Good post, I like how you pinpoint information asymmetry as the critical core issue.
Scott Alexander would sacrifice information symmetry in order to maintain trust in the rule of medical confidentiality. You propose to sacrifice this trust in order to attain information symmetry. I think there is a way out of the dilemma by reframing the issue.
As I see it, openly discussing the act of informally violating a rule weakens it (regardless of whether it is actually violated). In contrast, discussing to (formally) change the rule itself does maintain trust in the rule. A public discussion on whether the law that prescribes medical confidentiality needs to be amended with an exception for e.g. criminal offenses does not damage trust in the law. People can still assume that, until the law is changed, it is upheld in its current form. This is in contrast to public knowledge of (potential) informal rule-breaking, which leads to a situation in which one cannot be sure to what extent a doctor's compliance with the rule can be assumed.
So, I agree with Scott Alexander in that the doctor should not write a public letter to a newspaper to ask whether he should (informally) violate the rule. Additionally, I agree with you that information imbalance is bad. Instead, I would suggest that the doctor should write a letter to discuss whether the confidentiality rules/laws require some well-defined (and transparent) exceptions. This would keep both the discussion public and uphold information symmetry.
One caveat: In a situation where informal violations of the rule do already occur frequently and this fact is not known to the general public, I fully agree with your position of making that information public (e.g. by whistleblowing) in order to restore information symmetry. This enables a debate on whether the informal violations are deemed good/bad and should be formalized/prohibited. Here, I prefer that to Scott Alexander's position of silence.
Good post, I like how you pinpoint information asymmetry as the critical core issue.
Scott Alexander would sacrifice information symmetry in order to maintain trust in the rule of medical confidentiality. You propose to sacrifice this trust in order to attain information symmetry. I think there is a way out of the dilemma by reframing the issue.
As I see it, openly discussing the act of informally violating a rule weakens it (regardless of whether it is actually violated). In contrast, discussing to (formally) change the rule itself does maintain trust in the rule. A public discussion on whether the law that prescribes medical confidentiality needs to be amended with an exception for e.g. criminal offenses does not damage trust in the law. People can still assume that, until the law is changed, it is upheld in its current form. This is in contrast to public knowledge of (potential) informal rule-breaking, which leads to a situation in which one cannot be sure to what extent a doctor's compliance with the rule can be assumed.
So, I agree with Scott Alexander in that the doctor should not write a public letter to a newspaper to ask whether he should (informally) violate the rule. Additionally, I agree with you that information imbalance is bad. Instead, I would suggest that the doctor should write a letter to discuss whether the confidentiality rules/laws require some well-defined (and transparent) exceptions. This would keep both the discussion public and uphold information symmetry.
One caveat: In a situation where informal violations of the rule do already occur frequently and this fact is not known to the general public, I fully agree with your position of making that information public (e.g. by whistleblowing) in order to restore information symmetry. This enables a debate on whether the informal violations are deemed good/bad and should be formalized/prohibited. Here, I prefer that to Scott Alexander's position of silence.