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.
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
Karlawish JH, Bonnie RJ, Appelbaum PS, et al. Addressing the Ethical, Legal, and Social Issues Raised by Voting by Persons With Dementia. JAMA. 2004;292(11):1345–1350. doi:10.1001/jama.292.11.1345
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