Never mind November. Is Biden fit to be president right now?

No one who watched the presidential debate last month can seriously think that President Biden is at the top of his game. It would be a deeply unfair expectation — he will turn 82 two weeks after Election Day, and he has been in elected office almost continuously for more than half a century.

Even so, the president looked unsteady. He is the same age as Carole King and Martin Scorsese, who both seem much more vibrant. Several times, Biden lost his train of thought and jumbled his words. The arguments made by his defenders, that it was an isolated incident or that he was jet-lagged or overprepared, are simply not credible. Unsurprisingly for a man in his eighties, Biden is obviously suffering from some degree of cognitive impairment.

The American Psychiatric Association’s “Goldwater Rule” rightly states that it is “unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.” It is wrong, on that basis, for a clinician, or anyone else really, to diagnose the nature and degree of Biden’s affliction.

That said, something is wrong. And while the president’s supporters may deny it, it is now widely rumored that foreign leaders have noticed a decline in his condition as well. Bluntly, if the New York Times knows it, then foreign intelligence services know it too. The questions facing the American public are: What is wrong with their head of state? How frequent are these losses of focus? Will they get worse? And if so, how quickly?

This is not mere scaremongering or a ghoulish intrusion into Biden’s personal life.

There is now intense wrangling over whether Biden should step aside as the Democratic Party’s candidate in November’s election and, consequently, who should replace him to maximize the chances of denying Trump a second term in the White House. The merits of plausible and implausible substitutes are consuming a great deal of oxygen.

But this debate risks ignoring a pressing concern. Even if Biden agrees to cede the nomination to another Democrat, he remains in office until Jan. 20, 2025; that is more than six months away. Six months is a lifetime in politics. Leaving aside the nomination and the election, any responsible observer has to ask whether Joe Biden is fit to be president right now.

It is not necessary to suggest that Biden is permanently confused or unable to function. Cognitive impairment is often episodic. Those who attest to the president’s engagement and focus are likely sincere. But if the leader of the United States struggles to concentrate, engage and articulate his thoughts on occasion, that is a matter for concern, because the presidency is not a predictable job. He could be required to respond to a crisis at any hour of the day or night.

Let’s take an extreme example. Annie Jacobsen’s recently released study “Nuclear War: A Scenario” sets out in painstaking and terrifying detail what would happen if the ultimate foreign affairs crisis were to occur and a nuclear missile is launched at the U.S. This is an unlikely eventuality, but we know that North Korea’s Kim Jong Un has been flexing his nuclear muscles, and that Vladimir Putin has repeatedly alluded to the potential use of nuclear weapons in recent years.

This may be only a remote possibility, but let’s be clear: If Biden is informed that a nuclear missile has been detected heading towards Washington D.C., he will have six minutes to decide how the U.S. should respond and whether it should retaliate.

The president has sole authority to launch nuclear weapons which cannot be delegated. The pressure to make such a decision in six minutes is almost unbearable for anyone, but what happens if Biden is having a “bad night,” as Barack Obama put it?

In theory, the resolution of this problem lies in the 25th Amendment to the Constitution, which provides for the vice president and a majority of the cabinet to declare that the president is “unable to discharge the powers and duties of his office.” The procedure is straightforward, but the amendment was adopted in 1967 and has never been invoked. There is no indication that Vice President Kamala Harris and the current cabinet have any intention of invoking its provisions now.

There is a political argument about who is most likely to represent the Democrats and defeat Trump in November. It is a profound debate with potentially enormous implications for the future of the nation. But this is a separate and distinct issue: Is Biden physically and mentally fit, 24 hours a day, to faithfully execute the office of president?

If the answer is no, then is his administration just hoping for the best?

Eliot Wilson is a freelance writer on politics and international affairs and the co-founder of Pivot Point Group. He was senior official in the UK House of Commons from 2005 to 2016, including serving as a clerk of the Defence Committee and secretary of the UK delegation to the NATO Parliamentary Assembly.