IntroductionPresidential disability and presidential succession

Robert E. GilbertEdward W. Brooke ProfessorDepartment of Political ScienceNortheastern UniversityBoston, MA 02115r.gilbert@neu.edu

Erik P. BucyMarshall and Sharleen Formby Regents Professor of Strategic CommunicationCollege of Media and CommunicationTexas Tech UniversityLubbock, TX 79409-3082erik.bucy@ttu.edu

ABSTRACT. This introduction to the special issue on presidential disability and succession focuses on thedistinctly positive contributions that invocations of the Twenty-Fifth Amendment have made to Americanpolitical life since the Amendment's ratification in 1967. It also underlines the importance for Presidents, theirfamily members and aides to understand the necessity for putting the welfare of the country first, above allelse-even at times above the wishes of a disabled Chief Executive. As the articles in this special issue makeclear, the Twenty-Fifth Amendment provides an effective constitutional mechanism by which the country'swell-being can be maintained while simultaneously showing compassion and respect for a disabled leader.The idea for this issue emerged from a conference organized by Professor Robert E. Gilbert focusing onpresidential disability and succession held on the campus of Northeastern University in April 2014. Papersfrom the conference assembled here clarify and add to the historical record about presidential inability whileilluminating the many political, legal, and constitutional contingencies that future presidential administratorsmay face. Contributors to this issue have varied disciplinary and professional backgrounds, includingexpertise in American politics, constitutional law, the presidency and vice presidency, presidentialimpairment, and, of course, the Twenty-Fifth Amendment to the Constitution.

Key words: Presidential disability, presidential succession, Twenty-Fifth Amendment, transfer of power,presidential powers and duties

O n April 3, 2014, a day-long conferencefocusing on presidential disability and succes­sion was held on the campus of Northeastern

University in Boston, Massachusetts. The conferencewas sponsored by Northeastern's Department of Polit­ical Science and by the Edward W. Brooke Professorship

held by Professor Robert E. Gilbert, who served asconvener and coordinator. The purpose of this day-longevent was to highlight the multifaceted problems

surrounding the issue of presidential incapacity andthe questions about executive decision-making (andpotential succession) that it raises. At different times,such problems have seriously diminished both presiden­

tial power and presidential performance, as the articles

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in this special issue stemming from the conference makeabundantly clear.

It is a little-known fact that a significant number ofU.S. presidents have been seriously ill, and occasionallyincapacitated, for some time during their terms inoffice. 1 These include George Washington, JohnAdams, James Madison, James Monroe, AndrewJackson, William Henry Harrison, Zachary Taylor,Franklin Pierce, Abraham Lincoln, James Garfield,Chester Arthur, Grover Cleveland, William McKinley,Woodrow Wilson, Warren Harding, Calvin Coolidge,Franklin Roosevelt, Dwight Eisenhower, John Ken­nedy, Lyndon Johnson, Richard Nixon, Ronald Rea­gan, George H. W. Bush, and William Clinton. Illnesseshave been, over time, both physiological and psycho­logical in nature, and both types of illness have at timesled to significant levels of presidential impairment. Insome cases, inability arises at a particularly criticalpolitical or diplomatic juncture and the path ofadministration policy is adversely affected. Not whollysurprising, the very existence of some of thesepresidential illnesses was concealed by White Houseofficials and by family members while the gravity ofother illnesses was deliberately downplayed anddiminished.

The reasons for such concealment and downplayingrange from protecting the president's viability as anational and international political force, to lesseningchances that the president would be denied a secondterm, to protecting his (and, in the future, her)"presidentiality." Presidentiality can be defined as apresident's ability to use power and personal prestige toinfluence events both at home and abroad throughreputation as a skillful and imaginative "player.,,2 Sinceillness can well diminish a president's presidentiality,presidents are generally anxious to appear well,vigorous, and unimpeded by anyone or anything­and certainly not by any debilitating or image­destroying bout of ill-health.

