Health Law and Ethics
September 15, 2004

Addressing the Ethical, Legal, and Social Issues Raised by Voting by Persons With Dementia

Author Affiliations

Author Affiliations: Department of Medicine, Center for Bioethics (Dr Karlawish), Department of Medicine (Mr James), and Fels Institute of Government (Mr Patusky), University of Pennsylvania, Philadelphia (Dr Karlawish); Schools of Law and Medicine and Institute of Law, Psychiatry and Public Policy, University of Virginia, Charlottesville (Mr Bonnie); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Dr Appelbaum); Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins University, Baltimore, Md (Dr Lyketsos); Alzheimer's Disease Research Center, Department of Neurology, Mayo Clinic, Rochester, Minn (Dr Knopman); Long-term Care Resources Center, School of Public Health, University of Minnesota, Minneapolis (Dr Kane); and Stanford University School of Law, Stanford, Calif (Ms Karlan).


Health Law and Ethics Section Editors: Lawrence O. Gostin, JD, Center for Law and the Public's Health at Georgetown University, Washington, DC, and the Johns Hopkins University, Baltimore, Md; Helene M. Cole, MD, Contributing Editor, JAMA.

JAMA. 2004;292(11):1345-1350. doi:10.1001/jama.292.11.1345

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance to enable persons with cognitive impairment to vote; and formulation of uniform and workable policies for voting in long-term care settings. In some instances, extrapolation from existing policies and research permits reasonable recommendations to guide policy and practice. However, in other instances, additional research is necessary.