Mike Magee

May 5, 2020

Le Moyne College, Syracuse, NY

President Trump’s recent performance in his daily briefing on coronavirus has once again raised the issue of presidential health, both mental and physical health. What happens when one has Presidential inability and how does the country handle that? What are our laws and what is our history on this matter?

The first thing I should say is that our American Presidents have had lots of medical issues over the years, and often as not, they have not come clean with the public when they have had problems, hiding both mental and physical health challenges during their terms of office. They have been supported in these concealments by their close political and personal allies in the executive branch, including the White House physicians.

This opening collage features President Reagan on the left at the end of this second term, when issues of Alzheimer’s disease were raised. Below that we have Tom Eagleton who had to drop out of a Presidential race because it was revealed that he had had undergone inpatient treatment for  severe depression. Below him, President Eisenhower, who had not one, but several heart attacks while he was in office, actually had an understanding with his Vice President, Richard Nixon, what was to happen if he were to become too disabled to continue with  the presidency. Years earlier, FDR, as a result of polio, had chronic paralysis of his lower extremities, as well as severe congestive heart failure that was hidden right up to the end to avoid demonstrating weakness or vulnerability in the Allied leadership during WW II

Candidates for the highest office have been complicit as well. Senator Barry Goldwater was publically accused by his opponents, the media, and multiple psychiatrists of being too mentally unstable to be trusted as Commander in Chief in a nuclear age. Paul Tsongas, ran for President and hid the fact that he had a recurrence of his lymphoma, eventually coming clean to investigative reporters. Often the truth surfaces only after death.  President John F. Kennedy had been taking injections, both narcotics and steroids, to relieve a chronic back condition  throughout his brief presidency. And Woodrow Wilson was severely disabled with a stroke during his second term but was shielded from any sword by the combined efforts of his second wife and the controls set up by Congress.  

The issue of presidential health involves dynamic tension because we are a democracy that is fully dependent on our ability to make good informed decisions of who we choose to have represent us. But in order to make a well‑informed decision, we have to have information. And arguably one of the more important pieces of information is an accurate, real-time accounting of both physical and mental health of our candidates for the Presidency. So full disclosure, it would seem to be an obvious, is a requirement. Once we’ve made that choice, we have granted remarkable powers to a single individual, and it becomes very difficult to remove a president if there are problems.

Under severe circumstances, we basically have three choices. One is obviously to vote that person out at the next election cycle. And we’ve used that over the years. Second would be to impeach a president, and then convict him in the Senate.  That has been attempted recently. And the third approach is the 25th amendment that was enacted in the late 1970s. We’ll discuss the history behind that and what one is able to do with the 25th amendment and what one is not able to do with the 25th shortly.

Now this issue of President Trump’s mental and physical health has circulated since the first days of his presidency. It was ignited in earnest by an article by conservative columnist, Russ Douthat, in the New York Times in 2017. The article’s title was “The 25th Amendment Solution for Removing Trump.”  In that article, Douthat wrote “One does not need to be a Marvel superhero or a Nietzschean Ubermensch to rise to this responsibility. But one needs some basic attributes:  a reasonable level of intellectual curiosity, a certain seriousness of purpose, a basic level of managerial competence, a decent attention span, a functional moral compass, and a measure of restraint and self‑control. And if a president is deficient in one or more of them, you can be sure it will be exposed. Trump is seemingly deficient in them all.”

Well, that didn’t mince words. And, of course, the following day, there were response editorials. Here’s one in support of Douthat by Jamal Green in Commentary magazine.  He writes, “A President whose words are meaningless, cannot confidently conduct foreign policy. He cannot negotiate treaties, keep confidences or establish substantive relationships with foreign leaders.  He cannot be trusted to use the awesome and deadly powers of the military for legal and moral ends…in short, a compulsively lying president would be unable to discharge the powers and duties of the office.”

Other columnists that same day reacted in the negative to Douthat’s words, mainly because they did not believe that the 25th Amendment was designed for the purpose of removing somebody like President Trump. For example, Jonathan Bernstein in Bloomberg wrote, “It would be a grave mistake to use the mechanism of the 25th amendment to get rid of him…Sorry, Congress. If you believe Trump needs to go, you’re going to have to do it yourselves.” And, in fact, they made an attempt to do just that through impeachment several years later.

