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Jason H. Karlawish, MD; Richard J. Bonnie, JD; Paul S. Appelbaum, MD; Constantine Lyketsos, MD; Bryan James, MBioethics; David Knopman, MD; Christopher Patusky, JD; Rosalie A. Kane, PhD; Pamela S. Karlan, JD

JAMA. 2004;292:1345-1350.

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.

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).

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