In 1967, almost 200 years after the Constitution ofthe United States went into effect, it was amended in avery important way. During that year, the Twenty-FifthAmendment, which Dwight D. Eisenhower had triedhard, but failed, to have added to the Constitutionduring his administration, was finally implemented. Ithas four highly significant provisions. Section I

specifies that, "in case of the removal of the Presidentfrom office or his death or resignation, the Vice

President shall become President." In other words,when a President permanently vacates the presidentialoffice, the Vice President becomes President of theUnited States, not Acting President.

The Amendment provides in Section 2 that wheneverthe vice presidency is vacant, the President shallnominate a Vice President who shall take office uponmajority confirmation vote of both Houses of Con­gress. This provision is designed to ensure that the vicepresidency will not permanently be vacant-or vacantfor a significant period of time-during a presidentialadministration. The hope is that there will likely be aVice President in office who can succeed to thepresidency, or acting presidency, if the need shouldarise.

Section 3 of the Twenty-Fifth Amendment allows thepresident to give up voluntarily the powers and dutiesof the presidency for any reason(s) he sees as significantand be replaced by the Vice President who thenbecomes Acting President. Section 3 also provides that,at any time after passing on the powers and duties ofoffice to the Vice President, the President may transmitto Congress a written statement, indicating that he isnow again able to discharge the powers and duties ofthe presidential office. At such time, the powers andduties of the presidential office revert to the President.This means, of course, that a President who experi­ences an illness that is debilitating now has aconstitutional remedy at hand. He can transfer hispowers to the Vice President on a temporary basis andthen reclaim them whenever he sees fit to do so. Hecan, in fact, transfer his powers and duties to the VicePresident for any reason that persuades him to do so.Throughout the period of transfer, he remains Presidentof the United States while the Vice President serves onlyas Acting President.

Section 4 of the Twenty-Fifth Amendment is some­times referred to as the "nightmare provision" because itconjures up images of presidential overthrow at thehands of the Vice President and members of the Cabinet.In other words, it provides for the involuntaryseparation of a President from the powers and dutiesof office. Section 4 states: "whenever the Vice Presidentof the United States and a majority of either theprincipal officers of the executive departments or ofsuch other body as Congress may by law provide,transmit to the President pro tempore of the Senate andthe Speaker of the House of Representatives their

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written declaration that the President is unable todischarge the powers and duties of his office, the VicePresident shall immediately assume the powers andduties of his office as Acting President." This means, ofcourse, that the disabled President continues to bePresident of the United States but that the powers andresponsibilities of office pass on to the Vice Presidentwho functions as Acting President during the period ofthe President's inability. Thereafter, the President maydeclare in writing that no inability exists and shall thenresume the exercise of his powers and duties unless theVice President and a majority of cabinet members (ormembers of some other body created by Congress forthis purpose) protest. In such case, the matter is decidedby Congress within a specified period of time. If a two­thirds majority of each House of Congress determinesthat the President is unable to discharge the powers andduties of office, then the Vice president shall continue todischarge those powers and duties as Acting President.

Only seven years after enactment of the Twenty-FifthAmendment, Section 1 was invoked for the first time inAugust 1974 when Richard Nixon resigned thepresidency in the midst of the Watergate scandal andwas succeeded immediately by Vice President GeraldFord. Ford became, under Section 1 of the Amend­ment, President of the United States-and not ActingPresident. This transfer of power, even though occur­ring under extremely unpleasant and awkward circum­stances, was conducted peacefully, with great aplomband in accordance with the language of the Constitu­tion.

Section 2 of the Amendment was invoked in October1973 for the first time when Spiro Agnew was forced toresign the vice presidency on account of seriousfinancial "irregularities, " including bribery, in whichhe became involved during his tenure as Governor ofMaryland and, before that, Baltimore County Execu­tive. 3 After Agnew's resignation, President Nixonnominated Ford, then a Michigan congressman andHouse Minority Leader, to be the nation's new VicePresident. After being confirmed by Congress 54 dayslater, Ford became Vice President of the United States.