Ian Tuttle that same day in the National Review wrote, “My colleague, Charles C.W. Cook wonders “just how much of a psychic shock such a move would inflict upon this country – especially on those voters who backed and liked Donald Trump… How would that look to the people who would believe that Trump had been removed by the very elites he had set out to vanquish?” And finally in Slate, Dahlia Lithwick wrote what many of us were thinking by then, “Donald Trump is the disease that plagues modern America, he’s a symptom. Let’s stop calling it a disability and call it what it is: WHAT WE ARE NOW.”

As I began to put together this rather shortened version of a complex history, there was a range of questions that I raised in my own mind. What is the 25th Amendment? How do you define inability and who defines it? Who’s in charge of declaring presidential inability, and has this been a problem in the past? What’s the role of the White House physician? Isn’t he, or she supposed to be keeping an eye on the President’s mental and physical health for us? And what is that White House physician’s responsibility to the nation? Is the presidential candidate required to release medical records? Have White House doctors lied to the public in the past?  Have presidents lied about their own health? And what is the “Goldwater rule?”  

In trying to answer these questions, it is best to begin at the beginning. After we declared our independence in 1776, it took another decade or so before the Constitutional Convention raised the issue of leadership and succession.  Here’s what the Founding Fathers wrote about the issue, “In case of removal of the President from Office, or of his Death, Resignation, or Inability to discharge the Powers and Duties of the said Office, the Same shall devolve on the Vice‑President, and the Congress may by law provide for the case of Removal, Death, Resignation, or Inability, both of the President and the Vice President, declaring what Officer shall then act as President, and such Officer shall act accordingly, until the disability be removed, or the President shall be elected.”

So basically what they said is that the power lay with the Congress. If they saw fit for any reason to remove both the President and the Vice President, and put somebody in his place until the next election, they had the power to do so. Now the 1787 Constitutional Convention had already established that the office of the Vice President would be created, and that the President and the Vice President would be elected by the Electoral College. 

It took 5 more years for the body to decide on a plan who would led the country if both president and vice‑president were to become disabled or removed at the same time. They decided that the next top two people in the Federal Government who had actually been elected by the people would be the President Pro Tem of the Senate  and the Speaker of the House of Representatives. That was the line of succession as of 1792.

This was the established law for another half century, until 1841, when William Henry Harrison died of typhoid.  He had only served for 31 days and, as it was laid out in the Constitution, the Vice President assumed his office, but the extent of his powers and the titling associated with his assumption of power were unclear. Was the Vice President just a substitute until the next election or was he actually now president? John Tyler pretty much resolved that question by taking power into his own hands.  He found the first local judge he could find, and had himself sworn in as President, not as “Acting President.” This created a huge stir. John Quincy Adams went crazy over this issue, but a precedent had been set. From then on, if a President died, the Vice President became President.

Now, if you take a look through the years, presidential and vice‑presidential turnover is not uncommon.  Seven vice‑presidents have died in office and two have resigned. In addition, many vice presidents have had to assume the presidency as a result of presidential deaths in office. Eight Presidents have died in office and one (Richard Nixon) resigned.  So this focus on succession is not a theoretical exercise. It’s a real issue for our representative democracy. And it is quite surprising in many ways that it’s been left as loose as it has been left in our Constitution. Crises like the one that involved John Tyler are how this issue has been queued up. Legislative solutions have largely been reactive. For example, in 1886, there was the assassination of James Garfield.  He was shot on July 2nd, 1881, but he lived for another 80 days, unable to function as President during that period of time. It is notable that over all of those 80 days, he never had a discussion with Chester Arthur, the vice president, about assuming the presidency or what would be the priorities. In fact, Chester Arthur was totally isolated, both by Garfield and by the people who serve Garfield.

