Chief Concerns

I may be President of the United States, but my private life is nobody’s damn business.” Chester A. Arthur

During this past weekend, we have inaugurated a new President of the United States. While watching the ritual and celebration, we are hopeful that the next four years will be a prosperous time for our nation. And, we wish our Chief Executive a term of personal good health and vigor as well. This week, I think it’s appropriate to discuss some historical facts about the health of our Presidents and to ponder the significance of their physical and mental well being to our Country. How does Illness in the Oval Office affect the country, and what legitimate right do we voters have to the medical records of our Presidents?

Our Presidents have been shot five times; and four: Abraham Lincoln, James Garfield, William McKinley, and John Kennedy were killed by assassins’ bullets. Only Ronald Reagan,shot in the chest in 1981 by John Hinckley, Jr. made a full recovery. As expected, both historians and physicians have second-guessed the medical care of these individuals–esp. the care of Garfield and McKinley. Garfield was shot twice; one bullet was superficial but the other lodged near his spine and pancreas. Physicians felt an attempt to remove the deep bullet would be fatal. President Garfield was moved to the White House where he lived for 80 days following his shooting and ultimately died of hemorrhage from a ruptured splenic artery.

Health and disease of celebrities is always news. Even though George Washington, our first President, died two years after he left office, his manner of death remains controversial. He developed a severe cold and sore throat after surveying his property on horseback in December of 1799. Because he worsened, his doctors bled, blistered, and purged him–in keeping with the standard medical practices of the times. Despite these “accepted therapies”, he died on December 14, 1799 at age 67.

Other Presidents have died while still in office. William Henry Harrison allegedly developed pneumonia on the blustery day of his inauguration, and died one month later at age 68. Zachery Taylor died one year after inauguration following a 5 day gastrointestinal illness that was diagnosed as cholera. Because controversy persisted, his body was ultimately exhumed in 1991 to squelch suspicion of arsenic poisoning as the cause of death. There were no traces of arsenic in any of the tissues examined. And, Franklin Delano Roosevelt died of a cerebral hemorrhage 83 days after beginning his 4th term . Because of his polio infection at age 39 (11 years before his first election), FDR had dealt with publicity of his health and physical capacities his whole Presidency.

Since illness and disease may be construed as incompetence or weakness, Presidents have tended to hide their medical problems from the voters. Shortly after his second term began, Grover Cleveland (our only President to serve two non-consecutive terms) discovered mouth cancer. He chose to keep this a secret and even had his surgery done on a private yacht while cruising the East River. JFK had chronic back problems as a result of military service injuries, and he was treated for Addison’s Disease (an adrenal insufficiency) from 1947 until his death in 1963. Both of these medical conditions were either downplayed or hidden respectively. One year after entering office, Chester A. Arthur discovered he had Bright’s Disease (a kidney disease–glomerulonephritis) but kept this a secret despite accounts of fairly considerable pain. And after his rigorous touring of the western United States to promote our country’s participation in the League of Nations, Woodrow Wilson suffered a stroke which generated left sided paralysis . Apparently, his wife and the White House Staff fought diligently to keep his infirmity a secret.

On the other hand, some Presidents have intentionally informed the public and the media of their medical problems. Eisenhower suffered a heart attack at age 64 during his first term and required intestinal surgery for ‘ileitis’ just as he was beginning his campaigning for his second term. He recovered from both problems and shared his medical information fully with the American public. Lyndon Johnson disclosed full details of his gallbladder surgery after conferring with Eisenhower, and Ronald Reagan gave full disclosure about his colon cancer and related surgery early in his second term. Reagan’s more subtle development of Alzheimer’s Disease was not addressed publicly until 1994. . . five years after he had left office. From the time of JFK’s campaign forward, the publicity surrounding Presidential health and illness has been driven by the media and has a strong impact on perceived competence.

Have you personally pondered the significance of illness in the Oval Office? Well, plenty of folks have over the centuries. . .but it wasn’t until 1967 that we adopted the 25th Amendment to the Constitution. This amendment basically established a procedure to address issues of Presidential disability. Interestingly, the amendment does not define the term,”disability”, nor does it specify who makes this decision. Perhaps, before the amendment is ever invoked, these issues should be clarified.

Interesting ethical dilemmas exist in disclosure or nondisclosure of medical problems of high ranking government officials. On one hand, health law protects medical privacy by prohibiting physician disclosure of any patient’s medical records without the patient’s permission. On the other hand, we must weigh the political consequences of disclosing medical problems or concealing them. So what health information is relevant and justifiable in legitimate public interest? Certainly, in our media-conscious world today, all Presidential candidates and Presidents since Kennedy have done their best to communicate images of vitality and good health. Why, I’ll bet you can’t even count the number of jogging pictures you’ve seen of Clinton and Gore in the last four years!

In October 2000, George J. Annas, Professor and Chair, Health Law Dept. at Boston University was queried by the Ethics Standards Group of the AMA about health status disclosure of Presidential candidates. Citing the recent controversies involving the health of Thomas Eagleton, Paul Tsongas, and even John McCain and Dick Cheney in this year’s election, Dr. Annas made some cogent remarks. In his opinion, “the only medical information to which the public should feel entitled is information that indicates, to a reasonable medical probability, that a presidential candidate will not survive a four-year term, or will not be able to function mentally in a reasonable manner.” He continued with an interesting observation that medical information related topsychiatric care, abortion, HIV infection, and genetic predispositions should never be disclosed because all such information is “prone to misuse, misunderstanding, and simple prejudice.” I suspect that this latter statement will seem incredible to some people. But with appropriate treatment and surveillance, none of these four categories should realistically incapacitate a President during a four year term. And, of course, no medical information of any kind correlates predictability with the qualities of leadership, kindness, and integrity which we hope will typify our Chief Executives.

So, Hail to our new Chief! May he and our country prosper during his term in office. We wish him a Presidency of good health and good judgement. And we need to respect his right to medical privacy just as we wish others to respect our own. Even with these good intentions, I suspect we will all know much more about President Bush’s check ups (and perhaps even bowel movements) than we need to know or wish to know over the next four years.

Stephen L. Hines, M.D.
January 2001