Author: Karl Smallwood / Source: Today I Found Out
Joseph R.asks: What happens if the president is too sick to work?

The president of the United States never technically takes a day off. Even when they’re ostensibly “on vacation” they are still very much the leader of the country and have many duties to fulfill on a daily basis.
For example, even while on vacation, they need to continue to have things like intelligence and national security briefings and other such meetings so that if an emergency does suddenly come up, they can react quickly in an informed way. Because of this, the president, in addition to never technically being able to have a full day off while on vacation, doesn’t get sick days either.Of course, the president is not only human but also generally speaking a quite old human, and thus they get ill, occasionally seriously. So what happens then? This is where the 25th Amendment potentially comes into effect.
In a nutshell, among other things, it provides that if the president ever gets so ill that they cannot physically perform necessary presidential duties anymore, their vice president can become the “Acting President” on their behalf until they’re able to resume their duties. So, in a way, this is a mechanism for the president to take a sick day if they want it and whenever they want it.
It’s also noteworthy that even if the president does not wish to relinquish the office during a time when they are “unable to discharge the powers and duties of his office”, the 25th Amendment provides a mechanism for the vice president to simply take the office from the president until such time as the president is once again able to resume duties.
(Amusingly, it’s not fully clear here what the scope of this section of the 25th Amendment is. For example, while the president is sleeping, and thus in an unconscious state, they are most definitely “unable to discharge the powers and duties of [the] office” until someone wakes them up. So technically the vice president and certain others could get together on any given night and temporarily make the vice president acting president until such time as the president wakes up and no doubt sends off the appropriate document to declare that they are, in fact, fit for duty, with Congress no doubt concurring at that point… Or, if I were president and my VP did that, I’d probably just take that rare opportunity to roll back over and sleep in for once, then maybe around noon have a leisurely breakfast before finally sending off the appropriate letter that I’m back in business.)
In the end, this latter rule allowing the vice president to forcibly take over is probably for the best as United States presidents are generally loath to give up the office, even temporarily. Despite many, many presidents having serious health issues and occasionally being incapacitated during their time in office (generally largely kept from the public eye at the time), only two have actually used this power in the over half a century since the 25th Amendment was ratified.
Breaking the trend, the first president to make use of the 25th Amendment was Ronald Reagan on July 13, 1985 when he temporarily officially bestowed the powers of the office onto Vice President George Bush while Reagan underwent surgery for colon cancer. Bush reportedly spent a whole 8 hours being president before Reagan decided he’d recovered enough from his surgery to start being president again.
A thing to note is that prior to handing off the powers of the presidency to Bush at 11:28AM, Reagan spent his morning as he normally did, going about presidential duties, and subsequently spent most of the evening after he became president again at 7:22PM catching up on everything he’d missed during the day. So not really much of a sick day.
The only other president to bestow the powers of the presidency on their vice president was George W. Bush in 2002 and later in 2007, each time so that he could have a colonoscopy. On each occasion, Vice President Dick Cheney was acting president for a little over 2 hours at which point Bush resumed his duties. Or to put it another way, during his 8 years in office, Bush technically had four hours of official time off, most of which he spent with a camera up his butt… (It’s good to be the president?)
This lack of leave taken for ill health is a surprising fact given, as previously alluded to, the large percentage of presidents who have suffered through various serious illnesses during their time in office.
Most infamously, Woodrow Wilson had a massive stroke in 1919 resulting in the temporary loss of use of the left side of his body, as well as him becoming blind in the left eye and with diminished vision in his right. What his cognitive state was at this time isn’t fully known, as this was all kept from the public by his wife, Edith, and his physician, Dr. Cary Grayson.
So how was he able to run the country in this state? Well, he wasn’t really. His wife took over handling what information was passed to him and what issues she simply delegated out for other people to handle. She also barred any direct access to the president for several weeks after the stroke, with the lone exception being that Dr. Grayson was allowed to attend him (and we’re speculating nurses, though this…
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