This seems like an apt article to share today, this 2016 election day in the US. It touches on an issues that isn’t discussed too often, even among people who dedicate their lives to understanding, preventing, and treating dementia.

Dementia and voting.

This article and video discuss Rob and Margaret and their process of navigating voting after Rob’s diagnosis of moderate Alzheimer’s disease 2 years ago. Read the full article and watch the video at:  https://www.statnews.com/2016/11/07/alzheimers-voting-dementia/

In practice, whether they cast a vote often gets left to the discretion of a caregiver. Many geriatricians and ethicists who study the issue say there’s one key question to determine whether someone with Alzheimer’s should vote: Can they express their choice? It doesn’t matter if they’re confused about what day it is. Or whether they can physically fill out the ballot. What matters is that they’re able to state, write, point at, or otherwise cogently indicate who they want to vote for. And for many people with dementia, especially in the early and middle stages of the disease, that’s entirely doable.

I have mixed feelings on this. Of course, there is no cognitive testing for someone to be allowed to vote. There is no IQ testing. You have to be 18 and registered. This also includes people with developmental (and other) disabilities.

In general, I would agree with the above quote, that as long as they can express their preference, they should retain their right to vote. We may not always agree with people’s reasons, but if they can clearly express their decision, they should be encouraged to exercise it. What is especially touching in the story about Rob and Margaret, above, is that Rob had a lifelong, active interest in politics and seemed to understand the issues and his (perhaps formerly expressed) opinions on them when Margaret explained them. It really would be a disservice to take away his right to vote.

However, it gets trickier when the person has been declared legally incompetent, such as when someone else takes over managing the finances, and health and legal decisions. At this point, it is very reasonable to think that the person with dementia can no longer understand complex topics and use their reasoning skills to arrive at a decision which is based on cognitive thought. And I also think that by this point, the care partner will know that and not put the person with dementia in the stressful position of trying to navigate voting anyway.

Here’s what Alzheimer’s Society has to say:

Question: Can a person with dementia vote in the UK general and local elections.

Answer: Yes, a person with dementia can vote regardless of their capacity.

It is clearly stated in the Electoral Commission’s guidance for Electoral Registration Officers that mental health conditions do not constitute a legal incapacity to vote, so a person would not be stopped from voting at the polling station.

However, it is important to note that the guidelines also state that the decision as to whether and how to vote at an election must be made by the elector themselves, and not by a carer or a person making decisions on behalf of the elector.

I also found a 2011 research article which looked at the capacity to vote in older adults and people with dementia. They conducted their research with people diagnosed with dementia and people of the same age with no presence of dementia. Categories they rated were:  understanding of the nature of the vote, understanding of the effect of the vote, vote choice, comparative reasoning, consequential reasoning, and appreciation. They found:

We observe that patients with dementia understand the nature and effect of the vote (53% and 44%, respectively), and appreciate its consequences (66.2%) but do not do as well when it is time to make a voting choice (25%) and to consequential reasoning (35.3%)…The criteria of understanding and appreciation are easier for the patients, but not those of vote choice and reasoning. Cognitive deterioration, but not age, influences the capacity to vote.

What are your thoughts on this issue? Please share them in the comments!