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BRIEF COMMUNICATIONS: J. H.T. Karlawish, D. A. Casarett, B. D. James, K. J. Propert, and D. A. Asch Do persons with dementia vote? Neurology 2002; 58: 1100-1102 [Abstract] [Full text] [PDF]

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Dementia and voter competence

Marc A. Swerdloff, Neurologic Consultants, PA   (29 April 2002)

Dementia and voter competence

Victor W. Henderson, David A. Drachman, MD   (29 April 2002)

Reply to Dr. Swerdloff

Jason H.T. Karlawish, David Casarett, Bryan James   (29 April 2002)

Dementia and voter competence 29 April 2002
Marc A. Swerdloff Neurology consultant, Neurologic Consultants, PA Send Correspondence to journal: Re: Dementia and voter competence mswerd{at}bellsouth.net Marc A. Swerdloff, et al.	<P> I'd been following my patient from Palm Beach County for a few years, watching him decline slowly from Alzheimer's disease. At the time of the last Presidential election he thought it was 1942 and believed Roosevelt was President. The patient's wife told me she took her husband to vote and cast the ballot for him since she "knew who he would have voted for." I was amazed that in essence she was allowed to vote twice since her husband was completely incompetent. There was no mechanism to prevent such blatant election fraud from occurring. Unsubstantiated rumors were circulating at the time that partisans were going through nursing homes and filling out absentee ballots for the residents that were unable to vote. If this was the case then voter fraud was occurring at a high degree. <P> I call on the Academy to give guidance to Election Boards on who is competent to vote. Our freedoms depend on it.
Dementia and voter competence 29 April 2002
Victor W. Henderson Reynolds Center on Aging, David A. Drachman, MD Send Correspondence to journal: Re: Dementia and voter competence vwh{at}unimelb.edu.au Victor W. Henderson, et al.	<P> We appreciate the writer's observations and share concerns expressed in the letter. If partisans were indeed filling out absentee ballots for nursing home residents, we suspect that existing laws on voter fraud could be applied. The wife's undue influence on her demented husband at the ballot box raises issues that are more difficult to address. Whereas we presently lack information to support specific recommendations on voting by people with dementia, we believe that the issue should be addressed. <P> In the setting of brain disorders, the issue of voter competence poses not only neurological and psychological questions, but it also raises difficult and sensitive judicial, legislative, and political concerns. For this reason, we would recommend the formation of a working group of representatives from each area of expertise to study the problem. Ensuring rights of individual citizens and maintaining the integrity of democratic voting procedures will be a complex and delicate undertaking of considerable importance. In the meantime, even without specific guidelines from the AAN or governmental agencies, it is certainly within your purview as a neurologist to advise your patient's caregiver on this topic.
Reply to Dr. Swerdloff 29 April 2002
Jason H.T. Karlawish University of Pennsylvania, David Casarett, Bryan James Send Correspondence to journal: Re: Reply to Dr. Swerdloff jasonkar{at}mail.med.upenn.edu Jason H.T. Karlawish, et al.	Dr. Swerdloff’s letter is yet another case study provided us in reaction to “Do persons with dementia vote?” [1]. These cases and our data raise two questions. First, when a person goes to the voting booth or fills out an absentee ballot, what abilities should he demonstrate to show the capacity to vote? Second, who should have the authority to assess these abilities and judge a person’s capacity? The following is a reasonable proposal in answer to these questions [2]. The capacity to vote derives from the ability to either produce or the ability to describe the steps to produce the necessary documents to register to vote. For example, a useful question might be, “How can you prove to me that you are a citizen of the United States?” At the polling station, this assessment should be the charge of election judges. And at home or the nursing home where people complete absentee ballots, this assessment should be the charge of the family caregiver or person who serves in an equivalent relationship. Clearly, voting in place of another person is simply wrong. But we should not let the perfect become the enemy of the good. Hence, by whatever steps we take, or do not take, we should tolerate the error of incompetent people voting and be intolerant of the error of denying competent people voting. Historically, persons with mental illnesses such as schizophrenia have suffered the latter of these errors [3]. We should not repeat that history with persons with one of the most common causes of mental illness: dementia. References: 1. Karlawish JHT, Casarett DJ, James BD, Properrt K, Asch DA. Do persons with dementia vote? Neurology 2002; 58:1100-1102. 2. Sales BD, Powell DM, Duizend RV, Associates. Voting Rights. Disabled persons and the law. Vol. 1. New York: Plenum Press, 1982:99-112. 3. Applebaum PS. “I vote. I count”: Mental disability and the right to vote. Psychiatr Serv. 2000; 51:849-850, 63.