The 25th amendment and presidential dementia
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Quite a few people, including people who specialize in diagnosing dementia, believe there is at least a strong possibility that Donald Trump is in what should be the early clinical stages of some form or forms of dementia (Dementia comes in several varieties, and it’s not unusual for the disease to occur in a so-called “mixed” form, in which the patient has more than one type at the same time). “Clinical” here is being used in contrast to pre-clincal and sub-clincal dementia. In the former, the organic processes that will eventually result in symptoms of the disease are already present, but as yet have not produced any symptoms. In the sub-clincal phase, symptoms are present, but are subtle and/or ambiguous enough that a clinical diagnosis has not yet been made.
The distinction between sub-clinical and clinical is particularly important as a practical matter, because formally diagnosing dementia is not a simple or straightforward process, but rather a multi-pronged investigation that includes everything from family history, to various tests of current mental acuity and physical behavior, as well as sometimes tests for biomarkers that suggest the presence of Alzheimer’s — the single most common form of the disease. The reason this is of practical significance because even in a situation where somebody isn’t trying to avoid making a dementia diagnosis for political reasons, it’s easy enough to avoid a formal diagnosis in the early stages of the disease if the patient and those close to him or her would prefer to do so.
Pushing in the other direction is the fact that sometimes dementia will feature a long period of very gradual change, followed by a sudden worsening of symptoms, that make the presence of the disease much harder to deny, even for patients and their families who have been committed to remaining in denial.
The relevance of all this to Trump and the 25th amendment is:
As long as Trump remains in the slow gradual stages of early dementia, it’s basically certain that he won’t be formally diagnosed, and that the political process will do nothing about the situation.
However: if sometime in the next few years or months, Trump suffers the sort of sudden worsening that makes his dementia difficult or impossible to deny, the 25th amendment will become relevant (I acknowledge it’s not relevant at all at present, even though it should be). That is, if Trump becomes sufficiently demented that it’s not possible to maintain him in office even as a manipulated figurehead, then it is quite possible that various powerful social actors, starting with the Republican party, will at least explore the possibility of using the amendment to remove him.
Crucial to this process is that Trump has to become sufficiently non compos mentis that he won’t be able to thwart the invocation of the Section 4 of the amendment, by for example firing cabinet officers before they can sign a letter declaring him unfit to remain in the presidency. This kind of undeniable severe cognitive collapse will also be a precondition to getting enough Republican legislators to join with Democrats so that Congress generates the two-thirds majority in both houses necessary to permanently remove Trump via Section 4.
A very odd at least in my view reaction I’ve heard to the discussions of Trump’s possible dementia is that it really doesn’t matter whether he’s demented or not. I assume people don’t mean this literally, or rather they mean something like it’s irrelevant if he’s in early stage dementia, because that won’t be enough to either formally diagnose or legally remove him (I agree with this). But the hypothetical here is about something else: What if Trump suffers a severe and therefore undeniable cognitive decline while still in office? Now I admit that for the hardcore of his cult — maybe 20% of the populace — there’s probably almost no cognitive decline that would be severe enough to be undeniable, since denying the most basic sorts of facts is what these people do on a daily basis. But 20% isn’t, I don’t think, enough to keep him in office, despite the extremely high procedural and political barriers to removing any president via Section 4.
Related to this, it’s a testament to the extreme weirdness of this historical moment that there can be actual non-trivial debates about it would be worse for Trump to remain in office even after becoming undeniably demented, or for J.D. Vance to become Acting President for the rest of Trump’s term. But that may well be where we will be at some point in the next three years.
. . . I’ll add that this is all part of a conversation that’s taking place in basically uncharted waters. I think it’s perfectly within the realm of possibility that Trump will deteriorate significantly over the next two years, announce that he’s running for president again, and the Republican party will go along with this even though a large number of states would refuse to put him on the ballot. It’s also quite possible that he’ll simply announce there isn’t going to be a presidential election in 2028, because there’s too high of risk that it will be stolen from him, like in 2020, and the Republican party (and five SCOTUS justices) will go along with this too. We simply don’t know how bad it’s going to get, because we’ve never been in any place even remotely like this before.