What is the Goldwater rule and how does it apply today?
Executive summary
The Goldwater rule is an ethical guideline adopted by the American Psychiatric Association in 1973 that forbids psychiatrists from offering professional opinions about public figures they have not personally examined and authorized to discuss, born from a 1964 episode in which psychiatrists publicly commented on Barry Goldwater’s mental fitness [1] [2]. Its intent—to protect diagnostic integrity and public trust—remains affirmed by the APA while critics argue the rule is increasingly ill-fitting in a media-saturated, politically fraught era and should be clarified or updated [3] [4].
1. What the rule says and where it came from
Formally Annotation 7.3 in the APA’s Principles of Medical Ethics, the Goldwater rule arose after Fact magazine solicited psychiatric opinions on Senator Barry Goldwater during the 1964 presidential campaign and Goldwater successfully sued for libel, prompting the APA in 1973 to prohibit members from offering professional opinions about individuals they have not examined and authorized to discuss [1] [2] [5].
2. How professional organizations treat the rule today
The APA has consistently reaffirmed the rule and in 2017 clarified and tightened its scope to extend beyond diagnosis to broader public psychiatric commentary about living public figures without examination and authorization, a stance the APA defends as protecting patients, the profession and public confidence [6] [7] [3].
3. Why supporters defend it
Proponents argue that psychiatric diagnosis requires direct interview, collateral history and contextual evaluation—elements absent in media speculation—so restraint preserves diagnostic accuracy, avoids stigmatization of individuals, and prevents politicization of psychiatry [4] [8] [3].
4. Why critics say it’s outdated or too broad
Scholars and some clinicians contend the rule curtails psychiatrists’ ability to inform public debate on safety and leadership, may impinge on free speech, and fails to reflect routine forensic practices where psychiatrists offer opinions without a full clinical interview; these critics call for a refined rule that permits ethically framed, evidence-based commentary on risk or hypothetical manifestations [4] [9] [10].
5. Practical effects in recent politics and media
The rule became a flashpoint during coverage of Donald Trump’s candidacy and presidency, when many mental health professionals publicly speculated about personality disorders—sparking media attention, disciplinary discussion and the APA’s 2017 clarification—illustrating the rule’s real-world tension between public safety concerns and professional ethics [10] [3] [9].
6. Where exceptions and alternative guidance exist
Other professional bodies and contexts complicate a simple ban: some psychiatric and psychoanalytic organizations adopt different stances on members’ public commentary, forensic psychiatrists routinely give opinions without traditional clinical interviews in legal settings, and commentators have proposed narrow, teachable exceptions (e.g., commenting on general signs, historical figures, or hypothetical cases) that would retain safeguards while permitting public-interest analysis [4] [9] [11].
7. How it applies today—practical takeaways
Today the rule remains binding for APA members: public psychiatric diagnosis of a living public figure without examination and authorization is deemed unethical by the APA, but debate persists about scope, First Amendment implications, and reasonable carve-outs for public safety or educational commentary; journalists, clinicians and institutions therefore operate in a contested zone where professional discipline, academic freedom and civic responsibility intersect [6] [4] [3].
8. The unresolved questions that keep the debate alive
Key unresolved questions include whether and how to permit structured, non-diagnostic expert commentary in crises, how to reconcile forensic practice with the rule’s restrictions, and whether a revised annotation can balance ethical integrity with democratic needs for expert guidance—issues scholars and professional committees continue to study and debate [9] [8] [4].