Thoughts on politics and life from a liberal perspective

Monday, 28 September 2009

The Prime Minister and pills

Stephen Tall wrote an impassioned piece yesterday on Lib Dem Voice arguing that Andrew Marr was "wrong, wrong, wrong" to ask Gordon Brown whether or not he was taking pills yesterday on his morning TV show.

Stephen does make some good points, for example he suggests that if this was a Tory Prime Minister then the reaction of the right-wing blogosphere would likely be very different and the"scarcely contained glee" of some of the blogs at the question having been asked is certainly not edifying. He also asks what Marr's sources are for asking the question in the first place suggesting that unless he has substantial evidence then the question should not be asked.

But whilst Stephen puts a good argument forward I am afraid that ultimately I do not agree with his conclusion. He concludes:

..the only people qualified to make the decision to quit, or not to quit, are Mr Brown and his closest family, friends and advisors. If his feelings of depression were linked to his job as Prime Minister, and the only way he could break the link would be to resign his office, then so be it. I imagine we would all respond with sympathy and understanding to such a decision. However, if his depression were nothing to do with the job – perhaps linked to frustrations with his failing eyesight, or the tragic death of his first child – then resigning would make no difference to his depression, indeed may just make it worse.

There are any number of reasons why the Prime Minister should quit, and just as many again why he deserves to lose the next general election. None of them are related to his health. And in making it an issue on the basis of no evidence, Andrew Marr and the BBC have done a real disservice to serious political reporting.

I probably need to tread carefully here as it is a delicate issue so let me first outline a couple of caveats.

Firstly I have nothing but sympathy for people who have mental health issues. There can be few people in this country whose lives have not been touched by problems of this nature either personally or through friends or family. They absolutely deserve sympathy and support.

Secondly I am very unhappy about the stigma that mental health problems still have attached to them in this country. Just because somebody is suffering with issues of this nature does not mean that they are incapable of contributing to society and prejudice in this respect is thoroughly unhelpful.

However, just because I have sympathy for somebody in adverse circumstances and I do not wish to see that person unneccessarily discriminated against does not mean that I agree with the conclusion that in the case of the Prime Minister it is nobody else's business but his own. Let me explain why.

The Prime Minister of the UK is in a very special position. He/she is in theory "First amongst equals" but in practise that is no longer how it works. What has happened over the last few decades is that power has become more and more centralised in the hands of the Prime Minister. The cabinet and parliament are supposed to act as checking and balancing bodies but in practise all too often they do not work like that. There is also the question of the "Royal prerogative" powers which although nominally vested in the head of state, in practise are executed at the whim of the Prime Minister. There are also huge powers of patronage.

What has effectively happened is that we have moved much closer to a sort of presidential style of government but without a codified constitution to underpin this.

Given all of this, I think the public has a right to know about the health of the person holding this office.

It is instructive at this point I think to look at what happens in the USA regarding their Presidents. They have an annual health check and the results are made public. They obviously feel that the health of their primary political leader should be in the public domain. I think this is right for a situation where one person has so much power vested in them.

This is not to say that I think the way this was broached is correct. To have the Prime Minister of our country asked a question like this out of left field was not the way I would have liked to have seen this happen. However I can't imagine that Gordon Brown or any future Prime Minister would volunteer this information. Indeed it seems that the way Tony Blair played down his heart problems a few years ago was not entirely straight and it was a bit more serious than his office made out at the time. Therefore it was probably always going to take a journalist asking this question to provoke the debate as it has done.

I would just conclude by saying that if we had a less top-down style of government with much of the prerogatives and patronage removed from the hands of one person then I would not see the need so much for us to know about the health of any one individual. Unfortunately we are not in that position and I therefore reluctantly conclude that this is one of the those situations where although it to an extent goes against my liberal instincts I think we should know.

UPDATE: After some vigorous discussion in the comments below and also on Jennie's blog here I am inclined to have a bit of a rethink of my comments here. Andrew Hickey (below) has come up with some good points about flaws in my reasoning and has made the point that disclosure could actually be counter productive. As I say in the comments in both posts my aim was to try and overcome constitutional problems with so much power being concentrated with one person who is ultimately his/her own arbiter of suitability to continue in office.

I still think we should do something to make it easier for a PM to be removed from office if they become incapable, perhaps along the lines of the US 25th amendment but accept that my comments about making health information public may not be the best way to achieve this.


Kristan Smith said...

