Goldwater Rule: Change or Stay?
The conversation on the Goldwater Rule is taking place now. Don't miss out on the latest in the debate.
Alan D. Blotcky, PhD; Ronald W. Pies, MD; and H. Steven Moffic, MD, wrote this piece for the cover of Psychiatric TimesTM 2022 January issue. In their opinion, we can better define, clarify, and expand this rule to fit today’s societal needs, and it can be done ethically and effectively.
“In our view, the Goldwater Rule’s basic rationale is correct. However, ethical guidelines are not meant to remain static and fixed. Over years or decades, provisions may need to be revised or at least further delineated. Such is the case, in our opinion, with respect to the Goldwater Rule,” they wrote.
They go on to give 2 example cases of inappropriate and appropriate responses to media questioning on the mental state of public figures.
“Once revised, the Goldwater Rule could serve as a roadmap for psychiatrists and others who have a responsibility to improve the community and better the public health as they avoid the pitfalls of “armchair diagnosis.””
Read: The Goldwater Rule Is Fine, if Refined. Here’s How to Do it.
James L. Knoll IV, MD disagrees with the need for a change to the Goldwater Rule.
“By now, it is painfully apparent that most advocates of liberalizing or abolishing the [Goldwater Rule] are motivated by political partisanship. The temptation is evidently too great for us to avoid using the mantle of our profession to stigmatize a political figure with pejorative labels.”
In refuting his colleagues’ points, Knoll came up with a set of his own rules, the Knoll-Water Rules.
The Number 1 rule? GWR violations damage the credibility of psychiatry. Psychiatry is not in need of further credibility damage.
Responding to Dr Knoll, Drs Blotcky, Pies, and Moffic brought their varying perspectives back to the issue of the Goldwater Rule. What do all these responses share? A belief that refinements to the Goldwater Rule will advance the cause of psychiatry’s mission as a helping profession.
“The mission of psychiatry is to better society and improve public health. That mission cannot be accomplished in a clinician’s office. It requires contact with the community, often through the press. There must be ethical ways for psychiatrists and other professionals to achieve this stated mission,” said Dr Blotcky.
David T. Springer, MD, also disputes the claim that the rule needs changed. To him, “One individual’s “disinformation” is another person’s truth.”
“I believe that it does not serve the public good to give a scientific veneer to what amounts to a political opinion,” wrote Springer.
In his individual response to Dr Springer, Dr Blotcky asserts that “psychiatrists and other mental health professionals are in a unique position to comment on public health and societal matters due to our training, experience, and expertise.”
Read: Psychiatry’s Mission
Dr Pies, in his response to Dr Springer, discusses how best to interact with the media as a mental health professional, which is sometimes unavoidable. He shares his opinion that “an appropriate response to a reporter’s question is not always or necessarily the wisest response…”
Additionally, he points out that the APA often speaks out on public health issues and policies that affect the well-being of the general public and our patients. Why then should psychiatrists keep quiet?
Using his experiences from numerous psychiatric ethics committees, Dr Moffic responds to Dr Springer with this idea: “We also need to remind ourselves that we are public and political servants. Politics influence the funding of our work and licensing. It is impossible to completely separate the professional from the political.”
Dr Moffic also recommends the inclusion of a psychiatrist in future presidential administrations, especially as rates of anxiety, depression, suicidality, and burnout rise.
Read: Clarifying the Goldwater Rule and Other Ethical Principles
Dr Springer returned with the sentiment that psychiatrists must keep to the current restrictions of the Goldwater Rule in order to follow the key tenet of “do no harm.”
James L. Fleming, MD, responds to Drs Blotcky, Pies, and Moffic very differently: He believes they did not go far enough, calling them “reasonable, but insufficient.”
He believes this for 2 reasons. 1) The former US president’s extreme actions seem to still present a danger to the country and its citizens. 2) the APA does not specify how best to comment on public behaviors while also avoiding giving a professional opinion.
Responding to Dr Fleming, Dr Blotcky is unsurprised that some psychiatrists believe their suggested changes do not do enough.
“In light of psychiatry’s stated mission of bettering public health and improving society, it is reasonable for some mental health experts to believe that rendering opinions on public health and societal matters is within the purview of our field. I concur with that view.”
He concludes that only one thing can be done: compromise.
Dr Moffic, in his response, states that Dr Fleming’s opinion explores the other side of the coin.
“What we all must remember and emphasize, and what seems to have been forgotten or ignored by most of us and the media with the Goldwater Rule prohibiting any professional commentary on a public figure not examined and not giving permission, is that we can—and ethically must—still engage with public issues of psychiatric relevance,” wrote Moffic.
Read: The Other Ethical Side of the Goldwater Rule Coin: What We in Psychiatry Can and Must Do