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Before he agreed to become White House chief of staff in 1987, Howard Baker Jr. had a request for a longtime aide of his. Baker, a retired senator, asked James Cannon to assess the state of affairs inside the White House.

The presidency of Ronald Reagan was in “chaos,” Cannon wrote to Baker. Aides told him that Reagan was “inattentive and inept.”

Cannon’s first recommendation, as reported in a 1988 book and confirmed by Cannon himself soon after, was shocking.

“Consider the possibility that section four of the 25th Amendment might be applied,” wrote the aide, who had worked previously as a senior policy adviser to President Gerald Ford.

President Ronald Reagan

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The 25th Amendment was added to the US Constitution in 1967. Compared to some amendments, it might seem a little obvious or procedural, but the 25th Amendment was the long-belated response to more than a century of crises, and some of America’s darkest and most chaotic moments, dealing with one simple question: What do we do if something is wrong with the president? The amendment has four parts. The first two codify what happens if the president or vice president die or otherwise leave office (the vice president becomes president, and the president can nominate a new vice president, respectively). The third outlines how the president can temporarily hand over power to the vice president.

The fourth section — never used in the 50 years since it was adopted — gives the vice president and cabinet the power to declare that the president is “unable to discharge the powers and duties of his office.” It is heavily weighted in favor of the president’s ability to serve, enabling the president to force a congressional vote on the issue — a vote that would take two-thirds of both houses of Congress to keep the president out of power. In short, it’s a complicated and rigorous process that would require many elected and appointed officials to agree the president was unfit.

But that, in 1987, was what Cannon suggested to Baker, as Jane Mayer and Doyle McManus reported in their 1988 book, Landslide: The Unmaking of the President.

From the very origins of the United States, the country’s leaders did recognize that the question of presidential disability could be a problem, but they did little to work out how to resolve it.

Presidential history is subsequently rife with stories of life-threatening conditions and even secret surgeries. Eight presidents have died while in office. Several have been shot. Many have suffered from serious illness — sometimes for months or, in at least one case, for more than a year — that clearly left them unable to run the country. Along the way, the country’s leaders allowed constitutionally questionable practices to become informal precedent, messed around with the order of presidential succession (one role the Constitution explicitly assigned to Congress), and blatantly hid those presidential illnesses from the public (and sometimes even the vice president and cabinet).

Remarkably, it took the assassination of John F. Kennedy in 1963 — along with continued leadership from a former president, steady hands in Congress, and significant outside support — to finally address obvious issues from a constitutional perspective.

Now, in 2017, many Donald Trump critics contend he is unfit for office, and some have held up the 25th Amendment as a way to get him out of office, returning its fourth section to the public discourse in the midst of a presidency that has raised many questions about little-known constitutional provisions.

But that conversation has been speculative and focused on today’s political questions. A close examination of presidential history, however, reveals how exceptional and complex a move invoking the final part of the 25th Amendment would be, regardless of who’s president. It would be unprecedented. In fact, in looking at the nation’s history, something more fundamental emerges: No one has ever determined what, precisely, the Constitution means when it comes to disability.

Tellingly, in 1987, James Cannon’s recommendation remained under consideration for a grand total of one day. He and Baker, two men with no constitutional role in the 25th Amendment process, and others observed Reagan in a meeting the next day and decided that he was not incapacitated, Mayer and McManus reported.

The issue was not raised again.

/ National Archives

The Constitution itself is notably light on the question of what happens if the president can no longer serve. During the convention, the framers spent far more of the summer of 1787 debating how the legislature would be apportioned and selected, the role and election of the president, and the treatment and future of slavery. But a delegate from Delaware raised a particular dilemma regarding the president.

“What is the extent of the term ‘disability’ & who is to be the judge of it?” asked John Dickinson, according to James Madison’s notes from the debates, of proposed language referencing a president unable to serve due to some inability.

The question gets to the heart of the issue for a democratic republic with one person at the helm of its executive branch, and for a set of framers concerned with the concepts of tyranny, stability, and liberty: Who can — and should — have the power to declare that leader unfit?