By the time Garfield did die, Chester Arthur had had a lot of time to think over those 80 days. He decided that this whole situation was way too loose, and that we ought to have a better system for looking at inability. So he asked that Congress create a committee to look into this. The issues that they raised at the time were the line of succession after the vice president, the management of an inability, the status of the vice‑president during a presidential inability, and the range of issues around a temporary inability.

The most difficult issues like – what if Garfield had been disabled, but then had recovered? How would he get back into office if he had handed over power to Chester Arthur in the mean time? –were left unaddressed by the commission. What they did decide was that they needed to address the vacancy left when the Vice President assumed the presidency. They created a succession list of cabinet officers beginning with the Secretary of State, rather then rely on the existing plan using the President Pro Tempore and the Speaker of the House. Also it was decided that, in the situation where a President was inable or died in office as with Garfield, the successor would be acting president until the next election.  

Now, it took only a few years to reveal that a President in power, supported by political allies and family, was powerful enough to skirt or ignore all the rules and boundaries Congress felt they had established. Case in point: Woodrow Wilson. His troubled medical history likely began with a misdiagnosis in 1906. That was the year of his first of a series of small strokes that plagued him throughout his life. His final major disabling stroke while in office occurred 13 years later, during his second term on October 2, 1919. But if one looks at the history of the medical illness carefully, the first appearance of a neurologic problem was the temporary loss of sight in one eye. And many of the episodes that followed sounded more like I progressive neurodegenerative disease like multiple sclerosis than actual cerebrovascular accidents.

In 1906, his solution was to rest a couple of months, recover and then resume active life. He was born in the south. He was very intelligent. He proceeded through academic ranks and became president of Princeton University. The governorship of New Jersey followed and then the presidency in 1912.His first term was complicated by the death of his wife, Ellen Axon Wilson, from kidney failure, two years into his term. Less than one year later, he married his second wife, Edith Bolling Galt Wilson. By most accounts, she was the ideal political wife, extremely aggressive, and totally committed to him serving a second term. She supported his full international agenda, which included first keeping us out of World War I, then bringing us into World War I, and then taking the lead at the Treaty of Versailles, promoting the creation of the League of Nations, the predecessor to the United Nations.

So it is fair to say that he and his second wife had a full agenda. And yet, during that first term and into the second term, he was frequently unwell. This reality was kept well hid from the general public thanks mainly to the extreme loyalty of Dr. Cary T. Grayson. Wilson met Dr. Grayson was during his first term. He happened to be down in Florida and his first wife when his sister fell and injured herself. A young Navy physician, Cary Grayson, was a very solicitous, and made himself very available for several weeks. The President’s sister recovery completely, and by the second term Grayson was the White House physician and bumped up to a Rear Admiral.

Grayson returned the favor with extreme loyalty to the President over the years that followed, which included conspiring with his wife following a severe stroke in his second term of office on October 2, 1919. Edith and Cary were not acting on their own. They had another ally, a political loyalist named Joseph Tumulty. He had been chief of staff to Woodrow Wilson when he was the governor of New Jersey, and was fiercely loyal to the President. Woodrow Wilson brought him down to D.C. with him to become chief of staff when he was elected. He remained at his side for the entire eight years, jealously guarding the President’s reputation. But most importantly, he was able to work well not only with the first presidential wife, but with the second one as well. Together, they managed to keep the White House press corps at bay, especially after the president’s 1919 stroke. Access was strictly limited, creating a safe distance even outdoors.

In addition, Wilson’s loyal trio kept both the vice‑president, who made clear he would not challenge the President, or expose the severe nature of his disability that he had, the cabinet and Congressional leaders at bay. The President was bedridden and couldn’t speak for quite some time, a fact never revealed to the public. Any hint of a challenge from Cabinet or Congress resulted in swift removal from power by Edith Wilson, who acted as de facto President for months. Historians over the years that followed, revealed, the conspiracy that was at work during Wilson’s second term. All admit that Wilson suffered a severe inability to perform the duties of the presidency, a purposeful misdiagnose by his White House physician who lied directly to both Congress and the public about his condition, and press complicity in basically not pushing the issue, and therefore becoming entangled in the scheme.

