Presidents’ Health and Medical Confidentiality

Robert Klitzman

doi:10.1001/jama.2020.23476

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November 30, 2020

Presidents’ Health and Medical Confidentiality

Robert Klitzman, MD¹

Author Affiliations Article Information

¹Columbia University, New York, New York

JAMA. 2021;325(1):25-26. doi:10.1001/jama.2020.23476

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With the recent election of Joe Biden Jr, who is currently 78 years old and will be the oldest person inaugurated as US President, potential issues related to presidential health may emerge along with dilemmas concerning the privacy and confidentiality of the president’s medical information. Questions arise about what information the public has a right to know about a president’s health and who should decide and how. These issues require attention and informed public and professional discussion.

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November 30, 2020

Public Report of Presidential Health (or that of any individual)

Kent Savage, MHA | Retired Healthcare Executive

We need to be very careful regarding what medical information becomes public about a President, or any individual for that matter. Notifying sexual partners about properly diagnosed communicable diseases is quite different from determining someone's fitness for a particular role or job, including the President of the United States. While there are dozens of potential disorders that might or could affect one's ability to effectively perform the duties of President (or any other job), the key aspect to remember is "might" or "could." There is little evidence about nearly any disorder that symptoms will definitely produce any particular dysfunction in any particular role at any particular time.

Observationally, President Donald Trump exhibits various traits of some psychiatric disorders yet no physician has determined (correctly or incorrectly) that these psychotic or neurotic behaviors have diminished his ability to lead this country. The medical profession has long promoted its ability to predict a person's fitness for duty in any role yet it overlooks the most obvious when considering Mr. Trump. I think it would be a mistake, in our democracy, for any professional entity to assume the power of determining whether someone is fit for a role or not. In the private work sector, fitness is often tied to insurance risk and often bears little reference to whether or not someone can perform the work of a particular job. We run the same, or similar, risk when we try to apply this mindset to public offices of any level.

Only voters should ever be allowed to determine who they wish to place in a public office. While I have a great respect for physicians, I do not believe that they have the ability to accurately predict what does and does not affect someone's fitness for duty. Furthermore, only the President of the United States can accurately determine whether or not he or she can perform the requirements of the job. A morally sound President will step aside if he or she is unable to fulfill their job requirements. Thus, the more appropriate approach would be to allow voters to decide, even mid-term, if a President is capable of fulfilling the responsibilities of their job. Further, no physician should disclose medical information about a President or any other individual without their written consent. Voters should be required to determine if what is disclosed (or if the behaviors exhibited) warrant a national referendum about whether the President is competent and physically able to lead.

The AMA and other relevant medical organizations should be actively engaging all voters to always vote. Americans, as with most people around the world, are fully capable of determining for themselves whether or not they believe the President is competent for the office. We cannot ever allow any group the power to approve whom voters can place in office as this leads to yet another level of supremacy. It is the idea of supremacy, and all of its variants, that have created the divisive culture in which we now live. If the AMA and physicians want to truly do public good, then they should condemn the divisiveness based on physical traits since physicians, more than anyone, know that, physiologically, we are all basically the same beneath the physical traits of skin color, gender identity, and others.

CONFLICT OF INTEREST: None Reported

December 1, 2020

Mental Status of Presidents

Charles Brill, MD | Thomas Jefferson University Hospital, Retired

It would be important to have a neurologist with expertise in mental status/dementia on the presidential evaluation team.

CONFLICT OF INTEREST: None Reported

Presidents’ Health and Medical Confidentiality

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