I agree they need to have some health checks. They are in an important role and need to be tip-top condition (or as close as).

It would be interesting if health checks were in place - would people be complaining about another unnecessary public expenditure?

Harry Cole said...

what this Tall fella doesn't get is that this is not a party issue. I would be equally intrigued to know if a tory leader was on prescribed behaviour altering drugs.

Kalvis Jansons said...

I was surprised by the questions, but could see that there were good reasons to ask them.

Andrew Hickey said...

This is simply wrong. Unless there is a pressing reason why a particular health condition would prevent the Prime Minister from doing their job, there's nothing that should make it anyone's business. If the Prime Minister is incompetent (which this one is) that will show itself and s/he will be judged accordingly without the health problems being made public. If the PM is competent, then any health problems are no-one's business but their own.

Prime Ministers should be judged on their actual ability to do the job, not on possible hypothetical problems that might possibly be caused by hypothetical illnesses.

Mark Thompson said...

Andrew - but who would decide if a pressing health condition was causing problems of that nature? Cabinet colleagues? Their instinct would be to rally round and deny there was a problem. Civil servants? Above their pay grade surely.

It would ultimately be up to the PM him/herself or for the electorate but that would only come after up to 5 years.

Wilson for example recognised his health was failing and voluntarily stepped down but I bet not all PMs would be as willing to relinquish power even if they recognised they were no longer up to it.

I don't think it is a coincidence that the USA publishes this info already. They have carefully thought through their system whereas ours is a mish-mash of hundreds of years of political evolution and precedent.

Andrew Hickey said...

It would be up to the PM, the electorate, or the other members of the parliamentary party. Prime Ministers can be incredibly crap with no health problems at all, and can be great with severe ones. We have several mechanisms for getting rid of crap Prime Ministers, and should probably have more, but they should be related to *how well they're doing the job*, not to anything else.

If someone has an illness - of whatever kind - and is capable of doing the job, they should be allowed to do it. If someone's the epitome of physical and mental health but an incompetent buffoon, then they shouldn't.

And 'the Americans do it' is no argument at all. One might as well point out that the Americans have an entrenched two-party system where the only way to become leader is to spend hundreds of millions of dollars. If their system is that well thought-out, then aspects of that system should be defensible on their own merits, rather than by appeal to authority.

Mark Thompson said...

What are these "several methods" for getting rid of Prime Ministers then?

I still think we are largely in the position of relying on them to recognise if they are not up to it any more which they may or may not do.

And I am not appealing to authority with my US argument. I think the way they do it is right, they publish the information each year so everyone can see and decide. They do the same with candidates. It does not prevent people with health problems from running or becoming President (see Reagan and McCain as recent examples) but it does give the electorate the information.

Andrew Hickey said...

For a start, members of their own party can force a leadership election. And like I say, we should have more.

You still have yet to give a single reason WHY personal, private information about someone's health should be made available to the public - and, indeed, you've not said what you would do if a sitting PM had one of these illnesses while in office but considered him/herself perfectly fit to continue in the job.

At best, all you're arguing for here is the satisfaction of a prurient need for gossip, and at worst you're actively encouraging discrimination against one of the few groups it is still considered acceptable to marginalise in society.

Unless and until you can show some *actual evidence* that there is an *actual problem* (and yes, saying 'the USians do it and they must have thought about their reasons' *IS* argument from authority) that this would *actually solve*, then this is just, frankly, an excuse for bigotry. I really expected better from you, and I hope you reconsider your position on this.

Andrew Hickey said...

And on top of anything else, when it comes to mental illness - the original topic of discussion - you've *really* not thought this through.

Assume a Prime Minister worried s/he has a real but treatable mental illness.

Current system: Prime Minister goes to doctor, gets treatment, remains fully able to discharge their duties.

Your system: Prime Minister thinks "Hang on, if I get a diagnuisance it'll be all over the front page of the papers and I'll lose my job - and we'll be 'the party that put a nutter in charge' and lose the next general election too. I'll cope without treatment."

Given that there are no gross physical symptoms of mental illness - it's not something that can be picked up on a checkup in a way that, say, cancer or heart problems can - the effective result of your suggestions would be that the public still wouldn't know, but the Prime Minister *would be suffering from an undiagnosed, untreated mental illness instead of a diagnosed, treated one*.

Does that really benefit *ANYONE AT ALL*?

Mark Thompson said...

Right, the first thing I want to do is disentangle some stuff here. I am not saying that anyone with mental or any other health problems should be barred from the office of PM.