President Wilson could be accused of multiple transgressions. First, severe nepotism in handing over to his second wife powers that she had never been granted by the electorate. Second, there was collusion and conflict of interest with Joseph Tumulty. He was the political hammer brought down on public officials like Secretary of State, Robert Landing, who objected to Edith’s acquisition of power and decision-making, and tried to address the issue.

The case of FDR is equally egregious.  All were generally aware that FDR had a severe disability, lower extremity partial paralysis from polio, hidden in plain sight. What is less known is that for the last six years of his presidency (covering his entire third term), he was severely compromised by hypertension and coronary artery disease. For the final year of his Presidency, his condition greatly worsened, and his doctors (including a range of cardiac consultants flown in and sworn to secrecy) struggled to control his worsening congestive heart failure and keep him alive. At the helm of the team was his loyal White House doctor, Admiral Ross McIntire. It was McIntyre who brought in doctors from the Mayo Clinic and from Mass General Hospital to prescribe a regiment of pharmaceuticals and care to delay the inevitable. Dr. McIntire oversaw the alarming deterioration that occurred right during the last several months of World War II, when crucial decisions were being made. He was also the author of a Collier’s article, literally a month or so before the president died, that talked about the president’s unconquerable spirit and affirm that the President was in excellent health.

On April 2nd, 1945, the President “suddenly died,” and Truman took over.  As was the case with Chester Arthur who witnessed his superior’s death in office, Truman also moved to address what was clearly a problem with this element of federal governance. He formed a committee and they looked again at Presidential inability and lines of secession for the President and Vice President. Truman believed the office of the President should be filled by an elected officer who was Speaker to the House of Representatives, who has been elected in a geographic district, and was also elected to be the presiding officer of all the Representatives of the people. So once again, rather than dealing with the real issue, the most knotty problem, that is how do you define an inability and what do you do about it if it occurs, instead they focused on the issue of succession, which is an important issue as well, but arguably not as important as the issue of inability.

On July 18th, 1947, our nation officially switched again to Congressional back‑up for a vice‑president who assumes the presidency.  Soon after Truman left office, it became clear that the new President, who had smoked 4 packs of Camel’s a day during WW II, had a severe chronic disease burdens.  His White House physician had recently convinced him that his life was being shortened day by day, and that it would be wise to cut back on the habit. Nonetheless, on September 24th, 1955, he suffered a massive heart attack. He was out West at the time, and too ill to be transported back home. So he stayed there for four months recovering before allowing himself to be transported back to the Washington area. Why such a delay? He would not return until he could actually support his own weight and walk off the plane by unassisted.

Eisenhower was the first president to be extremely open about a life‑threatening illness while in the presidency itself. In fact, he released daily communications to the public about everything from his bowel habits down to what he ate that day.  And so the public became familiar with the issue of coronary artery diseases as a result of Eisenhower’s heart attack with all eyes now on this and other chronic diseases. This included inflammatory bowel disease that required surgery in 1957 and cerebrovascular disease or stroke that impaired him for a time in that same year.  His stroke was severe enough to impair his ability to speak and unilateral weakness of his arm and leg for several days. He fully recovered without ever handing over the responsibility of the presidency to his Vice President, Richard Nixon. But those episodes were making national leadership nervous. Specifically, Congress was anxious because we were in the middle of the cold war and they could see that the president was on thin ice. They decided that they would like to address this, and the fellow that was put in charge of it was representative Emanuel Cellar, a Democrat from New York. He was Chairman of the House Judiciary Committee, and wrote, “In view of the precarious condition of present world affairs and the tremendous responsibility which world leadership has placed in our hands, it ill behooves us to tempt provenance once more by inaction. The time to strike at the heart of the problem is here. Clarification must supplant procrastination.”  

The questions that his committee addressed at the time were:  (1) What’s intended by the term inability?  (2) Who should initiate and make the determination of inability? (3) Who declares an inability has ceased to exist. (4) Does the Vice President succeed to the powers and the duties of the office or to the office itself? (5) Is a Constitutional Amendment necessary.  

