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?

:sdl:

Here, I'll spell it out for you. Professional judgement is just that, professional judgement. What you described would never be professional judgement.

Let's be real clear here. Here is the question I asked:

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?

SkepticGinger answered, "Yes, it's called professional judgement."

Clearly, SG thinks that professionals can cherry pick which rules are gold standard and which are not absolute by exercising professional judgement.

My scenario is obviously an exercise in bad professional judgement and it's one that happens in the real world all the time. Therefore, "professional judgement," is not a very good tool to use in selecting which ethical rules should apply and which should not.

Where am I wrong?

You are accusing me of bad logic and that's what you come back with?

That's a circular definition of "professional judgement" and it points out the fatal flaw in your argument. To further illustrate this point: Professional judgement is just that, professional judgement. What the Yale Group is doing would never be professional judgement.

Is that convincing? I didn't think so.

So what is "professional judgement?" and then tell me why the "sex with a patient" scenario isn't a case of using it but the actions of the Yale Group is.

One of these (highlighted) things is not like the other.

You figure it out.

BTW, can you imagine physicians and other medical practitioners that were so anal they wouldn't override some written guideline that should not be applied?

Your argument here is that if a doctor decides to sleep with a patient that decision has nothing to do with professional judgement.

There is a professional relationship between the two. The decision to have an intimate relationship in that context is a perfect example of poor professional judgement. How can you say that it isn’t?

I mean, you can continue to handwave away my arguments here, but I’d really like to see you defend it.

Really? You're going to keep going around and around with this bull **** pretending we should exchange actual professional judgement with some rules you found on the Internet lest we be so incompetent we think professional judgement is a license to to do anything? Do you not understand what you are saying?

Do you believe they teach following the APA's positions in lieu of professional judgement in med school? Really? :rolleyes:

You keep dismissing the ethical code as just some rules I found on the internet. Do you not think that that the ethical code is an important part of professional judgement?
Do you think they tell students and residents, "Ethics? That's just some rules on the internet. Ignore them and use your professional judgement, instead."

Even our beloved but obviously insane Lord President knows that "judgment" is properly spelled with only one E. Granted he scribbles the word in crayon or his own waste, and doesn't know what it means, but still.

Isn't that what you've given us? You seem to be demonstrating an "understanding" that is based solely on a couple cherry picked paragraphs.

This is a preposterous accusation.

I have linked to the pdf containing the entire Code of Ethics. I've also linked to the APAs various position pieces that came out in the wake of this. You are free to peruse them at your leisure and tell me what I've misunderstood. I think you will find that the APA's position on this is crystal clear and their arguments sound.

So please tell me, you, SG, anybody . . . how does professional judgement override those sound arguments?

I have used my professional judgement (as a trained reader and writer with experience of over 47 years) and decided that spelling rules are just something you found on the internet and I can ignore them.

That's a clear example of #3415 on the official "Doctor Science's Is You Crazy? Diagnostic Tool". Per the guidelines that means you is mentally crazy, and I must urge you not to be a president.

If their arguments are so sound and "absolute" as you tried to claim earlier can you explain why other professional organizations have explicitly chosen not to adopt this particular one? Similarly, why has it not been codified in to law as some jurisdictions have done with your sex example?

Which professional organizations are those? The American Psychological Association and the American Psychiatric Association are the two biggest professional organizations in control of the mental health profession. The American Psychoanalytic Association has been misconstrued as saying that their members don't have to follow the Goldwater Rule, but that's not what they said (covered extensively in the thread before). So which organizations were those?

Now, I guess you could argue that: Dr. X chooses not to be a member of any professional; therefore, no ethics rules apply to Dr. X. But that seems like a really bad argument. I believe medical ethics is an inextricable part of medical practice that exists independent of membership in a group.

Ethics is independent of law. Sex with a patient is both unethical and a violation of board rules. Not every ethical violation should be a violation of board rules. The absence of a law or board rule about something doesn't render that something ethical.

Wars have been fought over less.

Even Jenkins wouldn't misspell "ear".

You clearly cannot defend your position so you make up a straw man, all or none, to do battle with. You are arguing everyone should anally follow these 'rules' lest they have nothing upon which to base their ethical judgement.

That's a bizarre point of view. What if there is something for which no organization position paper exists?

What if there are two such position papers and they don't agree?

It's like you picture medical providers running around saying, "Oh no, what do I do, what do I do?"

It's mind boggling to me that you could actually believe that. So I don't think you do believe that. You are trying to justify the position you've taken and it takes a straw man to do that.

It's easy. Take the case of Trump as an example. More than a few highly credentialed professionals have described in detail why they felt the need to override the arguments you seem to think should be burned into one's soul.

Ethics: The Goldwater Rule had to be overridden here given the threat they believe Trump poses.

And if you are still arguing for that in-person exam, you are dismissing the professional judgement of thousands of professionals that can see it would add nothing in this case and Trump's pathologic NPD is blatantly obvious.

Thanks, no need to pointlessly beat this to death again.

Donald Trump has 'dangerous mental illness' say psychiatry experts at Yale... Pt 3
 

An appeal to popularity?

If you don’t think ethics should be the core of a professionals practice. I don’t think we will agree on very much.

Begging the question.

Another argument by popularity. And it’s worth pointing out that there is no evidence of “thousands of professionals” who think this way. At best, there are somewhere around 40 professionals who have publicly spoken about this.

You seem to be confusing a difference of opinion between professionals as an appeal to popularity.

Wow, that is some twisted logic: one side is valid and the other isn't?

