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By Barbara A. Perry
Professor of Presidential Studies at UVA’s Miller Center
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The announcement of Joe Biden's aggressive prostate cancer diagnosis prompted a rush of commentary about how the disease would affect his post-presidency and historic legacy.
How have other former presidents' images fared when they face life-threatening diseases?
The answer has varied depending on a multitude of factors: How long was the president out of office? Was his exit controversial? Did it result from an election defeat or dropping out of the race? How did his life and career shape his reputation? Did he follow the contemporary model of philanthropic presidential centers? How did they handle physical or mental infirmities as they aged?
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In the modern era, since 63-year-old President Franklin Roosevelt died of a cerebral hemorrhage at the beginning of his unprecedented fourth term, former presidents have rivaled symphony orchestra conductors, popes, and Supreme Court Justices in their longevity. The last nine presidents to die after leaving office reached an average age of 85, which would have been even higher if not for Lyndon Johnson's demise in 1973 at age 64, after chronic heart disease took his life. His scant four years of post-presidential life lowered the average for his colleagues to a still-impressive 21 years.
Those presidents who enjoyed long lives and generally robust health after having to drop out of races (Truman) or facing reelection losses (Hoover, Ford, Carter, and Bush I) had plenty of time to regain stature. Those presidents who left office with high approval ratings (Eisenhower, Reagan, and Clinton, despite the latter's second-term impeachment) enjoyed decades of public goodwill. Americans tended to wish them well as they faced heart disease, in the cases of Ike and Clinton, and Alzheimer's, as Reagan did.
Even the staunchest Reagan opponent had to feel a pang of sadness over the former president's parting words, which he shared with the public in a handwritten letter:
In closing let me thank you, the American people for giving me the great honor of allowing me to serve as your President. When the Lord calls me home, whenever that may be, I will leave with the greatest love for this country of ours and eternal optimism for its future. I now begin the journey that will lead me into the sunset of my life. I know that for America there will always be a bright dawn ahead.
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In Jimmy Carter's case, transparency about melanoma that had spread to his brain in 2015, as well as his fervent religious faith and subsequent recovery from the dreaded disease, only made the former president seem heroic. He continued to work for social causes, especially with Habitat for Humanity, even after falls, adding to his indestructible image. Eschewing hospice to die peacefully in 2024 at his modest Plains, Georgia, home at age 100, he cemented the record for presidential longevity and steadfast character.
Joe Biden exited the White House at the oldest age of any former president. At 82, he will have less time to rehabilitate his legacy. And the fact that he had to leave the 2024 race after an age-related (and perhaps diagnosable) decline will only add to criticism from opponents and supporters alike that he should have passed the torch to a younger Democrat, chosen by the party's normal selection process.
Biden's battle with cancer parallels former president Richard Nixon's near-fatal bout of phlebitis just after his August 9, 1974, resignation over the Watergate scandal. A little more than a month later came a public announcement that he was suffering from a worsening blood clot in his left leg, leaving him with pain and depression. He had first experienced this condition, often labeled now as deep vein thrombosis (DVT), in 1964 before his presidency, while he traveled around the world to bolster his image as a global statesman. He experienced another bout in 1974 in a flight from Egypt back to the U.S. For patients prone to such symptoms, long-distance flying or other confinement can induce the disease.
During his September 1974 attack, Nixon initially refused hospitalization, but DVT is potentially fatal if a clot travels from the leg to lungs or heart. Finally, the former president agreed to be admitted to a Long Beach, California, hospital where doctors discovered a clot in his lung. With surgery, blood thinners, and other prescriptive measures, Nixon recovered and lived another two decades but succumbed to a stroke in 1994.
Some observers believed that the stress of Watergate had contributed to Nixon's condition. Whether it did, his fragile health may have led his successor Gerald Ford to issue him an unconditional pardon. Undoubtedly, the DVT and ultimate hospitalization prevented Nixon from testifying in the Watergate trials.
And there lies another parallel with Biden—his dire diagnosis hit amid the rollout of a new book on his failing health in the White House and the Justice Department's revelation of his faltering speech in a taped October 2023 deposition with Special Counsel Robert Hur.
Former president Biden's illness may prompt empathetic support—or additional criticism for his decision to remain in the 2024 race until it was too late for his party to retain the White House. Only history will tell.
Dr. Barbara A. Perry is the J. Wilson Newman Professor in Presidential Studies at UVA's Miller Center, where she co-chairs the Presidential Oral History Program. Follow her on Bluesky @BarbaraPerryUVA.
The views expressed in this article are the writer's own.
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