Following Nixon's resignation and Ford's assump­tion of the presidency, President Ford in August 1974nominated former New York Governor Nelson Rock­efeller to be the nation's new Vice President. Congressfinally confirmed Rockefeller's appointment after adelay of 121 days." If the Twenty-Fifth Amendment

had not existed at the time of Agnew's resignation, thevice presidency would have remained vacant untilJanuary 20, 1977, when a new President (JimmyCarter) and Vice President (Walter Mondale) wereinaugurated following the election of 1976. Without aVice President in office, this would have meant that theperson who succeeded Republican Richard Nixon inthe White House in August 1974 would have beenSpeaker of the House of Representatives, Carl Albert ofOklahoma, a Democrat.

Section 3 of the Twenty-Fifth Amendment has beeninvoked on three occasions since it went into effect in1967. The first was in 1985 when Ronald Reaganinvoked it shortly before undergoing surgery for coloncancer. Some commentators have argued, however, thatthe Amendment was not really invoked at that time.They point to Reagan's ambiguous and hesitant wordsabout invocation of Section 3 in the letter that hesigned while in the hospital and soon before undergo­ing abdominal surgery. But a closer analysis wouldindicate that Reagan did indeed invoke Section 3 of theTwenty-Fifth Amendment at that time. More specifi­cally, although Reagan had indicated in the letter hesigned prior to undergoing surgery that "I do notbelieve that the drafters of this Amendment intended itsapplication to situations such as the instant one," hewent on to state, "Nevertheless, consistent with mylong-standing arrangement with Vice President GeorgeBush and not intending to set a precedent bindinganyone privileged to hold this office in the future, Ihave determined and it is my intention and directionthat Vice President George Bush should discharge thosepowers and duties in my stead commencing with theadministration of anesthesia to me in this instance."

Since Section 3 of the Twenty-Fifth Amendment isthe only constitutional mechanism by which a Presi­dent of the United States may voluntarily transfer hispowers and duties temporarily to the Vice Presidentand since Reagan clearly wanted to implement such atransfer, he must, by necessity, have invoked Section 3.Supporting this conclusion is the fact that some ninehours later, President Reagan signed a second letter,this one reclaiming presidential powers and duties.Again in this instance, Reagan was adhering to aprocedure established directly by Section 3 of theTwenty-Fifth Amendment.

Indeed, if there were other constitutional mecha­nisms that would have achieved such a transfer of

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presidential power, why would Section 3 of theTwenty-Fifth Amendment have been needed at all?Reagan himself seems to have taken a definitive step toend this debate over his intentions when he statedclearly and unequivocally in his autobiography, AnAmerican Life, that "Before they wheeled me into theoperating room, I signed a letter invoking the Twenty­Fifth Amendment, making George Bush acting presi­dent during the time I was incapacitated underanesrhesia.:" It would certainly appear that Reaganhimself is the best authority in determining whether ornot he invoked Section 3 of the Twenty-Fifth Amend­ment-and Reagan himself has written explicitly thathe did do so.

The two remaining instances when Section 3 was putinto effect took place in 2002 and 2007, whenPresident George W. Bush passed on his powers andduties to Vice President Dick Cheney for short periodsof time as the President was about to undergocolonoscopies under general anesthesia. In each in­stance, Cheney became Acting President of the UnitedStates. Also in each instance, presidential powers andduties reverted to George W. Bush shortly after thesemedical procedures were completed.

