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Should presidential candidates be able to keep medical records private?

Democratic presidential candidate Sen. Bernie Sanders, I-Vt., pauses while speaking at a campaign event, Sunday, Sept. 29, 2019, at Dartmouth College in Hanover, N.H.
Cheryl Senter, AP

SALT LAKE CITY — Presidential candidate Sen. Bernie Sanders was hospitalized in Las Vegas Tuesday night after feeling “discomfort” in his chest. This raised speculation about his health and how it could affect the viability of his campaign. Is that fair? What medical information do candidates owe to voters?

The New York Times reported Sanders’ campaign would neither confirm nor deny if the senator from Vermont, who is 78, had suffered a heart attack. Slate published a doctor’s conclusions that the episode was “very likely a heart attack.” The Las Vegas Review-Journal reported that the future of his campaign could be in jeopardy if it was.

According to the campaign, Sanders received two stents, small tubes inserted into narrowed or blocked coronary arteries to hold them open. This is a common procedure used to both treat and prevent heart attacks.

Sanders later tweeted, “Thanks for all the well wishes. I’m feeling good. I’m fortunate to have good health care and great doctors and nurses helping me to recover.” His wife said he will be home by the end of the week. He is expected to participate in the next Democratic debate Oct. 15.

But his hospitalization has ignited concern about the health of the candidate and of two other septuagenarian Democratic front runners, Sen. Elizabeth Warren, 70, and former vice-president Joe Biden, 76.

Sanders had already promised to release his medical records before the Democratic primary election. “The American people have the right to know about whether the person they are going to be voting for for president is healthy,” Sanders told NBC News a few weeks ago.

His statement echoed Biden, who said “there’s no reason for me not to release my medical records,” in response to questions from reporters at Texas Southern University.

Some experts warn that such health disclosures can significantly skew the outcome of a race if Americans prematurely disqualify a candidate based on medical information.

But others say the presidency isn’t the kind of job where a prospective employer doesn’t need to know you once had cancer.

“Because of the specialness of the presidency and the difficulty of replacing the president, it seems to be the balance falls in favor of releasing relevant information about somebody’s capability of doing the job,” said Leslie Francis, a law and philosophy professor at the University of Utah who directs its Center for Law and Biomedical Sciences. “You can make a stronger ethical case than you can in other cases.”

One problem, though, is “people equate certain types of health problems with age,” she added, “so there’s the risk of just plain stereotyping and age discrimination.”

Laura Polacheck, communication director for AARP Utah, thinks discussions about medical information are particularly salient with older candidates, since many people view senior-citizen status itself as a sign one in any profession has become weak or frail or perhaps even less mentally sharp than those who are younger.

Democratic presidential candidate Hillary Clinton speaks at a rally Thursday, Feb. 18, 2016, in Las Vegas.
FILE - Hillary Clinton speaks at a rally Thursday, Feb. 18, 2016, in Las Vegas.
John Locher, Associated Press

Americans went through this during the last presidential election cycle when in 2016 a video emerged where Hillary Clinton seemed to stumble getting into a van after excusing herself from a public appearance. Rumors flew that she’d had a stroke. It was actually pneumonia.

Polacheck said that while age brings perspective, skills and more experience on many levels, it’s not necessarily viewed as an advantage.

“With a younger person, if they have a medical issue, you make the assumption that they’ll bounce back quickly, that they’re healthy. … With an older person, there’s so much stereotyping,” she said.

Nor does age alone determine one’s health. When physician and attorney Dr. Aaron Seth Kesselheim looked at privacy issues for presidents vs. the public’s right to know in The Journal of Legal Medicine in 2002, he pointed out that no fewer than 14 of the 19 presidents in the 20th century experienced significant illness while in the White House, including Woodrow Wilson’s debilitating stroke, the heart failure that plagued Franklin Delano Roosevelt and Ronald Reagan’s colon cancer. Kesselheim also noted that presidents are often older and that the stressors associated with the job could contribute to illness, too.

Americans are fairly divided on medical disclosure. A 2016 Gallup poll found 51% thought a president “should release all medical information that might affect his or her ability to serve.” However, 46% said they should have the same right to privacy over their medical records everyone else is afforded.

“Just because a president has an illness doesn’t mean that’s a disqualifying factor if that illness can be effectively treated,” Lawrence C. Mohr, a former White House physician, told the Los Angeles Times.

Dwight Eisenhower suffered a heart attack during his presidency, but lived more than a decade.

Hiding medical conditions and keeping health matters private was the norm until the 1990s when former Massachusetts Sen. Paul Tsongas challenged Bill Clinton in the Democratic primaries, according to Time.

Tsongas was diagnosed with non-Hodgkin’s lymphoma, and left the Senate in the mid-’80s after one term. Once cancer-free for five years, he ran for the Democratic presidential nomination, but during the race died from treatment complications after a new growth was found. That set the stage for the race between former Arizona Sen. John McCain, 71, and Illinois Sen. Barack Obama, 47. And again, age and health were key topics.

In 2008, McCain addressed concerns by giving news agencies access to 1,200 pages of health records, which ABC reported “painted a picture of a man healthier than average for his age.”

Finding the balance between a candidate’s right to medical privacy and the public’s right to know relevant information about the person they’re voting for is difficult, said Robert Streiffer, a professor of medical history and bioethics at the University of Wisconsin-Madison.

Streiffer believes a high standard should be set for what kinds of information candidates should disclose.

He uses the analogy of an airline pilot: Employers can make taking health tests and giving the employer access to those tests a condition of the job.

“Medical conditions that are likely to seriously undermine the candidate’s ability to fulfill the core functions of the office” should be disclosed, said Streiffer. He stressed the word “seriously” and “likely.”

The standard should be strict, and anything below that standard should be up to the candidate to decide. Things like slightly elevated blood pressure or a normal case of pneumonia would not be considered relevant.

“Demanding wholesale release of candidates’ medical records sets a dangerous and inappropriate precedent,” wrote Dhruv Khullar a physician at NewYork-Presbyterian Hospital, in Slate.

He argued, like Streiffer, that only the most serious conditions that would clearly impede a candidate’s ability to act as president should be public. Otherwise, it could “stigmatize Americans struggling with certain diseases” or result in attempting to predict the future in ways that are impossible.

No one knows when their time is up.