Republican presidential hopeful Nikki Haley, age 51, remarked that if President Joe Biden, age 80, is reelected, he likely wouldn’t make it to the end of that term.
Ageism is the last domino standing after society has at least admitted that racism and sexism need to be knocked down. Of the eight presidents who have died in office, four died from being shot. Abraham Lincoln and John F. Kennedy died from the gunshot itself, while James A. Garfield and William McKinley died later of septic complications from contaminated wounds. Zachary Taylor suffered a fatal bacterial infection. William Henry Harrison died of pneumonia. Warren G. Harding died from a heart attack. And FDR died from a stroke.
At 46, JFK was the youngest. At 68, William Henry Harrison was the oldest — hardly old age in our times. So while Nikki Haley is correct — everyone, even presidents, can die —what evidence is there for her seemingly ageist warning about Biden?
In a document signed by his physician and dated November 19, 2021, Biden was declared fit for his duties. Several medical issues were identified, including heart-rate-controlled atrial fibrillation with normal left ventricular function, seasonal allergies, osteo-arthritis of the spine, neuropathy in his feet and some heart burn. His blood work looked good. His weight was good. He exercised five days per week. From a physical health perspective, family doctors would be extremely unlikely to give him a second look. These noted medical conditions are certainly within the normal constellation of health challenges in an aging man in America.
Politicians go to great lengths to convey vitality. The reality does not always match the myth. FDR worked very hard to conceal the ravages of polio that paralyzed his legs — so much so that the honest memorial depiction of him in a wheelchair was considered controversial. JFK was depicted as a man of great health, but his famous suntan was caused by Addison’s disease, a disorder of salt regulation, that pigmented his skin. He was plagued with chronic pain and the back brace he wore possibly prevented him from ducking for cover after the first shot.
In a 2014 article in The Atlantic, Ezekiel Emanuel, the noted bioethicist, oncologist and former adviser to Barak Obama, wrote that he would refuse all medical treatments, including antibiotics and vaccinations, after age 75. For people like Emanuel, accustomed to power and agency, the logic of his desire to die younger perhaps represents his fear of frailty — a need to preserve his legacy and to be remembered as vital and not decrepit. The American population is aging, and Emanuel may not be wrong that in our youth-orientated society, growing old in America is far from desirable. Nikki Haley appears to agree.
Why did Emanuel pick age 75 over all other ages? As a direct consequence of COVID-19 and drug overdoses, life expectancy in America is now on the decline. Life expectancy represents the average age of death of a population starting at a particular point in time. This breaks down differently for women and men, as women tend to live longer. Since 2014, life expectancy has fallen every year; in 2021, a man in America might expect to live to be just over 76.
What can be noted about a person like President Biden, who can happily glance back over his shoulder at age 76? Something important is present in those who live past life expectancy: They are the survivors.
In truth, life is a “survival of the fittest” curve. President Jimmy Carter left the White House at age 56. Assuming the repeal of the 22nd amendment, he could have served for an additional 10 four-year terms. Considering the contributions made by the former president since leaving the White House, Biden’s potential for an unfulfilled second term now seems a small risk.
The cohort of survivors after life expectancy are fundamentally different than those younger than 76: their risk of death with each passing year slows down. Physicians see this interesting effect frequently. To be frank, Nikki Haley at age 51 has entered a dangerous decade, when the accumulation of bad choices and bad luck start to be more likely to cause death. Of the eight presidents who died in office, four were between the age of 50 and 60.
If Biden is alive to be inaugurated in January 2025, he will be 83 years old. He needs four years to serve his last term. Recent actuarial models predict that at age 83, he should live another 6.3 years. If he makes is to 87, he should live another four years — time enough for two terms in Congress.
While certain human abilities decline with age — and to a degree, younger people can anticipate more subsequent years of life than older people — others improve. Discernment and wisdom can be the products of a life of experience. And when it comes to our leaders, isn’t that really what we all looking for?
Joel Zivot, MD, MA, JM, is associate professor of Anesthesiology and Surgery, Emory School of Medicine; former adjunct professor at the Emory School of Law; and senior fellow in the Emory Center for Ethics.