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08/02/2017

Ethics and the "Goldwater Rule"

As reported recently in the Huffington Post, Earlier this month, the American Psychoanalytic Association sent an email to its members https://www.statnews.com/2017/07/25/psychiatry-goldwater-rule-trump/"}}" data-beacon-parsed="true">encouraging them to offer analysis on behavior among those in the public eye if they feel inclined to do so. The APA maintains that it is unethical to do so.

The “Goldwater Rule:”

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry                 

Talking Points:

  1. The Goldwater Rule applies to members of the American Psychiatric Association. It states that members cannot give a professional opinion to the press or the public on the mental health of a someone that they have not examined. Also, a psychiatrist would need that person’s consent, if a patient, to discuss their medical condition in public.  
  1. A person’s behavior is apparent to everyone. The public does not need a psychiatrist to reach their own conclusions or judgement about a person’s behavior.
  1. Patients with certain physical illnesses (i.e.- heart disease, diabetes, cancer) can sometimes develop symptoms of mental illness. That’s why it’s important to thoroughly examine the patient to make sure there isn’t a missed diagnosis.
  1. If approached by the media, APA members can share their expertise regarding psychiatric issues in general. This is an important way to educate the public about mental health issues and reduce stigma.
  1. Enforcement of the Goldwater Rule: As with all ethics complaint investigations--This is a confidential, peer-reviewed process. 
  2. A complaint must be filed first with an APA District Branch.
  3. The APA Ethics Committee will review the complaint. Possible sanctions include educating the member on the Goldwater Rule, suspension from the APA, or expulsion from the APA.   (The APA does not control professional licensing)
  1. It’s important to remember that breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and unethical.
  1. Stress that good mental health care is part of overall health care for everyone.
  2. “Duty to Warn” has been coming up in the news.  In 1974, a trial known as the Tarasoff case established the law —saying that if a patient is in imminent danger of physically hurting themselves or someone else, his or her doctor may break confidentiality and alert the likely victim or call the police.  This applies to a patient in the doctor’s care.  NOT someone being observed from a distance.

History:

Since 1973, the American Psychiatric Association and its members have abided by a principle commonly known as “the Goldwater Rule.”

The rule is so named because of its association with an incident that took place during the 1964 presidential election. During that election, Factmagazine published a survey in which they queried some 12,356 psychiatrists on whether candidate Sen. Barry Goldwater, the GOP nominee, was psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency.

While there was no formal policy in place at the time that survey was published, the ethical implications of the Goldwater survey, in which some responding doctors even issued specific diagnoses without ever having examined him personally, became immediately clear. This large, very public ethical misstep by a significant number of psychiatrists violated the spirit of the ethical code that we live by as physicians, and could very well have eroded public confidence in psychiatry.