I don't know that it's a good case. Dr. Gilligan is an expert in violence, an expertise gained by his years of working with violent criminals. Trump is catagorically different from the type of patient Dr. Gilligan has worked with. He hasn't done any research on people like Trump, he hasn't worked with patients like Trump and he certainly hasn't ever worked with Trump himself.

Let's take the first item in the list: Trump reportedly asked why we couldn't use nukes if we had them. This story is solely sourced to an unnamed source NBC's Joe Scarborough spoke to before Trump was elected:

That does not sound to me like ample evidence to base a sound professional opinion on. It is, however, perfectly fine for a concerned citizen to speak out -there's no need to invoke the medical profession to do so.

I'm not minimizing it; I'm putting it in it's proper place -it's a tool for professionals to use as a part of arriving at a diagnosis. One tool of many that includes semi-structured interviews, review of medical records, etc. When used as part of a complete assessment it's a well validated tool. When it's used as the only thing you are looking at, not so much.

It's criticism of a politician in order to convince people to remove that politician from office. It is by it's very nature a political attack.

Been done many times in the thread. Most recently about 3 or 4 posts up.
You don't agree with the Goldwater rule? That's fine. Your disagreement with the rule doesn't change the fact that it's a rule and that the Yale Group is in violation of it. The rule has been challenged and upheld by the APA so that's the relevant thing here.
That's a mere restatement of terms. What is gained by such knowledge? What are we supposed to do with that?
What useful information do you derive from a diagnosis? Are you going to treat the President?

I'll grant you that he's concerned with dangerous violence tendencies in Trump. In no way does that imply that he has no other concerns (like the ones I mentioned).


'K. On the other hand, that's irrelevant to the question of what I consider (un)ethical. But thanks for trying.

Haven't we been through this aspect of the discussion before? As long as there is the potential for more Americans to become aware of the danger of Trump, I consider that a gain.



For examples: If a patient receives a diagnosis that he has a poor heart, he has the useful information that he should go easier in his lifestyle: Eat more healthy. Moderate physical activity.

If someone close to me is diagnosed with borderline personality disorder, the mere fact of that useful information allows me to be more cautious and aware around the individual with the correlation for violent behavior.

Seriously, I can't believe you need to ask this question. Really.


Do you think I should? Someone certainly should, and not one of his typical Kiss-Ass-Quacks, neither.

I'll get right on it, if you need me to.

I don't suppose you see the contradiction there.

Your analogy is a fail.

Your example of fuelair has nothing in common with the issues here.

The only concerns we are ...uh, concerned with are those that he has actually made a part of his professional opinion.

No problem. The answer to the question I asked, it seems, is: “Yes they breached the ethical code, but I’m ok with that.”

And that’s the difference between us. I don’t know why you think that way because you haven’t told me. I can only say that I strongly disagree because adhering to an ethical code is fundamental to ensuring good practice of medicine. If a professional breaches ethics, how can we be sure they are actually acting professionally? I’m sure you would have a problem with ethical breaches in most other medical contexts (Doctors dating patients? Breaking confidentiality? Advocating unproven treatments?), so I’m not sure what makes this different. Or maybe you don’t think ethics in medicine is a big deal?


Haven't we been through this aspect of the discussion before? As long as there is the potential for more Americans to become aware of the danger of Trump, I consider that a gain.











There, you are talking about situations where someone has been personally diagnosed in the traditional way by a professional who has spent time assessing the person and going through the diagnostic process. That isn’t what we are talking about here. In those situations, a diagnosis is useful for treatment.

And as to your second example, the diagnosis itself isn’t telling you anything, if they really are close to you. You’ve already observed their behaviors and know that you have to be wary. The diagnosis will facilitate their treatment and that’s about it.

You’ve observed Trump. You already came to a conclusion about him before the Yale Group existed. I’m quite sure you didn’t vote for him. What did the Yale Group tell you that fundamentally changed your view of him?


Uh...because in order to have a conversation I need to find out what you think and the best way to do that is ask?



Exactly, you aren’t treating him so there’s no useful information in a diagnosis for you.