The senators and the congressmen were fully engaged in the issue at that time. Frederick Payne, who was the Republican Senator from Maine, summed up the challenge. He said, “What then does it really boil down to in general terms? It’s a question of determining presidential inability.” Most were aware by now that the challenge began or ended with the power to actually declare a President disabled or enabled. It was unclear who would do that and what would happen after it was done. So the Congressional committee began to focus on what body would be responsible for actually saying the President was incapable of continuing in office. The first person that they proposed was The Justice of the Supreme Court, who summarily declined the opportunity as inappropriate. His reasoning was that, as one of the three branches of government, he did not want to get in the position where he would be determining what happened with the leadership of one of the other branches, the Executive Branch.

They next explored the notion of a medical panel, but they could not agree on the composition of such a body, and the selection process. How would you keep this from becoming politicized? What would happen if the medical panel had a disagreement amongst themselves? What about a medical panel that used this power to force a President out of office? Finally, they determined by a process of exclusion that the President would declare his own inability. Once he declared that inability, he would temporarily hand over the power of the presidency to the Vice President, but would be able to retrieve that power whenever he felt his inability had disappeared.

There was no actual congressional action at the time. But Eisenhower took advantage of the guidance and penned an agreement with Vice President Nixon, which codified this approach in writing. This included Nixon’s willingness to return power to Eisenhower on request, no questions asked.  This approached seemed to settle Congressional concerns for the moment, and was reaffirmed when President Kennedy assumed office by Attorney General, Robert Kennedy, on August 2nd, 1961,  when hestated, “There is no question that the Vice President acts as President in the event of the President’s inability and acts in that capacity until the disability is removed. There is no substantial question that it is the Vice President who determines the President’s inability if the president is unable to do so.” This final addition, the Vice President’s power to assume power if the President was rendered unconscious or unable to communicate, became practice at that moment.

On November 22,1963, President John F. Kennedy was assassinated. Vice President Lyndon Baines Johnson, as his very first action, with Jacqueline Kennedy at his side, had himself sworn in as the President of the United States, not as an acting president, serving out the term without a Vice-President, and then running for re-election. The 1964 election pitted the activist LBJ against arch conservative, Barry Goldwater. Television marketing had come of age, and LBJ did not mince words. Democrats ran a classic advertisement featuring a little girl was picking pedals off a daisy, unaware that behind her a nuclear explosion (unleashed by a mentally disturbed Goldwater) was about to blow her away. The nation was in the middle of the Cold War at the time, and Goldwater had made statements about all options being on the table against the Soviets, including nuclear weapons. Psychiatrists throughout the country were very alarmed by some of Goldwater’s rhetoric. In fact 1,189 psychiatry’s went on record, signing on to a statement that Goldwater was “psychologically unfit to be President.” The American Psychiatric Association reacted negatively to their member’s political activism, and established “The Goldwater Rule” effectively barring their members in the future from commenting on a candidate’s mental state, a rule that held for over a half century until the Trump era.

Once LBJ entered his second term, he decided that we needed a Constitutional Amendment to finally settle this issue of presidential inability and presidential succession. Few Congressional leaders wanted to take on the issue, believing, with good reason, it would never be successful and would mar their careers. If you look back in history, since 1788, there had been over 11,000 proposed amendments to the Constitution, but only 27 succeeded. 

What is most remarkable is that the final three of these Amendments – the 25th, 26th, and 27th, carry the name of one legislator, Birch Bayh (D, IN). Bayh modestly described himself as “just a shirttail lawyer from Shirkieville, Indiana.” But Bayh saw an opportunity where no one else did.  Most felt that passing any Amendment to the Constitution was a long shot. First, you had to get two-thirds of the members of both Houses of Congress to vote in support the amendment.  Then you had to secure at least three-quarters of the states (now 38 of 50 states) by a majority vote of their state legislatures.

