To the Editor.
—The descriptions of the risks to Americans of presidential ill health and a flawed process for succession reflect a bias.1-4 Currently, 10 nations possess a nuclear weapons capability and the urge to acquire this technology appears irrepressible. In a world of emerging, quasi-, and many nondemocratic states, far more serious threats to US and international security are likely to arise from the cognitive impairment of leaders (and an ill-defined leadership succession) beyond US borders than at home. The current allegations of severe alcoholism directed at Russia's Yeltsin are a case in point, and the Gulf War demonstrated clearly that questionable mental status in a political leader without access to nuclear weapons can also threaten US interests and international stability. Perhaps one third of the world's countries possess sufficient conventional weaponry to destabilize entire regions5 if power rests in the hands of a leader suffering from
Gellert GA. Presidential Disability and the Twenty-fifth Amendment. JAMA. 1995;274(10):798. doi:10.1001/jama.1995.03530100037026