Prof. Sam Lehman-Wilzig: The Leadership Quandary: Age? No; Health? Yes.
I recently received a notice from Israel’s Motor Vehicle Bureau to undergo a medical checkup and an eye test before it would grant me the renewal. Because this was the first time they requested this, I asked them why. Their response: at age 75, all Israelis have to undergo a medical and an eye exam to ascertain their fitness (age 80 too, and so on).
So I started thinking: to drive a car a medical checkup is called for – but the leader of our country does NOT have to be checked for physical and mental fitness? But if such were instituted, the next question arises automatically: who decides if and 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 mentioned: that he couldn’t overcome Donald Trump. The real reason (which should have been discussed more widely): by the end of his next 4-year tenure (assuming he was elected), and with some decline already evident, Biden would most probably not have made it in full control of himself. And then during those years, who would decide whether he was fit, and through what sort of system? The 25th Amendment to the U.S. Constitution (only) partly solves that problem.
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 far from negligible.
On the Israeli front, 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 minister(s). Over forty years ago, PM Menachem Begin became deeply depressed for more than 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 to select his successor.
Even more scary was what happened two decades later when PM Ariel Sharon suffered a massive stroke, never coming out of his vegetative state. But what if he had partly recovered? Half fit (or even three-quarters)? Political pandemonium would have ensued as Israel did not then have a legislatively set procedure for deciding on who replaces the PM.
That changed in 2022 – somewhat. The Knesset passed a law stating that only PMs can declare themselves unfit for office temporarily (e.g., before undergoing a serious operation), or permanently. However, 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 also 2/3 of the Knesset (80 MKs) have to declare this in order for it to be effectuated. If such a vote is affirmative, then the new PM is automatically the me’malei makom Rosh Ha’memshala – a statutory position called “the PM replacement.” If no such person was designated ahead of time, the Cabinet must vote on a successor.
This is a recipe for what can only be described in colloquial 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 incapacitated (or likewise, more than a third of the government’s ministers). The law doesn’t state whether it’s 2/3 of the full 120 complement 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 change of the leader is necessary for health reasons: that of the prime minister as well as for 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
