A question reverberating through the media this election cycle is: How old is “too old” to serve as president? The age of leaders for Democratic field include former Vice President Joe Biden, 76 years old; Sens. Bernie Sanders, 77; and Sen. Elizabeth Warren, 69 — all hoping to topple President Donald Trump, 72. Eighty-nine-year-old former Sen. Mike Gravel remains a long shot. As a bioethicist who studies the history of presidential health, I think this is fundamentally the wrong question.
Age has arisen in presidential politics before. Readers born prior to a certain date will recall that Ronald Reagan’s 69 years proved controversial during his campaign to unseat President Jimmy Carter in 1980, and again when, at 73, he ran for reelection against former Vice President Walter Mondale. During the latter campaign, Reagan largely dispelled these questions with humor, responding to a debate question from the “Baltimore Sun’s” Henry Trewhitt with the quip, “I am not going to exploit, for political purposes, my opponent’s youth and inexperience.” Reagan coasted to a landslide victory.
The problem with age as a criterion is that it is both over-inclusive and under-inclusive. In the era before the Age Discrimination in Employment Act (1986), many Americans faced mandatory retirement at age 65. The result was the widespread loss of talent, especially among mid-level and senior executives, driven from their jobs at their primes. Now, such forced retirement is largely limited to fields where advanced age directly correlates with safety risks, such as commercial piloting.
One might argue that the average septuagenarian is not fit to serve as president, but the major presidential candidates are, by definition, not average. They are outliers. In addition, presidents shape the jobs to their skill-sets. An older president might conduct fewer lengthy meeting, but bring more wisdom to those he does hold.
Chancellor Konrad Adenauer, the father of modern Germany, began his first term in 1949 at age 73. Winston Churchill was reelected Prime Minister in 1951 at 77. Nor does age mean today what it did a generation ago: When President Eisenhower was elected at age 62, the average life expectancy for men in the United States was 65.8. Now it is 76.1, the same age as Vice President Biden.
Another question voters might as is: Are the candidates healthy? Unfortunately, this line of inquiry is neither easy to answer nor particularly revealing. Healthy enough for what? Franklin Roosevelt suffered from severe, often debilitating cardiovascular disease while leading the nation to victory in Europe. John F. Kennedy twice collapsed in his twenties as a result of his Addison’s disease. Abraham Lincoln endured years of agonizing clinical depression.
But even if a presidential candidate’s health were relevant to abilities, history shows that politicians are far better at hiding their infirmities than the media is at discovering them. In 1893, President Cleveland concealed surgery to remove a tumor from the roof of his mouth. A paralytic stroke left Woodrow Wilson an invalid in 1919, his wife and inner circle largely running the executive branch for his final year in office. In 1992, during his unsuccessful campaign for the Democratic nomination, Senator Paul Tsongas had his doctors tell the world that he had recovered from a lymphoma and was cancer free, when he had actually suffered a undisclosed recurrence in 1987. Tsongas died in 1997, before what would have been the end of his first term. Both 2016 presidential candidates, Donald Trump and Hillary Clinton, had their physicians vouch for their good health, but the public has no way of ascertaining whether those claims are true.
In the past, some bioethicist, like myself, have called for independent physical and cognitive testing on major presidential candidates. Unfortunately, in the current political climate, any such evaluations are likely to fall victim to accusations of partisanship. Moreover, the public is ill-equipped to evaluate the data that might be revealed: What is the average voter to do with the knowledge that a candidate scored a 25 out of 30 on his Folstein Mini–Mental State Examination or has a 15 percent change of her cancer recurring within five years?
Rather than focusing on age and heath, voters and the media should focus on issues of policy and temperament. These factors are visible to the public and likely do shed light on how a particular candidate will perform in office. For those genuinely concerned about age and health, I suggest asking fewer questions of the presidential candidates and their doctors, and scrutinizing the vice presidential candidates most carefully.
Jacob M. Appel, M.D. J.D., is director of Ethics Education in Psychiatry at the Icahn School of Medicine at Mount Sinai. His collection of ethical conundrums, “Who Says You’re Dead,” is forthcoming in October 2019.