Joe Biden is not performing well in ad hoc interviews, debates and campaign stops. This is clear to the lay person and has been explicitly brought up by other candidates, such as Julian Castro and Cory Booker, at points during the primary. It is not offensive or abusive to recognise the evidence of our eyes and ears. In fact, it is deeply unethical and exploitative to do otherwise. And those most guilty of this are the democratic establishment who, in their propping up and support, are engaging in a form of elder abuse.
I am a psychiatry registrar, with experience in psychogeriatrics. I’ve treated many people with different types of dementia, late-onset psychotic disorders, mood disorders and psychotic depression. I’ve worked very closely with them and their families, trying my best to shepherd them through an extraordinarily difficult process. The code of conduct I took an oath to uphold places the patient at the centre, with specific emphasis on their autonomy and dignity. And I have seen first-hand the consequences of exploitation and manipulation to which these patients are exquisitely prone.
Doctors understand that it is never wise or prudent to diagnose someone without a full assessment and examination. I have not stated here or online that Joe has dementia. That’s not confirmed and to say so would be incorrect. But doctors also have an ethical duty to refer someone if they have a reasonable suspicion that they are unwell, and to advocate for them in the face of others who may sadly take advantage of their infirmity. That is all I am trying to do.
I read with deep concern that Biden’s recent medical did not include any form of cognitive testing. If this is true, it would constitute medical negligence – yet another failure of those around Joe to look out for his interests. I have communicated with the American Psychiatric Association and urged them to look upon this matter as a real-time example of elder abuse and exploitation. I hope they reflect on their duty of care and act accordingly.
I support Bernie Sanders and always have. I disagree profoundly with Biden’s worldview. But this is not the issue. It seems very difficult for people to recognise this and I am accused of being a ‘Bernie Bro’ hiding behind a false sense of concern. Mainly I find this critique sad, but also very cynical. Despite what too much time on Twitter has taught us, there are people out there who have made a commitment to certain principles and to a duty of care, and whose principles sit above partisan politics.
Biden supporters will often bring up Bernie’s heart attack as a counterpunch, which only demonstrates their unwillingness to engage in the discussion, and indeed their disregard for its ethical contours. Objectively speaking as a medical professional, Bernie is likely healthier now he has a patent artery. Are the rigors of an election, particularly the stress, going to impact upon his heart? Possibly, although exercise is generally a good thing for cardiovascular health. But people making these claims are being blind to the fact that Bernie’s heart attack does not result in visible and daily humiliation and indignity. We can argue the merits of him running with the spectre of another heart problem, but we can all agree that he has made this decision himself, with full capacity. I am genuinely concerned that we cannot say that with as much confidence for Joe Biden. The irony in all of this is that I support Bernie but, unlike Biden ‘supporters’, am trying to advocate for his dignity and autonomy.
What concerns me most is that a vulnerable man is being paraded around as the standard-bearer and being exposed to an immense amount of pressure and media attention. He is being put out to the cameras where he will predictably not cope, and this humiliation will continue and possibly worsen. I am deeply dismayed by the people who, for their own personal and political gain, are disregarding the person at the centre. Biden deserves dignity and support – not a public and intellectually demanding Herculean task. A task which, by the way, demands many things that the evidence suggests are most distressing to those with cognitive issues – travel, shifting environments and the lack of consistent care.
Finally – stigma around mental illness remains a big problem. The effect of Trump’s potential campaign against Biden in hampering awareness and resistance to stigma will be profound. It will be cruel and difficult to watch, as it should be. The fact those close to Biden pushing his campaign are aware of this and do not seem to be concerned is yet another example of their disregard for his dignity and health. Nice words about mental illness are all well and good, but actions matter. And their actions are reprehensible, exploitative and abusive. If I had objections to the Democratic establishment before for other reasons, I now have genuine disdain.
To reaffirm my opening point – to recognise the evidence of our eyes and ears is not offensive or abusive if it genuinely indicates concern for someone’s welfare, and indeed in this case the welfare of the country. To do otherwise is the real ethical abrogation. The Democratic establishment should be ashamed of themselves. And some on the progressive left should remember that ‘punching down’ is never a good thing. Attacking Joe Biden on his issue is punching down and is not acceptable. ‘Punching up’ is much better, and we should be reserving our criticisms for those craven opportunists around Joe, in the spirit of concern and compassion for him.
Dr Todd Smith