Presidential disability and the XXV Amendment.

Following an attempted assassination on March 30, 1981, President Reagan had an operation under anesthesia and was seriously ill during the postoperative period. At that time, no one in the Administration suggested that the President invoke Section 3 of the 25th Amendment to the Constitution. That amendment, which was ratified in 1967, provides for voluntary transfer of powers to the Vice-President (Section 3) or for the possibility of involuntary transfer of powers and duties (Section 4). The amendment also defines the Vice-President's role after transfer as that of Acting President so that when the President recovers, he or she can resume the powers and duties of office. Such a transfer of authority did take place in July 1985, when President Reagan had a colectomy for colon carcinoma, but he initially denied that he was using the amendment. This reluctance to employ the mechanisms available for transfer of power led to the formation of a Working Group on Disability in U.S. Presidents under the leadership of a prominent neurologist, James F. Toole, MD, FACS, of Winston-Salem, NC. The working group has held meetings at the Carter Center at the invitation of President Jimmy Carter, at Wake Forest University with the participation of President Gerald Ford, and most recently, at the White House Conference Center in Washington. As a representative of the American College of Surgeons, the author participated in the latter meeting, where agreement was reached on nine specific recommendations that provide guidelines for use of the amendment.