MIA SWART: Presidents have long hidden the state of their health

Joe Biden must have a very thick skin. For many months his opponents, the media and the public have made fun of the 81-year old US president’s cognitive decline.

In speeches made during his presidential campaign he confused Emmanuel Macron with former French president Mitterand, who died in 1996, confused the war in Ukraine with the war in Iraq, and failed to remember the date of his son Beau’s death. 

After growing calls for him to pull out of the presidential race Biden finally did the right thing on Sunday. Meanwhile, his mental decline has resurrected the issue of presidential fitness for office. US presidents have long hidden the true state of their health. In a less televised era John F Kennedy suffered from a multitude of health conditions, including Addison’s disease, an adrenal deficiency, yet managed to hide it from the American public.

In a pre-television age Woodrow Wilson contracted the Spanish Flu in 1919. While he was suffering from an exceptionally high temperature, a terrible cough and weakness, Wilson’s doctor lied to the press and said it was just a bad cold.  

Franklin D Roosevelt concealed the crippling effects of his polio from the US public. In July 1931, Liberty magazine published an article headlined, “Is Franklin D Roosevelt physically fit to be president?” During his 12 years in power Roosevelt was rarely photographed in his wheelchair. Commentators believe that had the public known the extent of his disability, it would have put an end to his election chances. Roosevelt was well aware that the public would have viewed physical disability as incompatible with exercising presidential power.

The US public also did not know about the cocktail of mood-stabilising medications taken by Richard Nixon. 

What does the US constitution say about fitness for office? The 25th amendment allows for the orderly transfer of presidential power should a US president die or become incapacitated. The amendment was prompted by the assassination of John F Kennedy and has rarely been invoked.

The wording of section 4 of the amendment leaves open the possibility that mental incapacity could be a ground for removing a president. But this section has never been invoked and is therefore still uncharted territory. Interestingly, in a 2018 commentary, the think-tank Brookings asked whether the reservations expressed about Donald Trump reaches the level of the 25th amendment.

These questions were prompted in part by Michael Wolff’s controversial book Fire and Fury: Inside the Trump White House, which suggested Trump was unhinged, dangerously impulsive, divorced from reality, had short-term memory loss, was at risk of starting a nuclear war and was therefore dangerous to the future of the US.

During the current presidential campaign, Trump has at times displayed some of these same signs of cognitive decline as Biden, including nonsensical rants and confusing names and current events. 

Trump has tweeted that his “two greatest assets have been my mental stability and being, like, really smart”. He claimed to have “aced” his last physical exam at the end of 2023, but medical testing of US presidents has never been fully transparent. There have been increasing calls for more transparency of late. 

Transparency cannot be left to politicians themselves. After all, the hubris of most politicians knows no limits. Take former president Jacob Zuma. Born in April 1942, he is about six months older than Biden. He previously refused to relinquish power after eight motions of no confidence in parliament.

Yet Zuma used the issue of his health to get him released from prison on medical parole, even while fighting tooth and nail to keep his medical information secret. But the public has an interest in this information. Transparent health testing in SA, when such health testing is in the public interest, is just as overdue as in the US. 

• Swart is a visiting professor at Wits Law School specialising in human rights, international relations and international law. She writes in her personal capacity.