On Monday, President Trump returned to the White House after being hospitalized for three days to treat the coronavirus. The decision by his physician, Sean Conley, to release only partial information about Trump’s condition raises two urgent questions for all Americans: What obligation do the president’s doctors have to tell the public what they know about an ailing president? And who takes charge when the president falls ill?
The 25th Amendment to the Constitution, which was adopted in 1967, sought to address the latter question. It spells out how a president can voluntarily and temporarily transfer power to the vice president. It also allows for the Cabinet to remove a president who is unwilling to cede power, though it sets a very high bar in such a case: a two-thirds vote of both houses of Congress. For this reason, as well as the political damage that can be done by appearing ill or weak, presidents are reluctant to share personal medical information in the midst of a health crisis.
The origins of the amendment lie partially in the experience of President Dwight “Ike” Eisenhower, whose frequent illnesses while in office were artfully hidden from the public by his doctors and by Eisenhower himself. Even as Eisenhower endured three serious health crises in office, the public was given only a limited amount of information, and at no time was power transferred to the vice president, despite the disability of the president.
Eisenhower was 62 years old when he took office in 1953 — young by today’s standards. Only three previous presidents had been older than Eisenhower at the start of their terms: William Henry Harrison (68), Zachary Taylor (64) and James Buchanan (65). Harrison and Taylor died while in office.
Eisenhower was a chain-smoker most of his life, until 1949. He also endured frequent bouts of agonizing abdominal pain, later diagnosed as ileitis. He had a volcanic temper, often erupting in fits of red-faced rage, and he worked under enormous stress while serving as supreme allied commander in World War II. All of these risk factors caught up with him during his eight years in office (1953-1961).
In the late summer of 1955, Eisenhower left Washington for Denver, intent on enjoying a long vacation of golf and fishing. On Sept. 23, in his seventh week away from Washington, Eisenhower played 18 holes of golf at Cherry Hills Country Club, then rapidly ate a hamburger for lunch and headed back to the links for nine more holes. He began experiencing heartburn and indigestion, so he went home, picked at his supper and went to bed early.
At 2 a.m., he awoke with a searing pain in his chest. His wife, Mamie Eisenhower, called Howard Snyder, the presidential physician, who swiftly arrived and administered morphine to the ailing president. Snyder was an Army doctor, with adequate but limited training. He assumed Eisenhower was having a bout of indigestion. In the morning, Snyder examined the president again and told the staff that the president was resting after a “digestive upset.”
But by the afternoon, Snyder had grown anxious. He called nearby Fitzsimons Army Hospital to order a cardiologist to administer an electrocardiograph to the president. Now the picture became clear: Eisenhower had suffered a serious heart attack. Snyder ordered the president to be transferred to Fitzsimons by the Secret Service. Once there, doctors gave Eisenhower oxygen and anticoagulants.
Most of Eisenhower’s closest advisers were still on the East Coast. Snyder reached press secretary James Hagerty, who was napping at home in Washington, by phone. Hagerty in turn called Vice President Richard M. Nixon and a few other senior Cabinet members. The public was informed about the heart attack late on Sept. 24, but given only partial information. The staff in Denver released a statement that Ike had suffered a “mild” coronary thrombosis, or a blood clot in his coronary artery. But in fact, the heart attack was not mild, and Eisenhower’s condition — under sedation, in an oxygen tent, lying still in a hospital bed — was not made plain to the public.
The staff made a conscious effort to show that the experts were in charge. The nation’s top cardiologist, Paul Dudley White of Massachusetts General Hospital, flew to Denver from Boston. He examined the president, declared him in good hands and then delivered an impromptu seminar to the press about heart disease, a subject not yet widely understood in America.
White tried to put a good face on the president’s illness. But when Eisenhower’s son John saw his father on the morning of Sept. 25, he was “obviously under sedation,” according to John’s later account. On Monday, Sept. 26, the stock market plummeted — its biggest decline since the crash of 1929.
In Washington, Nixon, who had been informed of the president’s condition, had no idea what to do. He would later write extensively in his memoir “Six Crises” about how the heart attack caught him “completely unprepared,” as Eisenhower had never discussed the possibility of a transfer of power, and there was as yet no constitutional guidance on replacing an ill but still living president. In fact, Eisenhower wanted it that way. He had little confidence that the 42-year-old Nixon could ever take his place, and he had never confided in him while in office.
Instead, Eisenhower directed that a few senior advisers would serve as a kind of temporary executive. Chief of Staff Sherman Adams came to Denver and operated as Eisenhower’s substitute. Hagerty gave daily and upbeat accounts of the president’s health to the press. In Washington, Attorney General Herbert Brownell Jr. took command of domestic affairs, while Secretary of State John Foster Dulles handled international matters, and each periodically visited the president’s bedside in Denver for brief conversations. Nixon chaired meetings in Washington but never assumed the role of “acting” president.
Yet Eisenhower was incapacitated. He slept most of the week after the heart attack. On Sept. 30, his staff (like Trump’s) orchestrated a show of Ike signing papers in bed, but Eisenhower could not stand up or walk unaided until Oct. 23 — a month after the heart attack. Not until Nov. 11 was Eisenhower well enough to be transferred back to the East Coast — and he went not to Washington, but to his home in Gettysburg, for further recovery. He did not resume full duties for 3½ months after the heart attack.
Eisenhower’s popularity was enormous. Already well known as the leader of American forces in wartime, his election as president in 1952 had been a thumping landslide. His approval rating hit 77 percent two months after the heart attack, and so he felt no need to demonstrate his strength by leaving his hospital bed early or making spurious claims about defeating his illness, as Trump has done.
But Eisenhower continued to soft-pedal his health problems to the public. On June 9, 1956, about eight months after his heart attack, Eisenhower had abdominal surgery to relieve the pain of his inflamed ileum. During the surgery, he was unconscious for at least four hours. Hagerty told the press that “no thought had been given to transferring presidential powers” to Nixon. And in November 1957, Ike had a small stroke that left him dizzy and weak for days. Nixon never took command as acting president.
In March 1958, Eisenhower drew up a memo for Nixon, outlining a procedure he would like followed should he fall gravely ill again. This informal document had no legal standing. That year, Congress took up the matter of presidential disability, but the 25th Amendment on transfer of power was not adopted for another nine years.
Section 3 of this amendment gives great discretion to the president in handing over power voluntarily. Section 4, however, makes it difficult to take power away from an unwilling president. In that case, the vice president and a majority of the Cabinet must agree upon transferring authority, and should the president dispute that action, two-thirds of both the House and the Senate would have to vote for removal.
Should a president choose to hide crucial health details from the public, as Trump and his doctors have done, citizens have little recourse. All they can do is draw their own conclusions about the trustworthiness of the president and make their voices heard at the ballot box.