It might be worth noting here that Section 3 was notinvoked in at least one instance when it certainlyshould have been. This was on March 30, 1981, justtwo months after Ronald Reagan became President,when he came close to death at the hands of would-beassassin John Hinckley. When Hinckley opened firethat day with his .22 caliber handgun outside theHilton Hotel in downtown Washington, DC whereReagan had just given a speech, the President's presssecretary, James Brady, was struck in the head by abullet, a secret service agent was shot in the stomach,and a Washington, DC policeman was wounded in theneck and shoulder. Although neither Reagan normembers of his Secret Service detail believed initiallythat the President had been struck by a bullet, theyquickly learned that they were incorrect. 6 Suddenly, thePresident began coughing up blood and his limousine­at that moment speeding toward the White House­was redirected immediately to George WashingtonUniversity Medical Center, a four-minute drive away.Upon arrival there, doctors quickly discovered that thePresident's left lung had collapsed, making it verydifficult for him to breathe, that he had lost nearly halfof his blood supply, and that he had no recordable

blood pressure. Transfusions were begun at once andReagan soon underwent surgery under general anes­thesia for three hours so that his severe internalbleeding could be stopped. During this surgery andduring the immediate recovery period that followed,the President was simply too incapacitated to haveresponded to any crisis that might then have beset thecountry. Yet the Twenty-Fifth Amendment was notinvoked in this unsettling instance.

This led to an embarrassing episode in whichSecretary of State Alexander Haig, believing errone­ously that he was second in line (after Vice PresidentGeorge H. W. Bush) in succeeding to the presidency,announced during an impromptu news conference that"Constitutionally, gentlemen, you have the President,the Vice President, and the Secretary of State in thatorder. As of now, I am in control here, in the WhiteHouse.,,7 In making this unfortunate statement, Haigwas publicly misinterpreting the line of presidentialsuccession, apparently forgetting that in 1947 Congresshad changed that line by inserting the Speaker of theHouse of Representatives and President pro tempore ofthe Senate before the Secretary of State and othermembers of the Cabinet. Haig's blunder frightenedmany people both in and outside of the United Statesbecause it appeared to be an awkward attempt to seizepresidential power. The episode badly damaged Haig'sstanding in the Reagan administration, hastened hisdeparture from the cabinet and effectively ended hischances to seek the presidency at a later date.

The important lesson that emerges from this episodeis that Section 3 of the Twenty-Fifth Amendmentshould be invoked by presidents whenever they aremedically incapacitated so that presidential powers andduties will devolve clearly and constitutionally on theVice President, who stands first in the line ofsuccession, or on to whichever official stands next inthe line of succession if the vice presidency should bevacant or the Vice President unable, for whateverreason, to succeed. Ironically, in the instance ofReagan's attempted assassination, the possibility ofinvoking Section 3 was, in fact, briefly considered byReagan's staff and then quickly rejected. Somewhatironically, these staff members did not discuss thematter with the senior White House Physician, Dr.Daniel Ruge. This was unfortunate because Dr. Rugewas convinced that Section 3 of the Amendment shouldcertainly have been invoked since the President was

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then too incapacitated to exercise the powers andduties of office." This episode underlines the impor­tance of Section 3 in allowing presidents to voluntarilytransfer their powers and duties to the Vice President,as specified by law, until such time as they feel able toresume their powers and duties. Failure to do so maywell put the country at risk and may also endanger thehistorical reputation of the President.

There were at least two additional instances wheninvocation of Section 3 might have emerged asnecessary but, in both instances, the need seemed todisappear when the status of the presidential incapacityquickly changed or became clarified. The first was in1991 when President George H. W. Bush suddenlybegan to experience a protracted episode of atrialfibrillation (irregular heart rhythm and increased heartbeats per minute). The condition is normally not life­threatening in itself but if it continues for an extendedperiod of time, it can lead to the formation of bloodclots that may strike the brain. Bush was quicklytransported to Bethesda Naval Hospital where he wasgiven digoxin and then procainamide. Within arelatively short period of time, the President's heartbeatreturned to a normal rhythm. Had his heartbeat notreverted to its prior rhythm, doctors might well haveused electrical shocks to achieve this end result. Ifelectrical shocks had been necessary to use, Bush wouldhave had to undergo a general anesthetic--renderinghim unconscious-for a short period of time and hisVice President, Dan Quayle, would have becomeActing President of the United States. This assumes,of course, that Section 3 of the Twenty-Fifth Amend­ment would have been invoked by President Bush inthis instance, as seems quite likely.

