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 is never mentioned anywhere we could find).

As Edith herself would later write,

So began my stewardship, I studied every paper, sent from the different Secretaries or Senators, and tried to digest and present in tabloid form the things that, despite my vigilance, had to go to the President. I, myself, never made a single decision regarding the disposition of public affairs. The only decision that was mine was what was important and what was not, and the very important decision of when to present matters to my husband.

That said, it is thought by many historians that her claim that she never made direct presidential decisions herself is at best stretching the truth and at worst a blatant lie. That’s not to mention completely controlling the information that went to the president and what tasks (and to whom) were delegated out is questionable for a person not elected to office to do, even for a day, let alone an extended period.

While Wilson did recover somewhat over the next year and a half or so of his presidency, in the interim there was much question over whether he was actually still mentally and physically fit enough to continue on as president.  Despite this and certain very pressing and far reaching matters being decided, like whether the United States should join the League of Nations, he refused to give up his position- a key point discussed when the 25th Amendment was being drafted a few decades later.

While other presidents had before and after Wilson suffered from various ailments, most notable to the development of the 25th Amendment was Dwight D. Eisenhower. While in office, he suffered a severe heart attack and then a subsequent stroke.  He also had to have surgery to remove about ten inches of his small intestine as a result of complications owing to Crohn’s disease.

During these times, he did attempt to take sick days by having Attorney General Herbert Brownell Jr write up a document passing off some of the powers and duties of the president to Vice President Richard Nixon. Other presidents had more or less done similar things before when necessary, but always in secret, so as not to publicly reveal their medical issues. Eisenhower was essentially bucking the trend of keeping it secret and trying to set a precedent to make the whole thing official.

And, indeed, from a practical standpoint, Nixon and Eisenhower’s cabinet did take over his duties when he was incapacitated. It also could be interpreted that Article II, Section 1, Clause 6 of the U.S. Constitution did allow for such when the president was unable “to discharge the powers and duties of the… office”.

But the wording here is sufficiently vague to call into question whether in these cases the vice president is actually endowed with the powers given to the president. Because of this, despite Eisenhower giving the green light, there was uncertainty whether Nixon was actually the acting president or not at these times, which could have created major problems had certain emergencies come up.

The matter finally came to a head with a president most considered the picture of robust, youthful, health- John F. Kennedy.

It turns out, Kennedy essentially needed his own pharmacy and team of doctors to keep him functioning semi-normally throughout his presidency- a fact only quite recently made publicly known.

The medical issues Kennedy suffered from were many and serious (some of which may in turn have been caused by the extensive medication he regularly took). First up was a potentially life threatening problem in Addison’s disease, where the adrenal glands don’t produce enough of certain essential hormones.

Next he suffered from osteoporosis resulting in three fractured vertebrae in his back. He also suffered from irritable bowel syndrome that saw him dealing with severe abdominal pain and occasional dangerous bouts of diarrhea. Then there was his hypothyroidism. And, just for fun, likely because of some of the medications he was on, he seemed particularly prone to infections.

To treat all this, he was variously put on thyroid hormone, Ritalin, methadone, Demerol, barbiturates (such as phenobarbital), various antidiarrheal drugs, testosterone, procaine, codeine, corticosteroids, Lomotil, Metamucil, paregoric, amphetamines, meprobamate, Librium, and given penicillin and various other antibiotics whenever infections would spring up…

Notably, many of these medications could potentially effect mood and his decision making ability. But without some of them, Kennedy would have been crippled by pain.  Even with them, as Kennedy’s political advisor, Dave Powers, once noted, Kennedy always traveled “with crutches”. Further, when he was out of the public eye, he walked

gritting his teeth…but then when he came into the room where the crowd was gathered, he was erect and smiling, looking as fit and healthy as the light-heavyweight champion of the world. Then after he finished his speech and answered questions from the floor and shook hands with everyone, we would help him into the car and he would lean back on the seat and close his eyes in pain.

Kennedy’s many maladies were not, however, what helped spur the creation of the 25th Amendment, though may have been had they been widely known.  Rather, it was when Kennedy was shot that everything finally came to a head, with the question being asked, “What would have happened had Kennedy lived, but been in a brain-dead state?”

As previously noted, while one could interpret Article II, Section 1, Clause 6 of the Constitution in such a way as to provide for the vice president to take over almost immediately in such cases, the wording wasn’t concrete enough on this or for many other such scenarios in which the vice president might need to become Acting President. It wasn’t even clear in these cases if the vice president did take over if the original president should get the job back if they were once again fit for office later during the allotted term.

This ambiguity is a major issue if, say, a nuclear strike was launched against the United States in the interim from when the president was no longer fit for office and when the government finally got around to deciding the vice president should indeed take over.

Thus, about a year and a half after Kennedy’s assassination, in July of 1965, congress sent the 25th Amendment out to the states to ratify, which it finally was on February 10, 1967, clarifying what should be done in many of these scenarios.

So to sum up, the president is not given any allotment of sick days, but the 25th Amendment does provide them a mechanism to take such if they feel like they’re unable to perform the duties of the office. But, for reasons like that it’s not politically couth for the president to show any weakness, only two presidents in history have ever done this since it became an option- both of whom were having something done to their colon at the time…

For the rest, when they were medically incapacitated, they seem to generally try to hide this from the public whenever possible and to delegate tasks and rearrange their work schedule as best they could to take a little time off. And, where they couldn’t do such, they simply muscled through the rest of their duties.

If you liked this article, you might also enjoy our new popular podcast, The BrainFood Show (iTunes, Spotify, Google Play Music, Feed), as well as:

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Bonus Facts:

• It’s noteworthy that before the ratification of the 25th Amendment, the office of the vice president was vacant for various reasons about 1/5th of the history of the United States up to that point. Nobody much concerned themselves with this until more recent history when the vice president more or less became the “deputy president”. Since then, and thanks to the 25th Amendment clarifying such, the office of Vice President is obviously meticulously kept filled.
• As noted, even when a president is “on vacation” they’re still expected to work and most modern presidents have typically travelled with an entourage of hundreds, including military advisers and even the press to ensure they’re remain briefed and aware of any relevant information they may need. To quote Nancy Reagan about the matter, “presidents don’t get vacations — they just get a change of scenery”.