Among the most fraught questions about this election is the health of the aging candidates themselves.
President Biden is 81 and former President Donald Trump is 78; the major presidential parties have never before put forth candidates who are as old. Both men have been seen as showing signs of cognitive decline, leading to calls for greater disclosure about the health of our presidential candidates.
These arguments raise hard questions that will not be addressed in this week’s debate, but they are still increasingly timely. How much information do our politicians owe us about their health? And more broadly as our society ages, who gets to decide how old is too old? It is natural to assume that physicians might have a better understanding than other voters of how healthy either Mr. Trump or Mr. Biden is. But it’s not that simple.
The health of politicians has long been characterized by secrecy and political maneuvering (recall President Franklin Roosevelt, whose wheelchair was rarely visible in photographs). But they are even more pressing today, as social media amplifies questions about the health and fitness of public officials. Take, for instance, Senator John Fetterman of Pennsylvania, whose health was a topic of great debate when he ran for office while recovering from a near-fatal stroke. Or former President Trump’s diagnosis of Covid in office and the attendant, and highly politicized, speculation about its severity.
This is not a surprise. So much of politics is about perception, and good health is intertwined with the perception of strength. Some of this is justified — the public should know if a presidential candidate has a high chance of dying while in office. And some of it stems from the stigma that comes with disease and old age — the way that we have long conflated sickness or disability with weakness.
It is time for us to challenge those assumptions. People are increasingly living with illnesses that were once fatal. Cancers that were once terminal can now be chronic. Conditions like heart disease can be managed. When we consider the health of political candidates, we need to take those shifting realities into consideration. It is also important to parse out the difference between a disability that requires accommodation but does not remove the ability to perform a job — blindness or using a wheelchair, for instance — and a progressive and possibly life-limiting condition. Age can be a life-limiting condition, but aging is a process we all go through.
Thoughtfully evaluating the health of a political candidate is nearly impossible to do, however, when health information itself becomes politicized and it is unclear what the truth is. For instance, Mr. Trump has been effusive about doing well on the Montreal Cognitive Assessment in 2018 and recently said Mr. Biden should take the test. But what isn’t clear in Mr. Trump’s statements is that this is a screening test for dementia or other cognitive decline, not a test of aptitude. We would expect any candidate for president to do well; it is not something to announce. Though a candidate might give an update from a physical exam performed by his or her own doctor, it could be more useful to receive objective data, like lab results or — if cognition is the question — more extensive neuropsychiatric testing. If we are to demand that our politicians disclose health information, we need to receive that information in a standardized fashion that does not start as artillery, weaponized by one party against another.
Health information related to age is particularly complicated. There is no one test that can tell us how old is too old. And in many fields in which individuals have a huge degree of power, there is no official age cutoff or testing required to assess the impact of age. There is no official age cutoff to perform surgery, for example, nor is there any mandated cognitive or physical testing. It is up to surgeons and to their colleagues to police themselves, to know when the scales tip and it is time to step away.
This is inevitably a wrenching decision, linked to how we all come to terms with mortality and how we define ourselves. Colleagues have told me that there are surgeons who come to this decision only after not one but several bad patient outcomes or near misses. But it is a decision that each of us, if we are lucky enough to see old age, must one day make in our own ways. There are countless other examples, like deciding when to stop driving or when it is time to no longer live alone.
Whatever that cutoff is, it is different from one individual to the next and changes over time. When I started practicing medicine, there were official age limits beyond which patients with organ failure were not considered for a transplant. You could be a robust 75-year-old, but if you had catastrophic lung disease, you were simply too old to receive a transplant. That donated organ would better serve a younger person.
But now, many transplant programs have no such hard and fast cutoffs. We look instead at broader markers of health and resiliency, like frailty, to give an indication of whether patients on the margins of what we once thought were unacceptable ages would benefit from a transplant. This makes sense. But as we continue to push the upper limits, there will inevitably come a time where we go too far, for instance by performing a transplant on someone who is too frail to benefit. Or allowing a surgeon in the operating room despite recognizable physical or cognitive deficits. Or even pushing the margins of age when it comes to our elected officials. These examples are all different, of course, but they come from the same changing perception of age.
It is easy to say that 40 is the new 30, that 50 is the new 40 and so on. What that really means depends on who we are. For some, it could mean decades to live between retirement and death, and for others, it could mean never getting to retirement in the first place.
Age is real. This does not mean that someone in their 80s is not competent enough to become president. But presidential candidates are under no obligation to reveal their health records, which leaves the public uncertain about the impact of aging on our candidates.
This doesn’t mean that all medical data should be disclosed — but we would benefit from pertinent medical data that is consistent among candidates. If we had this, we would be able to see age for what it is — not a political weapon, but one more factor alongside political views and experience that we need to weigh.
The history of our presidency is rife with examples of hidden illnesses, of secrets and stigma when it comes to disease. But illness and aging do not need to be synonymous with weakness or hidden from public view. In the intensive care unit, we need to learn about our patients’ ages and comorbidities to know how best to treat them, to know what they are capable of tolerating and when to step back.
As an American public, we deserve this same level of understanding about the health of our political candidates.
Daniela J. Lamas is a contributing Opinion writer and a pulmonary and critical-care physician at Brigham and Women’s Hospital in Boston.
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