Prime Ministers and Presidents must be more open about their health status

Anyone who runs for Prime Minister or President should have an independent health examination to ensure their ability to govern, argues a doctor on bmj.com today.

Lord David Owen, a trained doctor and member of the House of Lords, says that millions of people are affected by the decisions of people in high public office, and these leaders have an obligation to the general public to ensure that their decision making is not impaired by physical or mental illness.

No one has to stand for high public office he says, "if potential candidates knew they faced independent assessment and that they had a health problem then they would either not stand or they would make it public of their own volition."

According to Owen, many heads of governments and their personal doctors do not tell the truth about their illness and have received inferior medical treatment as a result of this secrecy. For example, when Francois Mitterrand was President of France he kept his cancer of the prostate and secondaries in the bone secret for 11 years, even though his personal doctor made monthly public statements about his health with no mention of his true medical condition.

More recently, despite happily revealing his medical records from Vietnam, in the run up to the US elections, Senator McCain was not so open about his malignant melanoma diagnosis.

When in office, leaders should be obliged to have an annual independent health check to ensure that they are fit for office and are able to step down temporarily or permanently if their illness is affecting their capacity to do the job, writes Owen.

In 1998, the Prime Minister of Norway suffered a severe depressive reaction and offered to resign. But, after discussion with the Foreign Minister, he publicly announced that he was suffering from depression, and after four weeks of treatment and adapting his working practices he returned to work. His actions commanded great respect from the Norwegian public and helped lessen the stigma surrounding mental health.

According to Owen, this example illustrates the lessening prejudice and much greater public understanding of illness. A greater openness would not necessarily preclude someone with an illness from convincing their party and the public that they are fit for office, he concludes.