It’s a question those framers left untended. Instead, the limited, vague discussion of how the new nation would deal with a president serving less than a full term would be the only constitutional guidance, giving Congress authority to deal with presidential succession:

In case of the removal of the president from office, or of his death, resignation or inability to discharge the powers and duties of the said office, the same shall devolve on the vice president, and the Congress may by law provide for the case of removal, death, resignation or inability, both of the president and vice president, declaring what officer shall then act as president, and such officer shall act accordingly until the disability be removed, or a president shall be elected.

“Disability” remained undefined, and the question of who would determine it left unanswered. Within 20 years, it became clear that would be inadequate, as John Feerick, a lawyer and professor who played a key role in the development and passage of the 25th Amendment, details in his book The Twenty-fifth Amendment: Its Complete History and Applications.

In 1813, Madison — now the president — postponed a meeting with senators indefinitely. His illness was serious, the vice president was old, and there was a vacancy in the next office in the line of succession — then the Senate President pro tempore. It turned out to be a false alarm: Madison recovered (and lived for more than 20 more years). The same could not be said for William Henry Harrison, who died on April 4, 1841 — a month after taking office as president.

An illustration detailing the death of President William Henry Harrison.

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His vice president, John Tyler, took the oath of office and asserted that, with Harrison’s death, he had become the president.

Not everyone agreed Tyler was actually the president.

Some argued that the Constitution’s language meant, as John Quincy Adams put it, that Tyler should continue to be addressed as the “Vice-President Acting as President.” It took two months until Congress acceded to Tyler’s position, recognizing him in a debated resolution as the president of the United States.

In a classic example of a constitutionally questionable practice turning into informal precedent, the “Tyler Precedent,” as Feerick called it, would guide the way succession worked the next seven times a president died in office.

An illustration of President James A. Garfield being shot by Charles Guiteau on July 2, 1880.

Bettmann / Bettmann Archive

What became clear 40 years later, in 1881, however, is that the death of a president can involve more than just who becomes president next.

After Charles Guiteau shot President James A. Garfield on July 2, 1881, doctors first thought he would die because of his grave initial condition. He recovered just enough that doctors believed he might live. “The general feeling was expressed that the worst was over, and the nation began to take courage,” an extremely sympathetic, but extensive, account by Emma Elizabeth Brown in her 1888 book, The Life and Public Services of James A. Garfield, Twentieth President of the Unites States. In late July, Garfield had what Brown describes as a relapse that required surgery. Throughout August, Garfield declined.

Who was serving as president, though? Garfield wasn’t exercising the “powers and duties” of his office. As presidential succession expert Ruth Silva detailed in a 1956 article, “During the eighty days of President Garfield’s fatal illness, he performed but one official act, the signing of an extradition paper.”

“The cabinet thought that the shock of taking any action on the matter might cause his death… the whole matter of succession and inability was dropped.”

“Plans were suggested” for Vice President Chester Arthur to exercise the powers of the presidency while Garfield was sick, according to a report from the Congressional Research Service. But cabinet members ended up debating whether Arthur would become the president if he took over the duties during Garfield’s disability. Some cited Tyler’s actions after Harrison’s death, suggesting the same would apply here. What would happen, then, if Garfield recovered? Would he be unable to resume the presidency?

“The cabinet thought that the shock of taking any action on the matter might cause his death,” Silva wrote of Garfield. “Consequently, the whole matter of succession and inability was dropped.”

So the plans, according to the Congressional Research Service, never “progressed beyond the talking stage” — despite nearly three months in which the president of the United States couldn’t perform his duties.

By September, Brown wrote that it was determined “the malarial atmosphere surrounding the White House was a constant drawback” to Garfield’s recovery and he should be moved.

The president’s “last hope” — a trip to a cottage on the New Jersey shore — was planned. Workers literally put down new railroad tracks in New Jersey so the president’s train could go directly to the cottage.

Attorney General Isaac Wayne MacVeagh, who was with the president at the cottage, sent a telegraph to the US minister to England on the evening of Sept. 12, describing in detail that the president had “eaten sufficient food with relish” and “[h]is wound and the incisions made by the surgeons all look better.”