We've gone round and round and round on this issue ad nauseam. I don't really give a **** about the Goldwater rule, whether or not Lee's book is 'ethical', whether or not Trump has been seen in person by a mental health professional, whether he is going to be violent or whether he wears pink undies with lace. I do know what I've seen of the man and what his behavior leads me to conclude is that there is something seriously wrong with him. He is not stable. He is an extreme narcissist who can never, ever admit he's wrong, thinks he's above the law, who never learns because he thinks he knows better than anyone else, who has the emotional maturity of a child, is a bully and pathological liar. That makes him unfit to hold the most powerful position in the world. People here can continue to nit pick about semantics and get all huffy about 'ethics' till the cows come home. It doesn't change what I see and why over 70,000 mental health officials are so concerned about that they signed a petition warning about how dangerous he is.

Nominated. :thumbsup:

People being selected for positions that require decision making of vast consequence are not discriminated against for having mental illnesses; they are discriminated for not being exceptional at dealing with stress, distraction, lack of information and emotional impact.

It is utterly bizarre to claim that we cannot ask more of the President in terms of competency for the job than we could for a Wallmart worker stacking shelves.

I was with you until that bit about 70k mental health officials -that part simply isn’t true. Otherwise, bravo! You have summed up my position quite well when it comes to my view of Trump. Where I disagree is the importance of ethics.

I’m getting huffy about ethics because I manage doctors. It is very important to me that ethics remain a cornerstone of the profession. From a societal view, I would think we all want ethics in medicine. What the Yale Group is doing is a gross violation of ethics for all the reasons we’ve gone round and round about. I can’t understand why so many here fight me on that point.

If that were true, Trump wouldn’t have been elected.

You are right, it would be bizarre for someone to make that claim.

In what way would it look different if it wasn't politically motivated?

It would make sense, for one thing.

That's subjective.

Is there anything at all that the accusers could say that would convince you and XJ that this is not political?

I only ask, because if there isn't, then any discussion with either of you is pointless.

The truth is, this particular situation would not look at all different if it were a sincere concern. It's the inability of the lay audience to tell the difference between a political attack and a sincere concern that is a core problem.

It's kind of like when a doctor recommends a treatment that doesn't have good science behind it. Is the doctor recommending it because he truly believes in the treatment or because he makes money off of it? The patient isn't equipped to tell the difference.

However, I can see a couple of scenarios in which mental health professionals can and should speak out:

1)They speak as citizens without any of the trappings of their profession. Sure, their expertise and experience will inform what they say, but they should leave out any mention of diagnosis or dangerous mental illness. Include a clear disclaimer -something like, "I've never met him and I'm not diagnosing him but I have to speak out as a citizen . . ." Dr. Francis almost hits the mark but his "He's not mentally ill; he's the worst person ever," schtick is a bit over the top.

2)His actual therapist breaches confidentiality because Trump has spoken in session about his desire to nuke NK/Syria/wherever, his desire to purge certain ethnicities, a threat to shoot someone on 5th Avenue to see if he still has support, etc -actual specific dangers. I could see other professionals rallying in support. Then it would be based on sound medical practice and invoke a true Duty to Warn as spelled out by law.

Do you count yourself as one of the 'lay audience' that you mention?

It doesn't make sense to you that Trump just might be mentally ill?????

You're asking what would convince me it isn't political. Obviously that's a question that can only be answered by my subjective judgement.

For example, the "duty to warn" argument doesn't make sense to me in this context. The real "duty to warn" is a narrowly-scoped legal exception to the legal requirement for medical confidentiality. It applies when a medical professional has reason to believe their patient poses an imminent risk to themselves or others. It's so that law enforcement can act immediately to prevent tragedy.

It doesn't make sense here. It's inappropriate here. In my opinion, it's being used to try to paper over the ethical breach of going public with what should be confidential patient information. There is no imminent danger. There is no public safety objective that depends on revealing this information for immediate police action.

Either the Yale group doesn't know what the duty to warn actually is, in which case they're bad doctors; or they do know, but are misusing it here on purpose, which makes them evil doctors.

