The Twenty-fifth Amendment to the Constitution evolved as a response to the need to relieve a sick and disabled president fromthe responsibilities of office, in the best interests of both the sick president and the nation. The congressional hearings that preceded and accompanied its enactment made clear that some members of Congress understood the need for objective medical information to be available to the vice president andCabinet before they couldmake the political determination of disability.Nevertheless, not a single physician was called to testify or advise in the Senate or the House despite the fact that they represent the only societal repository of expertise on physical and mental impairment. Nor was any mechanism defined whereby a dispassionate medical appraisal of the cognitive competence of the president could be obtained if it were in question. Instead, there was an implicit reliance on the physician to the president, whose conflict of interest is so strong that he or she has been used in the past more to conceal than to reveal the true state of the president’s health. The Twenty-fifth Amendment remains a vital mechanism for ensuring the stability of the presidency. But its disability provisions (sections 3 and 4) have not been implemented as the framers intended. Sooner or later, the nation will be confronted with a president who has Alzheimer’s disease, brain trauma, or illness such that his cognitive faculties are not up to the demands of office. A powerful antidote to the White House cover-ups of the past would be a medical advisory committee on the health of the president, created by congressional action. The committee would review the president’s health annually and report to the nation on its significant findings; it also would be convened urgently to assess his health status whenever it was in serious question. It would then advise the vice president and Cabinet of the degree of presidential impairment to provide a scientific medical foundation for the political decision as to the presence or absence of disability. The independence, breadth of expertise, lack of conflict of interest, availability, and credibility of the committee would assure the public of an objective appraisal and would preclude inaction by the executive branch in the face of disability. The arguments against such an advisory committee—that physicians would decide rather than advise; that they might disagree; that they might harass the president or violate confidentiality; and that the committee is unnecessary,would function poorly,
could not assemble quickly, and would infringe on the separation of powers doctrine —have been carefully analyzed and been found wanting. Because the advantages of establishing a medical advisory committee are compelling, it should be the subject of congressional action before, rather than after, the next medical cover-up in the White
House and the accompanying public crisis of confidence.