Trump is posing a public health threat that must be addressed
There is no more time to waste. Too many people are dying. Dozens of very smart citizens, even citizen representatives, have expressed enough concern that a response seems to be in order. These are the same mental health concerns we had from the beginning, and the coronavirus pandemic has only deepened these concerns. Hence, in accordance with our code of ethics and our duty to society, we are issuing a prescription.
As health professionals, we abide by a code. It is to place human safety and survival first. We have chosen in advance, as a society, not to let patients commit suicide, for, no matter how they may seem to desire it at the moment, they often alter their choice after they have recovered their normal state of mind. We have determined in advance, as a medical standard, to allow the breach of any other rule, even the most sacred rule of confidentiality, if it helps with safety; in fact, the law sometimes mandates it. We have accepted in advance, as medical professionals, to dedicate our lives to the service of humanity and to take anyone in need of care as our patient in cases of emergency. We have chosen these principles in advance, since when a time of urgency comes, there will be temptations to alter them to suit the situation.
Hence, when a society is heading down a path of self-harm, we have an obligation to intervene, in the same manner as we do with patients, in accordance with the principles we established in advance. The preamble of our ethics code makes clear that we have a “responsibility to patients … as well as to society.” In other words, society is our patient as well. With the development of science and research, our societal role has become bigger, not smaller, as we learn of the many ways in which we can prevent diseases in society, far more efficiently than we can by treating one patient at a time only after they have fallen ill. Patient care will always be important, but societal care must not be neglected.
The current emergency is that we have a president who has been allowed to continue in his position despite our dire warnings since early in this presidency.
His personal care is up to his personal physician, but societal care is up to independent health professionals who are not White House-employed and not subordinates of the commander in chief. They must, of course, also be clear of any political conflicts of interest when they speak up.
A guideline of one voluntary psychiatrists association, called “the Goldwater rule,” encourages us to educate the public in relation to public figures it asks about, for the interests of society: It falls under the principle that we participate in improving the community and bettering public health. Since public figures are not our patients, it recommends that we refrain from diagnosing without a personal examination and from publicizing the diagnosis without authorization — reasonable standards of patient care that do not even need restating. Yet we have described elsewhere how this informal guideline has been changed with the Trump administration and distorted politically to serve the current president.
Here, we are not speaking of patient care but of societal care. In the case of danger, diagnosis is irrelevant, and our obligation is to society, not to the public figure. We noted and warned against the psychological dangers of Donald Trump from the start, through our ethics conference and through our public service book — all proceeds of which have been donated so as to keep ourselves free of conflicts — far before the dangers happened.
Medical standards generally require that we err on the side of safety, but we had deferred to political authorities in the same manner that we do to security forces in the case of our patients. When security forces fail, however, the onus is on us to protect against victimization of society: We cannot simply walk away.
Now, the dangers we warned against are unfolding by the hour, causing the deaths of thousands of Americans, not only through decision-making that is dangerously detached from reality in the midst of a deadly pandemic but through daily press briefings, during which the president must draw attention away from medical experts and even to the issue at hand because of his compulsion to promote an alternative reality.
If the situation becomes an emergency that remains un-dealt with, our ethics code states that we do not have the choice not to take the emergency case as our patient. This is something we would like to avoid, especially given the possible political complications and a lack of public education around mental health issues in general.
We recommend the president’s removal from all authority over the coronavirus pandemic. This may seem like political interference, but it is not. As health professionals, we are trying to meet our responsibility to society and to public health. We are not concerned about how this is done, but that it must be done, and we call on the appropriate authorities to do their part.
Bandy X. Lee, M.D., is a forensic psychiatrist at Yale School of Medicine, expert on public health approaches to violence prevention, and editor of “The Dangerous Case of Donald Trump.” She is the president of the World Mental Health Coalition. The views represented here do not reflect the views of Yale University.