The probability of illness arising in any individual increases with age. Political leaders of countries are usually well into middle age when they assume top responsibility. Incapacitating illness has very serious implications in such cases, and it is therefore very important that crystal-clear procedures should be in place to allow the smooth take-over of the presidential responsibilities.
This complex issue, which involves political and security considerations, as well as medical ethics, is discussed by Kenneth Crispell and Carlos Gomez in their book, Hidden Illness in the White House (Duke University Press, 1988).
When the president of a country gets seriously ill, his/her natural instinct, and that of the personal advisers and minders, is to issue reassuring public statements. The more powerful the country the stronger this instinct asserts itself. The motivation behind the reassurance is a desire to calm public fears, to maintain stability and to discourage political rivals and enemies, both at home and abroad, from moving to take advantage.
This is all understandable, but the danger is that a cover-up will develop to hide a disabled president who is neither capable of making wise and informed decisions nor of wisely delegating responsibility. The United States is the most powerful country in the world, and this book details a long history of hiding serious illness at the White House.
In 1893 President Grover Cleveland (18371908) hid the fact that he had developed cancer of the jaw. America was in economic depression and Cleveland was fighting to preserve the gold standard. He feared that public knowledge of his illness might unsettle things and lead to financial panic. Under the strictest security Cleveland underwent a secret operation aboard a cruising yacht in which most of his left upper jaw was removed.
He continued his work in office without any noticeable effect from his illness. When the press published the story, Cleveland and his physicians denied it, and a full account of his condition was not confirmed until 1917.
Cleveland was succeeded by President Thomas Woodrow Wilson (18561924). The poor man was not at all well. He suffered a number of strokes which left him with a weak right arm, bad digestion, chronic headaches and occasional bouts of severe depression.
Unlike Cleveland, Wilson's illness was such that it obviously affected his work. His wife, Edith, and his personal physician tried to help by encouraging him to believe he would recover good health and by screening out some important documents that might upset him.
They restricted access to the president and, during the final 18 months of his presidency, Mrs Wilson, with the assistance of Senator Glass of Virginia, tried as best she could to run the government herself, her husband being fatigued by ill-health.
Historians have blamed Wilson's ill-health, in part, for inhibiting his efforts to build a workable Treaty of Versailles (1919). A better treaty might well have prevented the conditions in Europe that led to the second World War. Wilson also failed to persuade the US Congress to accept his plan for the League of Nations.
President Franklin Delano Roosevelt (18821945) suffered from hypertension right from the start of his first term of office in 1932, and his health problems worsened throughout his tenure of office. His close advisers kept the extent of his illness hidden from the public. By the start of his third term in 1941, President Roosevelt was making secret visits to Bethesda Naval Hospital using assumed names in order to seek relief from his deteriorating fatigue.
By February 1945, when he met Winston Churchill and Joseph Stalin at Yalta, his health had worsened to an alarming extent. Many who had not seen him for a while were shocked at the sight of his ashen, gaunt face and trembling hands. Negotiations did not go well at Yalta, and Roosevelt agreed to Stalin's demand that, after the war, Poland would be ruled by a regime that was subservient to the USSR rather than by the Polish government-in-exile that was on standby in London.
Some historians argue that Roosevelt's illness had weakened his ability to co-ordinate military and foreign policy and that this contributed strongly to the result of Yalta.
President Dwight D. Eisenhower (1890-1969) was quite ill during his first term of office, suffering from three major problems. In June 1955 he had coronary thrombosis and in June 1956 he underwent surgery to relieve an inflamed intestine. In November 1956, following his re-election, he suffered a cerebral occlusion. On each occasion Eisenhower's press secretary issued a detailed statement on the president's medical condition.
The cabinet, under the direction of Sherman Adams, assistant to the president, was able to conduct most of the government's routine business during the president's illness.
The US Congress was spurred by Eisenhower's illness to initiate hearings that led to the passage of the 25th amendment to the constitution, finally ratified in 1967. The purpose of the amendment is to formalise procedures for the smooth transfer of power should a president die in office or become incapable of carrying out his/her duties.
The amendment tries to be as comprehensive as possible, but the authors of this book argue that several possibilities are not covered adequately by the amendment, e.g. what is to happen if both the president and the vice-president both become seriously ill at the same time. The most troublesome case to deal with would seem to be where the president cannot or will not declare himself unable to serve.
William Reville is a senior Lecturer in biochemistry and director of microscopy at UCC