Editors’ response

We are indebted to Dr Chaturvedi for raising concerns about the ethics of publishing a debate on the ethics of diagnosing public figures.¹ This question has entered public discourse in both national and international associations and the press, hence, it is relevant to air in the Journal.

The use of fictional characters would not work, as it is the role public figures occupy that is the basis of why some wish to raise concerns about their competence, precisely because of the office they hold or the power vested in their decisions. Mickey Mouse and Donald Duck as fictional characters would not raise so much concern, as they are not real. Using a pseudonym would also be disingenuous. For example, we could say, ‘let's take a fictional character, JJ. Let's imagine he is the president of the United States, etc…’. It would not be easy to capture the consternation and concern of different audiences about the actual decisions made by the public figure, and the way it affects people's lives. JJ would not be on TV or in the press, nor be known by anyone. Such an approach would not be credible or progressive.

We were careful in scrutinising the debate, and minimising polemic, yet a debate by its nature seems to engender extreme arguments. Suffice it to say that there was careful editorial scrutiny, and we took much legal advice. The material discussed is already in the public domain and we have not added new information, moreover, the debate is centred on professional ethics and responsibilities, and would not be worthy of discussion were there not an ethical dilemma rather than an evident inevitable and obvious stance to take. Dr Langford's arguments are robust and sufficient, although the Editor in Chief did comment on the debate in the ‘From the Editor's Desk’ column. What seems to be at play here is a citizenship right to criticise public figures if they behave immorally or unethically in public office, versus the professional responsibilities of doctors, psychologists, nurses and social workers and public servants in general, where they make a statement that seems like a professional judgement, but in the absence of the usual professional codes of assessment and practice. These two positions seem to be conflated in Gartner's assertion, yet he is entitled to make them, and that the arguments are considered before rejection, or qualified, where this seems necessary. Professional codes of conduct are governed by regulatory bodies, such as the General Medical Council in the UK for doctors as well as guidance from the Royal College of Psychiatrists, where psychiatric practice is under scrutiny. There are no easy answers, which is the foundation for the ethical dilemma. Thus, we think the debate appropriate and a reasonable offer in the Journal to promote discussion and a consideration about good practice among readers. There cannot be a debate unless we present both sides of the argument, otherwise we would be considered one sided, and as we have not revealed any new information other than that already in the public domain, we have not contravened the Goldwater principle; yet the article asks readers to question the principle and make up their minds, and to receive the arguments for and against Gartner's position. Certainly, the Royal College of Psychiatrists' position is to support the Goldwater principle,² as is the view taken by the American Psychiatric Association.

Dr Braithwaite asks for a correction, that Gartner is a psychologist. A correction has been issued, but we consider the principle should be considered more generally by all professionals working in specialist mental healthcare, not just psychiatrists; and it would be even more controversial were different professional disciplines and their regulatory bodies to come to very different conclusions. The Journal welcomes the input of our allied professions. We can only invite other regulatory bodies to give a view.

The College's position statement can be found here: https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/other-policy-areas/goldwater-rule.²