When a Country Leader’s Health Goes Downhill

As my annual driver’s license renewal approached recently, I received a notice from Israel’s Motor Vehicle Bureau to first undergo a medical checkup and an eye test before granting me the renewal. As this was the first time I had gotten such a demand, I asked why. The answer: at age 75, all Israelis are required to undergo these medical exams to ascertain their fitness (age 80 too, etc.).

Which set me thinking: for driving a car we need a medical checkup – but the leader of our country doesn’t? From there, the next question becomes self-evident: who decides when the Prime Minister is no longer capable, physically or mentally?

Joe Biden did the right thing by dropping out of the presidential race, but not for the reason most bandied about: that he couldn’t beat Donald Trump. The real reason is (and should have been discussed more widely): with some decline already evident, he would most probably not have made it in full control of himself by the end of his next 4-year tenure (assuming he was elected). And then during those years, who would decide whether he was fit, and through what sort of system?

Indeed, the shoe is now on the other foot. When he was president, Trump released a medical report showing that he had heart disease and was obese. Unfortunately, now as a candidate again for president, he refuses to divulge basic information on his condition, nor allow a new assessment to take place for public consumption. Based on what we do know, the chances of his suffering a serious heart attack in the next four years are significant.

Turning to Israel, such a question has nothing to do personally with PM Netanyahu (although he did suffer one bout of fainting in 2023); it has everything to do with any and all Israeli prime ministers. For those who have forgotten, over forty years ago PM Menachem Begin became deeply depressed for well over a year in the aftermath of the 1982 (First) Lebanon War. However, no one in the government was willing to mention this; only when Begin himself declared that he could no longer go on, did the Likud move into overdrive to select his successor.

Even more scary was what happened more than twenty years later when PM Ariel Sharon suffered a massive stroke. He passed away soon thereafter. But what if he hadn’t died? What if he had come out of it half fit (or even three-quarters)? Political pandemonium would have ensued as Israel did not then have a legislatively set procedure for deciding on a replacement.

That changed in 2022 – somewhat. The Knesset passed a law that states that only PMs can declare themselves unfit for office temporarily (e.g., before undergoing a serious operation), or permanently. The law goes on to declare that if the PM is unable/unfit to make such a declaration, then 3/4 of the Cabinet ministers and 2/3 of the Knesset (80 MKs) have to declare such for it to go into effect. (If such a vote is affirmative, then there’s a statutory position called “the PM replacement”: me’malei makom Rosh Ha’memshala; if such a person is not designated ahead of time, the Cabinet must vote on a successor).

This is a recipe for what can only be described in juicy Hebrew as a “political balagan” (chaos). On what basis would such a vote of unfitness be taken? Which doctors would first check the PM and divulge the full array of the PM’s medical condition? What happens if only 79 MKs are convinced? Are politicians really able to judge medical advice? And here’s an even more frightful scenario: a terrorist attack in the Knesset in which 41 MKs are killed (or more than a third of the government’s ministers). The law doesn’t state whether it’s 2/3 of 120, or 67% of living MKs.

But we don’t have to go into doomsday scenarios to realize that there’s a serious problem here. Indeed, the potential situation incorporates a paradox at its heart: a mentally declining PM is the one who has to decide whether s/he is still mentally fit – an obvious, logical contradiction. Luckily for the United States, President Biden still has the mental acuity to understand what is happening around him (and perhaps within himself as well), rendering the right decision for the good of the country.

Whether Israel’s prime ministers – past (Golda Meir had lymphoma from the mid-1960s; Begin; Sharon), present (Netanyahu), or future – had or will have the same acuity or courage to “out themselves” psychiatrically or medically, is a question left hanging. That’s a recipe for disaster. The time has come for delineating in much greater detail when, how, who, decides – and under which circumstances – that an immediate a change of the leader is necessary, for health reasons: that of the prime minister as well as the nation as a whole.

P.S. For those interested in the journalistic aspects of leadership ill-health reporting, see my article from 2003: https://www.researchgate.net/publication/10857074_Political_Ill-Health_Coverage_Professional-Ethical_Questions_Regarding_News_Reporting_of_Leaders’_Ailments