By admin 
Aside from some brief written statements, the public has not heard directly from 84-year-old Senator Mitch McConnell since he fell at his home in Washington, D.C., and was taken away by an ambulance two months ago. Why he fell, what has happened since, and how he’s doing now remain unclear. His absence has inspired conspiracy theories, memes, and morbid speculation that a couple of awkwardly staged proof-of-life photos have done little to assuage.
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If Americans are doubtful that McConnell will ever return to the Senate floor, it’s understandable: This is not the country’s first encounter with a frail or ailing representative. Six elderly members of Congress have died just this term, and others have demonstrated mental decline. Younger members have also had episodes of incapacity, as when Representative Tom Kean of New Jersey missed months of work this past spring while hospitalized for depression. Our previous president suffered obvious but under-disclosed deterioration while in office; our current leader, who will leave office the oldest president we’ve ever had, is under constant scrutiny for signs of impairment.
Historically, our elected leaders have argued, for plenty of good reasons, that they are entitled to privacy regarding their health and discretion about when they leave. Congressional norms tie power to seniority, which discourages early retirement; airing the health status of our leaders risks creating national-security concerns. But letting politicians judge their own capacity to serve has simply not worked in the public’s interest. I’m a physician—a geriatrician, in fact—and I know from countless encounters with frail, aging patients that many have difficulty admitting when their capacity has started to slip. Many people struggle to recognize, too, when a new impairment means a permanent change in conditions, not just a temporary setback.
The United States needs a system to oversee its leaders’ fitness to serve. Currently, no independent entity assesses and publicly reports on the health of the president or members of Congress. Congress should make one. Let’s call it the Office of the Medical Adviser: an office of medical personnel designated to routinely evaluate whether our highest-ranking public servants can reliably fulfill their duties.
The OMA would serve a distinct function from the Office of the Attending Physician, which responds to emergencies at the Capitol, handles occupational-health concerns for Congress and the Supreme Court, and provides many members with primary care. Brian Monahan has held the role of attending physician of the U.S. Congress since 2009. On occasion, Dr. Monahan has provided information to the public about a representative’s health; in McConnell’s case, for instance, he has twice recently provided letters that offered few details about the senator’s condition, other than to imply that McConnell’s health was not as bad as the speculation surrounding it. (The OAP did not respond to a request for comment.)
This is the dilemma of both the OAP and the president’s physician: Their charge is to provide clinical services, not to represent the interests of the public. Their loyalty, correctly, is primarily to their patients. I would never lie if one of my patients asked me to offer documentation of their health, but I might agree to downplay areas of uncertainty or to keep some things private. My obligation to disclose would be secondary to my patient’s wishes and privacy.
The OMA, crucially, would not provide elected officials with care or medical advice. Rather, the office would periodically—say, once every two years—evaluate officials’ health and cognitive well-being. Congressionally appointed physicians would be empowered to request medical records, refer officials to specialists for additional input, and arrange additional testing. Their charge would be to determine whether an individual is cognitively and physically capable of carrying out the responsibilities of their office until their next evaluation, two years down the line.
The OMA would then publicly release brief, structured documentation attesting to a congressional member’s functional capacity. These letters would provide insight into a member’s health status without revealing details immaterial to their ability to meet the demands of their position. The public doesn’t need to know about every blood-pressure medicine someone is prescribed or every mole they have removed. Many members can and do ably perform their role while living with a disability, a chronic disease, or a treated mental illness; the OMA would enumerate only issues relevant to someone’s ability to meet the terms of their job, and would summarize all else as “additional health issues reviewed.”
But were a member to show signs of decline, whether from age or illness progression, the OMA would assess whether that person’s ability to fulfill their responsibilities was in jeopardy. And if an official suffered an acute event that might change their circumstances, as McConnell may have this summer, the office would automatically conduct additional evaluations of their health after a two-week absence.
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Other high-stakes professions require their practitioners to submit to this kind of evaluation. Hospitals, the military, and the Federal Aviation Administration all conduct periodic, proactive health assessments to determine fitness for duty. Pilots get evaluated for risk of sudden incapacitation during flight; soldiers get evaluated for “force readiness.” I am tested each year for various communicable diseases and have agreed to random drug testing in order to be staffed at the clinic where I work. If a pilot is found to have a health condition that might put them at risk midair, or a soldier is found to have developed a new impairment, or I am found to have tuberculosis, our employer can compel us to resolve those conditions before returning to duty, or put limitations on what work we can do.
In a situation in which an OMA physician had concerns about a member’s capacity, those concerns would be evaluated by a second physician. If both doctors agreed, they would then communicate their findings to the patient, to allow the person time to consider and adjust their plans—they might take a medical leave, or decide not to run for office again, or, in extreme cases, resign. Within a month, the OMA would provide the documentation to the relevant bipartisan ethics committee for review. In cases of member misconduct, the House and Senate ethics committees can recommend censure, expulsion, or, in the case of the president, impeachment; their mandate should be expanded to consider cases of medical incapacity, with the same recourses to action. Whatever decisions the committees or the officials themselves come to, the OMA would release its findings into the public record after an additional period, barring significant security concerns.
The OMA, in other words, would not have the authority to remove anyone from office; it would be empowered only to provide expert input to the committees already charged with maintaining the integrity of our government and to inform the public of its findings.
The U.S. would not require such an office if elected officials were willing to step aside when their health demanded it or if the people closest to them—their doctors, staff, and family—were willing to confront them in cases of decline. But recent years have provided too many examples of this kind of self-policing failing. In her memoir, Jill Biden confessed that she’d become concerned after President Biden’s disastrous 2024 debate performance that he’d had a stroke; Hunter Biden, on a recent podcast, suggested that perhaps the president’s undiagnosed-at-the-time prostate cancer was already causing impairment. These reports only affirm suspicions that people around the former president knew that he wasn’t well, even as he insisted on another presidential run.
Most Americans resent such lack of transparency. More than 60 percent believe that Biden was not forthcoming regarding his health, and approximately the same percentage agree that presidents ought to be required to release all medical information to the public. In another national survey, a proposal to remove officials when they show signs of mental decline achieved 87 percent approval. Age limits for office, which I support wholeheartedly, are also extremely popular.
Some younger elected officials recognize this. This year, Democratic representatives have put forward three separate proposals that would increase transparency about the health of public officials, whether by empowering a newly created commission to remove a president, creating a standard for “significant irreversible cognitive impairment,” or requiring members to file a public disclosure regarding any absence longer than 21 days. But none of these proposals can account for the uncertainty inherent in so many clinical scenarios, and they rely too much on civilians to make sense of complex medical situations. The proposals also become relevant only once an official shows signs that they are unable to do the job. Creation of an OMA would proactively offer assurance that they could.
Aging representatives may balk at increased medical scrutiny, but an OMA would also protect them. Structured disclosures should help prevent prying and skepticism. The public would be provided with enough information that leaders could then demand their privacy in good faith. An official process for determining whether and for how long someone needs to be out of work when ill would also mean that sick officials can take time and space to convalesce without feeling furtive.
The mere existence of medical oversight would also help nudge American elected leaders to confront their own frailties before they were faced with real censure. The body is a rate-limiting factor that many of us choose to ignore until we can’t; the requirement to disclose some health information might serve as a deterrent to older members considering running again, or to younger ones struggling to balance health issues with the job. Our leaders, after all, are only human, and most people don’t readily give up the keys when it’s time to stop driving. Sometimes, the right decision is to take the keys away.
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