Privacy vs Public's Right to Know

The White House had a very direct explanation for Laura Bush's initial refusal to reveal that she had a skin cancer tumor removed last month from her right shin. She is not an elected official, said White House spokesman Tony Snow.

Therefore, he said, she was under no obligation to disclose something that was not life-threatening. "Perhaps," said Snow, "if there's something more major, this would be discussed."

Mrs. Bush did not lie about the squamous cell carcinoma. She simply remained silent until a reporter asked about the bandage below her right knee, a bandage she has worn for more than five weeks. Tony Snow told reporters, "I think you guys are trying to whip this up into something much larger than it is." Unlike President Bush and Vice President Dick Cheney, he said, "other members of the family" do not reveal medical problems "and have not done so in prior administrations, and are not likely to do so."

That is not entirely accurate. Some first ladies have been forthcoming, such as Nancy Reagan, when she discovered she had breast cancer. She underwent a successful mastectomy in 1987. Earlier, Betty Ford had the same operation shortly after her husband became president. Mrs. Ford became a spokeswoman for the importance of detecting breast cancer early.

However, Mrs. Ford, while in the White House, stayed silent about another problem that had privately worried friends and family. They suspected her dependency on alcohol and opiod analgesics. According to a former staffer in the Ford White House, Donald Rumsfeld, who was White House chief of staff at the time, grew concerned about her drinking and chided a friend of hers for encouraging it.

The problem became worse after the Fords left the White House in 1977. The following year, Betty Ford's family forced her to confront her addiction. After her recovery, she established the now world-famous Betty Ford Center for the treatment of chemical dependency.

For the most part, Americans seem to give first families wide leeway in how much medical knowledge should be shared. Of course, Americans love rumors, and there was talk about alcoholism in some families long before Gerald Ford became president. But while some may have enjoyed gossip about a first lady's tippling habits, there was no public demand that the White House address whether those rumors were true.

Even as a child in Alabama, far from the chattering circles of Georgetown, I heard tales of how Mamie Eisenhower enjoyed a drink or two or three while "Ike" was otherwise occupied with government or golf. Many years later, her granddaughter, Susan, told me flatly there was no alcohol abuse. None. Nada. Zero.

When it comes to a president's health, the public has gradually come to expect full access to the results of physical examinations. It was not always so.

In 1919 President Wilson suffered a severe stroke, partially paralyzing him and leaving him blind in one eye. The country knew he was seriously ill but did not realize the extent of the damage done by the cerebral hemorrhage. Neither did his vice president. Wilson's wife took on many of the president's responsibilities, including choosing the issues worthy of his attention.

Anyone looking at Franklin Delano Roosevelt in the 1944 presidential campaign could tell he was a sick man. But the nation re-elected him without knowing the full gravity of his condition. The White House was not honest about his health. And some of FDR's biographers believe he was not honest with himself, that he chose to ignore that he was a dying man. He suffered a fatal cerebral hemorrhage less than three months into his fourth term.

When John F. Kennedy assumed the presidency, the nation was agog with his vigor and youthful appearance. But he'd endured serious health problems. He lied when asked whether he ever had Addison's disease, a serious and sometimes fatal illness resulting from adrenal gland failure. Kennedy also suffered severe back pain.

The White House admitted there was some pain but did not reveal how disabling it could be at times.

Early in his presidency, I occasionally got a glimpse of how much he suffered. I was in the Army and assigned to the White House press office. One evening in March 1961, I saw the president stagger out of the Oval Office with help from two Secret Service agents. He was in a foul mood, cussing and clearly furious and embarrassed that the pain forced him to rely on others as he made the short walk over to the living quarters of the White House.

The nation had no idea he lived with so much discomfort. Nor did it know that he relied on injections to cope with the pain.

We know much more about the health of our presidents now. It has become an annual ritual as the president is examined and a report is released to the press corps. No other members of the first family are forced to submit to such an intrusive ordeal.

Now people are raising questions about Laura Bush's bout of skin cancer. Did she, as some contend, have the obligation to make a full disclosure as soon as she received the news from her doctor? Even though she was not elected, she does make appearances, both here and abroad, in which she represents her husband and her country. The White House insists she has no such obligation, and that she did not give up all her rights to privacy when she became first lady.