How hale is the Chief?

Today is election day. Where, according to the Constitution, we “elect a President in peaceful succession and transition.” But in another November, in 1963, there was an unanticipated, very violent succession. Which reminded the nation again of a flaw overlooked by the Founding Fathers in the US Constitution. There was no provision for succession to the Vice Presidency in the event a President died in office. And other aspects of Presidential succession were not well defined, either.

After JFK’s assassination, Congress finally attempted to remedy these shortcomings by passing the 25th Amendment, which clearly laid out an orderly process of succession in the event of the death of the President, Vice President, etc. But, unfortunately, it still left a large loophole—rife with conflict of interest—when it comes to Presidents who become medically disabled. 

In fairness to the legislators, the 25th Amendment anticipates that Congress would pass enabling legislation to establish an orderly process by which a President may be declared medically disabled. But no such legislation has ever been introduced, let alone passed.

And this is no theoretical concern. In fact, it may be a bigger concern than Presidential death itself. After all, half of our nation’s Presidents have experienced at least one disabling, potentially fatal illness during their terms in office.

George Washington himself almost died from various infections three different times during his eight years, finally succumbing to an upper respiratory infection in December 1799 (barely more than two years after leaving office). Woodrow Wilson was totally medically disabled following a stroke. And for the last 18 months of his term in office, the country was led by an unconstitutional triumvirate of his second wife, his chief of staff, and his White House physician. Eisenhower nearly died in office three times. And there’s some speculation that Ronald Reagan may have begun suffering the effects of Alzheimer’s Disease during his final months in office.

And those are just a few examples of the many serious illnesses and disabilities that have afflicted our Commanders in Chief over the years.

Unfortunately the 25th Amendment also leaves the nation vulnerable to medical dissembling and cover-ups. And White House physicians—now provided by the military without any Constitutional basis—have been known to keep both their oaths of Hippocrates and their oaths of office (to protect and defend the Constitution) in their back pockets at times of true medical crisis. 

Just during the 20th century, White House physicians have covered-up serious illnesses and disabilities of Presidents McKinley, Wilson, Harding, Roosevelt, Eisenhower, Kennedy, Johnson, Nixon, and Vice President Cheney.

Also during the 20th century a tradition emerged (that appears nowhere in the law) that the military medical corps provides free physician services to the President and to members of Congress. This potentially gives the military even more enormous influence over the President and Congress, and their families, especially during a Presidential illness, crisis, or disability. 

Recognizing this history—and the potential threat it poses to the nation, while I was Executive Director of the College of Physicians in Philadelphia, I worked with the late Sen. Arlen Specter (R-PA) and Rep. Henry Hyde (R-IL) to draft recommendations and legislation that would enable the 25th Amendment to act in the event of medical disability in the President. The results were published in 2001 but Congress never acted on them.

So no matter what the outcome of today’s election is, we can only hope and pray that the nation does not fall victim to paralysis, or political malfeasance, in the event of a disabled President. Because a hope and a prayer will be all that we have.


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