Editorial

A Misguided Venture: Presidential Fitness and the Duty to Warn

Authors: Charles G. Kels, JD, Lori H. Kels, MD, MPH

Abstract

A small but vocal cadre of mental health professionals has questioned President Donald Trump’s fitness for office and claimed that his mental state is dangerous.1,2 These experts have frequently cited a “duty to warn” as the ethical basis for their outspokenness.3 The rallying cry of an obligation to protect the public from a dangerous president has inspired a medical conference at Yale,4 an eponymous online movement,5 and a best-selling collection of essays assessing the president’s psychological instability.6

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References

1. Lee BX, Glass LL, Fisher EB. The ethics of warning the public about a dangerous president. https://www.bostonglobe.com/opinion/2018/01/02/theethics-warning-public-about-dangerous-president/PimY2PNNKnOd1QG0lbc17N/story.html. Published January 2, 2018. Accessed March 16, 2018.
 
2. Dodes LL, Schachter J. Mental health professionals warn about Trump. https:// www.nytimes.com/2017/02/13/opinion/mental-health-professionals-warnabout-trump.html. Published February 13, 2017. Accessed March 16, 2018.
 
3. Voelker R. Finding a better way to assess presidential fitness. JAMA 2017;318:2285–2286.
 
4. Yale School of Medicine. Transcript of duty to warn conference. https://us.macmillan.com/static/duty-to-warn-conference-transcript.pdf. Published April 20, 2017. Accessed March 16, 2018.
 
5. A Duty to Warn. Mental health professionals warning the nation. http://www.adutytowarn.org. Accessed March 16, 2018.
 
6. Lee BX, ed. The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. New York: St Martin’s Press; 2017.
 
7. National Conference of State Legislatures. Mental health professionals’ duty to warn. http://www.ncsl.org/research/health/mental-health-professionalsduty-to-warn.aspx. Accessed March 16, 2018.
 
8. Tarasoff v Regents of University of California, 551 P2d 334 (Cal 1976).
 
9. People v Poddar, 518 P2d 342 (Cal 1974).
 
10. American Medical Association. Code of medical ethics opinion 3.2.1(e): confidentiality. https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-3.pdf. Accessed January 2, 2018.
 
11. 45 CFR 164.512(j).
 
12. American Psychiatric Association. The principles of medical ethics with annotations especially applicable to psychiatry. [Section 7.3]. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/principles-medical-ethics.pdf. Accessed March 16, 2018.
 
13. Boroson W. What psychiatrists say about Goldwater. https://www.scribd.com/ document/322479204/Fact-Magazine-Goldwater-1964. Accessed March 16, 2018.
 
14. Goldwater v Ginzburg, 414 F2d 324 (2d Cir 1969), cert denied, 396 US 1049 (1970).
 
15. Friedman RA. Role of physicians and mental health professionals in discussions of public figures. JAMA 2008;300:1348–1350.
 
16. American Medical Association. AMA adopts guidance for ethical physician conduct in the media. https://www.ama-assn.org/ama-adopts-guidance-ethical-physician-conduct-media. Published November 14, 2017. Accessed March 16, 2017.
 
17. American Psychiatric Association. Opinions of the ethics committee on the principles of medical ethics, with annotations especially applicable to psychiatry. 2017 edition. [Expanded Opinion Q.7.a] https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/Opinions-of-the-Ethics-Committee.pdf. Published 2016. Accessed March 17, 2018.
 
18. Kroll J, Pouncey C. The ethics of APA’s Goldwater Rule. J Am Acad Psychiatry Law 2016;44:226–235.
 
19. Appelbaum PS. Reflections on the Goldwater Rule. J Am Acad Psychiatry Law 2017;45:228–232.
 
20. Knoll JL, Pies RW. Psychiatry, “dangerousness,” and the president. http:// www.psychiatrictimes.com/psychiatry-dangerousness-president. Published February 16, 2018. Accessed March 17, 2018.
 
21. Stone A. The psychiatrist’s Goldwater Rule in the Trump era. https:// lawfareblog.com/psychiatrists-goldwater-rule-trump-era. Published April 19, 2018. Accessed May 7, 2018.