Crisis in the Presidency. The physician's role in assessing official capacity.

Abstract

Making a judgment about how the health of an individual affects his or her ability to perform daily tasks, let alone official duties, is a difficult and delicate procedure. Physicians, especially neurologists, are frequently asked to assist in such a judgment by assessing cognitive and reasoning skills. The neurologist may be asked to assess a person's capacity to not only drive a car or perform skilled tasks, but to evaluate whether a person is able to continue to practice law or medicine, hold political or judicial office, or run a company, to name a few. To complicate matters, the procedures for arriving at this judgment and the plans for implementing the resulting decisions are rarely in place when a crisis arises. The history of the most powerful office in the nation, the United States Presidency, indicates that confusion, disagreement, and often, nonaction or ill-considered action follow a crisis. The nation has lacked firm leadership in many instances of presidential incapacity, including Garfield's lingering death after being shot, Cleveland's covert surgery for cancer of the roof of the mouth, Wilson's major stroke, Roosevelt's hypertension and cardiac failure, Eisenhower's transient aphasic episode, the assassination attempt on Reagan, and others, which are likely unknown. Three recent conferences convened by James F. Toole, MD, and Arthur S. Link, PhD addressed the issue of determining the capacity of a president to continue in his official duties. Participants included neurologists, psychiatrists, internists, historians, lawyers, and reporters. Several physicians who had cared for various presidents attended. President Carter addressed the first conference, President Ford addressed and participated in the second, and the third was …