The Golden Goldwater Rule

Many of my colleagues across the country have teased me about it. “So, have any of your academic publications gotten as much attention as your writing about the Goldwater Rule?” I have to admit it. The answer is a resounding NO. It has been surprising to see the intense interest not only from the press, both the Spanish- and English-language media, but also on the part of the membership. I am quite certain that this is the single issue that has moved our members the most to write to APA and to me during my presidency. So insistent was the stream of communications that we decided to ask our Ethics Committee to thoroughly review the Goldwater Rule and render an opinion as to whether it still applied in today’s world, more than four decades since it was first articulated.

We are very fortunate that we have APA members with extensive expertise in ethics, as well as members who are well versed in the law. We are also lucky to have a very carefully organized association, which provides for position statements and other types of communications to be scrupulously evaluated by a series of councils and committees composed of knowledgeable, thoughtful APA members. This means that before anything comes before the Board of Trustees for a vote, it has been carefully vetted. And then, the Board does its own careful evaluation of the issue. Nothing random about it.

Last month the APA’s Ethics Committee issued an opinion that reaffirms our organization’s support for “The Goldwater Rule”. The opinion from the Ethics Committee clarifies the ethical principles behind the rule and answers several questions that have recently cropped up surrounding its applicability and use.

The Goldwater Rule was implemented in 1973. It is so named because of a controversy that emerged during the 1964 presidential election, when Fact magazine published the results of a survey in which 12,356 psychiatrists were asked whether Sen. Barry Goldwater, the GOP nominee, was psychologically fit for the presidency. Of the 2,417 total responses to the survey, 1,189 said that Goldwater was unfit for office. Goldwater eventually won a defamation suit against Fact.

In its opinion, APA’s Ethics Committee asserts that while it is perfectly fine for psychiatrists to share their expertise about psychiatric issues in general, it is unethical to offer a professional opinion about an individual without conducting an examination. The committee clarified that the rule applies to all professional opinions offered by psychiatrists, not just diagnoses. For example, saying that an individual does not have a mental disorder also constitutes a professional opinion.

Three main points form the basis for the opinion:

• When a psychiatrist comments about the behavior, symptoms, diagnosis, etc., of a public figure without that person’s consent, that psychiatrist has violated the principle that psychiatric evaluations be conducted with consent or authorization.

• Offering a professional opinion on an individual whom a psychiatrist has not examined is a departure from established methods of examination, which require careful study of medical history and firsthand examination of the patient. We know that without careful evaluation, medical errors are bound to happen. Such behavior compromises both the integrity of the psychiatrist and the profession.

• When psychiatrists offer medical opinions about an individual they have not examined, they have the potential to stigmatize those with mental illness. Many times, such opinions are intended to discredit the individual’s suitability for a role. The implication, then, is that if a person has a psychiatric condition, he or she should be automatically disqualified from certain opportunities. This reinforces the discrimination that many of our patients suffer.

The committee also offered rebuttals to some of the most commonly heard arguments against the Goldwater Rule, including concerns centered on freedom of speech and civic duty; professional opinions or psychological profiles solicited by the courts or law enforcement officials for forensic cases; and the Tarasoff doctrine, which states that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient.

I recommend that you take a moment to read the full opinion of the Ethics Committee. It is a thorough and well-reasoned explanation on why the Goldwater Rule is more important than ever. The complexity of today’s media environment demands that we take special care when speaking publicly about mental health issues, particularly when what we say has the potential to damage not only our professional integrity, but the trust we share with our patients and their confidence in our judgment as physicians. ■