Breast cancer screening.

Cass R. Sunstein's 2016 book The Ethics of Influence: Government in the Age of Behavioral Science provides an extremely informative introduction to the science and ethics of the exercise of "influence" over others. As a longtime physician employed in both the public and private sectors, I now recognize that most of my formal training has been in the hard sciences, with little, if any, training in the appropriate influence of the decision-making processes of my patients and/or other health care professionals in institutional settings. Breast cancer screening is an excellent example of the conflicts of modern medicine, highlighting our collective inability to effectively "nudge" others in the pursuit of health and/or organizational effectiveness and efficiency. Using the framework of Sunstein's ethical values of welfare, autonomy, dignity, and self-government, I discuss many of the conflicting issues in a nationwide breast cancer screening program and the effects of these issues on client nudging to determine whether mammography screening is ethical.