Interstate truck drivers, airline pilots, and workers in other occupations that may present hazards to the public must periodically demonstrate they can adequately perform their jobs. But we don’t require similar proof from the president of the United States, despite a president’s ability to launch a devastating nuclear strike and by other means affect the lives of millions. The president’s physician may be best situated to know if the president becomes unable to discharge the powers and duties of the office. However, presidential physicians, like all personal physicians, are bound by confidentiality (with rare exceptions). What’s more, historians have documented multiple instances when physicians have hidden the truth or frankly lied about the health of presidents.
On July 1, 1893, President Grover Cleveland, in what has been called “a masterpiece of concealment,” underwent surgical removal of a malignant tumor on the roof of his mouth and jaw. Cleveland’s surgery was performed in secrecy aboard the camouflaged yacht Oneida. His doctors lied, describing Cleveland’s problem as rheumatism and two badly ulcerated teeth. During his surgery and for a time afterward, the United States did not have a functioning president.
On October 2, 1919, President Woodrow Wilson’s wife, Edith, found him collapsed in the bathroom. He’d suffered a stroke that left him unable to perform his constitutional duties. The first lady and Wilson’s physician, Cary Grayson, kept his medical condition secret for the remainder of his term, which lasted more than a year. Twenty-eight acts of Congress, many of them at variance with Wilson’s views, became law in the absence of presidential review.
In the months before the 1944 presidential election, Vice Admiral Ross T. McIntire, President Franklin Roosevelt’s personal physician, lied about Roosevelt’s health, even though he knew Roosevelt had dangerously high blood pressure and trouble breathing due to congestive heart failure. During the 1960 Democratic presidential primary, aides to Lyndon Johnson correctly reported that his opponent, John F. Kennedy, had adrenal insufficiency. Kennedy’s doctors, however, described his health as excellent, and occasionally falsely ascribed his symptoms to malaria. After he became president his many medical problems were kept secret. (In his 1994 book, The Health of the Presidents, historian John R. Bumgarner noted that Kennedy’s adrenal insufficiency “in all probability, was to become the most lied about illness of any suffered by any public figure.”)
Political commentators and some mental health professionals have expressed serious concerns about the mental health of President Trump. They cite his seeming increased mental instability, loss of touch with reality, and unpredictable behavior. The American Psychiatric Association’s controversial “Goldwater rule” says it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization. Whether Trump is unfit should not be decided by cavalier critics. A mandated independent and objective medical evaluation could be the best answer.
The idea of a commission to assess presidential health has been suggested before but never implemented. A respected institution, such as the National Academy of Medicine, should form the commission from both health professionals and people familiar with the responsibilities of the presidency. The commission would define the physical and mental health standards a president needs to meet to fulfill his or her duties, and document how to best test for them. I suspect presidential incapacity would be infrequent, but with the tremendous powers our highest office holds, this commission, implemented carefully, is a safety measure we must consider.
Section Four of the Constitution’s 25th Amendment, which addresses presidential succession, allows for the president to be removed from office when “unable to discharge” its powers and duties, and unable or unwilling to step aside. If the vice president and the Cabinet (or another body designated by Congress) were to invoke Section Four, the vice president would immediately assume presidential powers and duties, becoming acting president. The amendment is silent on what constitutes presidential disability; this omission has been called its blind spot. In the 50 years since the amendment passed, Section Four has never been invoked.
Senator Birch Bayh, a principal framer of the 25th Amendment, would have vigorously disagreed with periodic presidential medical examinations. He said inability should be a political decision, not one made by “a panel of physicians.” Since a disabling condition could be due to a medical or psychiatric problem, an expert independent medical panel might offer useful information. Making the medical panel’s opinion advisory would ensure the ultimate decision remains political, in accordance with the 25th Amendment.
The president’s personal physician has dual responsibilities, to the president and to the nation. We’ve seen from history that serious presidential illnesses may be hidden from view. Although mandated examinations of the president by an independent body would be complicated to implement, they might someday prevent a disaster.Dr. David Steinberg is a retired hematologist who has been on the clinical faculty of Harvard Medical School and editor of the Lahey Health Medical Ethics journal. Send comments to firstname.lastname@example.org.