Addressing The Ethical, Legal, and Social Issues Raised By Voting By Persons with Dementia


  • Pamela S. Karlan
  • Karlawish, Jason H.
  • A. Douglas Melamed
  • Bonnie, Richard J.
  • Appelbaum, Paul S.
  • Lyketsos, Constantine
  • James, Bryan
  • Knopman, David
  • Patusky, Christopher
  • Kane, Rosalie A.
Publish Date:
September 15, 2004
Publication Title:
The Journal of the American Medical Association
Journal Article Volume 292 Issue 11
  • Jason H. Karlawish, Richard J. Bonnie, Paul S. Appelbaum, Constantine Lyketsos, Bryan James, David Knopman, Christopher Patusky, Rosalie A. Kane, and Pamela S. Karlan, Addressing The Ethical, Legal, and Social Issues Raised By Voting By Persons with Dementia, 292 The Journal of the American Medical Association (2004).


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.