That's just one example. The call for a 25th Amendment solution, the citation of the "what good are nukes" anecdote as medical evidence, and others, all signal that this is an unserious and unethical effort.

These particular accusers? Probably not. I don't think they have standing to make the kinds of medical accusations they're making.

If a doctor who was actually treating Trump believed the president posed an imminent risk to himself and others, consistent with the actual letter and spirit of the duty to warn, and issued that warning directly to the Secret Service, I'd probably take it seriously.

---

I'd take the Yale group more seriously if, instead of a book, they'd published peer-reviewed articles citing specific data sets and methodologies for their novel techniques of remote diagnosis.

Of course. And I don't know for sure if it's a sincere concern or a political attack. It looks and sounds, to my eyes and ears, like a political attack, the same kinds of things being said in other threads and media pundit opinion pieces, just with a long white coat lending it more gravitas.

I do know, because of my position and research on the subject, that medical ethics and standards of practice are important to the profession. I also know that the professionals here aren't following either. That leans me more to the political attack side than the sober analysis side.

Thanks.

That leaves me believing you're utterly unconvincable. regardless of any current or new evidence.

Then how are you making your judgement? If you are, self confessedly one of the lay audience, about which you say this:


How are you managing to discern the difference between a sincere concern and a political attack when you put yourself in the group of people that you say are unable to tell the difference between a political attack and a sincere concern?

This has now been addressed.

You don't seem willing to acknowledge that the President holds a unique position in our society and the world. He is invested with unique powers and responsibilties that touch all of our lives directly. He's no longer just a reality TV star. Anything bearing on his fitness for office is a matter of public concern.

Suppose for the sake of argument that Trump started displaying obvious signs of a stroke: slurred speech, drooping facial muscles, stumbling, maybe dragging a foot behind him, maybe keeling over during a speech. Would doctors be out of line for saying "Damn, that sure looks like he had a stroke!" Would you say "You're not his doctor! Keep your mouth shut!" Would you say we're supposed to pretend we can't see what's in front of our eyes? His obvious psychiatric deficits are just no different.

I actually cited evidence that would change my mind.

I don't understand your complaint.

Have you objectively determined that the Yale group isn't politically motivated? What evidence would cause you to reconsider?

I anticipated this response and I answered it in advance in that same post. In short, I can't determine the difference and that's a big problem with these kinds of "I'm an expert and I say this," pronouncements.

That's obvious with the suggestion alone that one cannot tell if this is political or not. It's ludicrous.

It's like seeing a dog and saying you aren't sure if it's a cat and for political reasons people are calling it a dog.

You can't tell the difference? :dl:

See my above post.

That’s not it at all. The analogy is ludicrous. It’s like you aren’t listening to what I’m actually saying.

You do admit that professionals are humans with bias, yes?

You do admit that a human with mental illness is still a human, yes?

So we have professionals saying a human they have never met has something clinically wrong with their mind, which they can’t see. I can’t tell if they are saying that on the basis of their bias or on the basis of a sincere concern.

I already know Trump is an incompetent buffoon.

Of course people want ethics in medicine, but you are insisting that the Goldwater Rule is somehow the gold standard of ethics in medicine which much never be breached. It ain't. Rules are not absolute and there are always exceptions depending on circumstances. We've never had a president so blatantly exhibit, in public and on almost a daily basis, his disconnect from reality and his paranoia by repeating proven falsehoods of "deep state" conspiracies against him, his out of control lying and stunted emotional development.

https://www.psychologytoday.com/us/b...t-donald-trump

https://www.usatoday.com/story/opini...mn/1260781001/

Because you are missing quite a bit.

The POTUS is one of a handful of people who could destroy civilisation on a whim. They also have the ability for less apocalyptic abuses of power that still damage many citizens.

Given this, if someone has sufficient evidence to form a professional opinion that the POTUS (or potential POTUS) is a danger then I'd argue it's unethical to keep quiet.

