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Introduction to the Special Section on the Goldwater Rule ANALYSIS AND COMMENTARY SPECIAL SECTION: THE GOLDWATER RULE Introduction to the Special Section on the Goldwater Rule John Martin-Joy, MD J Am Acad Psychiatry Law 45:223–27, 2017 The publication of this special section offers a chance Times, Psychology Today, and other popular publica- to reflect on a topic of perennial interest in psychia- tions. Until recently, however, there have been re- try: the ethics of commenting on public figures. markably few scholarly contributions on the ethics of Since at least the election of 1964, when publisher the Rule. Ralph Ginzburg became concerned about Barry Goldwater’s psychological fitness, psychiatrists have debated the ethics of speaking out about the mental Ethics Inquiry and Scholarship health of public figures. In that year Mr. Ginzburg By 2002, when Jerrold Post wrote “Ethical Con- commissioned a partisan “survey” of U.S. psychia- siderations in the Psychiatric Profiling of Public Fig- 1 trists for his new magazine, Fact. Although many ures,”7 there had been many developments in the psychiatrists said that Mr. Goldwater was mentally psychiatric community on the subject of the Rule. At ill, some called Mr. Ginzburg’s survey unethical. It least one APA trustee acknowledged having voted was later proved that Mr. Ginzburg had shaped the against the Rule, and a former APA president had results to support the conclusion he had already considered the possibility of “rigid overscrupulosity” 2,3 reached. The American Psychiatric Association in interpreting the Rule (Ref. 7, pp 642, 645). But (APA) quickly condemned the survey, but Mr. Gin- with the exception of Slovenko,8 who was indebted zburg published it anyway. Mr. Goldwater consulted to him, Post was the first to bring extended critical his friend William F. Buckley, who advised him that analysis to the Rule in a scholarly publication. there was no point in bringing a libel suit (Ref. 4, p Post’s arguments addressed the challenge of recon- 390). Mr. Goldwater sued anyway, prevailing in dis- ciling the Rule with his experience in profiling for the trict court and then in the Supreme Court. In 1969 Central Intelligence Agency and with his own need he said how pleased he was that the APA had spoken to respond to an ethics complaint after he testified out against “those members of the profession who before a committee in the House of Representatives.7 5 did not act in a proper ethical way.” Reviewing the Rule’s complex history, Post de- The APA addressed the matter formally in 1973, scribed his perplexity in trying to understand the when its Board of Trustees adopted Section 7.3 of language of Section 7.3. He read its provisions as The Principles of Medical Ethics With Annotations Es- internally contradictory, with the injunction to serve pecially Applicable to Psychiatry: the so-called Gold- public education and consult to government (Sec- 6 water Rule (hereafter Rule). Since 1973, there have tions 7.1 and 7.2) clashing with the Rule’s ban on been many articles on the Rule in the New York media comments. His arguments, which are still cen- Dr. Martin-Joy is Staff Psychiatrist, Mount Auburn Hospital, Cam- tral to discussions of the Rule, may be summarized as bridge, MA, Codirector, PGY-3 Adult Development seminar, Har- follows: vard Longwood Psychiatry Residency Training Program, Boston, MA, and Instructor in Psychiatry, Part Time, Harvard Medical Sound ethics principles sometimes conflict, and School, Boston, MA. Address correspondence to: John Martin-Joy, in some circumstances there should be a public- MD, Department of Psychiatry, Mount Auburn Hospital, 330 Mount Auburn Street, Clark One, Cambridge, MA 02138. E-mail: figure equivalent of the Tarasoff warning, [email protected]. whereby a psychiatrist may educate the public Disclosures of financial or other potential conflicts of interest: None. about a public figure’s psychiatric illness if the Volume 45, Number 2, 2017 223 The Goldwater Rule communication is undertaken to prevent greater Perhaps the most dramatic contribution to this harm. flowering was the systematic attack by Kroll and 20 Because unprofessional diagnoses proliferate in Pouncey on the Rule. Where Post had been quiz- the media and government, leaving these unchal- zical and questioning, Kroll and Pouncey were bold. lenged could lead to the mismanagement of Covering the history of the Rule and its development world crises or even death. In these circum- in detail, they asserted that the Rule was intended to stances, it would be unethical for a psychiatrist to cover all areas of psychiatric practice, not just com- withhold his assessment. ments to the media. They provided evidence that everyday psychiatric practice and personal con- Richard Friedman, taking note of the importance science require evaluations of just the sort prohibited of Post’s work, provided a cogent summary of the by the Rule. In their view, the