Voting with dementia

Rob Moir doesn't like Republican presidential candidate Donald Trump, but he can't say why. But not for the reason you may think. Moir, a retired history teacher and liberal activist, has moderate Alzheimer's disease.

He can still tell you what he believes, but his wife told Stat she needed to help him with ballot wording and be with him in the voting booth.And yes, people with dementia can vote. The question of whether people with dementia can vote becomes an ethical one, then.

“We found that judges, family caregivers and long-term care staff do not have adequate guidance to determine whether individuals with dementia have the capacity to vote,” said Jason H. Karlawish, MD, professor of medicine, medical ethics and health policy and neurology at the University of Pennsylvania School of Medicine, in a press release

Karlawish and a group of Alzheimer’s researchers, Constitutional scholars, geriatricians, gerontologists and philosophers gathered in 2003 to discuss dementia and voting; their findings were published in the Journal of the American Medical Association. They concluded:

  • There is no valid test to determine when a person reaches the point of incapacity to vote.
  • Under no circumstance is it legal to have a proxy to cast the vote of another person.
  • Two conditions must be present for a person to vote: 1) the voter understands what they are doing and 2) the voter understands the person who wins received the most votes and takes office.

A review of existing voting law found inadequate legislation at the federal, state and local level. A handful of states exclude voters on the basis of the specific “capacity to vote” but none provide a standard for assessment, meaning laws likely violate the Constitution as well as the American with Disabilities Act.

The best assessment, researchers say, is choice.

“We recommend focusing on whether a person can understand the nature and effect of voting and can make a choice,” Karlawish said. “For example, ask the person with dementia how people will choose the next president and when the voting is over how will it be decided who is the winner. If they understand these concepts and they want to vote and can make a choice, that is all that is necessary. They do not need to comprehend the details of each candidate’s platform.” 

Topics: Alzheimer's/Dementia