It can't be a breech of confidence, if one is basing it on publicly available information and that information is sufficient to form an opinion. Is it unethical for FBI psychological profilers to try looking at a hostage-taker's social media posts and any public statements/manifestos?

Maybe it's not surprising and you think that it's obvious that he's a danger, so saying that in someone's professional opinion, he's a danger is superfluous, but in this thread we have people saying (and I am paraphrasing) that in their layperson's opinion he's not a danger. Which, if professionals disagree and it's not a political decision but a clinical one, suggests that they are bringing something new to the table.



Well, there is plenty of evidence, and it's building up every day about Trump's mental and physical decline. I wonder whether you'd accept that his doctor had been remiss if Trump turns out to be unable to walk unaided by November or somehow misses presidential debates.

The evidence you require is a ludicrously high bar given that there are doubts about the independence of Trump's doctors (remember the medical report that Trump dictated).

In your view, are ethical codes something professionals can choose to follow or not? Can they cherry pick which rules are gold standard rules and which are not absolute?

If so, then I'm not really sure what you think the point of ethical codes is. If not, the above makes no sense.

Yes, there are exceptions to ethical rules depending on the circumstance.

Examples:

Rule: Doctors shouldn't treat family members. Exception: In emergency cases or cases where there isn't access to another doctor. Real world: My wife has refilled my meds for me when we are out of town and I forgot to get them before we left. When she does, she documents the reason why she's doing it and sends a note to the doctor who originally prescribed them.

Rule: Doctors should not publicly talk about the diagnosis and treatment of their paitents. Exception: When the patient poses an imminent specific threat to specific people. Real world: The Tarasoff case, linked to before, which established this exception to the rules.

Rule: Doctors should obtain informed consent before initiating a treatment plan. Exceptions: 1)Emergencies, 2)When the patient specifically waives the right to informed consent and 3)When the doctor judges that informing the patient will harm them in some specific way. Real World: Incapacitated trauma victims. When a patient consents to one treatment, they often sign waivers of consent for other treatments that might arise during the original treatment.

These ethical exceptions are well covered in the various ethical codes and journals of ethics in the medical field.

The Goldwater Rule has been challenged. It has survived those challenges in the profession. Maybe it will change in the future. However, while it stands, professionals should abide by it.


That's all stuff that you yourself have observed.

That's a really big if. There is no case to be made for a Duty to Warn in the legal and ethical senses, for example. There is no standard of practice for distant diagnosis, for another.

In any case, there is no established ethical exception for "I think this guy I've never met before is dangerous." Ethics matter a great deal in medicine.

FBI profilers aren't diagnosing anyone. They are looking at a criminal who has already done violence and looking for patterns that might help capture them or negotiate with them. There are ethical codes in Forensic Psychiatry, too.

If professionals have never evaluated the subject personally, how are they arriving at a professional opinion? I don't think you can get around that one.

I think it's obvious that ethical codes do not consist entirely of absolutes. Some of these professionals we are talking about probably belong to multiple organizations that don't even agree on the Goldwater rule.



And how did you decide that? Obviously some professionals disagree with you.

Yes, it's called professional judgement.

OK, it would therefore follow that, if in their professional judgement, ethical rule X is not a good rule for the circumstances, they should feel free to ignore that rule.

Having sex with patients? "In my professional judgement, there is no harm in this particular case; therefore, I shall ignore the rule."

Does that sound right to you?

Wow. You sure you don't want to think about that for a minute? Can't you name at least four major differences between this and what we're talking about?

Big giant logic FAIL.

Try again.

It’s an ethical rule. If professionals can use professional judgement to pick and choose which situations ethical rules apply to, it’s a valid comparison.

What do you see as a problem with the scenario?

Wow.

See my reply above. Spell it out.

You implied that ethical rules can be cherry picked based on professional judgement. I gave an example of an ethical rule that could be circumvented by the judgement of a professional -a flawed judgement, to be sure.

How does your “professional judgement “ argument account for flawed professional judgements? Couldn’t the Yale Group be making a flawed professional judgement?

I’m more than willing to admit when I’ve made an error. I can’t see it. Can you spell it out?