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假如特朗普有心理问题,可以罢免他吗?

更新时间:2017-8-31 12:07:49 来源:纽约时报中文网 作者:佚名

Who Decides Whether Trump Is Unfit to Govern?
假如特朗普有心理问题,可以罢免他吗?

The mental health of Donald Trump has been under scrutiny since he began running for president. Now 28 Democratic Congress members have signed on to a bill, introduced in April, that could lead to a formal evaluation of his fitness.

自唐纳德·特朗普担任总统以来,他的心理健康状况便一直受到人们的严格审视。现在已有28位民主党国会议员在一项于4月份提出的法案上签名,该法案一旦生效,便可对他的健康状况进行正式评估。

The bill seeks to set in motion a part of the 25th Amendment that empowers Congress to establish a body to assess the president’s ability to govern. The commission created by the bill would have 11 members, at least eight of whom would be doctors, including four psychiatrists. If the commission doctors found Mr. Trump unfit to govern and the vice president agreed, the vice president would become acting president. Since the 25th Amendment was written to address temporary disability, it allows the president to announce that he has recovered — presumably Mr. Trump would do so immediately — and force a congressional vote on the finding of unfitness.

该法案旨在启动第25修正案的一部分,授权国会建立一个机构来评估总统的执政能力。该法案授权创建的委员会将包括11名成员,其中至少应有八名医生,含四名精神科医生。如果该委员会的医生们发现特朗普不适合执政,副总统也表示同意,那么副总统将成为代总统。因为第25修正案是为了解决暂时失能问题而提出的,它允许总统宣布自己已经康复——那想必应该是特朗普第一时间会做的事——从而迫使国会就他是否适合任职做出表决。

The role of psychiatry in this process would be problematic. One of us is a lifelong Democrat, the other a Republican (if an increasingly ambivalent one). But as psychiatrists and citizens, we agree on this point: The medical profession and democracy would be ill served if a political determination at this level were ever disguised as clinical judgment.

精神病学在这个过程中的作用是存在问题的。我们两人,一个一生都是民主党人,另一个是共和党人(虽然对此愈发感到矛盾)。但是作为精神科医生与公民,我们一致认为:如果这一级别的政治目的被伪装为临床医学判断,那么医生职业和民主就会遭到不当的使用。

Much has been written lately about the Goldwater Rule, the American Psychiatric Association’s prohibition against members’ evaluating anyone they have not personally examined. The rule dates to 1973, when analysis of patients’ unconscious processes drove diagnosis. Today, diagnosis is often linked to observable traits, making evaluation at a distance plausible. Even if Mr. Trump refused to cooperate, diagnosis might be the easy part — perhaps too easy. Whether or not they can say so, many experts believe that Mr. Trump has a narcissistic personality disorder. He is grandiose, entitled, desperate for admiration and so on.

最近有很多文章写到戈德沃尔特守则(Goldwater Rule),这项美国精神病学协会的规定禁止其成员对任何他们没有亲自检查的人做出评估。该规则可追溯至1973年,当时,诊断是通过对患者的无意识心理过程进行分析而做出的。如今,诊断通常与可观察到的特征相关,因此远程评估是可以采信的。即使特朗普拒绝合作,诊断或许也是较为容易的部分——也许太容易了。不管他们是否可以这样说,许多专家认为特朗普具有自恋型人格障碍。他浮夸、自以为是,迫切渴望赞美,诸如此类。

But any number of presidents have remained in office despite some level of mental impairment. Historians believe that Abraham Lincoln, for example, had clinical depression. A president can have a mental disorder and, overall, function admirably. In the absence of disability, a president may be inexperienced, indecisive or inept. Psychiatrists would be alarmed if mental illness were considered an absolute bar to public service.

但是,有很多总统尽管有一定程度的精神障碍,但他们仍然履行了职务。例如,历史学家认为,亚伯拉罕·林肯(Abraham Lincoln)患有临床抑郁症。总统可以患有精神障碍,但总的来说仍能出色地履行职责。一位没有失能的总统也可能缺乏经验、优柔寡断或是非常无能。如果认为精神病患者应当被绝对禁止担任公职,将令精神科医生深感忧虑。

The 25th Amendment is imprecise, but clearly the intent is to cover impairment arising from illness. Once an impairment is diagnosed, doctors on the panel would need to determine whether the president is incapacitated and whether the incapacity results from the disorder. For grave conditions like psychotic episodes, severe dementia or massive strokes, the connection is easy. But what of less automatically disqualifying ailments?

第25修正案是不严谨的,但其目的显然是为了弥补疾病造成的损害。一旦诊断出总统受到疾病损害,专家小组中的医生就需要确定他是否已经丧失工作能力,以及丧失工作能力是否由机能失调造成。对于精神病、严重的失智症或中风来说,做出这种判断是很容易的。但是那些不太会直接导致丧失工作能力的疾病又怎么样呢?

