As Malta gears up for another election, this time tied to the European Parliament, the issue of whether patients with mental health conditions, such as dementia, should be asked to vote arises on medical, legal and political grounds.
Whereas individuals suffering from mild dementia may be able to understand election issues, those suffering from severe dementia hardly can, a relative of a dementia patient who resides in a state funded home for the elderly, has told this newspaper. The relative’s mother was a dementia patient, who passed away. She has another relative who has been diagnosed with the same condition.
She said: “People with dementia are being requested to vote, regardless of their capacity”, questioning whether this practice should go on.
Citing an example to highlight the incapability of a dementia sufferer when it comes to voting, she said that two elections ago, her mother started to mix up political candidates with those of the 1950s.
“She thought (referring to her late mother) that it was 1950 Malta.
“After having cast her vote, she told us that she was mixed up on whom to vote for, and started to mention candidates who contested elections some 50 years ago,” she said.
And now she said that history was about to repeat itself since another relative of hers, who has been diagnosed with the same condition as her late mother, has been asked to vote on 24 May.
“Political parties are calling on those suffering from dementia to vote,” she said.
She also pointed out that it was unfair for elderly persons in state homes to be denied visits by relatives on the day of the election.
But the problem does not end here. Individuals hardly capable of choosing whom to vote for are also denied the right to choose a person whom they trust to accompany them at the polling booths.
As the law stands, only assistant electoral commissioners are present at polling booths to assist those who need help to vote.
The only difference this time around is that elderly residents can vote at the state home where they are residing and do not have the burden of having to go out and vote.
The number of individuals with dementia in Malta is estimated to rise from the current 6,000 to 12,000 over the next 25 years.
As of 2010, 1.2% of the Maltese population suffered from dementia, according to Franco Mercieca, who served as parliamentary secretary, and who stated so last year during the appointment of Charles Scerri as the national focal point for dementia in Malta.
Contacted for a comment, Dr Scerri said that individuals with dementia should not be treated differently and it would be unethical to do so since voting is a constitutional right.
“An individual with dementia should be allowed to vote regardless of their capacity.
“Mental health conditions should not constitute a legal incapacity to vote and thus such individuals should not be stopped from voting at the polling station,” he emphasised.
He further stated that the decision whether to vote or not (and how) lies with the electors themselves and not with the carers or relatives taking decisions on their behalf.
“I'm not conversant with what the law states in terms of elections, but if I'm not mistaken, it is the electoral officials attending the polling booth who will finally have a say on whether the elector has the cognitive capacity to cast the vote.
“In a way this is ambiguous because these officials have no competence or training in this particular area (e.g. how they should question the individual, how to explain the ballot paper in simple terms and avoiding coercion, asking questions several times and be sure that the elector understands.)
“Besides, the most common forms of dementia are progressive, with individuals showing early symptoms fully capable of voting,” Dr Scerri explained.
What the political parties had to say
PN Deputy Leader for Party Affairs Beppe Fenech Adami said that for the first time ever, residents in old peoples’ homes will be entitled to vote at the retirement home where they are living. This became possible only recently through amendments proposed by the Opposition to the General Elections Act which were accepted by the government.
“All persons on the electoral register have a right to vote. It is up to each voter to decide for themselves whether to exercise this right or not. People in old peoples’ homes are entitled to assistance by Assistant Electoral Commissioners and any person finding difficulty to vote may ask for assistance by these staff.
“No voter may be coerced to vote and any voter who desires not to vote or finds difficulty in voting and does not want to ask for assistance may opt not to vote.
“As the law stands today, once one is listed in the electoral register and no application is filed to strike off his or her name from the list, that person retains the right to vote irrespective of any illness he or she may have."
A spokesperson for the Labour Party said that every person whose name appears in the electoral register published on 1 April, 2014 is issued with a voting document. And those who have a voting document and qualify for the requisites as a voter have the right to express their opinion and cast their vote.
The residents of 23 homes for the elderly which are government owned, private, or church homes which have more than 50 residents will be casting their vote at their residence, for the first time. This is due to an amendment in the electoral law which was passed last March in Parliament on a motion presented from the government side.
Details of persons suffering from dementia will still appear in the electoral register, if the electoral commission does not file an appeal in court requesting the names of persons suffering from dementia or mental illness to be struck off the electoral register.
In each polling booth there are assistant electoral commissioners who are nominated from each political party that is contesting the election.
AD chairman and MEP election candidate Arnold Cassola said that people should be free to choose whether or not to vote, and not forced to do so.
He said that AD was also in favour of such persons being given the choice to select a person they trust to accompany them while voting, “opposed to the other political parties”.
Asked what he thought about relatives of elderly people residing in state homes not being allowed to visit them on the day of the election, he said that such individuals should not be barred from seeing relatives simply due to an election.
A psychiatrist’s views
Consultant psychiatrist Etienne Muscat said that he cannot tackle the issue without the combined viewpoint of a psychiatrist and a citizen since as a psychiatrist he said he holds the principles of self-determination, the right for full engagement in the civic process, the right to make one's own decisions, and the right to individuality, to all be self-evident and sacred.
“We are all, by virtue of being born in a liberal society, assumed to be capable of making our own independent decisions once we reach adulthood, and any changes or interference in this fundamental principle must never be taken lightly.
“As a psychiatrist, determining whether an individual has the capacity to make these individual decisions, (which could include making a will, entering into a legal contract, entering into a marriage contract, as well as exercising our right to vote for the leadership of our country) is a minor part of the everyday reality of our work.
“A person may have been a high-functioning contributor to society, but if at a point in his or her life a condition robs them of their ability to understand basic issues, there are checks and balances in place to prevent them from being exploited, or from harming themselves through lack of awareness, or from making critical decisions about medical care which they do not appreciate.
“At the same time, as a citizen I very strongly believe that the democratic process is an equally-fundamental aspect of our life, and I feel that in order for it to remain relevant, and for each vote to be meaningful, then the person submitting that vote should be aware of what he or she is doing.”
“However, I feel that the principle remains and should be absolutely respected: when an individual, either from birth or development, or by a process through which he or she suffers a decline in their mental faculties, loses to reason effectively, then the democratic process should be safeguarded by making sure that there is a system in place to identify, examine and ultimately make the determination about whether an individual retains or lacks the capacity to participate in the electoral process.”