My concern is that at the moment as far as I can tell, the only person who is the arbiter of whether somebody is fit to execute that office is the PM themselves, irrespective of what the reason may be.

In other countries, including the US there are mechanisms for dealing with issues like this. The US has the 25th amendment in which a majority vote by the cabinet can allow the next in line (usually the Vice President) to take over as president if the incumbent becomes incapable of executing his/her duties. As far as I am aware we have no formal mechanism for doing this in the UK. I suspect that if it was very obvious that a sitting PM had become incapable of executing his/her duties then people around the PM would take the necessary decisions to relieve him/her of their duties but I imagine there would be chaos around that with no guide to how to go about doing this.

The crux of my concern is that there be
a mechanism in place to cover a situation like this.

So perhaps on reflection the information does not need to become fully public. Perhaps medical info could be disclosed to the privy council or cabinet if the mechanism was triggered (in a situation where serious concerns had been raised) and a decision could be taken like this.

My concern is really to do with us not having a properly thought through constitution and with so much power resting in the hands of one person with no proper oversight or checks and balances.

I have just seen your latest comment which does make a good point but hopefully a more formal mechanism like that outlined above would mitigate the problems you describe.

Andrew Hickey said...

But that could still be done *without anyone having to be informed of anyone's illness*.

If you have a situation where Cabinet (or whoever) can vote that the PM is no longer capable of doing the job, that vote should be based on *evidence that the PM is no longer capable of doing the job*. If the PM is fulfilling his/her functions adequately, then whether s/he is ill is irrelevant. If s/he *isn't* doing the job adequately, Cabinet would be able to tell that without the information about health, so it's *still* irrelevant.

The two things have absolutely nothing to do with each other. Either an illness impacts on their ability to do the job - in which case anyone given the power to remove them from office should be able to see that without being told they're ill- or it doesn't - in which case the illness is nobody else's business.

Your suggestions here interfere with the principles of personal privacy and medical confidentiality, encourage bigotry against a group that frankly has enough to deal with as it is, require interference by the State in someone's personal life, and would actually exacerbate the (purely hypothetical) 'problem' for which you put them forward as a solution.

Can you REALLY not see that this is illiberal nonsense of the worst kind?!

Mark Thompson said...

Well I knew I would be walking into a minefield with this.

It does go against my gut instincts to argue for disclosure but I was trying to find a way to ensure that someone incapable of executing the office would be able to be removed but I accept that this should be for any reason based on performance.

I suppose in the real world it would not necessarily be as clear cut as we are discussing here and medical information could be beneficial to anyone or group making a decision like this, however every argument you are coming up with does resonate with me (it's my own fault for being a bloody liberal I suppose!) so I probably need to have a further think about this.

I got some stick for my comments on this on Twitter last night (the words illiberal nonsense were used there too) so I thought the best way to test them out was to post on them, and you haven't let me down!

I will post an update in the main post pointing to this discussion we have had here.

Jennie Rigg said...

I'm sorry for taking this so personally, btw.

Mark Thompson said...

Hi Jennie.

No worries. This is a difficult subject which I knew was a potential minefield when I originally posted.

I have responded to your second comment on your blog now BTW.

Cardinal Richelieu's mole said...

If Brown had any of Richard Nixon’s communicating skills he would have said “The British people have a right to know if their Prime Minister is taking mind-altering drugs to cope with being off his rocker ‘cos of the stress of the job, made worse by his deeply flawed personality. Well I am not taking drugs yet, deeply flawed though I am”. A. Marr would have been gob smacked and we would all have been re-assured.

Instead, we were get all the fuss we have had and Brown’s persecution complex (allegedly) gets all the worse - making a prescription more likely perhaps, allegedly.

It is a primus inter pares system and if there are sufficient doubts then a responsible cabinet (not this one, obviously) has a constitutional duty to act. We do not need ghastly US type disclosure. Note a key distinction between the systems is that the Prime Minister can be removed with a startling suddenness and at any time: a US President not.

Whilst it is an oft used quote that “No-one leaves Downing Street completely sane” what is less well known and acknowledged is that no-one enters it completely sane either. Let us hope the present incumbent sees some relief from his torment soon.

Dingdongalistic said...

PMs can be removed from office if their parties or their legislature force the issue -- a mechanism that the US does not actually have. It need not actually involve a vote of no confidence -- just a party rebellion of required magnitude.