Should Domenici Retire Now?

Senator Pete Domenici was diagnosed with Pick’s Disease, a progressive and aggressive form of dementia.  It is unknown when he received the disease, or at what stage the disease is in.

However, it is always fatal, and it always affects insight, judgment and behavior.

Given the known disease progression and prognosis (fatal, usually within five years), should Domenici retire now instead of planning to serve out the remainder of his term until 2009?

Here’s what the NY Times described:

Mr. Domenici, who is 75 and in his sixth term, revealed on Thursday that he had frontotemporal lobar degeneration, a term that describes a family of diseases that damage parts of the brain that control language, behavior, planning, organizing, decision-making and movement. Patients can have either speech problems or behavioral ones, or both, and the symptoms can vary from subtle to flagrant. There is no treatment or cure. All they can do at this point is to rely on support from sources similar to Home Care Heroes to ensure that Mr. Domenici is comfortable. The cause is not known, though in about 40 percent of cases, there is a family history of it.

The disorder is also called frontotemporal dementia, and sometimes Pick’s disease, for the doctor who first identified a form of it in 1892. Frontotemporal disease causes a different pattern of brain damage than Alzheimer’s disease, and does not start with the kind of memory loss that usually signals the onset of Alzheimer’s. It is also less common than Alzheimer’s, affecting 100,000 to 200,000 Americans, compared with the 4.5 million people afflicted with Alzheimer’s.

eMedicine lists some of the symptoms during the first two years of the disease.  Several of the psychiatric symptoms are especially alarming in view of the role of senators.  They include:

  * Clinical course during the first 2 years is as follows:

  o Psychiatric abnormalities that seem to respect the pattern of the classic frontal lobe syndromes are present (Gregory, 1996).

  + Patients with orbitofrontal dysfunction become aggressive and socially inappropriate. They may steal or demonstrate obsessive or repetitive stereotyped behaviors.

  + Patients with dorsomedial or dorsolateral frontal dysfunction may demonstrate a lack of concern, apathy, or decreased spontaneity.

  + Patients may be depressed early in the disease.

  + These mood changes can predate amnesia.

  o Speech and language abnormalities often begin early and progress rapidly.

Most patients diagnosed with Pick’s Disease do not work.

Some questions for consideration include:

Since the onset of symptoms is insidious, what is the benchmark for diagnosing and assuring mental competence in judgment, insight and decision-making?

As senators are explicitly charged with representing constituents, may they legitimately be recalled or forced from office when this diagnosis is made, instead of when symptom progression is evident or by some other means of evaluation?

What role does the Senate ethics committee have in determining Domenici’s continued “fitness to serve”?

Are Domenici’s votes since his diagnosis, but before his public acknowledgment, valid?

What means should be put in place to remove elected officials from office who are diagnosed with health problems that affect mental competence relative to insight, judgment and mental capacity to make decisions in the best interests of their mandated constituencies?