President Joe Biden, 2020. Andrew Harnik/Associated Press.
Nancy C. Unger is a professor of history at Santa Clara University and a faculty scholar with the Markkula Center for Applied Ethics. Views are her own.
It’s still early days in the controversy over Original Sin: President Biden's Decline, Its Cover-Up, and His Disastrous Choice to Run Again. Nevertheless, Jake Tapper and Alex Thompson’s insistence that Joe Biden’s refusal to relinquish power and the misguided compassion and loyalty that led his inner circle to hide or deny the extent of his diminished physical and mental capacity raises some hard, ethical questions. The focus here is not whether even a diminished Joe Biden would have been a better president than Donald Trump, but rather identifying the ethics of compassion in politics and in daily life.
Anyone who’s ever worried if a parent or grandparent is losing their capacity to drive safely knows that sometimes the desire to protect a loved one’s dignity and preserve their independence and personal power can be directly at odds with their physical safety—and the safety of others on the road. But deciding when “diminished capacity” rises to the level of requiring intervention is tricky. Sure, in Biden’s case the president had slowed down physically, but peak physical fitness is hardly a requisite for vital political leadership. Franklin Roosevelt served three terms and the beginning of a fourth, guiding the nation through The Great Depression and World War II despite paralysis from polio. Combat veteran Senator Tammy Duckworth (D-Illinois) demonstrates that even profound physical injury does not necessarily have a negative impact on a politician’s leadership abilities.
A certain level of physical fitness should nevertheless play a role in compassionately helping someone in power decide if they remain fit for office—now and in the foreseeable future. The prognosis following Joe Biden’s recent prostate cancer diagnosis, particularly if it had been denied or downplayed, might well have had a profound impact on his second term. Encouraging a leader, out of loyalty and compassion, to refuse to relinquish their seat of power in the face of almost certain serious physical decline can have enormous political ramifications. Ruth Bader Ginsburg, who, despite her myriad bouts with cancer and public pleas from liberal law scholars, decided not to retire in 2013 or 2014 when President Barack Obama and a Democratic-controlled Senate could have appointed and confirmed her successor.
Prior to his cancer diagnosis, it wasn’t Biden’s increasing physical frailty that was so concerning. His critics have presented it as the least important aspect of the overall diminishment of the president’s ability to provide sharp and reliable leadership. The list of concerns is long including cognitive fuzziness, especially late in the day; forgetfulness, including the inability to recognize close friends and associates; and poor communication, including mumbling, losing the thread of the conversation, and non sequiturs.
Is it fair to blame someone in cognitive decline to fail to recognize that they’re in cognitive decline? Is it fair to blame those who love and admire, and deeply support, the work of someone in cognitive decline to refuse to recognize and acknowledge that decline? The difference between the president and his inner circle is where ethical considerations become paramount.
Joe Biden appears to sincerely not be able to recognize his decline, asserting emphatically on The View in May that those who claim that his ability to govern was diminished “are wrong,” adding, “There’s nothing to sustain that.” This insistence explains his willingness to debate Donald Trump late in the day, rather than insist on an earlier time that would likely have resulted in a far better performance by the incumbent. It explains his willingness to grant interviews after the election in which he performed poorly. To blame an impaired man for not recognizing his impairment seems unjust.
So where do compassion and ethics enter the picture, and what happens when they are at odds against each other? For certainly Biden’s wife and inner circle did recognize his decline. His work hours and public appearances were scaled back. His aids attempted to remedy some of the president’s communication problems with prepared scripts. Jill Biden is widely recognized as a fierce protector of her husband. Even as she insisted that he was fully capable, she was increasingly assisting him in a variety of ways during public appearances. Some of her actions and comments were strikingly similar to those of First Lady Nancy Reagan, who also frequently sought to run interference for her husband, particularly as rumors of his cognitive decline increased in his second term, while insisting on his fitness to serve.
Significantly, just as an elderly or increasingly impaired driver can point to a spotless record as evidence of their fitness to continue to remain behind the wheel, the Bidens and their inner circle could point to the many achievements of his administration and the lack of any damning evidence of poor or irrational decisions. Biden’s personal physician declined to administer a cognitive screening, saying to those who doubted that the president was cognitively capable, “Listen, he is doing the job.”
But the efforts by those closest to him to mask Biden’s cognitive decline reveal that they recognized it. Once recognized, cognitive decline requires acknowledgement and careful analysis of its severity, particularly in regard to the impact that poor decision making and communication can have on others. This is rarely easy. But in the case of a possibly impaired driver, the potential for damage can’t be ignored just because there hasn’t been an accident yet. A single impaired driver could cause untold damage. A cognitively impaired president has the power and resources to do damage, through action or inaction, on an almost unthinkable scale. It is imperative that our compassion and desire to protect the dignity and independence of our loved ones not overshadow our ethical obligation to the greater good.
Moreover, our commitment to protecting the greater good can also prove to be a compassionate act that benefits our loved one. Certainly, compassion drives us to protect our loved ones and even ourselves from hard truths—like recognizing and acknowledging cognitive decline. And confronting a loved one in denial about their impairment can be exceedingly difficult and painful. But acknowledging that there’s a problem can also be the first step in assessing it. Such assessments can aid in understanding not just the limits of the person in question, but also the strength of their ongoing capabilities. Screening tests are available, for example, to help determine if a person is still able to drive safely despite impairments. And having a disinterested expert present results that indicate significant cognitive decline can go a long way towards preventing or alleviating personal feelings of hurt or betrayal. In the case of a political figures like Joe Biden, Ronald Reagan, and a current host of elderly U.S. Senators, knowledge is power, in that it can belie rumors of exaggerated infirmities. Perhaps most importantly, acknowledging impairment is the first step to gaining access to a wide variety of interventions that may improve function and/or provide compensatory strategies and coping skills.
Recognizing and investigating impairment is the ethical and compassionate choice. Whether the person in question is the president or a private citizen, they may not be able to recognize their own impairment. In such cases, the evaluative process must be put into motion by family and/or inner circle members. If this difficult but ethical action is taken, the impaired individual and the greater good can both be protected and empowered.