Dr David Owen wrote an interesting piece in the Quarterly Journal of Medicine last year about his experience as a doctor-turned-politician. He found it hard to switch off his medical training, and relates some experiences:
On Iran:
As both a physician and a politician, I was first touched by the question of how illness can affect the decision-making of Heads of State or Government when I met the Shah of Iran in Tehran in May 1977. He appeared to be at the height of his power: self-confident, and enjoying his global role in helping to determine world oil prices. It would have been a great help to have known then, and particularly a year later, that he had been suffering from chronic lymphocytic leukaemia.
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The French Foreign Minister Louis de Guiringaud told me later, when we had both left office, that he had known of the diagnosis. But he never told me when I was Foreign Secretary, or Cyrus Vance, the US Secretary of State. Had I known I would have pressed far more vigorously early in 1978, and certainly been adamant in the late summer and autumn of that year, that the Shah should stand down immediately on health grounds. We had already argued for appointing a Regent in our own internal debate in the Foreign Office. Leaving the country would have left the path open for the Shah’s son to succeed when he became of age. We were then desperately searching for a way to defuse the personal animosity in the streets against the Shah. However, we were still treating him as an imperial leader, capable of making bold decisions, when in retrospect what he needed was to be told what to do and virtually forced to take treatment in Switzerland. If he had done so, the Revolution in Iran would not have taken place in the way that it did, President Carter might have won a second term, and certainly the history of the Middle East would have been very different.
On Uganda:
In the summer of 1977 the British Government decided to try to stop Idi Amin from attending the Commonwealth Heads of Government meeting in London. We could not persuade African Commonwealth leaders to agree that he should be formally uninvited, but we told him that he would not be welcome to attend. So bizarre was his behaviour that we believed a wild story that he was in the air about to fly in, and the Home Secretary made arrangements for his flight to be refused permission to land, and diverted to Ireland. Because of the many brutal killings he authorized, questions were raised about his mental state. Some physicians hazarded the opinion in the newspapers that he might be suffering from general paralysis of the insane. That diagnosis, however, has never been substantiated, and is unlikely, since he is still alive today, having fled to Saudi Arabia after the Tanzanian Army invaded Uganda in 1979 with the full encouragement of the British government. At one point I even raised the question of assassination, so appalling were the atrocities he was ordering, only to be told rather haughtily that MI6 would not contemplate arranging such a thing. Eventually, in desperation we increased the Tanzanian aid budget, knowing it would provide ammunition for President Julius Nyerere to authorize a military attack, and he promised not to install Milton Obote, but a respected paediatrician who unfortunately did not last long as President. All because one dictator was deranged and we had no other means of ousting him.
On the Soviet leadership:
In October 1977, I was asked by the Intelligence Service to report on the health of the President of the Soviet Union, Leonid Brezhnev, following rumours that he had been treated for cancer of the throat. When I met him in Moscow and talked to him for some time I could find no obvious abnormality. My interpreter, who had previously been at frequent meetings with him, felt his speech might have changed, but it was not possible to be sure. Later in February 1984, having left office, I attended the funeral of President Andropov. After shaking the new President Chernenko’s hand at a Reception in the Kremlin, I mentioned to some journalists that he had emphysema. Somewhat to my embarrassment, this aside was soon flashed around the world, and I spent days explaining that I had mentioned his condition, later confirmed, on little more than his wheezing chest. A doctor does not stop looking at people as patients just because they are politicians, but medical views are best kept private.
On Mugabe:
There was no evidence that Mugabe was mentally unstable when I negotiated continuously with him as joint leader of the Patriotic Front with Joshua Nkomo in the then Rhodesia from 1977 to 1979. Of the two, Mugabe was the more controlled and the less corrupt. Nonetheless, he displayed an aptitude for dictatorship which Nkomo did not, and this was one of the reasons that we unashamedly sought, by clandestine diplomacy and manipulation, to get Nkomo as the first democratically elected leader of Zimbabwe. Eventually it was Mugabe who won power, and he almost certainly would have won even without the intimidation from ZANU that lay beneath the surface in the rural villages during the Commonwealth supervised elections in 1980. What Mugabe had within him was an odd combination of Jesuit Catholicism and Chinese Communism. After an amazing period of reconciliation which surprised everyone and was unsurpassed by anything anywhere else in the world, Mugabe within a few years used North Korean troops in a brutal suppression of the population in Matabeleland, and in recent years he has presided over the ruination of his country. Commentators today refer to Mugabe as mad: I doubt if he could be so diagnosed, but he is undoubtedly acting evilly, and ought to be removed as President. The current sanctions have failed against the elites, but they should be maintained and there will have to be an internal political coup, supported or at least not disowned by neighbouring South Africa. South Africa has been adversely affected already in terms of investor attitudes to Africa.
The article is fascinating, and has an interesting discussion about the possibility of madness in dictators. There is also a discussion about the management of health issues in leaders of democracies. He suggests a solution:
On balance, I believe there should be provisions in place in a democracy to ensure that before voting any candidate for Head of State or Government into office, whether for the first or for subsequent elections, the general electorate should know the results of an up-to-date independent medical examination. Relying on a politician, ambitious for office, to reveal their true health or on their own personal doctor, family or friends is not sufficient. Nor can electors depend on probing journalists or fellow politicians to know the medical condition of a candidate, particularly those who have not already been subjected to the intrusive scrutiny surrounding a Head of State or Government. The Electoral Commission in the UK, on advice from the Royal College of Physicians, could appoint two panels of general physicians and neurologists. Provided the doctors had no medical or personal knowledge of the candidate concerned, two doctors, one from each panel, could be chosen by the candidate. The Electoral Commission could then supervise the content and manner of the publication of their findings.