Americans need a better way to evaluate the President’s health (opinion)

Although the Constitution provides a pathway to replace a vice president who resigns or dies, it lacks a way to replace one who becomes disabled. I assured Cheney that if I ever determined he was no longer fit for office, he could rely on me to tell him. Later that month, knowing that another heart attack or a stroke might leave him unable to do his job, the vice president wrote and signed a letter of resignation and gave it to his lawyer, David Addington, with instructions to give it to the President if it were ever needed. Fortunately, it never was.

In contrast to Cheney’s improvisation, the 25th Amendment does contain specific procedures for removing a disabled President. The amendment was ratified in 1967 in response to both the assassination of President John F. Kennedy in 1963 and the heart attack that nearly killed President Dwight D. Eisenhower a decade earlier and kept him out of Washington for months.

Section 3 of the 25th Amendment is voluntarily initiated by the President himself, enabling the chief executive to designate the vice president as acting President during a period of presidential disability. This provision has been used twice, in 2002 and 2007, to briefly transfer power to Cheney when President George W. Bush had a colonoscopy. Although President Ronald Reagan temporarily transferred presidential authority to Vice President George H.W. Bush in 1985 during surgery for colon cancer, he declined to invoke the 25th amendment.

Section 4 was designed to address presidential incapacity when the President is either unable or unwilling to relinquish authority. It empowers the vice president and Cabinet to certify the President incapable of performing his constitutional duties.

No President has ever been removed because of a physical or mental disability, but the circumstances under which it should have been considered have occurred. They reappeared again this week when President Donald Trump was hospitalized for treatment of Covid-19.

In October 1919, President Woodrow Wilson suffered a large stroke that left him paralyzed on the left side and unable to speak. From then until the end of his term in 1921, his wife, Edith, performed many of his duties. More recently, in 1981, Reagan was shot by John Hinckley. Despite being taken to George Washington University Hospital in shock, with a near-fatal bullet wound to the chest that required emergency surgery, the 25th Amendment was never invoked.

So, while the Constitution provides a pathway to replace a disabled president, in reality, who would make such a consequential determination?

The Cabinet has an obvious incentive to block the disclosure of presidential disability. As Dr. Ludwig Deppisch writes in his 2007 book “The White House Physician,” “They have a collective need for their leader to be perceived as wise, decisive, and in control. Illnesses that affect the leader’s mental processes would be perceived as especially threatening and might likely be concealed.”

The Cabinet also serves at the pleasure of the President, and concern about retribution may impede a frank and free discussion about presidential fitness.

Evaluating and maintaining the health of a sitting President remains the primary responsibility of the White House Medical Unit, a team of doctors, nurses and physician’s assistants chosen from the military services. While providing exceptional medical care, the unit’s staff faces an impossible conflict of interest because their primary patient is also their boss. The President can derail or enhance an officer’s career, or — as we’ve seen in this administration — nominate them for a Cabinet post.

There is also an irreconcilable disparity in power. Imagine Donald Trump’s physician, Dr. Sean Conley, a 40-year-old Navy Commander, having to tell his commander in chief that he is too sick to serve.

Over the past century, White House physicians have repeatedly deceived the public about the health of the President. In April 1944, Franklin D. Roosevelt struggled with congestive heart failure, yet his physician, Admiral Ross McIntire, told the press the President simply had the flu. President Kennedy’s medical team obscured the presence of his Addison’s disease.

The current administration has doggedly refused to disclose the reasons for President Trump’s urgent trip to Walter Reed in November 2019, and over the last two weeks, Dr. Conley has repeatedly omitted or misrepresented key data concerning the medical status of the President.

Fortunately, the 25th Amendment provides for a potential alternative for the objective assessment of the fitness of the President, permitting “such other body as Congress may by law provide.” This week, in response to the President’s emergency hospitalization and his subsequent chaotic behavior, House Speaker Nancy Pelosi introduced a bill to create a Commission on Presidential Capacity to determine the ability of a President to fulfill the duties of the office.

Airline pilots are required to undergo periodic evaluations by certified examiners. So are school bus drivers and Secret Service agents and many other individuals whose job performance is critical to public safety.

The President of the United States commands the most powerful military in the history of the world and has the singular capacity to launch a nuclear strike. Shouldn’t the American people have confidence that their President is well, and if he or she is not, shouldn’t there be a reliable way to assess presidential fitness and have a secure path to succession?

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