In a typical presidential election year, voters might wonder how the candidates' views compare on issues such as abortion, tax cuts, gun rights and immigration policy.
But this year, as a 78-year-old Republican candidate campaigned to replace an 81-year-old Democratic incumbent, a different question arose on the minds of many voters: What's in his medical records?
That issue overshadowed all others after President Biden’s botched performance in last month’s debate against Donald Trump, which sparked widespread concern about Biden’s physical and cognitive health. It became even more relevant after Trump suffered a gunshot wound to the ear and Biden contracted COVID-19.
Secret Service members tend to former President Trump's bloodied ear after he was shot at a campaign event in Butler, Pennsylvania, on July 13.
(Gene J. Puskar/Associated Press)
When Biden dropped out of the presidential race on Sunday, House Speaker Mike Johnson (R-La.) kept the health issue alive by calling for the commander in chief to resign.
“If Joe Biden is unfit to run for president, he is unfit to serve as president,” Johnson wrote on social media platform X.
Biden's doctors have denied speculation that the president is receiving treatment for Parkinson's disease or another neurological disorder. Meanwhile, the Trump campaign has released limited information about the former president's condition after he was grazed by a rifle bullet.
Does the public have a right to know more than both men have voluntarily revealed?
“In an ideal world, it would be great if there was complete transparency,” said Dr. Robert Klitzman, a psychiatrist and bioethicist at Columbia University. But no patient, not even a president, should be forced to share medical information they would prefer to keep secret from their doctor, he and other experts said.
The reason is simple: A successful relationship between a doctor and a patient is built on trust, and that includes trusting that the doctor will not share information that could be considered embarrassing, unflattering or stigmatizing.
“In order to help a patient as much as possible, we need to know the whole history,” Klitzman said. “We need to know if the patient is depressed, if they can’t urinate, if they’re in pain, if they’re forgetting things. We need that information to make an accurate diagnosis and determine the best treatment to help them.”
Without the guarantee of confidentiality, a president might well decide it's best to stay away from doctors altogether, said George Annas, a professor of health law, bioethics and human rights at Boston University.
“We want him to have access to whatever treatment is out there, and he’s not going to get it if he doesn’t get tested,” Annas said. “That’s why we’re keeping this information confidential, and why it makes perfect sense to do so even if everything inside of you is screaming, ‘I want to know what’s wrong with him.’”
The principle of doctor-patient confidentiality dates back to ancient Greece and is enshrined in the Hippocratic Oath“Anything I see or hear in the lives of my patients, whether related to my professional practice or not, that should not be discussed outside, I will keep secret, since I consider all such things to be private.”
About 2,400 years laterThe notion that a patient's medical information should remain private was codified in federal law as part of the Health Insurance Portability and Accountability Act of 1996better known as HIPAA.
There are limited circumstances in which physicians have a duty to disclose a certain amount of information about their patients.
For example, if a patient poses a danger to himself or herself or others, the physician has an obligation to: duty to warn law enforcement or potential victims of the threat, said Dr. Bandy X. Lee, a forensic psychiatrist and educator at Harvard Medical School's psychiatry and law program.
If a patient has a reportable sexually transmitted infection, such as syphilis or HIV, that diagnosis should be shared with a public health department, along with the names of the patient's past partners so they can be informed and tested, Klitzman said.
And if doctors detect an increase in cancer cases among people clustered in a geographic area, that, too, is relayed to public health officials for investigation.
Beyond cases like these, consensus fades, Annas said.
Congress could try to carve out an exception to HIPAA and require presidents and presidential candidates to make their medical records public. But in the unlikely event that the law were to change, it’s unclear whether it would survive a court challenge, said Bert A. Rockman, a professor emeritus of political science at Purdue University who specializes in the American presidency.
“This raises a lot of questions that we don’t know the answers to,” he said.
Moreover, forcing current and future presidents to waive their right to doctor-patient confidentiality would not ensure that voters would know the truth, Rockman said. A president could simply seek out a doctor willing to withhold his or her opinion in a medical report, for example.
“There will always be ways to find an alternative solution,” he said.
Even if a president is forthcoming, knowing his diagnosis doesn't necessarily reveal much about his ability to function. A White House occupant might have a mild case of Parkinson's but be able to perform his job just fine with the right treatment, Klitzman said.
Voters should also keep in mind that there is a difference between the president and the presidency, Rockman said.
“The presidency can function even if the president is impaired,” he said. “Chances are, unless the president is completely out of it for some reason or another, either physically or mentally, the office itself will function.”
In fact, American history is replete with examples of presidents who hid serious medical problems from the public.
John F. Kennedy was taking narcotic painkillers, amphetamines and steroids To treat your Addison's disease and other ailments as he tried to avert a nuclear crisis with the Soviet Union in the early 1960s.
Grover Cleveland said he was going on a four-day fishing trip when… got on a yacht In 1893, a malignant tumor was surgically removed from his palate, along with part of his jaw and five teeth.
Woodrow Wilson suffered a stroke In 1919, Wilson suffered a cerebral hemorrhage that left him partially paralyzed, bedridden, and unable to feed himself for the remainder of his presidency. When asked to elaborate on Wilson’s condition, his doctor said that “the President’s mind is not only lucid but also very active.”
It's not okay to lie to preserve a patient's privacy, Klitzman said, but that doesn't necessarily mean a doctor should reveal “the truth, the whole truth and nothing but the truth.”
“You can say, ‘The president is not feeling well today,’ or you can say, ‘The president has COVID,’” he said. “You want people to trust the government, and if people feel like the government is lying all the time and we can’t trust anything they say, that’s not good.”
