Psychiatrists Diagnosing the President — Moral Imperative or Ethical Violation? — NEJM

Editor's Note: The narration and closed captions in this video are in English. For subtitles in 13 other languages, see this video on the website of the World Health Organization .Editor's Note: For reasons of public health, readers should be aware that this letter has been “heavily and uncritically cited” as evidence that addiction is rare with opioid therapy. Leung et al. describe its history.Editor's Note: The scientific reports by Hwang et al.1,2 that are described in this article were retracted by Science on January 12, 2006. See Snyder and Loring for further information.Editor's Note: The scientific report by Hwang et al.1 that is described in this editorial was retracted by Science on January 12, 2006. See Snyder and Loring for further information.

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Correspondence

December 27, 2017DOI: 10.1056/NEJMc1716751

Comments open through January 3, 2018

Article

To the Editor:

The premise of the Perspective article by Pouncey1 is that moral and civic responsibilities justify the mental health professionals who, along with editor Bandy Lee, authored TheDangerous Case of Donald Trump2 and any others who might be impelled, in violation of psychiatry’s Goldwater rule,3 to cite medical reasons that would compel the President’s ouster.

Although moral and civic imperatives justify citizens’ speaking out against injustices of government and its leaders, that does not mean that psychiatrists can use their medical credentials to brand elected officials with neuropsychiatric diagnoses without sufficient evidence and appropriate circumstances. To do so undermines the profession’s integrity and credibility.

Psychiatry has made too many past missteps4 to engage in political partisanship disguised as patriotism — witness its collusion in Nazi eugenics policies, Soviet political repression, and involuntary confinement in mental hospitals of dissidents and religious groups in the People’s Republic of China. More than any other medical specialty, psychiatry is vulnerable to being exploited for partisan political purposes and for bypassing due process for establishing guilt, fault, and fact.

Moreover, there is no reason for psychiatrists to take the risk of overstepping ethical boundaries for the purposes of political expression. Any of the neuropsychiatric conditions that the President is believed to have can be confirmed (or ruled out) by standard diagnostic tests, including mental status and neurologic exams, blood tests, imaging procedures, and neurocognitive testing.5 The 25th Amendment to the Constitution addresses presidential competence and when invoked by Congress and administration officials could require such an evaluation.5 If Congress fails to act, the public can force the government’s hand, as during the Vietnam War, when widespread protests forced President Lyndon Johnson to decline renomination, President Richard Nixon to sign a peace treaty, and Congress to cut off funding.

I believe that Pouncey and Lee and her coauthors are acting in good faith and are convinced they are fulfilling a moral obligation. But I believe this is a misguided and dangerous morality.

Jeffrey A. Lieberman, M.D.

Columbia University College of Physicians and Surgeons, New York, NY

jlieberman@columbia.edu

Disclosure forms provided by the author are available with the full text of this letter at NEJM.org.

This letter was published on December 27, 2017, at NEJM.org.

5 References

1
Pouncey C . President Trump’s mental health — is it morally permissible for psychiatrists to comment? N Engl J Med . DOI: 10.1056/NEJMp1714828
Free Full Text
2
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.
3
Appelbaum PS . Reflections on the Goldwater Rule. J Am Acad Psychiatry Law 2017;45:228-232
Web of Science | Medline
4
Lieberman JA. Shrinks: the untold story of psychiatry. New York: Little, Brown, 2015.
5
Lieberman JA. Trump’s brain and the 25th amendment: eight experts gathered to discuss POTUS’s mental situation. Tonic. September 8, 2017 (https://tonic.vice.com/en_us/article/wjjv3x/trumps-brain-and-the-25th-amendment).

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