How to take the politics out of cognitive testing of politicians

Cognitive testing is not a weapon. But you wouldn’t know that by following the last few years of American politics.

Here are some recent headlines: “Embarrassing Video Reveals Trump’s Alarming Cognitive Decline” (New Republic). “Democrats Will Pay for the Biden Big Lie” (Wall Street Journal). “America’s Gerontocracy Problem Goes Far Beyond the President” (New York Times).

Donald Trump himself got into the game. “Joe should immediately take a Cognitive Test,” the former president posted on Truth Social in June, “and I will go with him.”

Cognitive testing, when properly administered, can identify signs of mental decline, allowing for prompt interventions. In the case of elected officials, such tests could theoretically protect government integrity and the public good. But these tests also raise important issues of appropriateness, privacy and consent.

First, who exactly should be tested? With many elected officials remaining in their positions well past the traditional retirement age, the case for testing national leaders seems relatively strong. But other jobs also hold great authority, responsibility and public trust. What about airline pilots, surgeons or CEOs?

Even when cognitive testing is appropriate, we must be vigilant about privacy and confidentiality. Personal healthcare data derived from cognitive tests is highly sensitive, and its misuse or unauthorized disclosure can have profound consequences. We should focus on creating a balanced approach that safeguards the efficacy of cognitive testing, the privacy rights of elected leaders and the needs of the office.

Furthermore, whenever sensitive cognitive and medical data is collected, robust protection measures are essential. Health care data must be stored securely, with strict access controls to prevent leakage or unauthorized use. We must be on guard against self-serving practices and people who would force elected leaders to withdraw from a race or step down prematurely, or who would use such testing to manipulate or coerce them in the performance of their public duties.

Critically, decisions based on these results should be made with a comprehensive understanding of each individual’s overall health and performance context. A sudden decline in test scores might not necessarily indicate an immediate inability to perform; it could be influenced by temporary factors such as stress or lack of sleep. Thus, cognitive testing should be part of a broader assessment strategy, including regular performance reviews and holistic health evaluations.

Cognitive tests should not be used as the sole determinant of individuals’ capability to perform their duties. Instead, they should be integrated into a broader assessment framework considering multiple aspects of performance and health. There is a risk that overreliance on cognitive testing could lead to premature or unjustified conclusions about someone’s fitness for a role, potentially resulting in unfair treatment or forced retirement. 

Moreover, the potential misuse of cognitive testing results for purposes other than assessing cognitive fitness — such as using the data to influence succession planning or to apply undue pressure on individuals to retire — must be strictly prohibited. While high government officials may waive the right to object to cognitive testing by accepting the public trust, there should still be a role for informed consent beyond the narrow use case of assessing fitness for office. Policies should be implemented to ensure that cognitive test results are used ethically and responsibly, with clear guidelines on their intended use and limitations.

Within this process, it is essential to define the role of independent oversight, especially when assessing our elected leaders. Independent reviews help ensure that testing protocols are unbiased and ethically sound. Such supervision can also address potential conflicts of interest, as the entity conducting the tests must not be vested in the outcomes, especially in tightly contested political races.

As we navigate the complexities of cognitive testing in high-stakes political roles, it is crucial to balance ensuring elected officials’ performance and protecting their right to privacy. By fostering a culture of full transparency, informed consent and robust data protection, we can harness the benefits of cognitive testing while respecting the dignity and autonomy of those being tested.

Neil Richards is the Koch Distinguished Professor in Law and codirector of the Cordell Institute for Policy in Medicine and Law at Washington University in St. Louis. Mary Mason, MD, is associate director of the Cordell Institute and an adjunct law professor.