Antoine Bosquet

The Vote of Acute Medical Inpatients A Prospective Study

Objective: There may be ethical issues associated with allowing certain inpatients to vote as some may be cognitively impaired. During the 2007 elections in France, we conducted a prospective observational study on voting among hospitalized patients. Method: Patients hospitalized in an Internal Medicine and Geriatric Department on election day were included. The primary outcome was the turnout among registered inpatients, and secondary outcomes were Mini-Mental State Examination (MMSE) scores and reasons for abstention. Results: Of 142 inpatients (mean age 73 years), 84 were eligible to vote, and 22 actually voted (turnout 25.2%). Among the voters, 23% had an MMSE score of less than 12; 58% of abstentions were procedure-related. Discussion: In our study, some inpatients did not vote as a result of procedural issues. When patients with severe cognitive impairment vote, there is a potential risk of vote diversion. Voting procedures should be improved to give inpatients easier access to the ballot while protecting them from the risk of fraud.

Le vote des sujets ayant des altérations des fonctions cognitives : aspects législatifs et éthiques

In democratic countries, cognitively impaired persons are a substantial and growing group of citizens. Most of them are citizens with dementia. In dementia, cognitive impairment induces a loss of some capacities, resulting in vulnerability and increased need for assistance. Voting by cognitively impaired persons raises any questions about the integrity of the electoral process, the risk of fraud and the respect of their citizenship. In France, the law is not definite about the voting of cognitively impaired persons. An objective assessment for voting capacity may be useful both for professionals in charge of voting organisation and for guardianship judge in order to help him in his decision to remove or keep the voting right of persons placed under guardianship. Assessing the reality of voting by cognitively impaired citizens is necessary to advance respect for their right to vote.

Conditions for Exercising Residents’ Voting Rights in Long-Term Care Residences: A Prospective Multicenter Study

To assess voting conditions in long-term care settings, we conducted a multicenter survey after the 2009 European elections in France. A questionnaire about voting procedures and European elections was proposed in 146 out of 884 randomized facilities. Sixty-four percent of facilities answered the questionnaire. Four percent of residents voted (national turnout: 40%), by proxy (58%) or at polling places (42%). Abstention related to procedural issues was reported in 32% of facilities. Sixty-seven percent of establishments had voting procedures, and 53% declared that they assessed residents’ capacity to vote. Assistance was proposed to residents for voter registration, for proxy voting, and for voting at polling places, respectively, in 33%, 87%, and 80% of facilities. This survey suggests that residents may be disenfranchised and that more progress should be made to protect the voting rights of residents in long-term care facilities.

Protected adults’ voting rights: an interdisciplinary study of medical assessment and jurisprudence in France

Objectives The study’s objective was to describe the decision-making about voting rights of protected adults, which includes the medical assessment and the magistrate’s decision to maintain voting rights or not. Design This work explores using an interdisciplinary approach: first, magistrate’s decision-making with a systematic review of jurisprudence and second medical assessment with semistructured questionnaires sent to physicians assessing adults under guardianship. Setting France. Participants For jurisprudence’s analysis, all guardianship decisions found on the Legifrance.gouv.fr website and that specified the protected person’s voting rights were analysed. For the survey about medical civic assessment, an 18-item questionnaire was sent to all physicians drawing up medical certificates prior to placement under guardianship in one urban (Paris and the three surrounding departments) and one rural area of France (the 10 most rural French administrative departments). Main outcome measures The analysis of jurisprudence explores the situation concerning protected adults’ voting rights and the reasons for magistrates’ decision. The survey about medical civic assessment explores the means of medical assessment (persons consulted, information collected), the content of the medical certificate, the physicians’ opinions regarding their role. Results The analysis of the jurisprudence demonstrates that 30% (51/171) of protected adults kept the right to vote. The survey shows that medical assessment varied according to the physician’s gender, specialty and geographical location. Voting capacity was the main criterion common to both physicians and magistrates in the decision whether to maintain voting rights. 27% (34/124) of physicians would like the official texts to be more precise, and one-third (41/133) wished to have tools to facilitate assessment of civic capacity. Conclusions Official guides need to be drawn up to detail the criteria for and means of medical assessment of the civil capacity of protected adults, with a view to ensuring transparency and homogeneity in the exercise of justice.