The second instance when invocation of Section 3was at least contemplated occurred on March 14, 1997when President Bill Clinton tripped and fell badly inFlorida. As he fell, his leg snapped so loudly that it washeard clearly by those near him. Clinton sat on theground in great pain until being taken by ambulance toa nearby hospital. There it was determined that thepresident should undergo immediate surgery on hisinjured leg. Mindful of the Twenty-Fifth Amendment,White House Physician, Dr. Connie Mariano, consult­ed with one of the hospital's orthopedic surgeons aboutthe type of anesthesia that leg surgery of the President'ssort would require. She was informed that theprocedure is usually performed under epidural, and

not general, anesthesia. In other words, the Presidentwould be fully awake throughout. Clinton thenspecifically instructed his medical team not to givehim anything that would diminish his reasoningabilities. This meant again that the President wouldbe fully conscious and mentally alert throughout thesurgery and invocation of the Twenty-Fifth Amend­ment would not be necessary. The surgery lasted fortwo hours and four minutes and after its completion,Clinton was brought back to his hospital suite with theepidural still in place. Two days later, he returned to theWhite House seated in a wheelchair and on thefollowing day, left for Helsinki for a summit meetingwith Russian leader Boris Yeltzin. Therefore, Section 3was not invoked in this case because the Presidentremained fully alert-and able to respond to any crisisthat might emerge-while undergoing surgery on hisinjured leg."

Section 4 of the Twenty-Fifth Amendment is the onesection that has yet to be invoked. Although it surelyraises the unpleasant specter of presidential "over­throw," some attention should be focused on thebenefits of this provision. Simply, it offers a constitu­tional remedy for any instances in which a Presidentrefuses-or is for whatever reason unable-to ac­knowledge severe inabilities. It also inserts into thedecision-making process the Vice President, the personselected by the President as a running mate andpotential successor, whether because of geographicalbalance, shared political perspectives, or some otherfactor. Then too, it involves the members of theCabinet, all of whom were appointed by the Presidentfor specific reasons and subsequently confirmed by theSenate. In other words, at least some members of theCabinet are likely to be close associates, and even closefriends, of the President as well as having influence inthe executive branch. These individuals are likely to bevery careful and solicitous of the President's status aschief executive and hesitant in separating him from thepowers and duties of the presidency. Perhaps theseconsiderations should have a calming effect when onecontemplates possible invocations of Section 4 of theTwenty-Fifth Amendment. The greater problem, infact, might be that the closeness of Cabinet members tothe President could render them very reluctant to voteto relieve him of his powers and duties, even when theneed seems present.

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Special issue contributors

Contributors to the Northeastern University Confer­ence on Presidential Disability and Succession present­ed a series of papers that touched directly or indirectlyon various aspects of these complex topics. Theirpapers are assembled here in this special issue ofPolitics and the Life Sciences not only to clarify andadd to the historical record about presidential inabilitybut also to illuminate the many political, legal,medical, and constitutional contingencies that futurepresidential administrators may face. Although thecontributors to this issue have different disciplinaryand professional backgrounds, they have significantand somewhat overlapping credentials and interests­in American politics, constitutional law, the presidencyand vice presidency, presidential impairment, and, ofcourse, the Twenty-Fifth Amendment to the Constitu­tion. Below, biographical sketches of each contributorare listed in the order in which their papers appear inthe issue, along with a brief summary of their primaryfocus and findings.