Birch Bayh was following in the footsteps of James Madison. His Bill of Rights, which included the first 10 amendments, never made it into the Constitution. In a compromise, the Founding Fathers agreed to add it later as a statement of our first ten Amendments. Bayh scored fewer Amendments, but arguably during much more challenging legislative times. He is responsible for the 25th Amendment, which established the succession pattern and how we deal with Presidential inability. He passed the 26th amendment, which allowed anyone over the age of 18 to vote in this country. And he nearly passed the 27th Amendment, which was the Equal Rights Amendment that may in the future establish that you could not discriminate against women based on gender. In this last effort, he came up one state short, but did manage to pass Title 9, which established in higher education, women’s sports had to be funded at the same level as their companion men’s sports. Finally, he came up five votes short in efforts to pass the 28th Amendment, which would have eliminated the Electoral College.

The 25th Amendment was ratified on February 23rd, 1967 Birch by did prevail. There were four sections.

Section 1: A Vice President succeeds a removed President.

Section 2:  The new President now can nominate his own Vice President and, with Congressional approval, that vice‑president is able to serve without the popular vote.

Section 3: When a President declares himself inable, the Vice President serves as the acting President until the President declares himself able again. (This is the Eisenhower letter of agreement with Nixon.)

Section 4: The Vice President, along with majority of the Cabinet officers, may declare a President inability to Congress. If the President objects to being declared inable, he can appeal to the Congress for a final decision on his inability.

As it turned out, the 25th Amendment arrived just in time. President Nixon supported the resignation of Vice President Spiro Agnew after he was accused of felony corruption, and appointed a new Vice President, Gerald Ford, who was easily ratified by Congress.  Ford, in turn, assumed the role of President when Nixon resigned, and after pardoning Nixon of all crimes, appointed Nelson Rockefeller as his new Vice President.

Now, just because we had a 25th Amendment doesn’t mean that all future presidents took advantage of it. In fact, most did not initially. For example, Ronald Reagan, by all measures, was rendered inable on March 30th, 1981, by John Hinkley’s assassination attempt. Even though this was a life‑threatening injury, the 25th Amendment was considered by some Cabinet members but never used.  History has recorded mass confusion at the time over who was even in charge. Reagan’s White House physician, Dr. Daniel Ruge, went mute and lied about his condition. The White House public relations team manipulated the narrative and used it to create hero status.  This proved useful when President Reagan returned in triumph 6 weeks later to a joint presentation to Congress to steamroll through a huge tax cut.

The 25th amendment was never engaged. Two hours after the shooting, Larry Speakes, the White House Deputy Press Secretary is asked, “Is the President in surgery?” His response: “I can’t say.” Question: “Who’s running the government right now.” Answer:  “I cannot answer that question at this time question.”  Question: “Who will be determining the status of the president and whether the Vice President should in fact become the acting President?”  Answer: “I don’t know the details on that.” That was enough for Secretary of State Alexander Haag, who rushed into camera site to declare, I’m in charge here.” That film clip, run again and again, pretty much confirmed that the 25th Amendment wasn’t in effect when needed most. In fact, Reagan’s Attorney General, Fred Fielding, standing quietly to the side at that moment, carried a manila envelope with the text of the 25th Amendment inside.

The Amendment was also ignored on July 12, 1985, when Reagan had colon surgery. Instead the President signed a document that addressed to the Speaker of the House of Representatives, and to the President Pro Tempore of the Senate, that he was transferring power to Vice President George H.W. Bush. But in that same letter, he also wrote, “I do not believe that the drafters of this Amendment, the 25th Amendment, intended its application to situations such as the instant one.”

Five hours after that surgery, barely awake from his anesthesia, he signed a letter brought to his hospital bed by aides, “Please be advised. I am able to resume the discharge of the constitutional powers and duties of the office of the President of the United States. I’ve informed the White House of my determination and my resumption of those powers and duties.”  

A decade later, on June 29, 2002 (and again, July 21, 2007), George W. Bush did use the 25th Amendment while under anaesthesia. This made it clear that the Amendment was loose enough that President’s felt comfortable ignoring it or following it as they felt best. So Congress decided in 2011 to address whether there needed to be improvements. The fellow that they chose to lead this investigation was John Feerick, the Dean of Fordham Law School at the time, and an expert on the 25th Amendment. In fact, Birch Bayh had used him as his legal counsel when he first came up with the wording for the amendment. After much deliberation by this committee in 2011, Feeric wrote, “The debates of 1964 and 1965 made clear that unpopularity, incompetence, impeachable conduct, poor judgment, and laziness do not constitute an inability within the meaning of the Amendment.”

