In a typical presidential election year, voters might wonder how the candidates’ views stack up on issues such as abortion, tax cuts, gun rights and immigration policy.

But this year, as a 78-year-old Republican Party nominee campaigned to replace an 81-year-old Democratic incumbent, a different question rose to the forefront of many voters’ minds: What’s in their medical files?

That issue eclipsed all others after President Biden’s : “Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.”

About 2,400 years later, the notion that a patient’s medical information should remain private was codified into federal law as part of the Health Insurance Portability and Accountability Act of 1996, better known as HIPAA.

There are limited circumstances where doctors have a duty to disclose a certain amount of information about their patients.

For example, if a patient presents a danger to himself or others, a doctor has a duty to warn law enforcement or potential victims of the threat, said Dr. Bandy X. Lee, a forensic psychiatrist and educator in Harvard Medical School’s program on psychiatry and the law.

If a patient has a reportable sexually transmitted infection such as syphilis or HIV, that diagnosis must be shared with a public health department, along with the names of the patient’s past partners so they can be informed and get tested, Klitzman said.

And if doctors notice a spike in cancer cases among people clustered in a geographic area, that too is passed along for public health officials to investigate.

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Beyond cases such as these, the consensus fades, Annas said.

Congress could try to carve out an exception to HIPAA and require presidents and presidential candidates to release their medical records to the public. But in the unlikely event that the law were to change, it’s unclear whether it would survive a challenge in court, said Bert A. Rockman, a professor emeritus of political science at Purdue University who specializes in the American presidency.

“It raises a lot of questions to which we don’t know the answers,” he said.

Besides, forcing sitting and would-be presidents to waive their right to doctor-patient confidentiality wouldn’t guarantee that voters learn the truth, Rockman said. A president could simply shop around for a doctor willing to obfuscate in a medical report, for instance.

“There are always going to be ways to get a work-around,” he said.

Even if a president is forthcoming, knowing their diagnosis wouldn’t necessarily tell you much about their ability to function. A White House occupant could have a mild case of Parkinson’s but be able to carry out the job just fine with proper treatment, Klitzman said.

Voters should also keep in mind that there’s a difference between the president and the presidency, Rockman said.

“The presidency can work even if the president is diminished,” he said. “In all likelihood, unless the president is completely out to lunch for some reason or another, either physically or mentally, the office itself functions.”

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Indeed, U.S. history is rife with examples of presidents concealing serious medical problems from the public.

John F. Kennedy was taking narcotic painkillers, amphetamines and steroids to treat his Addison’s disease and other ailments while trying to avert a nuclear crisis with the Soviet Union in the early 1960s.

Grover Cleveland said he was going on a four-day fishing trip when he boarded a yacht in 1893 to have a malignant tumor — along with part of his jaw and five teeth — surgically removed from the roof of his mouth.

Woodrow Wilson suffered a stroke in 1919 that left him partially paralyzed, bedridden and unable to feed himself for the remainder of his presidency. When pressed for details about Wilson’s condition, his doctor said “the President’s mind is not only clear but very active.”

It’s not OK to lie to preserve a patient’s privacy, Klitzman said, but that doesn’t necessarily mean a doctor must reveal “the truth, the whole truth, and nothing but the truth.”

“You can say, ‘The President’s not feeling well today,’ or you can say, ‘The President has COVID,’” he said. “You want people to trust the government, and if people feel the government is lying all the time and we can’t trust anything they say, that’s not good.”

This story originally appeared in Los Angeles Times.