It is true that the public deserves a sense of a candidate’s physical and mental fitness, and that candidates have a moral responsibility to disclose serious conditions that could impair their ability to serve. It’s just not clear that indiscriminate release of medical records gets us there.
If genuine concern persists about candidates’ health, we could consider creating an independent panel of doctors to perform a physical examination and offer impartial assessments of candidates’ ability to serve. Such a panel has been proposed by Jimmy Carter, among others, and could vet not only candidates’ health, but also when and whether the Twenty-Fifth Amendment should be invoked for an incapacitated president.
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Indeed, a more important concern about whether a president can effectively govern is declining mental acuity over time—subtle cognitive changes due to nascent dementia or other neurological conditions. Unlike cholesterol levels and colonoscopies—which are objective, diagnostic, and widely used—no single test determines whether a person has the mental or emotional deficits we might worry about with presidential candidates.
While screening exams exist, such as the one President Trump took in 2018, diagnoses of cognitive decline are made based on comprehensive assessments of in-depth interviews, laboratory data, and imaging tests. But a candidate who runs an effective presidential campaign is unlikely to arouse sufficient clinical suspicion for a doctor to actually pursue and document any significant cognitive impairment.
Moreover, not all patients—least of all the powerful, high-performing patients running for president—routinely receive this type of cognitive evaluation. Doctors calibrate neurocognitive testing and treatment to the individual patient in front of them—and even with the same patient, different doctors may consider different diagnoses and record different data. Doctors’ notes, then, are more like journal entries than tax returns—and thus don’t allow for objective, meaningful comparisons of mental fitness across candidates.
And so, annual nonpartisan health evaluations, ones that include cognitive assessments, would be far more helpful than old medical records or letters from longtime doctors. This is partly because, as Carter notes, unlike candidates’ personal physicians, an independent panel wouldn’t have to “balance patient confidentiality and personal interest vis-à-vis the nation’s interest.” But it’s also because most neurocognitive tests are more valuable as repeated measurements used to track trends in cognitive and behavioral functioning over time—as could be performed by annual evaluations—than as snapshots of mental acuity available through old medical records.
Ultimately, however, no medical stamp of approval exists for presidential fitness. The best test of whether a candidate is fit to serve is their performance during the campaign (that is, if we ever get back to a normal campaign). Just as impeachment is a political process—not a legal one—determining whether someone is fit for the highest office requires the public’s judgment, not the doctor’s note.
Aside from a few rumors, Grover Cleveland’s maritime operation remained largely secret for nearly a quarter century, until the mission’s last surviving surgeon finally revealed what had happened. Cleveland, a cancer survivor who weighed 260 pounds, recovered swiftly and completed his second term without incident. He went on to enjoy more than a decade of post-presidency life, and died, according to one report, “a perfectly natural death.”