Discouraged by the Goldwater Rule

This doctor believes the Goldwater Rule discourages psychiatrists from expressing themselves.

The suggested refinements by Alan D. Blotcky, PhD; Ronald W. Pies, MD; and H. Steven Moffic, MD,1 to Section 7.3 of the American Psychiatric Association (APA) Ethics Code—known as the Goldwater Rule—are reasonable, but in my view insufficient. I believe so for 2 reasons: 1) The extreme actions of the former US president and the party he still seems to largely control present a clear and present danger to the core functions of our system of government and call for stronger action from every responsible citizen, more so from those with knowledge and expertise in the workings of human behavior; and 2) the APA’s most recent defense of the Goldwater Rule2 does not adequately detail how a psychiatrist can both comment on the behaviors (“public actions”) of political figures and avoid rendering a “professional opinion,” given the unusually broad definition this entails (ie, any wording that “draws on the skills, training, expertise, and/or knowledge” inherent in our practice of psychiatry).

We could try to stipulate that we are not speaking as psychiatrists or simply not mention anything about our profession, but either approach would seem both disingenuous and ineffective, if not impossible. Imagine the case of a prominent psychiatrist such as a faculty chair or a well-known author, or a psychiatrist in a small town or rural setting where every medical professional is well-known in the entire community. For all of us, once our identity as a psychiatrist is known, whatever we say or write will be inextricably tied—in the mind of the public—to our professional training and expertise.

The Blotcky article encourages psychiatrists as private citizens to express their political views in the interest of fulfilling other aspects of the APA Ethics Code, which calls on physicians to “participate in activities contributing to the improvement of the community and the betterment of public health.” However, even with guidelines on how to separate our status as private citizens versus psychiatric professionals, concerns about being called up on ethics violations will likely continue to put a significant damper on any public commentary by psychiatrists. Section 7.2 states that psychiatrists “may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness.” Unfortunately, these affirmative ethical guidelines from Section 7 of the Ethics Code seem to have been stymied by the prohibitive guideline in Section 7.3 (Goldwater Rule).

I strongly agree with the last line of the Blotcky article that “our representative democracy functions best when all its citizens are active, vocal, and assertive.” But the sad, even tragic, impact of repeated assertions and reminders about the prohibitive Goldwater Rule without an equal emphasis on other affirmative ethical guidelines is that psychiatrists—the very citizens who may have the most to offer society in terms of expertise on crucial social and political determinants of mental health—are discouraged from expressing themselves. A potential solution is for the APA Ethics Committee to review these issues again and provide some concrete guidelines which allow psychiatrists to feel reassured about their ability, indeed their duty, to express their opinions—both as private citizens and as psychiatric physicians—in ways that do not violate existing ethics guidelines including the Goldwater Rule.

Dr Fleming is a psychiatrist in Kansas City, Missouri.

References

1. Blotcky A, Pies R, Moffic HS. The Goldwater Rule is fine, if refined. Here’s how to do it. Psychiatric Times. 2022;39(1).

2. American Psychiatric Association Ethics Committee Opinion. American Psychiatric Association Ethics Committee. March 15, 2017. Accessed February 9, 2022. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/APA-Ethics-Committee-Goldwater-Opinion.pdf