Professional Ethics in the Age of Trump -- UPDATED

Some supporters of Justice Ruth Bader Ginsburg argued that her recent condemnation of Donald Trump was a justified departure from the usual standards of judicial ethics, explaining that Trump represents a unique threat to democracy that calls for special measures.  Justice Ginsburg herself reconsidered, however, and retracted her comments after a few days.  “Judges should avoid commenting on a candidate for public office,” she said. “In the future I will be more circumspect,”

Now the same set of issues is playing out among psychiatrists and psychologists.

As reported in the New York Times yesterday, some psychotherapists are pushing to reconsider the decades old “Goldwater Rule,” which says that “it is unethical for a psychiatrist to offer a professional opinion [about an individual] unless he or she has conducted an examination and has been granted proper authorization for such a statement.”  The rule was prompted by events during the 1964 presidential election, when more than 1000 psychiatrists called Sen. Goldwater psychologically “unfit for office.” According to The Times, one doctor branded him “a dangerous lunatic.”

The Goldwater Rule was relatively uncontroversial until this year’s election, as Donald Trump has proven to be a “seemingly irresistible” target for some psychotherapists who are appalled at the prospect of his election.  One mental health specialist referred to Trump’s “malignant narcissism,” and over 2000 mental health specialists have signed a Manifesto Against Trumpism. (The Manifesto does not offer a diagnosis.)

According to Dr. William Doherty, a psychologist at the University of Minnesota,” the departure from the Goldwater Rule is justified by the circumstances.  “Yes, for me this is an exception,” he told The Times. “What we have here is a threat to democracy itself.”

This is an unfortunate trend.  As much as I hope that Donald Trump loses the election as thumpingly as possible, I also believe that the Goldwater Rule serves an important ethical principle that should not be compromised.  Remote and second-hand diagnoses are unreliable and potentially harmful, and they are just as likely to be informed by political preferences as by clinical judgment.  It turned out, for example, that Barry Goldwater was quite stable, and he ended his career as a champion of gay rights within the Republican Party.

And of course, the tables can be turned.  Donald Trump has recently challenged Hillary Clinton’s mental health.  Conservative websites, including the Drudge Report, have diagnosed her with everything from depression to Parkinson’s disease, with support from Dr. Mark Siegel of NYU, who watched a videotape of Clinton slipping on some stairs and suggested that she suffers from “post-concussion syndrome.”

And let’s not forget Dr. Bill Frist who, when serving as Senate Majority Leader, diagnosed Terry Schiavo on the basis of a videotape. 

I am not saying that physicians should stay out of politics.  Many have shown significant leadership – from Howard Dean to Rand Paul to Jill Stein.  I just don’t want to see Ben Carson claiming that Hillary Clinton has shown the symptoms of a cerebral aneurism or a subdural hematoma.

Professional ethics exist for reasons that have nothing to do with politics, and they should therefore be respected without regard to partisan advantage.  Once the ethics rules are abandoned – even in what is seen as a compelling case – both sides will feel free to weigh in, and the only result will be damage to the ethics standards themselves. We would not want to see lawyers disclose confidences, or priests violate the sanctity of the confessional, simply because they think a particular election is uniquely important. That is why federal judges need to stay out of politics and doctors need to reserve their diagnoses for people whom they have actually examined.      

The American people are capable of making electoral choices without the extramural political opinions of judges or the second-hand diagnoses of psychotherapists. 

UPDATE:  Paul Horwitz's thoughtful post on the same issue is here.

Comments

[Captain Hruska Carswell, Continuance King]

Silence. Another Hitler would be ok then?

[Alex Lubet]

On Wed, Aug 17, 2016 at 10:12 AM, Alex Lubet wrote:

I would add that people who actually have these conditions are stigmatized when public figures are "diagnosed" as euphemisms for bad character. It's a painful irony that one often reads an accusation of racism, sexism, or homophobia, which ascribes those faults to a disability (typically a mental illness). And the idea that not "diagnosing" Hitler would be giving him a pass fails to understand that the Nazis (as well as the former Soviet Union) were leaders in using diagnoses as tools of persecution. Let's not medicalize evil.

[Captain Hruska Carswell, Continuance King]

Alex,

Your argument is speculative. Any good, ideal, institution can be twisted to an abuse or an evil purpose. Perhaps we should "medicalize evil." Until the medical profession came out against smoking it was acceptable. Perhaps if doctors and other "trusted" medical professionals came out against guns and violence---I didn't hear the AMA or any other doctor's group call the Sandy Hook children's killing Evil. It was a deafening silence. Folks trust medical professionals. Why not use that capital and call things what they are? Trump is doing it. What if the "good guys" did it?

[Alex Lubet]

With all due respect, no. The speculators are those who would diagnose someone who is not their patient and whom they do not know and have not met. And even when there is an election as frightening as this one, there are certain principles that must transcend the crisis of the moment. One of them is professional ethics, perhaps medical ethics more than others. Coming out against guns and violence is one thing. Using diagnosis inappropriately is something altogether different. And if you haven't seen the AMA coming out against gun violence, it's because you haven't looked very hard, if at all. See, for example http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-gun-violence-lobby-congress.page, from June 14, 2016.

And no, we should not medicalize evil. Not only is this what the Nazis and the former Soviet Union did (and, contrary to what you say, that does make the tactic suspect by association), we should all know better, for having seen how the right in this country has racialized (Obama and many others) and sexualized (Hillary Clinton most prominently) evil. The difference between these and the medicalization of evil, which stigmatizes millions of innocent people, is that those stigmatized by medicalization are inherenlty and not just socially vulnerable and live with conditions that are inherently and not just socially painful. Using medicalization as a tactic against Trump (who has claimed HRC is mentally fragile) is stooping to his despicable level.

There is a significant difference between the medical profession -- or any other group --calling out Trump appropriately and abusing the tools of their profession to do so. There is no need to call out Trump using unethical means, when it can be done ethically, responsibly, and in a manner far more effective than name calling (think teens labeling each other "retarded," as is unfortunately common). And hindsight aside, it would have been wrong to label smoking hazardous until it was established scientificallty that it was unhealthy. You argue that I am speculating because I eschew the sociobiological claim that evil is a medical condition before science has substantiated that claim. Not only would playing such a hunch be irresponsible in general, it would be particularly fraught given the complex relationship between psychiatric diagnosis and culture (including, of course, religion) and politics. Consider, for example, the etymology of "hysteria," "scientific racism," or the evolution of the psychiatric understanding of sexuality and gender.

Since I am new to this list (though not its only Lubet), I should note that, while I am not a legal scholar, I founded and head the University of Minnesota's disability studies research group. I have appointments in five programs, including bioethics and cognitive sciences.