The Goldwater Rule: Why breaking it is Unethical and Irresponsible

Every four years, the United States goes through a protracted elections process for the highest office in the land. This year, the election seems like anything but a normal contest, that has at times devolved into outright vitriol. The unique atmosphere of this year’s election cycle may lead some to want to psychoanalyze the candidates, but to do so would not only be unethical, it would be irresponsible.

Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical. Maria A. Oquendo, M.D.

Since 1973, the American Psychiatric Association and its members have abided by a principle commonly known as “the Goldwater Rule,” which prohibits psychiatrists from offering opinions on someone they have not personally evaluated. The rule is so named because of its association with an incident that took place during the 1964 presidential election. During that election, Fact magazine published a survey in which they queried some 12,356 psychiatrists on whether candidate Sen. Barry Goldwater, the GOP nominee, was psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency.

While there was no formal policy in place at the time that survey was published, the ethical implications of the Goldwater survey, in which some responding doctors even issued specific diagnoses without ever having examined him personally, became immediately clear. This large, very public ethical misstep by a significant number of psychiatrists violated the spirit of the ethical code that we live by as physicians, and could very well have eroded public confidence in psychiatry.

We live in an age where information on a given individual is easier to access and more abundant than ever before, particularly if that person happens to be a public figure. With that in mind, I can understand the desire to get inside the mind of a Presidential candidate. I can also understand how a patient might feel if they saw their doctor offering an uninformed medical opinion on someone they have never examined. A patient who sees that might lose confidence in their doctor, and would likely feel stigmatized by language painting a candidate with a mental disorder (real or perceived) as “unfit” or “unworthy” to assume the Presidency.

Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.

The Goldwater Rule is published as an annotation in the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. I encourage you all to read the full text of the rule below, and keep it in mind during this election cycle, and other events of similarly intense public interest.