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Markkula Center for Applied Ethics

Presidential Leadership Ethics: One Decision, Two Colonoscopies

George W. Bush

George W. Bush

Ann Skeet

J. Scott Applewhite/Associated Press

Ann Skeet is the senior director of Leadership Ethics with the Markkula Center for Applied Ethics. She tweets from @leaderethics. Views are her own.

There are as many definitions of leadership as there are chief executive officers. We can focus on the leader’s practice of keeping the interests of the people he serves front and center to analyze leadership ethics. Choices being made right now, at the highest levels of government leadership in the United States, are eroding this practice. Government officials are failing to model best practices for health and safety, neglecting the well-being of the American people, and undermining Americans’ abilities to fulfill their own leadership duties. 

Turning away from Covid in this White House, and looking instead at colonoscopies during the presidency of the last Republican president, George W. Bush, provides a lens free of partisan politics, exemplifying best practices. President Bush had two colonoscopies during his presidency, choosing to transfer power temporarily to his vice-president, Dick Cheney, under Amendment 25 of the Constitution, Section 3, during both, even though the procedures were brief and did not require general anesthesia. After each, detailed findings, including the removal of polyps, and the size and seriousness of the polyps, were disclosed. 

President Bush’s choice to transfer power during short, routine medical procedures might appear to be overkill. From an ethical perspective, however, it was a sound choice.

First, President Bush modeled support for preventative medicine. Colonoscopies involve unpleasant preparation, inconvenience patients, and, at the time of President Bush’s presidency, were not often discussed in polite society. They are the most effective way to prevent colon cancer and the president set a powerful example of prioritizing preventative health care measures by having them. 

By adopting the section of the amendment enacted to address moments when the president is incapacitated, President Bush strengthened it. His use of the section created precedence in a low stakes political moment during a relatively low stakes medical procedure. Invoking the amendment indicated to all Americans that he did not see himself above following guidelines that pertain to him. His choice expresses his own confidence in his power by willingly giving it away when appropriate.

Using this amendment put the interests of the American people first. Even for a procedure that lasted just 30 minutes, President Bush respected the American public by clearly shifting authority to the appropriate person to be sure that, even over a short time, there was someone charged with their care. He also cleared the way for his own doctor to serve without conflict or concern, keeping the health of his patient as his top priority. Vice President Cheney could focus on the country.

What President George W. Bush demonstrated in this relatively simple act was his awareness and respect for the relationship he had as president of the United States with the people he served. Our relationships are the foundation of our own ethical scaffolding, framing our priorities and responsibilities. President Bush met his obligations to his country and to his family with a single, simple move, temporarily relinquishing his power as president. 

President Bush strengthened our trust in his relationship with us, the American people, when he disclosed the scans’ findings. His personal transparency about information many people consider private honored his constituents and tacitly acknowledged the privileges he received with the office he held. Yes, he had his colonoscopy at Camp David and received top-notch care. In return for that privilege, he gave up his personal right to privacy and told us what that care revealed.

This is a story about a leader willing to put the well-being of the American people first. In this routine, somewhat mundane decision, President Bush signaled that he understood the power he had. He appreciated the impact his choices have on other people and accepted responsibility for the care of his people by delegating his duties. He demonstrated a willingness to openly share relevant information with the public. He acknowledged the important work of other people like his doctor and his cabinet and demonstrated his love for his family and country by taking care of himself. These are significant, positive outcomes from one decision and two colonoscopies.

Oct 13, 2020

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