Robins, Robert S. and Henry Rothschild. "Ethical Dilemmas of the President’s Physician." Politics and the Life Sciences 7, 1 (August, 1988):3-11.
From the Introduction. During the 1984 presidential campaign, questions were raised concerning President Reagan’s cognitive integrity in the televised debates. He hesitated before answering questions, appeared to lack attentiveness, and had difficulty remembering and finding words to accurately express his thoughts. These signs, sometimes indicative of early dementia, were reportedly intensified during the 1987 Reykjavik Conference, at which time the President was criticized by James Reston¾ admittedly an unsympathetic critic¾ the New York Times columnist. According to Reston, there may be "a human problem at the top of the government [that]. . . will have to be addressed with uttermost sympathy and care" (December 21, 1986). These questions were again raised by the Iran-Contra affair. For the President of the United States to have even a hint of cognitive dysfunction carries profound implications….
We know, however, that the problem of mental decline among chief executives is a real one. The mental capacities of Woodrow Wilson and Franklin Delano Roosevelt, for example, deteriorated while they were in office. Wilson developed hypertension as a young adult and suffered small strokes, which over a long period rigidified his behavior and thought processes. The changes in his personality were probably apparent during the negotiations at the Paris Peace Conference in 1919, and grew even stronger in his unsuccessful battle with the Senate for the ratification of the Versailles treaty. A massive stroke during a fatiguing whistle-stop tour in defense of the treaty destroyed not only his hopes for ratification, but the remainder of his presidency. His behavior after the stroke turned into a near parody of his earlier rigidity and denial. The United States never joined the League of Nations, and the remainder of Wilson’s presidency became a pantomime, with his wife, private secretary, and personal physic ian playing the principal roles (Weinstein, 1981; Post, 1983).
A different sort of mental impairment had led to a near-miss with international disaster several years earlier. Wilson and his first wife had an especially close emotional and romantic bond. When she died, Wilson experienced a severe reactive depression, the side effects of which included confused thinking and poor memory….
While attending the Yalta Conference, Roosevelt had evident impairment of his decision-making capacity resulting from a combination of hypertension, diffuse atherosclerosis, and congestive heart failure secondary to hypertension. He suffered from prolonged episodes of clouding of consciousness….
During his second term as Prime Minister of Great Britain at the age of eighty, Winston Churchill was afflicted by a significant dementia consequent to two strokes, in 1949 and 1960, a minor arterial spasm in 1952. He became but a shadow of the extraordinary leader he had been during World War II….
These four instances of disability illustrate two things. First, that chief executive disability can and has been highly consequential. In the two American illustrations, the composition of the League of Nations and the post-war settlement of Eastern Europe were likely affected by the decreased capacity of the American president. It is not possible to be sure what would have been had Wilson and Roosevelt been their younger selves at the crises described. On the other hand, unless one believes that negotiations are irrelevant or that the competence of the principal negotiators is irrelevant, then the medical impairment of Wilson and Roosevelt can be assumed to have had some, and perhaps decisive, effect.