How to determine if a politician is incapacitated

The day we really knew my father had dementia was when a doctor asked him what year it was and he answered, tentatively, “1948?”

All the suspicions and doubts, the inclination to pass things off as minor lapses, suddenly crystalized. Other questions followed. Who is the president? Where are we? He couldn’t answer.

Once the family was sure of the diagnosis, the

preceding few years suddenly came into focus.

Things we had thought were one-time “senior moments” — his confusion in the face of relatively simple tasks, even the way he grasped the steering wheel tightly and seemed unsure while driving on normally familiar freeways a few years earlier — were understood as early signs. They had stood in front of us like flashing lights, but we hadn’t seen them — largely because he seemed to be functioning well in other ways.

The tragic recent death of Salt Lake County recorder Gary Ott followed much the same pattern. Some of his friends and relatives testified at a recent court hearing that he was functioning well when he successfully ran for re-election in 2014. Others said he had trouble giving speeches or driving as early as 2012.

This timeline of symptoms, often disputed by the honest recollections of close friends and relatives, are what makes it so hard to write a law that would allow for the removal of an elected official who seems to be losing it.

The trick is to find a method that includes enough checks and balances that a political party can’t use it as a tool to simply get rid of someone.

The latest attempt by a Utah lawmaker, unfortunately, is so complicated it could not be used in a majority of Utah counties, where only three county commissioners rule.

Jeremy Faust, a clinical instructor at Harvard Medical School, has a different idea. Writing recently for Slate, he suggests giving office holders a “mini mental state exam” on a regular basis once they reach a certain age, say 65 or 70.

This exam, similar to the one my father received, presents a series of simple questions. A healthy person could finish the test in a few minutes. But it’s important to note that someone who trips over one or more question would not immediately be thrown into a care center.

Faust said, “… diagnosing early or mild dementia is no easy matter. It is rarely something that a physician can determine in one encounter.”

Competent people can indeed have bad days. Giving the test at regular intervals, however, would reveal patterns. The tests would not necessarily become public record, unless someone tries to prove the public official no longer is competent.

The obvious flaw in this suggestion is that Ott was only 66 when he died. His symptoms, according to those who testified at a recent court hearing, may have started when he was about 60, or even earlier. It may not be feasible to begin testing politicians at age 55.

But then, so many things about Ott’s tragic situation were unusual, including how his declining state was held from public view by his closest aides, and how his family had to negotiate his resignation. The state may not see another case like this for many years.

But with Alzheimer’s expected to increase by about 60 percent in Utah over just the next eight years, as an Alzheimer’s Association spokesman told the Deseret News, the chances of this affecting more politicians should not be discounted.

Nor should we underestimate the strong emotions that often get in the way.

 “Hypothetically, yes, elections are supposed to address this, but a politician’s staff and family often ‘cover’ for the individual — either intentionally or unintentionally,” Faust wrote. “

Washington currently is buzzing with allegations about the mental state of this or that politician. Some point fingers at the president. Others point at Arizona Sen. John McCain, who blamed a series of odd questions at a recent hearing on having stayed up too late watching a baseball game.
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Given how the population is aging, the question of how to tell for sure when an elected official has lost it could be an important part of self-governance in the 21st century. We have to be careful to get it right.