John D. Feerick, LL.B., Fordham University, writeshere about the Constitution's Twenty-Fifth Amend­ment, a topic of enduring interest. Professor Feerickserved as Dean of the Fordham Law School from1982 to 2002. Currently, he is the Sidney C. MorrisProfessor of Law in Public Service and Founder andDirector of the Feerick Center for Social Justice. Hisexperience in the public sector is extensive. Hechaired the New York State Ethics Commission,Commission on Public Integrity, Commission toPromote Public Confidence in Judicial Elections,and served as President of the New York City BarAssociation (1992-1994). In 1964, he was a memberof the American Bar Association's Conference onPresidential Disability and Vice Presidential Vacancy,the recommendations of which contributed greatlyto shaping the final version of the Twenty-FifthAmendment. He is the author of numerous articleson topics of constitutional and ethics reform and hisPulitzer-prize nominated book, The Twenty-FifthAmendment (Fordham University Press, 2014), isnow in its third edition. In his article for this specialissue, Professor Feerick offers a perceptive analysisof the Twenty-Fifth Amendment's development andits role in resolving various issues associated with

presidential disability. The first of these is that, underthe Twenty-Fifth Amendment, the President now hasthe opportunity to declare his own inability and maydo so unilaterally for whatever reason(s) seemappropriate. He may also determine when theinability ends. This two-way, entirely peaceful andentirely constitutional transfer of power, initiatedpersonally by the President, is now one of the mostimpressive features of our constitutional system andthe envy of much of the world. There remain notablegaps in succession procedures, however, and Feerickurges the policy-making community to resolve thesediscrepancies proactively rather than risk facing afuture constitutional crisis.

Joel K. Goldstein, J.D., Harvard University, D. Phil.(Politics), Oxford University, is the Vincent C. ImmelProfessor of Law at St. Louis University School ofLaw. In addition to his reputation in the field of law,Professor Goldstein is a preeminent scholar of theAmerican vice presidency. He has published TheModern American Vice President (Princeton Univer­sity Press, 1982) and his chapter on the vicepresidency of Al Gore is included in RosannaPerotti's The Clinton Presidency and the Constitu­tional System (Texas A&M University Press, 2012).His articles have appeared in such journals as theUniversity of Pennsylvania Journal of ConstitutionalLaw, Fordham Law Review, Houston Law Review,Wake Forest Law Review, and Presidential StudiesQuarterly. In his contribution to this special issue,Professor Goldstein explores one of the mostchallenging, and interesting, cases of presidentialillness-and also one of the most challenging, andinteresting, cases of presidential disability-in Amer­ican history. In 1919, Woodrow Wilson suffereddebilitating strokes that prevented him from exer­cising presidential powers and serving fully asPresident of the United States. In fact, Wilson wasso withdrawn from events that rumors circulatedthat he had died. Yet when the Secretary of Stateconvened cabinet meetings in Wilson's absence, theailing President summarily removed him from office.Understandably, Vice President Thomas Marshall,reluctant to overstep "proper" bounds, was largelyinvisible during this protracted crisis. As presentedhere so well, the Wilson case should serve as a usefuland important reminder of the grave impacts of

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presidential disability and the many challenges suchdisability can pose for the political system and thenation.

