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Health Law and Ethics |

Addressing the Ethical, Legal, and Social Issues Raised by Voting by Persons With Dementia

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(11):1345-1350. doi:10.1001/jama.292.11.1345.
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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.

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