As the oldest person elected president of the United States, Donald Trump has long faced questions about his health. But is it appropriate for doctors to comment publicly on a president’s mental health?
In an opinion article published by The BMJ today, David Nicholl and Trisha Greenhalgh examine the ethical tensions involved. While heads of state are entitled to medical confidentiality, their decisions can have far-reaching consequences, raising the question of whether professional norms against public commentary should ever be set aside.
The authors emphasise that professional standards generally prohibit clinicians from offering diagnoses without direct assessment. They caution strongly against attempts to diagnose specific conditions—such as neurodegenerative disorders—on the basis of media reports or publicly available material.
In particular, they note that conditions such as behavioural variant frontotemporal dementia (bvFTD) require detailed clinical evaluation and appropriate imaging, and cannot be reliably inferred from observed behaviour alone.
They acknowledge that some commentators have interpreted public statements and behaviours as evidence of cognitive decline, but stress that such claims fall well short of the standards required for diagnosis. “In our view, it would be impossible to make a diagnosis of probable bvFTD without full clinical assessment and appropriate imaging,” they write.
At the same time, the authors distinguish between making a clinical diagnosis and expressing broader, clinically informed concerns. They note that, in 2016, senior psychiatrists raised concerns * about Donald Trump’s mental fitness for office while explicitly refraining from diagnosis, and called for an impartial medical assessment. Nicholl and Greenhalgh agree that such an assessment remains an appropriate course of action.
The article concludes that greater clarity is needed between clinical judgement and public commentary, and that doctors should exercise caution, humility, and adherence to professional standards when engaging in debates about the health of public figures.
A linked article reviews what has been said by medical experts about President Trump’s physical and mental health over time, including debates around the “Goldwater Rule,” which discourages psychiatrists from commenting on individuals they have not examined.
Footnote: * On 29 November 2016, three US psychiatrists wrote to then president Barack Obama about their concerns about the mental health of Donald Trump. They said that symptoms that had been widely reported had led them to question his fitness for office. "We strongly recommend that, in preparation for assuming these responsibilities, he receive a full medical and neurological evaluation by an impartial team of investigators," they wrote.
The BMJ
Not applicable
Opinion: Should doctors speak of their concerns about the mental health of a president?
22-Apr-2026
Competing interests: TG is a member of Independent SAGE.