The traits that might earn Mr. Trump a diagnosis of personality disorder were on display during the election campaign. His supporters judged that egotism was compatible with leadership. He is governing as he campaigned. He is impulsive, erratic, belligerent and vengeful.

特朗普在竞选期间表现出的一些特征可能会导致他被诊断为人格障碍。他的支持者认为他的自我中心是与领导气质相容的。他在执政期间的表现与竞选期间的表现一样。他冲动、不稳定,好斗,报复心强。

But is Mr. Trump unfit to govern in the meaning of the 25th Amendment? If so, its provisions might have been invoked the day he took office. If not, when did the incapacity arise? Would the commission monitor a president’s behaviors, judging which is the last straw?

但是,特朗普不适合执政这一点是符合第25修正案精神的吗?如果是这样,该修正案中的条款在他上任之日就可能会被援引了。如果不是这样,他会在何时丧失工作能力?委员会是否应当监督总统的行为,判断哪个行为可以被视为丧失工作能力的最后一根稻草?

In practical if perhaps not in moral terms, these decisions might be less troubling if Mr. Trump were found, say, to have Alzheimer’s disease, with a resultant coarsening of longstanding personality traits. To the extent that the president’s supporters accepted expert opinion, they might be less resistant to the removal of a demented commander in chief than a narcissistic one.

从实际的角度,而不是从道德的角度出发,如果发现特朗普患有诸如阿尔茨海默症之类疾病,从而导致其长期人格特质受到侵蚀,这些决定可能就不会那么麻烦。只要总统的支持者接受专家意见,那么撤掉一个失智的三军统帅,可能比撤掉一个自恋的三军统帅更容易令人接受。

But considering personality disorder only: How does it relate to fitness? Can erratic behavior be strategic? Decisions at this level of refinement become ever less scientific, less medical.

但是如果只考虑人格障碍呢:它同健康有何关系?行为乖张会不会是一种策略呢?在这种细化程度上的判断会变得越来越不科学,越来越同医学无关。

However flawed, the Goldwater Rule saves psychiatrists from the temptation to misuse diagnosis for partisan purposes. The establishment of a standing oversight commission reintroduces this concern, in spades. Assuming that doctors confirmed that Mr. Trump was egotistic, would they then declare him unfit based on established patterns of conduct — on Trump being Trump?

戈德沃尔特守则虽然有缺陷,但它可以让精神科医生免受诱惑,将诊断错误地用于倾向性用途。建立常设监督委员会肯定会重新引发这一关切。假设医生证实特朗普有自我中心的症状,那么他们是否会根据既定的行为模式宣布他不适合执政——就因为特朗普是特朗普?

That result would strike those who elected him as elitist and anti-democratic. Don’t the people have the right to choose an exceedingly narcissistic leader?

这样的结果会打击那些将他视为精英主义者和反民主主义者,从而为他投票的人。人民难道没有权利选择一个非常自恋的领导者?

For a president who is unfit but not impeachable and who still has the support of his cabinet, the Constitution offers Congress only this one way out, a declaration of impairment presented by a deliberative body of its choice. But that body need not be dominated by doctors. Senator Birch Bayh, the Indiana Democrat who drafted the 25th Amendment, which was ratified in 1967, specifically opposed relying on physicians to make what he considered a political determination.

对于一个不适合执政但又无法弹劾,而且依然得到其内阁支持的总统,宪法为国会提供的只有这种解决方式:一份由国会选择的审议机构提出的健康受损声明。但那个机构不一定要由医生掌控。第25修正案是于1967年获得正式批准的,该修正案的起草者,印第安纳民主党参议员伯奇·贝赫(Birch Bayh)特别反对靠着医生来达到他所认为的政治目的。

If the time comes that Congress finds Mr. Trump unable to discharge his duties, its members should appoint a bipartisan commission dominated by respected statesmen to set the removal process in motion. Obviously, if a president’s health deteriorates drastically, medical consultants should be called in. But when the problem is longstanding personality traits, a doctor-dominated commission simply provides cover for Congress — allowing legislators, presumably including those in the majority, to arrange for the replacement of the president while minimizing their responsibility for doing so.

如果国会发现特朗普先生不能履行自己的职务,其成员应该任命一个由德高望重的政治人士主导的两党委员会,以便将免职程序纳入议案。显然,如果总统的健康状况出现急剧恶化,就应该请来医疗顾问,但如果问题在于长期存在的人格特质,一个由医生主导的委员会只是为国会提供掩护——允许议员(想必应该包括那些多数党议员)安排更换总统,同时尽量减少他们自身在这一事件中的责任。

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