Robert E. Gilbert, Ph.D., University of Massachu­setts, Amherst, is the Edward W. Brooke Professor ofPolitical Science at Northeastern University and aformer long-time Chair of Northeastern's PoliticalScience Department. He has published three booksand many articles that focus on the issue ofpresidential disability. His book The TormentedPresident: Calvin Coolidge, Death and ClinicalDepression (Praeger, 2003), along with his articlesin such journals as Political Psychology, PresidentialStudies Quarterly, Journal of American Studies,Congress and the Presidency, White House Studies,and Fordham Law Review changed the way manypeople view the Coolidge presidency. Rather thanseeing Coolidge as an inept and weak president,Professor Gilbert made a strong case that Coolidgewas incapacitated by unrelenting grief over theunexpected death of his favorite son, 16-year-oldCalvin, Jr. In this special issue, Gilbert focuses onanother President who suffered a serious illnessduring his presidency and who, soon after, becameinvolved in a debilitating political scandal. In 1985,Ronald Reagan underwent surgery for colon cancerand then, some nine hours later, unwisely reclaimedthe powers and duties he had passed on to VicePresident Bush under the Twenty-Fifth Amendment.Shortly thereafter, Reagan, still heavily incapacitatedbecause of the medical procedures he had under­gone, apparently made decisions that contributeddirectly to the development of the Iran-Contrascandal, one of the most serious and devastatingscandals in modern American political history.Although some believe that President Reagan surelylied about his recollection of his own involvement inthe arms-for-hostages (and funding of the Nicara­guan rebels) deal, Professor Gilbert offers a different,more medically informed explanation in this article.

Rose McDermott, Ph.D., Stanford University, isProfessor of Political Science at Brown Universityand former President of the International Society forPolitical Psychology. She has authored or co­authored five books, including Presidential Leader­ship: Illness and Decision-Making (Cambridge Uni-

versity Press, 2007) and her articles have appeared insuch journals as the American Journal of PoliticalScience, Political Psychology, Journal of Politics,Emory Law Journal, International Studies Quarterly,and Politics and Gender. Professor McDermott'scontribution to this special issue focuses on a veryimportant, and generally overlooked, topic. Presi­dential physicians are usually exceptionally trainedand highly accomplished in their fields of medicalexpertise. But even White House medical staff mightoccasionally be focused more on their own ambi­tions than on providing the President with the bestmedical care possible. Additionally, we see inProfessor McDermott's analysis that some presiden­tial physicians have been skillful infighters who haveused their political "smarts" to protect their role andstatus in the President's inner circle. In this article,McDermott focuses on just such a scenario, one thatshowed itself with force during the presidency ofJohn F. Kennedy. A President with multiple illnesses,Kennedy's medical care was arguably compromisedby the explosive and unsettling problems that, asMcDemott documents, were associated with variousmedications and drug treatments prescribed byphysicians who were not working as a team. Whendisruptive power struggles erupt over presidentialcare, these political machinations themselves becomethreats to the President's health and well-being. Yetproblems involving presidential medical care can bedifficult to resolve because the President and familymembers close to the President might not be awarethat they exist.

Michael S. Dukakis, J.D., Harvard University, isDistinguished Professor of Political Science atNortheastern University and Visiting Professor ofPolitical Science at the University of California, LosAngeles. Earlier, he served as Governor of Massa­chusetts for 12 years and remains the longest servingGovernor in the history of the Commonwealth. Hisfinal gubernatorial election in 1986 saw him capturealmost 70 percent of the vote. After defeating otherprominent Democrats, including Al Gore, GaryHart, Joseph Biden, and Jesse Jackson during the1988 primaries, Governor Dukakis became theDemocratic presidential nominee. As a presidentialcandidate, Dukakis experienced the frustratingreputational harm that can be inflicted when untrue,

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inflammatory, and inaccurate accusations of ill­health were leveled against him during the courseof the campaign. In this instance, Dukakis' imagewas tarnished by one particularly high-placedsurrogate, the President of the United States. RonaldReagan's seemingly benign intervention in thecampaign, combined with media coverage of thehealth issue being raised against Dukakis, contrib­uted to an 8-point drop in support for his candidacy.Interestingly, this drop was identical to the 8percentage points by which Dukakis lost the 1988presidential election. In his unique contribution tothis special issue, former Governor Dukakis chron­icles the frustrations and disappointments he expe­rienced during this episode and offers a candidatepost-mortem of his unsuccessful election bid. Hisobservations are an important addition to thehistorical record and should prove instructive forfuture candidates, for public discourse, and forscholars interested in the political damage thathealth-related accusations can cause.

