on her kids, what if Mary focused on the long-term impacts on her children?
Larissa MacFarquhar: If I were a child and watched my mother take this risk—which was not an enormous risk, but doing something painful and difficult in order to vastly improve the life of her mother, my grandmother—I think it would be an extraordinary thing in my whole childhood to see something that heroic and that loving take place in my family. I think that would be more mothering than she could possibly do in those six weeks.
Charles: I totally understand that if my wife was out for six weeks, our entire house would fall apart, honestly. If you’re asking me right now to guess what would happen when she finally got out of bed, the children would be living in rags and we would be scavenging for food. But at the same time, one thing I could see happening is we actually have to learn how to make do. If you’re not there for your kids, they might have to learn how to take care of themselves a little bit more.
Larissa: Try, insofar as it’s possible, to imagine how you will feel after you’ve made one choice or the other.
Charles: There’s a name for this method of thinking about choices. It’s called futurecasting. And the reason futurecasting is so helpful is because we all have a natural tendency to see the future as binary outcomes: Either things go great, or they don’t. But of course that’s not really how life works. Reality is a mix of good and bad no matter what choice we make. So what if we were to imagine for a moment all the possible outcomes from a decision and figure out which ones would be easier or harder to live with. Futurecasting pushes us to think about how we’ll feel after the stress of deciding is over. It helps clear up which choices we can live with and which ones we can’t.
Larissa: So suppose you decide not to donate and your mother’s health predictably deteriorates and she probably dies before she’s 70 and lives a pretty blighted life before that. How will that strike you? How will it make you feel about your relationship with your mother or your relationship with yourself? On the other hand, suppose you do donate and other predictable dynamics come into play. Possibly complicated relationships with your mother, though maybe not. Suppose now I’ve sketched out a scenario where the children would be proud of their mother and excited to have the chance to take care of her for once and to help her as she usually helps them. But suppose they don’t react like that. Suppose they’re just resentful and they think, She’s our mother. How can she abandon us? Suppose her husband feels the same way. She needs to, as best she can, think about how she would feel if the less good scenarios, some of them, came into play afterwards in either case. And how is she going to feel about the choice she made?
Charles: Finally, there’s one other method for analyzing this decision for finding peace with Mary’s choice. Until now, Mary has been almost completely focused on how donating a kidney will affect other people. But what if Mary turns that on its head and she focuses entirely on herself? What would donating this kidney mean to Mary? Larissa has spoken to a lot of people who have donated kidneys.
Larissa: Every single one of them was so proud of what they did. They all felt, Here is something grand that I did. Here is something unambiguously good, and I can be proud of this for the rest of my life, and whatever else I do and however else I fail as a person, this is something that no one can take away from me. And that’s a big thing in a person’s life. And there aren’t that many chances to do something like that.
I talked to one man who donated a kidney. He woke up from surgery, and his first emotion was to be really pissed off. Why? Because the doctors who thought he was weird for wanting to do something so altruistic had given him a lot of grief, really made him jump through hoops to prove that he really wanted to do it. And when he got out of surgery, he felt so good that he thought they had not done it. He thought that surgery had not happened because the doctors had chickened out and he was really mad. He felt so good. Now, I’m talking to people who donate to strangers, who they’ve in some cases never even met, and they feel this way. If it’s your mother, how much more important?
Charles: Studies show that 90 percent of people who donate a kidney recover fully within six months. They never have any long-term health issues. And 96 percent of donors say they would donate again.
Mary, what do you think of what Larissa said about how people feel after they donate?
Mary: First, I agree. I can see where it would be something you would always be proud of, and it is heroic. On the other hand—I’m not quite sure how to express this. It’s like, is there any self-centeredness in me looking at that grand gesture? Does that make any sense at all? Like, it’s so big.
Charles: It almost feels selfish.
Mary: Well, not selfish, that’s the wrong word, but self-aggrandizing in a way.
Charles: Do you worry that maybe you’re not actually considering this because it’s the right thing to do for your mom, but because you just want to feel—
Mary: Good about myself?
Charles: Yeah.
Mary: I guess a little, or I wouldn’t have thought about it.
Charles: And can I just say—I’ve spoken to a lot of people who have done good in this world, and a number of them do great things for less noble reasons. You don’t strike me as one of those people. I mean the fact that even you’re struggling with this and that you’re honest enough with yourself to say that you are struggling with this choice, the way that you’re describing this—you do not strike me as a person who does altruism for selfish reasons.
Mary: Yeah. Well, I appreciate that.
Charles: Let me ask one more question. Let’s say tomorrow you find out that you have kidney failure. If it was one of your sons, and let’s say they’re 21 and you feel like they’re young, responsible, and they said, “Mom, I want to do this for you.” And they said exactly what you’ve said to me. They say, “Look, I’m actually torn, but despite that I’ve decided I want to give you my kidney.” What would you tell them?
Mary: I guess I would say thank you.
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