Incentives are not appropriate in all contexts. When it comes to breast screening, the right way forward is for all payers to offer incentives for using optimized evidence-based decision aids—irrespective of the ultimate decision in favor or against screening. Doing so promotes autonomy by minimizing regret that may result both from having and not having undergone screening. Incentivized active choice can furthermore assist with reducing disparities between income and educational groups.

Policy makers implementing the Institute of Medicine’s recommendation by making mammography completion rates a priority measure should complement this initiative with measuring the informedness of decision making. A focus on completion rates alone is ethically misguided given that the balancing of potential benefits and harms is highly preference sensitive.