Presidential Election 2024

President Joe Biden?announced last Sunday?that he will end his presidential re-election campaign, bringing an abrupt and humbling conclusion to his half-century-long political career and scrambling the race for the White House less than four months before Election Day.

He was the oldest president ever to serve in the United States, born on November 20, 1942, and took office on January 20, 2021, at the age of 78 years old.

Many commentators have questioned his medical fitness to serve. No U.S. president has ever been officially removed from office solely on medical grounds through the formal processes outlined in the Constitution, such as impeachment or the 25th Amendment. However, there have been instances where presidents have had significant health issues that affected their ability to perform their duties:

1. Woodrow Wilson: In October 1919, President Wilson suffered a severe stroke that left him incapacitated for the remainder of his term. His wife, Edith Wilson, effectively took on many responsibilities, though there was no formal transfer of power.
2. Dwight D. Eisenhower: President Eisenhower had a heart attack in 1955, an ileitis operation in 1956, and a stroke in 1957. During his illnesses, Vice President Richard Nixon was prepared to assume presidential duties if necessary, but Eisenhower remained in office.
3. Ronald Reagan: In 1981, President Reagan was shot and seriously wounded in an assassination attempt. While he was incapacitated during surgery, there was no formal invocation of the 25th Amendment. Later, in 1985, Reagan underwent surgery and transferred power to Vice President George H.W. Bush for about eight hours, invoking the 25th Amendment.

These examples highlight instances where presidents faced significant health challenges but were not officially removed from office. The 25th Amendment, ratified in 1967, provides a mechanism for the temporary or permanent transfer of presidential power in cases of incapacity, but it has been used sparingly.

The 25th Amendment to the United States Constitution, ratified in 1967, provides clear procedures for the transfer of presidential power in the event that the president is unable to fulfil their duties. This amendment was largely a response to the ambiguities and uncertainties that arose following the assassination of President John F. Kennedy in 1963.

Here are the key provisions of the 25th Amendment:

Section 1: Presidential Succession

If the President is removed from office, dies, or resigns, the Vice President becomes the President.

Section 2: Vice Presidential Vacancy

Whenever there is a vacancy in the office of the Vice President, the President nominates a Vice President who takes office upon confirmation by a majority vote of both Houses of Congress. This was used in 1973 when Vice President Spiro Agnew resigned, and President Richard Nixon appointed Gerald Ford as Vice President. It was used again in 1974 when President Nixon resigned, Ford became President, and he nominated Nelson Rockefeller as Vice President.

Section 3: Presidential Declaration of Inability

The President can voluntarily transfer power to the Vice President by declaring in writing that they are unable to discharge the powers and duties of the office. The Vice President then becomes Acting President until the President declares in writing that they are able to resume their duties. This provision has been used several times, such as when President Ronald Reagan underwent surgery in 1985 and when President George W. Bush underwent medical procedures in 2002 and 2007.

Section 4: Declaration by Vice President and Cabinet

If the Vice President and a majority of the principal officers of the executive departments (the Cabinet) declare that the President is unable to discharge the powers and duties of the office, the Vice President immediately assumes the role of Acting President. The President can resume their duties by declaring that no inability exists. However, if the Vice President and the majority of the Cabinet challenge this declaration, Congress must decide the issue. A two-thirds vote in both Houses is required to keep the Vice President as Acting President. This section has never been invoked, but it is intended to address situations where the President is incapacitated but unable or unwilling to step aside voluntarily.

The 25th Amendment ensures continuity and stability in the executive branch by providing mechanisms to address presidential incapacity, thereby preventing crises of leadership.

.S. presidents typically undergo regular medical examinations to assess their health and fitness for office. These medical check-ups serve several purposes:

1. Health Monitoring: Regular medical exams help monitor the president’s overall health and catch any potential issues early.
2. Transparency: The results of these examinations are often made public, providing transparency and reassuring the public and government officials about the president’s health.
3. Ability to Perform Duties: Assessments can help determine if the president is physically and mentally capable of performing the demanding duties of the office.

Historical Context

• Recent Presidents: President Joe Biden underwent a comprehensive medical examination in November 2021, where his doctor declared him fit to execute the duties of the presidency. President Donald Trump had annual medical exams during his tenure, with the results released to the public. His first exam in 2018 was notable for its detailed report on his health. President Barack Obama also had regular medical check-ups, with summaries released to the public.

Typical Components of Presidential Medical Examinations

1. Physical Examination: This includes checking vital signs (blood pressure, heart rate), evaluating cardiovascular health, pulmonary function, and other standard physical assessments.
2. Laboratory Tests: Blood tests, urine tests, and other laboratory work to monitor cholesterol levels, blood sugar, liver function, and other indicators of health.
3. Specialized Tests: Depending on age and health history, this could include stress tests, colonoscopies, prostate exams, and other screenings for specific conditions.
4. Mental Health Evaluation: While not always as publicized, mental health is also a component, especially given the high-stress nature of the job.

Legal and Procedural Framework

There is no legal requirement mandating these exams or dictating specific fitness-for-duty assessments. However, the practice has become a norm to ensure transparency and maintain public trust.

25th Amendment Relevance

In cases where there are serious concerns about a president's health impacting their ability to perform their duties, the 25th Amendment provides mechanisms for the temporary or permanent transfer of power to the Vice President. This amendment underscores the importance of monitoring the president's health to ensure they can fulfil their responsibilities.

The challenge is that medical fitness has limited relevance in most employment situations: many medical conditions, and virtually all minor health problems, have minimal implications for work and should not debar from employment. OH departments are well versed in advising individuals and organisations about fitness for work and in maintaining it in the long term.

With an ageing population, questions like this will continue to rear its head for senior leaders, managers and employees within a range of organisations, including politics and the general population.

With a (likely) incumbent approaching 80 + years of age when in office, medical fitness concerns may continue within political and media spheres. Medical fitness is relevant where illnesses or injuries reduce performance, or affect H&S in the workplace; it may also be specifically relevant to certain onerous or hazardous tasks for which medical standards exist.

In the UK, the no of people of pensionable age has been rising as life expectancy has increased and fecundity has fallen. Pension schemes are addressing the problem of a falling support ratio by increasing retirement age, increasing contribution rates, moving from 'defined benefit' to 'defined contribution' schemes. Currently, only a small proportion of people work after the age of 65, but this is likely to increase with the removal of default retirement ages, changes to the normal pensionable age, relaxation of tax rules and lifting of the max number of pensionable years of services.

There is some variation of early retirement, with higher rates seen in jobs that require high levels of physical fitness, but other non medical factors can influence this decision. OH physicians are now more likely to be involved in the decision making process. Recent longitudinal studies, suggest that mortality after retirement depends on the health of the retiree and not on early retirement per se. Self-perceived health, higher employment grade, and job dissatisfaction have been show to be independent predictors of early retirement.

Supporting older adults within the workplace while not compromising performance of employee and employer, will be of utmost importance over the next 10-20 years.