What would a presidential fitness-to-serve review look like, and why wouldn’t one be conducted?
Trump’s fitness to serve as president has been the subject of debate due to the risk of violence and various health concerns.
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The term “mental health” has been thrown around a lot recently. Both Presidents Trump and Biden have faced criticism about their ability to serve as president. The media and politicians alike tend to abuse the term. The result? Mass public misunderstandings and often misguided media debates.
“Mental fitness”: what exactly are we talking about?
The basic idea being debated in these situations is about fitness for duty. Fitness for duty answers whether or not a person can perform the job properly. Unfortunately, mental fitness is a bit more complicated than that.
Fitness for work is a medical and legal question about a professional’s capabilities (disabilities). The answer to this question is partly provided by a formal mental health evaluation. These mental health-related tests tend to be administered in occupations or situations where the candidate’s mental state puts their own safety or the safety of others at risk. High-stress occupations include the military, law enforcement, healthcare, and certain civil service positions.
There are two answers to the question of fit-for-job. A fit-for-job assessment requires a trained clinician to (1) assess whether a mental health problem, such as dementia, depression, or substance abuse, is present and (2) determine whether that condition makes the individual unfit to perform the job. The specific method of a fit-for-job assessment will vary depending on the setting and type of professional being assessed. As outlined in the clinical literature, possible approaches include:
- In-depth interview
- Talk to collateral contacts (e.g., coworkers, other health care providers)
- Check the record
- Psychological tests targeting personality traits, cognitive function, or mental health symptoms
- Role-playing work-related scenarios
Scientific reviews of job-related fit assessments also provide valuable context. For example, fit/unfit decisions are not straightforward; intermediate options, such as limited fit, exist; and the decision-making process that arrives at these conclusions is not clear. The science on which job fit is based is very limited.
Biden has recently faced concerns about his fitness to be president due to his declining cognitive abilities and poor performance in debates.
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Presidential fitness for duty
In reality, presidential fitness to serve doesn’t really exist. The 25th Amendment to the Constitution does say that a president can be removed from office if he is “unable to discharge the powers and duties of his office,” but there is currently no formal process or standard for doing so.
The debate over a formal presidential fitness process dates back to the Carter administration. As I have argued in previous articles, Psychology Today It’s time to consider presidential fitness-for-duty evaluations. In his article, Dr. Clifford Lazarus reminds us that the idea of presidential fitness-for-duty is not new. President Jimmy Carter floated the idea of having a panel of appointed physicians who would periodically evaluate the president.
Discussions of a formal evaluation process for presidential fitness to serve date back to the Carter administration.
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2017 Journal of the American Medical AssociationDetails were given of what the appointed committee would be like. It was argued that the President’s fitness should include an evaluation of medical, psychological and financial aspects. The committee would include the following members:
- Three psychiatrists — one clinical, one academic and one military — will assess the president’s mental state and provide varying insights into what he might encounter in the course of his duties, such as military scenarios and nuclear codes.
- 1 clinical psychologist with a focus on psychological evaluation
- One neurologist to provide expertise in cognitive decline and brain dysfunction
- Two physicians weigh in on common medical concerns
Of course, this is just one example of what a president’s job fitness looks like. It doesn’t address a clear and growing problem: political polarization. JAMA The article proposes that members of the Presidential Eligibility Commission be appointed by the scientific community, a solution that seems unrealistic in today’s hyper-partisan American culture.
No, the geniuses at CNN and Fox News are not qualified to judge the President’s fitness (no matter what they say).
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Recently, both the media and the general public have appointed themselves arbiters of presidential legal fitness. I have personally encountered the argument that “voters decide who is fit to be president!” Voters are entitled to decide who they want to represent them based on the candidates’ policy stances, personalities, and other increasingly polarizing grounds. But voters are not entitled to judge medical and legal fitness.
So how does this affect us? While both political sides would like to declare the other’s presidential candidate ineligible, whether due to personality abnormalities or cognitive impairment, it is unrealistic to see such a formal process taking place in the near future. In my view, political foundations would need to crumble before we could finally put in place significant safeguards regarding presidential fitness to serve. What those foundations are remains to be seen.