Mark J. Fisher, M.D., University of CincinnatiCollege of Medicine, J.D., Loyola Law School, isProfessor of Neurology, Anatomy and Neurobiologyand also Professor of Political Science at theUniversity of California, Irvine. His publicationsinclude articles in Clinical Neurophysiology, Journalof Cerebrovascular Disease, Journal of EmergencyMedicine, Journal of Neuroimmunology, Journal ofCerebrovascular Disease, the European Journal ofNeurology, and the Journal of Neurological Sciences.David L. Franklin, Psy.D., Alliant InternationalUniversity, is Associate Clinical Professor in theSchool of Medicine at the University of California,Riverside, where he studies severe mental illness andneurodegenerative processes. Dr. Franklin's articleshave appeared in the American Journal of Psychiatry,Annals of Clinical Psychiatry, Current Psychiatry,and Comprehensive Psychiatry, and other journals.Jerrold M. Post, M.D., Yale University, is Professorof Psychiatry, Political Psychology, and InternationalAffairs at George Washington University. Prior toGeorge Washington, he founded and directed theCenter for the Analysis of Personality and PoliticalBehavior, which provided assessments of foreignleadership for presidents and other senior govern­ment officials. Dr. Post played the leading role in

developing the "Camp David Profiles" on Menac­hem Begin and Anwar Sadat for President Carterprior to the Camp David meetings. His booksinclude The Mind of the Terrorist (Palgrave Mac­millan, 2007), The Psychological Assessment ofPolitical Leaders (University of Michigan Press,2005) and When Illness Strikes the Leader (co­authored with Robert Robins, Yale University Press,1993). In their paper for this special issue, Drs.Fisher, Franklin, and Post offer a compelling,research-based analysis of severe medical problemsthat might afflict older individuals who occupy high­level governmental positions in the United States andelsewhere.

Note

As the convenor of the April 3, 2014 Conference onPresidential Disability and Succession at NortheasternUniversity, I would like to express my gratitude tothose who presented papers at this day-long event.More specifically, I thank Michael Dukakis, JohnFeerick, Mark Fisher, John Fortier, Joel Goldstein,Rose McDermott, and Lawrence Mohr. I particularlythank those speakers who subsequently refined theirpapers and submitted them for review and publicationin this special issue of Politics and the Life Sciences.

I also wish to express my gratitude to Erik Bucy, thejournal's editor, for attending the April 3 conferenceand, of course, for agreeing to devote an entire issue ofPolitics and the Life Sciences to papers presented at thisevent. In particular, I am especially grateful to him forthe time expended and expertise lent in bringing thisspecial issue to fruition.

-Robert E. Gilbert

References1. Rudolph Marx, The Health of the Presidents (New York:G.P. Putnam's Sons, 1960), pp. 11-14.

2. See Richard E. Neustadt, Presidential Power and theModern Presidents (New York: The Free Press, 1990), pp. 50­72.

3. Richard M. Cohen and Jules Whitcover, A HeartbeatAway: The Investigation and Resignation of Spiro T. Agnew(New York: Viking Press, 1974).

4. For a fascinating account of the Rockefeller confirmationbattle, see John D. Feerick, The Twenty-Fifth Amendment: Its

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Complete History and Applications (New York: FordhamUniversity Press, 2014), pp. 170-187.

5. Ronald Reagan, An American Life (New York: Simon andSchuster, 1990), p. 500.

6. See John R. Barletta, Riding with Reagan: From the WhiteHouse to the Ranch (New York: Citadel Press, 2005), pp.132-133.

7. Alexander M. Haig, Jr., Caveat: Realism, Reagan, andForeign Policy (New York: Macmillan, 1984), p. 160.

8. Robert E. Gilbert, The Mortal Presidency: Illness andAnguish in the White House (New York: Fordham UniversityPress, 1998), pp. 224-225.

9. For a discussion of both the George H. W. Bush andClinton "cases," see Gilbert, pp. xi-xvi.

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