The Framers of the Constitution addressed the issues of presidential disability and succession in the document they wrote in Philadelphia in 1787 but they did so in ambiguous and uncertain language. Article II, section 5, states that "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." Two daunting problems emerged from this wording. First, it is not clear whether the words "the same" refer to the presidential office itself or to the powers and duties of the presidential office, an important distinction (Feerick 1992, 3). If the office passes to the vice president, he/she becomes president of the United States; if the powers and duties of the office are transferred, the vice president becomes acting president while the president continues to hold the office. Although the debates at the constitutional convention suggest strongly that the Framers preferred an acting presidency by the vice president rather than an actual succession to the presidential office (Ferrand 1911, 495), the Constitution itself neglects to make this clear. Further compounding the problem was that in 1841, after President William Henry Harrison became the first U.S. president to die in office, Vice President John Tyler's insistence that he had become president, and not simply acting president, of the United States, was accepted by Congress and the country. This created a powerful precedent supporting vice presidential succession to the office itself (Goldstein 1995, 522).
The second problem arising from constitutional ambiguity is that the Framers unwisely placed together in the same sentence of the document three permanent and irreversible reasons for presidential separation from office (death, resignation, and removal) with one that is temporary and possibly even fleeting (inability). Because they failed to define "inability" or indicate how it might be determined, the constitutional configuration they adopted contributed to understandable reluctance by presidents to admit any inability to discharge the powers and duties of their office because they feared that if they did so, the result would be the same as if they permanently vacated it. The vice president would become president and they were uncertain whether they would be able to regain the office when their inability ended.
Their reluctance was most unfortunate, because many presidents have suffered debilitating--although often well-concealed--illnesses while serving as the nation's chief executive. John Adams remained away from the capital for more than six months while trying to recover from the effects of probable hyperthyroidism (Ferling and Braverman 1998, 83). Madison suffered from a high fever and was delirious for almost a month, being described by some of his aides as deranged (Brandt 1961, 210). Jackson was afflicted with pulmonary hemorrhages, excruciating headaches, and shortness of breath. William Henry Harrison succumbed 30 days following his inauguration after developing viral pneumonia (Marx 1960, 113-14, 131). Cleveland underwent two concealed surgeries for cancer of the jaw while on board a yacht that traveled slowly up the Hudson River, procedures not disclosed until 1928, more than 30 years after he left the White House (Post and Robins 1992, 7-9).
During the twentieth century, Woodrow Wilson suffered a massive stroke that paralyzed his left side and made his speech labored and indistinct, but the White House at first described his condition as a digestive upset (Smith 1964, 91). Harding suffered a heart attack while traveling from Vancouver to San Francisco but his White House physician publicly attributed his illness to crabmeat poisoning (Ferrell 1996, 15). …