A Realpolitik for Presidential Health: A Psychiatrist's Perspective

The health and fitness of United States presidents has been a matter of concern since the Constitutional Convention. Several United States presidents, including James Madison, James Garfield, and Woodrow Wilson, were significantly impaired during portions of their tenure. Yet how to address this issue has proved both ethically and politically challenging, increasingly so during our nation's current period of elevated polarization. This essay reviews the history of presidential impairment and the range of proposals that have been offered to address it. Ultimately, the essay argues that any effort to require the release of medical records or to evaluate the president while in office is likely to prove ineffective and politically unworkable, but also that providing the public with more medical information about candidates and presidents is unlikely to prove useful to voters in rendering their decisions.