There seems to be plenty of evidence that we have a malignant narcissist in charge of the most powerful country in the world, with the capacity to obliterate that world. However, the ‘Goldwater Rule’ amongst psychiatrists prohibits them from making a diagnosis of mental illness without an examination. Some psychiatrists have been breaking that rule, citing the massive public importance of recognising Trump’s condition and removing him as a justification for breaking the rule. Others, such as this recent article, disagree. To me this seems to be one of those situations where consequential reasoning should come into play: where the consequences of not doing so are sufficiently big, we are justified in breaking rules that we would normally support. But do others agree?