Issue of whether mentally ill should vote unsolved

Despite the aging of the population and demands for empowerment of the physically and mentally disabled, the issue of whether to let everyone living in geriatric or psychiatric institutions vote there – whatever his or her state of mental capacity – has not been discussed.

Patients in such institutions for chronic illness have, for nearly 20 years, been able to go, or be taken, to the ballot box by a relative or friend or party representative. But they may not be taken by a boss or employee of the institution where they live.

The Central Elections Committee website states that anyone who is hospitalized on Election Day is entitled to vote in the institution if there are 50 beds or more. But it does not say anything about limitations on patients suffering from severe Alzheimer’s disease or other dementias, psychoses or other psychiatric conditions.

Haredi parties have been seen in previous elections taking to the polling booth inpatients staring into space and seemingly unaware of what was happening.

“I am sure there is manipulation, especially by the well-organized parties, to get everybody to the polls, but it’s very difficult to know who is severely demented or psychotic or ill but still able to vote competently, Prof. Shimon Glick, emeritus professor of medical ethics at Ben-Gurion University of the Negev told The Jerusalem Post when asked to comment on Sunday.

“It should be raised as an issue with the Central Elections Committee when there is time after this election. It would be ideal if, instead of party representatives, patients could be accompanied by absolutely independent duty officers at the polls who would help them vote as they wish.”

But one could never prevent relatives from picking the little piece of paper representing the party of choice and placing it into the envelope, Glick said.

He suggested that senior experts on psychiatry and psychogeriatrics be asked by the Elections Committee to prepare a position paper on the matter.

EMDA, a voluntary organization that assists Alzheimer’s patients and their families, announced on Sunday that it had launched for the first time a telephone hotline to help patients and their families about going to vote, whether they lived at home or in institutions.

The number is 03-534- 1274.

The organization noted that there are over 100,000 Israelis in various stages of Alzheimer’s disease or other dementias, and that from age 80 the progressive, incurable disease affects one out of every two.

Dr. Yehezkel Caine, director-general of the geriatric and psychiatric Herzog Hospital in the capital, said that by law no one is permitted to intervene in the voting process there, even if patients are being manipulated.

He added that it would be very difficult to determine patients’ competency or capacity to vote. Patients’ conditions change, and assessment can take hours. The financial cost would be huge, he said.

Many research papers on voting by people with serious dementias or psychiatric illness have been written abroad.

One article published eight years ago in the American Journal of Psychiatry reported that having Alzheimer’s patients fill out a short questionnaire called the Doe Standard quickly assessed mental capacity for voting when compared to the longer Mini-Mental State Examination.

“This approach can ensure retention of voting rights by capable persons and exclusion of clearly impaired persons from the voting booth,” the authors wrote. “Some legal experts are concerned about the implications of helping someone with dementia during the voting process. With concern about coercion, they believe a person should be assisted only with mechanical impediments such as filling out a ballot or other necessary election form.”