Who Decides Whether Trump Is Unfit to Govern?

The 25th Amendment is imprecise, but clearly the intent is to cover impairment arising from illness. Once an impairment is diagnosed, doctors on the panel would need to determine whether the president is incapacitated and whether the incapacity results from the disorder. For grave conditions like psychotic episodes, severe dementia or massive strokes, the connection is easy. But what of less automatically disqualifying ailments?

The traits that might earn Mr. Trump a diagnosis of personality disorder were on display during the election campaign. His supporters judged that egotism was compatible with leadership. He is governing as he campaigned. He is impulsive, erratic, belligerent and vengeful.

But is Mr. Trump unfit to govern in the meaning of the 25th Amendment? If so, its provisions might have been invoked the day he took office. If not, when did the incapacity arise? Would the commission monitor a president’s behaviors, judging which is the last straw?

In practical if perhaps not in moral terms, these decisions might be less troubling if Mr. Trump were found, say, to have Alzheimer’s disease, with a resultant coarsening of longstanding personality traits. To the extent that the president’s supporters accepted expert opinion, they might be less resistant to the removal of a demented commander in chief than a narcissistic one.

But considering personality disorder only: How does it relate to fitness? Can erratic behavior be strategic? Decisions at this level of refinement become ever less scientific, less medical.

However flawed, the Goldwater Rule saves psychiatrists from the temptation to misuse diagnosis for partisan purposes. The establishment of a standing oversight commission reintroduces this concern, in spades. Assuming that doctors confirmed that Mr. Trump was egotistic, would they then declare him unfit based on established patterns of conduct — on Trump being Trump?

That result would strike those who elected him as elitist and anti-democratic. Don’t the people have the right to choose an exceedingly narcissistic leader?

For a president who is unfit but not impeachable and who still has the support of his cabinet, the Constitution offers Congress only this one way out, a declaration of impairment presented by a deliberative body of its choice. But that body need not be dominated by doctors. Senator Birch Bayh, the Indiana Democrat who drafted the 25th Amendment, which was ratified in 1967, specifically opposed relying on…

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