[maxfan8]

One slightly reasonable common argument I hear for reduced medical diagnostics is: “we don’t have the resources; it’d overwhelm the medical system”. While this may be the case for some tests, there are probably a great number of tests that could be scaled to be done yearly on the whole population.

[CogitoCogito]

> While this may be the case for some tests, there are probably a great number of tests that could be scaled to be done yearly on the whole population.

Isn't this already the case? Tests that are considered worth doing regularly even without extra symptoms are done regularly. E.g. mammograms and colonoscopies/stool tests.

(I'm ignoring your focus on "yearly" since really you care about "regularly" given that yearly is totally arbitrary and timing that makes sense is clearly dependent on the tests in question.)

[maxfan8]

No. Not all screenings/tests are done, even when it's super low cost and non-invasive. For example, one factor that is used to determine whether to screen for certain types of cancer is "Possible harms from follow-up procedures". [1] Another factor that is taken into account it the chances of a false positive. [1] Both of these factors are irrational, since more information is strictly optimal given a rational agent. They should not even merit consideration in choosing whether to undertake a screening (this information should only be used after a screening is done, to determine follow-up action).

In my opinion, the only justifiable factors are probably along the lines of:

- invasiveness (e.g. if it's non-invasive or minimal cost)

- benefit to the patient if detected

- cost relative to other screenings/actions that can be done for the patient

Everything else seems strictly suboptimal.

[1]: https://en.wikipedia.org/wiki/Cancer_screening#Risks

[CogitoCogito]

> For example, one factor that is used to determine whether to screen for certain types of cancer is "Possible harms from follow-up procedures". [1] Another factor that is taken into account it the chances of a false positive. [1] Both of these factors are irrational, since more information is strictly optimal given a rational agent.

Your entire argument here seems to require patients to be rational agents. They aren't.

[maxfan8]

> Your entire argument here seems to require patients to be rational agents.

Yes, my argument does rely on patients being rational agents.

> They aren't.

That may be true, but it's certainly paternalistic (in the formal, definitional sense) to act as if they are not rational agents and withhold information/reduce autonomy. This is a case of pure paternalism (again, in the formal philosophical sense).

Different ethical systems, of course, make different judgements on whether this behavior is moral. It's also up for debate whether this is a desirable feature of the medical system.

[CogitoCogito]

> That may be true, but it's certainly paternalistic (in the formal, definitional sense) to act as if they are not rational agents and withhold information. This is a case of pure paternalism (again, in the formal philosophical sense).

Call it whatever you want. Idealizing patients as rational agents instead of considering how they are in reality results in worse outcomes. If your goal is to actually help people, you should base your arguments on how things are in reality instead of some idealized dream world.

[maxfan8]

> If your goal is to actually help people, you should base your arguments on how things are in reality instead of some idealized dream world.

That's a fair position (you seem to be a utilitarian), and probably quite defensible. But, one could argue that patient choice is an important feature for our medical systems to have. I certainly want to be able to refuse medications that my doctor recommends (e.g. opioids) or seek alternate advice/second opinions. My cost-benefit analysis equation is probably not the same as my doctor.

To be clear, I'm not talking about an "idealized dream world", as you put it -- I'm talking about patient autonomy in the real world, even if it means allowing patients to make what seems like a suboptimal decision.