What are the professional ethics rules (Goldwater Rule) governing psychiatrists and other physicians commenting on public figures without examination?
Executive summary
The Goldwater Rule is the American Psychiatric Association’s long‑standing ethics restriction that forbids member psychiatrists from offering professional opinions about the mental state of public figures unless they have personally examined the individual and obtained authorization to disclose findings [1] [2]. Parallel but not identical guidance from other medical groups—most notably the American Medical Association—similarly cautions physicians against making clinical diagnoses of public figures they have not examined [3].
1. What the rule actually says and where it lives
The Goldwater Rule appears in the APA’s Principles of Medical Ethics as Annotation 7.3 and states that psychiatrists should refrain from giving a professional opinion about an individual in the media when the psychiatrist has not conducted an examination and does not have authorization to make such statements [4] [5]. The APA’s 2017 Ethics Committee opinion clarified that the prohibition extends beyond formal diagnosis to most professional psychiatric commentary about specific persons who have not been evaluated [5] [6].
2. Why the rule was created — the 1964 origin story
The rule traces directly to a 1964 episode in which Fact magazine solicited psychiatrists’ judgments about Barry Goldwater’s fitness for office; the publication embarrassed organized psychiatry and prompted formal restrictions to prevent similar “armchair” assessments in the future [7] [8]. Goldwater successfully sued the magazine, and the episode led the APA to adopt the annotation in 1973 to protect the profession’s scientific credibility [9] [1].
3. How other professional bodies align—or don’t—with the APA
The American Medical Association added similar language in its 2017 Code of Medical Ethics, advising physicians generally to refrain from making clinical diagnoses about public figures they have not examined [3]. The American Psychological Association does not have a named “Goldwater Rule” but its ethics code instructs psychologists to take precautions so public statements are based on professional knowledge and do not imply a professional relationship with the subject [7] [10].
4. The APA’s rationale: credibility, stigma, and limits of remote judgment
The APA frames the rule as necessary to preserve psychiatry’s credibility and to prevent stigma and irresponsible public diagnoses that rest on incomplete information; the Ethics Committee emphasized that professional opinions require clinical evaluation and permission to disclose personal health information [11] [12]. APA statements repeatedly characterize breaking the rule as unethical, irresponsible, and potentially stigmatizing [12] [13].
5. Tensions and counterarguments inside the profession
Critics argue the rule can conflict with psychiatrists’ societal duty—for example when clinicians believe a public figure poses a danger and the public should be warned—and some formed groups (e.g., the World Mental Health Coalition) contest APA constraints, asserting an affirmative obligation to speak in rare cases [3] [6]. The debate intensified around the 2016 presidential campaign when some clinicians publicly opined about a candidate’s mental state and others defended the Goldwater Rule as essential [6] [5].
6. Exceptions, enforcement, and practical implications
The APA and allied bodies note narrow exceptions: clinicians may comment if they have conducted an evaluation and obtained authorization, or when legal authority (forensic role, court order) permits disclosure; forensic psychiatry has its own guidance for expert testimony [2] [10]. Sources document the rule as an enforceable ethical standard for APA members but do not provide comprehensive, public data on disciplinary actions—reporting limits preclude a full account of enforcement frequency [13] [8].
7. Taking the measure of the rule today
The Goldwater Rule remains the defining ethical boundary for psychiatrists speaking about public figures, reinforced by APA communications in 2017 and discussed repeatedly in professional journals as still relevant amid political controversy; at the same time, allied organizations and some practitioners contest its scope, producing an active, unresolved professional debate about public safety, free speech, and professional responsibility [13] [6] [4].