The cover-up of president Urho Kekkonen's dementia and its impact on the political life of Finland-a personal account.

Urho Kekkonen, born in 1900, was elected President of Finland in 1956. He stayed in office for 25 years, the longest term for any democratically elected chief of state, until his resignation in 1981. Since he was always a model of good health, news of his cognitive decline while still in office came as a surprise to the whole nation. The impact was aggravated by an attempted cover-up of his dementia. The attempt failed and the health of presidential candidates became, suddenly, a topic of intense public discussion. No special team of presidential doctors was established but Kekkonen's successor initiated a practice of reporting annually on his health. The ethical dilemma involving mass media was, and still is, its duty to inform people versus its right to self-censorship, which was practised in Kekkonen's case. The physicians face the question of when, how and whom to inform when they notice that the president or some other powerful leader suffers from cognitive decline or other neuropsychological or mental disability. These are universal problems whose solution depends on the degree of democracy and freedom of expression in each country. Kekkonen died in complete privacy in 1986. Until now, no scientific report of his cognitive decline has been published. Copyright 1999 Lippincott Williams & Wilkins.