When Disease Strikes Leaders: What Should We Know?
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Diseases of heads of state can affect national policy. Yet, cases of cover-up are numerous and involve not only dictatorships but also open and democratic societies. No system of full disclosure is currently in place to ensure that the public has access to all the information needed to establish whether a candidate to the presidency or an elected leader can discharge the powers and duties of the office. Hence, this essay reviews how the illnesses of democratically elected heads of state have changed history; addresses how to ensure greater transparency, so that leaders will not only be unable to conceal incapacitating disabilities, but also be removed from office once impaired; and lastly discusses how illness does not necessarily imply incapacitation, even though separating the two might often be difficult. These are issues of great relevance to national politics and medical ethics. They are particularly important as the 2020 presidential election is underway, and four out of the five leading candidates are well into their 70s. J Gen Intern Med DOI: 10.1007/s11606-020-06060-1 © Society of General Internal Medicine 2020
“We all breathe the same air. We all cherish our children’s future. And we are all mortal.” (President John F. Kennedy).1 The recent unannounced visit by President Trump to Walter Reed Medical Center,1 coupled with German Chancellor Angela Merkel’s unexplained tremors while on camera,2 has once again raised the question of what medical information political figures should be required to disclose. These two events have coincided with the 60th anniversary of the presidential campaign of Senator John F. Kennedy (who received last rites five times in his life and was arguably the sickest person ever elected to the White House),3 and the 100th anniversary of President Wilson’s disabling stroke, which removed him from political life and thus began “the most 1 Commencement Address at American University, Washington, D.C., June 10, 1963
Received January 15, 2020 Accepted July 14, 2020
serious case of presidential disability and White House cover-up” in American history.4 In all these instances, the public knew very little, thanks to the complicity of personal physicians, failure of the press, and a lack of clear legislation. Hence, the need to revisit the issue. Two glaring examples of leaders’ illnesses that changed history were the neurological ordeals of Presidents Wilson and Roosevelt. Neither was known to the American public, and both required substantial cover-up. Woodrow Wilson had a long history of hypertension complicated by a first stroke at age 40, and a second one in 1906 that left him blind in the central portion of the left eye.5 He had more neurovascular symptoms in 1907 and 1910, followed by a third stroke in 1913 that caused left arm weakness. In July 1919, he experienced transient amnesia.6, 7 Then, three months after signing the Versailles Peace Treaty, the president suffered a massive stroke. This catastrophe consigned the country to the care of his wife, who went to great lengths to
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