As unusual as the 2016 presidential election has been, one obvious aspect has gone largely unnoticed: By the time the next president of the United States is inaugurated on Jan. 20, 2017, he or she will have reached or come close to reaching 70 years old.
That all the remaining major candidates are among the “young old” at this stage of the election process is unprecedented. Yet, in spite of the stakes for the American people, there is no independent source that can provide an adequate accounting of the medical condition of the next president.
Historians have examined the ways that previous administrations have been affected by the medical problems of presidents including Abraham Lincoln, William Henry Harrison, Woodrow Wilson, Franklin Roosevelt, John Kennedy, Lyndon Johnson and Ronald Reagan. The news has not always been positive.
So what have we done to help independently vet those who would lead the most powerful nation on earth? Nothing.
Currently the candidates release information produced by their own doctors, entirely at their discretion. The most amusing recent example is a letter signed by Donald Trump’s personal physician that failed to include any data and simply assured us that he “will be the healthiest individual ever elected to the presidency.” This is unlikely to prove true, considering the remarkable fitness of George W. Bush and Barack Obama, whose physical examinations while president were made public.
Hillary Clinton’s doctor’s letter was far more detailed and persuasive, including a summary of her medical history, current medications, results of routine medical tests for blood pressure and cholesterol, and her diet and exercise routine. Bernie Sanders has released a similar letter from Congress’ attending physician. But in every case the doctors were chosen by the candidates.
Aren’t voters owed an independent accounting? Even competent physicians’ judgments and recommendations can vary, especially when they know what the stakes are for their wannabe-president patients. One of the rationales for our interminable election process is that it enables the voters to get to know the views and temperaments of the candidates. What about their physical capacity for the job? We might like to think that the rigors of a lengthy and strenuous campaign can give us such insight. But the candidates’ physical capacities might be masked by medication, health management that could be a more serious liability when in office.
Our system invests so much authority in a single individual as head of state, chief executive of the federal government and commander in chief that the ways in which any medical conditions might affect performance must be explored by a process that doesn’t allow for self-censorship. An independent examination by a panel of physicians at, say, Walter Reed National Military Medical Center, would at least provide voters with some trustworthy information. The results might influence not only the voters’ thinking but also the selection of a vice president whose “heartbeat away” status might become much more intensely apparent.
Our proposal would apply to all presidential candidates, regardless of age, and to the presidents themselves while in office. We recognize that in creating a requirement for independent assessment some will call for more than the standard physical and mental clinical information. At an extreme, given the capacities of modern medical science, some may even want to see a genomic analysis. Someday a deep genetic dive might be defensible, though that day is not quite here. Today there are well-established conventions for a physical examination that have earned prognostic credibility.
With so much at stake, an independent medical assessment not controlled by the candidates seems very little to ask. All voters may not care about the health status of the candidates, but the information should be available.
Arthur Caplan is a professor of bioethics at New York University Langone Medical Center. Jonathan D. Moreno is a professor of ethics at the University of Pennsylvania.