President Joe Biden is 81 years old. The presumptive Republican nominee in November, former President Donald Trump, is 77 years old. Biden has been mercilessly mocked over lapses of memory, stumbles, gaffes, and other symptoms of cognitive decline. Trump was described as mentally unfit for office by psychiatrists when he was president. 

One doesn’t have to endorse these allegations to ask whether the occupier of the Oval Office should be transparent about his health. President Dwight Eisenhower was exemplary in this respect. When he had a heart attack in his first term, he told his press secretary “to tell them everything”. Not all presidents were so open. Woodrow Wilson suffered a serious stroke in his second term and his wife and secretary ran the Oval Office for months. They organised an interview with a leading journalist who wrote that the President was in good health. (He won the 1921 Pulitzer Prize for that fabricated interview.)

Section 4 of the 25th amendment, which was adopted in 1967, says that the vice president and a majority of the Cabinet “or of other such body as Congress may by law provide” could declare that a president was unable to discharge his duties, in the event that a president is incapable or unwilling to do so voluntarily. 

This section has never been tested. It is easy to imagine a constitutional crisis arising over whether a president is “unable to discharge the powers and duties of his office”.

The Lancet recently ran an editorial on this potentially thorny issue. It says:” If the US public is truly invested in the health of its leaders, and not just grasping for fresh mud to sling, it must standardise ways to interrogate health that prioritise transparency and engagement … Normalising public discussion of personal health will inoculate candidates, presidents, and US democracy against the pestilence of speculation, misinformation, and slander that threatens to overwhelm political discourse.”