By Ann Julian, CSW
Special to Alzheimer's Weekly
RepPublished Week of November 2 - November 8, 2008 

Can a Person with Alzheimer’s go to the Polls?

It’s not a simple question.

For a person who has just begun the long journey that Alzheimer’s disease becomes, the right to vote is a precious privilege that few would willingly choose to forego.

But the question of whether a person has the ability to make a choice, and defining what that actually means, has become an issue of concern for legislators around the country. Top professionals are doing their best to help sort it all out.

Legislators in every state are grappling with the dilemma of how to set guidelines that are fair and make sense for voters with different levels of cognitive impairment.

Psychiatrists, neurologists, neuropsychologists, attorneys and advocates are meanwhile working on ways to define the issues that the lawmakers will need to deal with.

Soon after receiving the diagnosis, most people begin to realize that at some point the question will arise as to which will come first – losing the right to vote, or the capacity to do so.

This is an especially heart-rending problem for the Alzheimer’s patients themselves, who have spent a lifetime exercising their right to help choose a leader.

The patient’s family members, who must bear witness to the process, also struggle with feelings of anger, grief and helplessness which complicate the issue still further.

The good news is that there is a project which has begun to address the issue in a coherent, coordinated and focused way.

The Dementia Voting Project, sponsored by The University of Pennsylvania Alzheimer’s Disease Center, is an excellent resource for information on the topic.

The project is described in depth at, "Facilitating Voting as People Age: Implications of Cognitive Impairment."

All the sticky, uncomfortable questions about whether a person with cognitive impairment – an Alzheimer’s patient, among others – should be, can be or will be allowed to vote, are explored by the multidisciplinary team involved in the project.

Each state has its own opinion, and laws on the matter.  However, a federal court decided in 2001 to approve the “Doe Voting Capacity Standard”, a questionnaire used to measure one’s ability to exercise the right to vote.

In a November 2005 article published in the American Journal of Psychiatry, researchers measured the responses of Alzheimer’s patients to the Doe questionnaire as a way of measuring their capacity to vote.

The Doe standard may indeed provide answers about the ability of a person with cognitive impairment to exercise his or her right to vote, but it is unlikely to address the more painful points that remain regardless of the objective assessment.

The question remains: should anyone have the right to prevent a person with Alzheimer’s disease from choosing a leader?