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Commentary

The cost of conflation: Avoiding loose talk about the duty to warn

Publish date: October 12, 2017

Whatever its merits, the Goldwater Rule is intended to distinguish between educational activities – in which psychiatrists share their expertise with the public and shed light on mental illness – and professional opinion wherein psychiatrists offer diagnoses or prognoses unsolicited by the individual.⁹

Lt. Col. Charles G. Kels

Today’s critics often point to psychological profiling commissioned by government agencies as a reason for the Goldwater Rule’s obsolescence. During the first Gulf War, Jerrold M. Post, MD, a pioneer in this field, compiled a detailed profile and offered Senate testimony on Iraqi dictator Saddam Hussein’s “malignant narcissism.” Dr. Post cited a Tarasoff-inspired justification for his actions, maintaining that his psychiatric expertise could save lives.¹⁰

The APA has since clarified that the Goldwater Rule does not prohibit “psychologically informed leadership studies” so long as they maintain scholarly standards and do not specify a clinical diagnosis. When appropriately conducted as academic research, including acknowledgment of inherent limitations, psychological profiles do not implicate the Goldwater Rule by drawing clinical conclusions outside clinical practice.

Dr. Lori H. Kels

The duty to warn is inapposite where there is no confidentiality to be breached. It also defies logic where the physician, far from being the only one who can alert another to danger based on clinically derived insight, is working solely from public sources and may actually know less, not more, than others.

Ultimately, the debate over the Goldwater Rule pits concerns over professional standards and respect for persons against the ability of psychiatrists to apply the expertise and language of their profession according to their own best judgment, without running afoul of an ethical norm. The premise that the Tarasoff principle overrides the Goldwater Rule is a red herring that does a disservice to both. There may be valid reasons to reevaluate the Goldwater Rule, but the duty to warn is not one of them.

Lt. Col. Charles G. Kels practices health and disability law in the U.S. Air Force. Dr. Lori H. Kels teaches and practices psychiatry at the University of the Incarnate Word School of Osteopathic Medicine in San Antonio. Opinions expressed in this article are those of the authors alone and do not necessarily reflect those of the Air Force or Department of Defense.