What happens if a US president becomes incapacitated

The US Constitution outlines what should happen if the president becomes ill, dies or is deemed unable to fulfil their duties.

Surprisingly, the 25th Amendment, which deals with presidential incapacitation, was only added to the Constitution in 1967, following the assassination of John F. Kennedy in 1963.

While the Founding Fathers "anticipated the need for a line of succession" if the president "dies, resigns or became debilitated", the original text of the 1787 document left out "critical details", including "who has the power to declare the president unfit to serve", said History. Only when the 25th Amendment was introduced was there a "clear protocol" for dealing with such situations.

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What does the 25th Amendment say?

The first section of the 25th Amendment states that the "removal", death or resignation of the president from office means the vice-president will automatically become president. 

Section two simply says that in the event of a "vacancy in the office of the vice-president" the president will choose a new number two, to be confirmed by a majority vote in Congress.

Section three outlines the procedure for a president to declare that they are temporarily unable to "discharge the powers and duties" of the office, during which time the vice-president becomes acting president.

Section four outlines how the president may be removed from office if the vice-president and a "majority of either the principal officers of the executive departments or of such other body as Congress" agree that he or she is unable to perform their duties. If approved, the vice-president becomes acting president. The president can resume office by declaring "no inability exists", but this can be challenged by the vice-president and the executive or congressional majority.

From there, Congress will assemble within 48 hours to "decide the issue", with a two-thirds majority vote needed in both houses within 21 days to oust the president. If that succeeds, then the vice-president will continue as acting president.

How often has it been used?

The first three sections of the amendment have "all been invoked" since 1967, said National Geographic.

The most significant use came after Richard Nixon resigned from the presidency in 1974 following the Watergate scandal. Gerald Ford, his vice-president, was then sworn in as president under section one and served the remainder of the term.

Section three has been used four times by presidents including Ronald Reagan and George W. Bush to temporarily transfer their duties to the vice-president "during surgeries and medical procedures". Joe Biden was the last to do this, making Kamala Harris acting president in November 2021 for an hour and 25 minutes while he had a colonoscopy.

Section four, however, has "never been invoked".

Has a president been unfit for office?

After Woodrow Wilson suffered a stroke during his presidency in 1919, his wife Edith privately took on numerous presidential responsibilities, said Rebecca Boggs Roberts in Smithsonian Magazine. The severity of his illness was concealed from the public and Wilson served out the rest of his second term.

In the post-25th Amendment era, staff at the White House in 1987 "seriously suggested" invoking section four to remove then president Ronald Reagan, who in his mid-70s and had been "acting strangely", said History. It never happened and Reagan served his full second term. 

After Reagan revealed in 1994 that he had Alzheimer's, rumours spread that it "began during his presidency and caused these behaviours", but that was not disclosed to the public.

Could it be used on Joe Biden?

After an "alarming debate performance" last month, the prospect of invoking the 25th amendment to depose Joe Biden has been mooted, said Jim Ronan on The Hill. The 81-year-old's capacity as president has been under fierce scrutiny in recent weeks, but the prospect of section four being invoked is "virtually nil" given the numbers needed within his own party to back it.