Located in a swing state that could decide the 2024 election, the hospital asks psychiatric inpatients, regardless of diagnosis, if they would be interested in "Voter registration tools" that let them check their nearest polling station and register to vote online.
The hospital has continued registering patients-even those who are not near discharge and have not yet been stabilized-on the grounds that voting, as the institute puts it, is a "Therapeutic tool" that "Helps empower patients and makes them feel good." "Voting is an important part of the recovery process," Julie Graziane, a geriatric psychiatrist who leads the hospital's civic engagement efforts, said in a press release.
In more recent years it has turned to the nonprofit Vot-ER, which develops "Nonpartisan civic engagement tools" for "Every corner of the healthcare system." Founded by an emergency room physician at Harvard Medical School, Alister Martin, who served as an adviser to Vice President Kamala Harris, Vot-ER has helped more than 50,000 doctors register their patients to vote.
So does the Department of Health and Human Services, which encourages federally funded health centers to provide "Voter registration activities" to "Underserved populations." The HHS guidance is the result of a 2021 executive order instructing all federal agencies to promote "Access to voting." Vot-ER has advised the Biden-Harris administration on how to implement that order, according to documents obtained by the Washington Examiner, and, amid a tightening presidential race, appears to be targeting traditional Democratic voting blocs.
Though hospitals cannot conduct voter registration drives that endorse a specific party or candidate, federal law leaves plenty of room for more subtle appeals: Martin, Vot-ER's founder, who is affiliated with Massachusetts General Hospital's Center for Social Justice and Health Equity, said in an interview with the Boston Globe that he once told a patient recovering from an asthma attack to vote, since that was the "Only way" to "Take the smog out of the air." "It's very easy to insert politically coded speech into these interactions," said Kristen Walsh, a pediatrician in New Jersey.
"You are effectively signaling to the patient how you want them to vote. And then you've really muddled the patient/doctor relationship." Vot-ER was launched in 2019, a few months before the coronavirus pandemic, at Massachusetts General Hospital.
The group has argued that because voting affects public policy, which affects public health, a patient's voter registration status falls within the purview of physicians.
"Our pediatric patients," the message read, "Need us to be their voices through voting." For adult patients, some doctors now argue that voting is not just a form of civic uplift but an actual medical treatment, capable of alleviating anxiety, depression, and even suicidality.
At the Pennsylvania Psychiatric Institute, Graziane, the geriatric psychiatrist, has argued that voting can "Increase life satisfaction, decrease risky behaviors and increase mental wellbeing." The institute has sought to democratize those benefits by taking advantage of Pennsylvania's lax voting laws, which, unlike most states, do not impose competency requirements on voters in mental hospitals.
Another paper indicates that patients were approached with voter registration tools "Even if discharge was not upcoming." Jane Rosnethal, a psychiatrist and medical ethicist at New York University's Tisch Hospital, where she chaired the hospital's ethics committee for three years, said that the lack of restrictions raised serious questions about the exploitation of vulnerable patients and their ability to give consent.
"What are we doing ethically posing this kind of question to people who are so vulnerable?" Questions about voting can carry a whiff of extortion in psych wards, Kaminetzky noted, since some patients have been involuntarily committed and are there against their will: "They may fear that not registering to vote will be seen as non-compliant, necessitating a longer stay." The potential for coercion went unmentioned in a 2023 paper by Graziane and her colleagues, in which they argued that psychiatrists had an "Ethical obligation" to register their patients to vote.
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