Prudence, Not Silence

Editor:

We thank Redinger and colleagues for their comments, and we find that their remarks support our argument. Although our paper was not written with the 2016 presidential election in mind, the Goldwater Rule has again become topical in this context. There is no decision tree to be used to decide whether, when, and how strongly a psychiatrist may speak publicly about a public figure. The point of our discussion is that in the absence of such an algorithm, individual physicians must balance personal and professional concerns. We argue that professional proscriptions on using diagnostic terminology to describe public figures do apply, and we elucidate the other codified principles of medical ethics that direct professional action in this respect. Our claim is not that the Goldwater Rule is ill conceived, merely that it serves better as a guideline than as an enforceable part of the professional Code.

For this reason, we disagree that our position is “imprudent,” although we grant that the proclamations of individual psychiatrists may be. The fact of speaking publicly, however, is not prima facie imprudent. Social context, setting, and word choices in speaking out may be injudicious or self-serving, but the act of doing so may constitute a virtuous and appropriate response to unjust and immoral behavior on the part of a public figure. Our concern is that prudence can too easily slide into complicit silence. From a consequentialist rather than a virtue ethics perspective, the possible but transient harm that nonadherence to the Goldwater Rule might cause may be infinitesimal compared with the overall harm that an elected public official who has mental illness might produce. We encourage neither elected officials nor citizen-psychiatrists to succumb to ad hominem attacks, but a psychiatrist who enters a public political debate may have well considered reasons for doing so.

In light of the present election, it is worth noting that psychiatrists and other mental health professionals do not have unique insight into the behaviors of the candidates. There have been any number of lay persons with knowledge of the candidates who have publicly aired concerns about their public behaviors, and how those may anticipate the candidates' conduct in office. Ethics rules govern behavior in any community. Whenever those rules are broken we have reason to wonder why and what other morally impermissible behaviors we can expect or should fear. Psychiatric diagnosis contributes little in this case to the broader discourse in the moral community about the fitness and patterns of public behavior of the presidential candidates.