I’m not confused about anything.

There are thousands of doctors who promote full-blown woo as part of their practice. Their argument is that, in their professional judgement, these woo treatments are safe and effective. Does the fact that so many of them agree with each other make their judgement sound? No, it doesn’t.

The fact that a relative handful of MHPs disagree with the Goldwater Rule, similarly, tells us nothing about whether or not they are exercising good professional judgement.






Yes, there is one side of this that is clearly based on the established standards of practice and ethics. There is another side that is on the complete opposite side with nothing to support them but their own judgement and mutual agreement.

We fundamentally disagree about which side is valid. That doesn’t mean I’m being illogical.

Yawn... Doctors who promote woo isn't an example helping your argument. You're back to asserting that without anally following guidelines no professionals would know what to do.

I know you want that to be true, that said position papers are absolute. That's not how it works and no amount of feet stamping is going to make it so.

Nowhere in medicine does any provider not consider professional judgement superior in multiple cases. It's even taught that way in med school. Evidence based medicine, yes, but sometimes it doesn't fit the situation.

Donald Trump has 'dangerous mental illness' say psychiatry experts at Yale... Pt 3
 

My argument is: Professional Judgement is not a good tool for deciding which ethical rules are valid and which are not.

Do you consider advocating and providing unproven, ineffective treatments to be ethical, in general? Is there any situation. In which a professional’s judgement would override that?

If the answer is no to both situations, then there’s nothing wrong with my argument. It illustrates the point that “professional judgement,” is not a good tool for deciding which ethical rules are valid and which are not.

Not quite: Professional judgement includes knowing and understanding the ethical rules that apply to each situation. There is no mechanism by which a professional says,”Eh, I reject that ethical rule as invalid.” If it’s true for “sex with patients,” and “providing ineffective treatments,” the. It’s true for the Goldwater Rule.

This is nonsense. Doctors are not taught to consider their judgement superior to standards of practice and ethics. That sounds like institutionalized egotism.

Yeah, and your argument is stupid.

There's no way to help you understand this. But at least try to use legit examples and analogies.

AMA re Ethics
Do you understand why it's a guide and not some absolute law? Why choose that particular word?


AMA Code of Medical Ethics Opinion 4.2.7
You don't think there are professionals that disagree with this ethical position?

Why does this differ from other ethical rules people do not agree on?

Here's another one that not everyone agrees with:
Code of Medical Ethics Opinion 5.6
It's not ethical to do either of these in a Catholic Hospital.

That might have been very satisfying for you to write, but it isn’t responsive. Hope it made you feel better, though.

If you read past the highlighted part, you would see the words, “who strive to practice ethically.” Is it ok to not strive to practice ethically?

I don’t see the significance in the word “guide.” You are right in the sense that the ethics code isn’t law. But, that word doesn’t create an implication that it’s merely a set of guidelines to pick and choose. If you want to practice ethically, there’s the guide to do it.
What does not agreeing to that ethical opinion look like? The doctor doesn’t perform abortions. There is no ethical rule that says doctors must perform abortions so the choice not to is also ethical.

Its a permissive rule: you can do this if you choose to without breaching ethics. You can also choose not to do it.

It’s not unethical not to do them either.

Bad examples. You need to find restrictive rules: Don’t do this. With a restrictive rule, there is no “it’s still ethical if you choose to do it.”

Basically it sound like you just don't know what you are talking about (and have a very odd fixation to boot). It sounds like you think the phrase "professional judgement" means to do what the doctor wants without any consideration of guidance whatsoever. Professional judgement is what guides every decision a doctor makes and it is supposed to an informed judgement that takes in to consideration everything the doctor knows on the subject including relevant codes of ethics. It is taught as being primary and informed. It was pointed out to me last evening that the three alternative graduation oaths cited to graduates of U of A Medical School mention exercising judgement, two of them in their first sentence. And in the real world all codes of ethics on significant subjects have gray areas and contradictions. It's up to professional judgement to sort it out in any specific instance.

Yes but pros may be better at intepreting publically-available evidence.

Do you think the APA knows what it’s talking about?

It’s telling, I think, that so many arguments here focus on me: I have D-K, I don’t know what I’m talking about, I have odd fixations, etc etc ad nauseum.. Very few arguments have addressed the very clear opinions of the professional organizations and their rebuttals to all the arguments raised here.

If I were you I’d focus on that and not so much on me. I have cited ample evidence that the organizations (the AMA, both APAs) responsible for creating the ethics code do not see this as an acceptable exception to ethics code.

Really? Even though I specifically said that’s not what professional judgement is all about? Even though that’s clearly what SG thinks and I’ve been arguing against?

Perhaps if you took a little time to actually consider the words I write, you wouldn’t be so confused.
I have no quarrel with that at all; it’s my position, restated.

Professional judgement includes consideration of ethics. Such consideration does not entail outright rejection of clear ethical guidance. The professional is not above the profession.


What I said was: “Doctors are not taught to consider their judgement superior to standards of practice and ethics.” That is 100% true and it does not conflict with what you wrote above.

Is Andrew Wakefield’s (MD who lost his license because of his anti-vax activism) professional judgement superior to ethical codes and standards of practice? No it isn’t. The idea that professional judgement somehow replaces standards is ridiculous on its face.

You talk about grey areas and contradictions. However, in this particular case, there is no grey area or contradiction. There is very clear ethical guidance on whether or not to publicly speak about people they’ve never met. As such, how can you argue that professional judgement can lead to outright rejection of ethical codes? That is also ridiculous on its face.