When the President has COVID-19

This fateful year took another sad and surprising turn last week with the announcement that both President Donald Trump and his wife Melania tested positive for COVID-19.   The story became even more serious as we saw him being flown to Walter Reed Medical Center for treatment.  We wish President Trump and the First Lady a speedy and full recovery.

The media, of course, has raised important questions such as “When was he diagnosed?” and “Did he attend a political fundraiser while he was positive?”  Of more immediate interest at the moment is, “How is he doing?”  The president’s personal physician, Dr. Sean Conley, has addressed the media at least twice over the weekend, giving updates that have left many questions remain.

The ethical treatment of any patient includes the patient’s right to have his or her personal health information kept private.  Health care systems do not look kindly upon employees who reveal patient’s personal information to the press.  HIPAA laws are designed to ensure this protection.  The CDC website states it clearly:  “The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge” 

When your patient is the president of the United States, the rules seem to be different.  For example, over the weekend the Washington Post ran an article on the health of President Franklin Roosevelt as he was seeking his unprecedented fourth term in office.   The Post quotes Jay Winik’s book, 1944:  FDR and the year that changed history, and FDR’s visit with Dr Bruenn at the hospital that would become known as Walter Reed Medical Center:  

“Listening to Roosevelt’s heart and lungs with a stethoscope increased [Dr.] Bruenn’s sense of alarm: as Roosevelt inhaled and exhaled, Bruenn heard rales, telltale rattling or bubbling sounds indicating that fluid was building up inside the president’s lungs . . . Roosevelt was literally starting the slow process of drowning from within.”

What would the public have done if they had known — vote for Republican nominee Governor Tom Dewey?  It is difficult to imagine, but one never knows.  There are other examples from history of the public not knowing the medical condition of the president.  Ethically speaking, what does the public have the right to know, especially in an election year?

Back to the present.  On Saturday, October 3, Dr Conley gave a press conference updating President Trump’s health.  Not much long after, the press received quite a different (and more negative) message, apparently from White House Chief of Staff Mark Meadows.  On Sunday, Dr Conley addressed the discrepancy: “. . .I didn’t want to give any information that would steer the course of the illness in another direction. . .”  It raises the question of how information given at a press conference could possibly steer the course of the illness.  If he meant ‘steer our understanding of the course of the illness,’ he should have worded it that way.  I do not envy Dr Conley’s role.  At some level he is both the president’s physician and the president’s spokesman, with a very powerful audience of one.

Any president’s health will always be a bit of a mystery to the public and I believe that, in principle, the president deserves privacy.  My preference would be that his spokespeople state the facts in the most straightforward way possible.  If that isn’t possible, then perhaps wait until it is.

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