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Require Mandatory Independent Presidential “Fitness for Duty” Assessments

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We need mandatory independent assessments of presidential candidates’ and periodic reassessments of presidents’ physical and mental health and ability to safeguard sensitive classified information to proactively address risks of harm to United States interests.  Presidential candidates and presidents are not required by law to have any sort of examination to determine fitness to hold the highest, most sensitive position in the United States.  Annual presidential physical examinations are typically performed by the president’s physician of choice, and the results that are made public, if any, are determined by the President.  Serious, debilitating health problems have historically been withheld from the public. For example, Woodrow Wilson suffered a massive stroke during his second term, but did not leave office. Details of his illness were hidden from the public while his wife carried out many of his duties. President Warren Harding died in office of a stroke.  Mental health is not routinely assessed, if assessed at all, and should there be a history of or current debilitating mental health problem, it would likely be withheld from the public.  A Duke study of presidential biographies suggested that 8% of the presidents exhibited evidence of alcohol abuse or dependence. President Pierce died of cirrhosis of the liver; Grant was once allegedly so drunk he fell off his horse during a military parade in New Orleans; and Nixon was once unable to take a phone call from the British Prime Minister because he was “loaded."  Other presidents had physical conditions that can have a severe impact on psychological functioning. Taft, for example, had sleep apnea, which is associated with declines in cognitive functioning across the board, and some scholars now believe that Ronald Reagan showed early signs of Alzheimer’s while still in office.  At least 10 presidents were affected by mental health episodes while in office according to the Duke study, and the study found evidence that symptoms interfered with their performance in almost all cases.

Contrast these facts with the facts that many who work to provide safety and security for our nation, including members of the armed forces, police, fire departments, and all border patrol agents, must undergo rigorous physical and mental health assessments, some including polygraphs, to ensure fitness for duty in their official roles. The intent of these assessments is both to ensure that these individuals have the physical and mental prowess necessary to perform their duties and also to try to ensure that persons in a position of power do not abuse their power.

Additionally, background investigations necessary to obtain a formal security clearance for individuals with access to classified information are not required for the President of the United States or candidates for that position.  The US State Department states of background investigations, “It must be determined that the individual’s personal and professional history indicates loyalty to the United States, strength of character, trustworthiness, honesty, reliability, discretion, and sound judgment, as well as freedom from conflicting allegiances and potential for coercion, and a willingness and ability to abide by regulations governing the use, handling, and protection of classified information.” Unauthorized disclosure of classified information may be subject to criminal penalties.  Yet Presidents, who have access to the most sensitive information of national importance and who do not have security clearances, have disclosed classified information without proper vetting, a case in point being President Bush and/or Vice President Cheney authorizing Lewis “Scooter” Libby to release classified information to the New York Times to help buttress their case for the Iraq War.  We have also been informed that President Trump disclosed classified information from another nation, which had not given consent for disclosure, to Russia. 

Physical examinations reveal current and future problems for a person’s health through a review of bodily systems and diagnostic tests.  Similarly, mental health examinations, often known as psychological and/or psychiatric evaluations, use interviews and psychological tests to determine areas of concern.  A number of reliable and valid psychometric instruments can be used to measure emotional and personality functioning and identify areas of concern, e.g., cognitive (thinking) problems, mood instability, substance abuse, impulsivity, and low tolerance for stress.  Background investigations reveal potential conflicts of interest, opportunities for blackmail or extortion, and other risk factors for national security.

While the American electorate can be informed about the platform and the persona of presidential candidates as we hear them speak, we lack essential health and security risk information, which can help us to understand the candidates’ motivations and character, illuminate the potential for a debilitating physical or mental health crisis, whether they might have financial ties or be subject to blackmail or extortion by foreign powers, if they can be trusted with national secrets, if they might impulsively release a nuclear weapon in a fit of rage.  I suggest that this information is at least as important as the person’s stated agenda should s/he be elected to the highest position in the land.

Periodic independent physical, psychological/psychiatric, and security risk assessments would help to identify emerging or acute issues that could impair a sitting president's judgment and compromise our nation.  Given the amount of stress involved in the President’s job and the prevalence of stress-related health problems in this nation, including thinking/concentration problems, heart disease, stroke, and insomnia, a proactive rather than a reactive stance to the possibility of debilitating presidential psychological or physical health problems seems warranted.   

In summary, we need mandatory independent assessments of presidential candidates’ and periodic reassessments of presidents’ physical and mental health and ability to safeguard sensitive classified information.  Background investigations for security clearance would reveal among other things, financial ties to other nations or other compromising situations which might impair a President’s judgment


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