Intended for healthcare professionals


Do doctors have a “duty to warn” if they believe a leader is dangerously mentally ill?

BMJ 2017; 356 doi: (Published 09 March 2017) Cite this as: BMJ 2017;356:j1087
  1. Jeanne Lenzer, associate editor, The BMJ
  1. jlenzer{at}

Jeanne Lenzer explores the debate among healthcare professionals about whether to make public their concerns over Donald Trump’s mental health

US healthcare professionals are not supposed to comment on patients they have not examined themselves, and they can only discuss their patients with others if they have the patient’s consent or consider that a patient is a threat to someone else.

But in recent weeks, debate has raged within the profession about whether, if experts believe US president Donald Trump is mentally ill, they have a duty to inform the public. Many who choose to speak out opine that he has the traits of a sociopath that fall under the diagnosis of narcissistic personality disorder.12

Two rules govern US healthcare professionals and patient confidentiality.

The Goldwater rule states that it is unethical for psychiatrists to diagnose mental illness in people they haven’t examined and whose consent they have not obtained. The rule was issued by the American Psychiatric Association in 1973 after it surveyed its members about Senator Barry Goldwater, then Republican nominee for president.3 Nearly half of the responding psychiatrists said he was mentally ill, and some described him as “paranoid” and “grossly psychotic.” Goldwater successfully …

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