Garfield died a week later.

Arthur became president. There was no vice president, no Senate President pro tempore, and no Speaker of the House. There was, in short, no one authorized under the then-current succession law to act as president should something happen to Arthur. Despite Arthur’s expressed concern about those circumstances, that state continued until the Senate selected a President pro tempore nearly a month later, on Oct. 10, 1841.

Congress did, though, eventually address this issue. In 1886, Congress changed the order of succession — removing the congressional leaders and replacing them with the members of the president’s cabinet, in the order the cabinet departments were created.

The Oneida, an American steam yacht, photographed before World War I.

Department of the Navy, Naval Historical Center, Online Library of Selected Ships, Civilian Ships / Wikimedia

Perhaps the most complicated attempt to hide a presidential disability from the public was undertaken a few years later, in the summer of 1893. President Grover Cleveland arranged for a private yacht to take him out on the water so that he could receive secret surgery to remove a cancerous tumor from the roof of his mouth.

The president, his friends and family, and doctors agreed to keep the diagnosis — and surgery to remove it — a secret. The president would say he was taking a four-day fishing trip over the Fourth of July holiday to his summer home in Massachusetts. (The surgery took place on a friend’s yacht, the Oneida.) People didn’t buy this, even at the time. A reporter asked one of the doctors involved, and he did not deny the surgery took place.

Seated portrait of President Grover Cleveland.

Photoquest / Getty Images

As Matthew Algeo put it in his book that painstakingly details the cover-up, The President Is a Sick Man, “In the coming days, weeks, and months, Grover Cleveland’s closest friends, advisers, doctors, and even his pregnant wife would all dissemble to perpetuate the myth that the president was well. With their help, [Secretary of War Dan] Lamont would engineer a brazen and elaborate cover-up on behalf of a president whose reputation for honesty was unquestioned.”

Lamont and the others claimed Cleveland a) had an attack of rheumatism that led for him to need some time to rest, and b) that he had “a bad case of dentistry,” because he had ignored necessary dental work, and so c) he decided to have the dentistry done on the yacht on the way to Massachusetts so he could be “cool and comfortable” while it was being done.

Of course, none of that was true. But it wasn’t just the public that didn’t know. Vice President Adlai Stevenson didn’t know either. He had been at the World’s Fair in Chicago over the Fourth of July holiday, but, as Algeo wrote, “he was determined to find out what was really going on.” After telling reporters he was headed to Massachusetts to “consult” with the president, Cleveland stopped him, instead sending Stevenson orders to “meet with Democratic Party leaders — on the West Coast.”

Cleveland was not well, though. When Attorney General Richard Olney met with the president on July 8, he wrote that the president “did not talk much, was very depressed, and at that time acted, and I believe he felt, as if he did not expect to recover.” Olney went on to lie to reporters, however, telling them the president was “in good spirits, and apparently enjoying excellent health.”

When a “suspicious looking growth” was found near the wound in Cleveland’s mouth later in July, a second secret yacht surgery took place. The president again disappeared under the guise of a fishing trip.

Ultimately, Cleveland did not leave to return to Washington until August 4 — with the vice president, most of the cabinet, Congress, and the American public still in the dark about the president’s cancer, surgery, slow recovery, or second surgery, and no one even entertaining the idea that someone else might need to be — or at least be acting as — president.

The coffin of President Warren G. Harding in the East Room of the White House, before his state funeral in August 1923.

Fpg / Getty Images

Four presidents had serious health issues over the next half century. President Warren Harding became ill on a trip and was dead within a month; President William McKinley was shot and underwent surgery but died eight days later; and President Franklin D. Roosevelt died less than three months into his unprecedented fourth term.

Of the president’s condition at his final inauguration in 1945, reporter John Gunther wrote, “I was terrified when I saw his face. I felt certain that he was going to die.” Roosevelt did die soon thereafter, from a cerebral hemorrhage.

A soldier and two sailors reading newspapers announcing the death of President Franklin D. Roosevelt.

Anthony Calvacca / Getty Images

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