Rule is unable to 9 topic in JAMA in 2008 and in the New York Times distinguish flippant media comments from thought- 10 in 2011. He noted that exceptions to the Rule ful scholarly work and itself may be unethical if it 10 might be defensible in some circumstances. In “suppresses public discussion of potentially danger- 2014 C. Ray Lake cited Friedman in his introduction ous public figures” (Ref. 20, p 232). In fact, Kroll and to three Psychiatric Annals articles that inquired into Pouncey argued that the Rule should be demoted the motivations behind mass killings. Lake justified from a core ethics principle to a guideline for eti- “breaking the Goldwater Rule” on the grounds that quette (Ref. 20, p 234). Their contribution, while because treatment of bipolar disorder differs from influential, brought a rapid rebuttal from Redinger et that of schizophrenia, diagnostic discussions “are al.,21 who stood up for the value of prudence as an 11–14 likely to contribute to efforts at prevention”. By essential foundation of the Rule. that point the APA’s own view was changing. A 2008 APA Ethics Committee opinion declared that profil- Harms Private and Public ing, if conducted in a peer-reviewed scholarly context without specifying a diagnosis, is ethical.15 The papers in this special section are intended to contribute in new ways to our understanding of the Rule and its foundation in ethics. The papers began Recent Scholarship as contributions to “Ethical Perspectives on the Psy- By 2014 to 2016, a flowering of Goldwater Rule chiatric Evaluation of Public Figures,” a forum pre- scholarship was under way. Emerging from a long sented at the 2015 APA annual meeting.22 The in- tradition of attention to role conflict in forensic psy- tent of the Forum was to bring together a wider set of chiatry, Cooke et al.16 thoughtfully characterized viewpoints than is usually represented in psychiatric eight “responsible roles” that psychiatrists can adopt discussions of the Rule. I served as chair; panelists ethically when they interact with the media. Taking included the authors represented in this special sec- for granted the legitimacy of the Rule, they did not tion (with the exception of James Armontrout). explore areas outside the media domain. In 2015, I There were videotaped contributions for the occa- briefly noted the Rule’s origins, documented Post’s sion from Jerrold Post, who recounted his challenge challenge to the APA, and explored the public fig- to the APA, and from 1988 presidential candidate ure’s point of view.17 Pies,18 writing in 2016, differ- Michael Dukakis. In excerpts from a videotaped in- entiated between clinical diagnosis (one that includes terview conducted by Sagar Vijapura, Jonathan a personal evaluation) and other forms of comment. Carey, and me, Mr. Dukakis strongly supported the Pies proposed that the Rule be revised so as to ban current Rule, thereby becoming the first major pub- diagnosis of living subjects if not based on a personal lic figure known to have commented on Section evaluation, but he favored allowing “historical infer- 7.3.23 ences as to likely diagnoses” of deceased persons, dif- In his contribution to this special section, Paul ferential diagnosis of living persons, and “nondiag- Appelbaum24 offers a concise yet penetrating inquiry nostic” professional opinions on broad patterns of into the ethics of the Rule. Dr. Appelbaum, a former behavior in living persons. Robertson et al.19 noted APA president, brings careful scrutiny to the argu- how the Rule might be translated to the psychiatric ments that have been made for and against the Rule. context in Australia, suggesting a series of reflective Conceding that a motive behind the adoption of the questions to help guide psychiatrists’ media conduct. Rule may well have been to prevent further “public 224 The Journal of the American Academy of Psychiatry and the Law Martin-Joy humiliation” after the Fact episode, he nonetheless reading of the Rule. Following the Ethics Commit- argues that there are substantial justifications for the tee’s opinions over time, for example, makes it clear Rule. He identifies the first of these as the risk of that the APA never intended the Rule to apply in harm to the public figure, “a living human being” traditional institutional settings such as the courts who may be injured by unscientific speculation. Sec- and in government agencies. In my reading, the APA ond, he cites the adverse effect on the public of ob- ethics literature shows that the APA now views the serving such episodes. When members of the public Rule as applying only to “cavalier” comments made see psychiatrists drawing conclusions based on in- to the media about “unsuspecting public figures.” complete information or personal opinion, they may Recent APA literature has been confusing and even “write off the value of psychiatric evaluation and contradictory about whether a psychiatric diagnosis, treatment” (Ref.
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