What if a president goes off the deep end, but neither he nor his staff will admit it?
Former President Jimmy Carter and a group of doctors writing in today's Journal of the American Medical Association assert that the current method of certifying a president's incompetence is inadequate.
"The problem is hardly hypothetical," Mr. Carter writes. He notes that four of the 18 presidents who have sat in the Oval Office in the 20th century suffered strokes while in office, and six underwent major surgery under general anesthesia.
Currently, the president's personal physician must make the medical determination of whether the chief executive is able to perform his duties. But the doctor could be torn by the need to balance his patient's confidentiality against the nation's interest.
"We must find a better way," Mr. Carter says.
He calls for the creation of a "nonpartisan group of experts representative of the medical community who are not directly involved in the care of the president. They could be given the responsibility for determining disability, thereby relieving the president's physicians from their potential conflict of interest."
Robert S. Robins, a professor of political science at Tulane University in New Orleans and the author of a recent book on presidential disability, said, "It's true that the great problem would be with a president who should be replaced but who resists his replacement."
One benefit of having a panel of expert doctors is that they could go to the president directly, without going public, and advise him when his personal physician's advice is inadequate, Mr. Robins said.
He noted that President John F. Kennedy's personal physician, Dr. Max Jacobson, allowed him to take amphetamines -- which can cause paranoia.
Mr. Carter's commentary appears with the only firsthand account ever published of the medical care given to President Ronald Reagan after he was shot in 1981.
The doctors write that "it was a source of some amazement that he was mentally alert and unimpaired shortly after the surgery."
Even so, the fact that Mr. Reagan had to undergo general anesthesia and subsequently take sedatives and painkillers should have led his staff to invoke the 25th Amendment to the Constitution, which temporarily transmits presidential powers to the vice president, according to medical historian Arthur S. Link and Dr. James F. Toole, both of the Bowman Gray School of Medicine in Winston-Salem, N.C.
They also note that when Mr. Reagan was facing cancer surgery, he temporarily turned over executive power to then Vice President George Bush on the morning of July 13, 1985. But that same evening, they say, "President Reagan's advisers permitted him to sign a letter reclaiming his presidential powers, even though he was still medicated. Two days later, President Reagan agreed in principle to the initiative for the sale of arms to Iran."