Follow the Law and Say No More?

Since his inauguration on January 20, 2025, President Donald Trump has issued several Executive Orders that could have significant impacts on the ethical obligations and services provided by mental health professionals (MHPs). These include:

• EO 14187: Protecting Children From Chemical and Surgical Mutilation: This order purports to defund gender-affirming medical care for transgender clients, including bans on the use of Medicare or Medicaid coverage for gender-affirming hormone therapies and surgeries.
• EO 14190: Ending Radical Indoctrination in K-12 Schooling: This order purports to ban efforts to promote diversity, equity, and inclusion in K-12 schools.
• EO 14160: Protecting the Meaning and Value of American Citizenship: This order purports to deny U.S. citizenship to children born in the U.S. to undocumented or temporary-status parents. It also prohibits government employees or agents from acting “in any manner inconsistent with this order.”

The constitutionality of these Executive Orders is currently being challenged in the courts, meaning that it will take time to determine what they mean in practice and whether they will be enforceable. In the meantime, MHPs need to determine the extent to which they will comply with these orders, particularly when compliance may conflict with ethical obligations such as:

• Client autonomy, beneficence [promoting good/well-being], and nonmaleficence [avoiding harm] (American Counseling Association, 2014)
• Respect for the dignity and worth of all individuals, access to needed services, social justice, freedom from discrimination (National Association of Social Workers, 2021)
• Beneficence, justice, and respect for people’s rights and dignity (American Psychological Association, 2017)

Examples of Compliance

Let’s consider examples of how MHPs might comply with each of the three Executive Orders. An MHP serving transgender clients, for instance, might interpret compliance with EO 14187 as requiring them to cease providing gender-affirming services, including mental health assessments for gender-affirming medical care and assisting clients with social transitions. Withholding such services conflicts with ethical obligations in relation to providing clients with access to services, and honoring their rights to bodily autonomy and self-determination. Ultimately, withholding services may lead to higher rates of anxiety, depression, and suicide for transgender individuals.

A school-based MHP might view EO 14190 as a directive to eliminate all school-sponsored efforts to promote diversity, equity, and inclusion. To comply with this interpretation, they might stop providing educational groups and programs to promote intercultural understanding, acceptance of people with disabilities, or anti-bullying initiatives related to race, ethnicity, or gender. Discontinuing such services may conflict with MHPs’ ethical obligations to promote respect, beneficence, and justice for their clients and within their work settings. Discontinuing such programs could also result in more hostile environments for marginalized students.

An MHP working with a government-funded program working with migrant populations might view EO 14160 as requiring them to assist with deportation of children born in the United States if their parents were in this country unlawfully or if they were here on a temporary basis. By following EO 14160 in this manner, MHPs may not only be denying clients essential services, but they may also become complicit in policies that discriminate and inflict harm on vulnerable children—a direct contradiction to professional ethics.

Alternatives

When considering the impact of Executive Orders, MHPs should take appropriate steps to ensure that they fully understand their impact. They should be proactive to ensure that legal compliance does not come at the expense of their legal commitments. Prudent practice suggests consulting with attorneys and civil rights organizations not only to determine the meaning and scope of the Executive Orders, but also to determine whether they are enforceable and whether there are legal options to help clients without violating a law (e.g., referring clients outside the country for gender-affirming care, outsourcing nondiscrimination training so that government funds are not being used for such purposes, or other creative options). MHPs are uniquely positioned to educate the public and legislators about the real-world impact of such laws on the people they serve. Laws can change. MHPs can help ensure that social policy and law reforms take the needs and interests of various client groups into account. When laws affect the psychological, social, and safety needs of clients, it is imperative that MHPs do not simply follow the law, but that they also take active roles in promoting laws that are just, equitable, and beneficial to vulnerable populations and the country as a whole (Barsky, 2023).