So basically what Dean Feerick was saying was, and what others who challenged Russ Douthat’s 2017 article agreed, was that you can’t use the 25th Amendment just to get rid of somebody who is unpopular or incompetent, or because he does things that are offensive, or because he has poor  judgmental, or because he is lazy, or even  because, he’s on pharmaceuticals. There are other ways to address incompetence and inadequate behavior including impeachment and voting them out. But you can’t use the 25th Amendment for that purpose.  

Now in 2016 President Trump enters the picture. Nobody has ever seen a campaign like this before.  It becomes clear right away that his relationship with the truth is limited. He is exhibiting many of the behaviors that he exhibited, as a reality TV star. Some of his physical behaviors make people nervous. For example, in his speeches, he is amazingly repetitive, loudly sniffing, igniting rumors. Commentators ask out loud, “Might he be ingesting mind altering type drugs.”  There are all sorts of rumors floating around about his mental state. Psychiatrists begin to raise issues and break their own well-established Goldwater Rule. And then finally the American Psychiatric Association says, “The Goldwater Rule” is no longer in force. Psychiatrists are now free to say whatever they want about Trump and they do. But nothing sticks, and Donald Trump actually wins the election, and the people begin to clamor for a statement of his medical condition.

During the run for the presidency, candidate Trump released a rather brief one page document from Dr. Harold Bornstein, said to be his primary care doctor, that he was in excellent health. Within months after becoming president, Dr. Bornstein reverses course and informs the press that Trump dictated his own medical report. President Trump is beginning to have appearances on TV in front of teleprompters with excessive sniffing and rumors about him potentially taking a drug like Adderall begin to circulate. And then people like Tom Arnold, who appeared with him on his reality TV show say that he snorted crushed Adderall tablets during the filming of his reality show, The Apprentice.

The lying never gets better and he lies about silly things like his height, saying he is 6 foot 3 inches tall while standing a head shorter, next to Alex Rodriguez, who is actually that height. The whole thing is just a free for all – almost funny, if it wasn’t for the fact that the guy is now President of the United States. Is he acting, or is he truly impaired?

In  2018, Evan Osnos, a correspondent for The New Yorker, weighs in. He writes that, unless the President was unconscious, the public could see the use of the 25th Amendment as a constitutional coup.  Measuring Trump’s mental deterioration over time would be difficult, given that his judgment and ability to communicate clearly were already impaired and in full view before he took office.  So here Evan lays out the issue, which was the issue all along, going all the way back to 1787.  Who will define the word inability. And if one is inable, compared to what? If the behavior is the same behavior that was there in plain sight, when the person was elected to the presidency, should citizens, after the fact, express misgivings by then declaring him inable and using the 25th Amendment to remove him, or should we use one of the other two methods,  impeachment or the next election to remove the President?  

So that’s the great debate. Here are the two sides of it. One side of it says our democracy depends on the wisdom and participation of the voting public to make wise decisions. To do so, citizens must be fully informed. The job of the presidency places extreme physical and mental demands on the individual in the office, which may affect the quality of the decisions that impact the future health of our nation. Americans deserve to know in full detail, the health status of a candidate before they vote. 

The other side, presidential candidates are entitled to medical privacy. Such privacy encourages these individuals applying for the most stressful job in our nation to seek medical care when they need it and to benefit from the confidential care of a trusted physician. If the physician must expose a President’s medical details to a third party in government; sharing negative information that could impact the performance of the President, would this not make it harder for these Presidents to seek needed medical health. Might they just stop seeking the care and allow the problem to escalate?

Three questions remain unanswered:

  1. Should all Presidential candidates be required by law to release their complete medical records for the past five years, including a complete list of prescribed medications? 
  2. Should the White House physician, under the pain of perjury, be required by law to approach Congress with any changes in the President’s medical condition that would compromise his/her ability to lead the nation?  
  3. Should a committee of medical experts be created to decide when, and if, there exists a current inability?