Medical Aspects of Fitness to Drive

Licensing requirements depend on the type of vehicle driven, with more stringent requirements for commercial purposes and multiaxle vehicles. In many jurisdictions, including Canada, Australia, and the United Kingdom, it is the motorist's responsibility to inform the licensing authority of any relevant medical conditions. Similar requirements generally apply in the United States, except that six states (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania) require physicians to report patients with seizures (and other conditions that may alter levels of consciousness) to the department of motor vehicles (1). Drivers have a legal responsibility to inform the licensing authority of any injury or medical condition that affects their driving ability, and physicians should take great pains to explain this obligation. Occasionally, especially when dealing with patients suffering from dementia, ethical responsibilities may require doctors to breach confidentiality and notify patients against their will or without their knowledge (2); this situation is discussed in Subheading 2.5.

From: Clinical Forensic Medicine: A Physician's Guide, 2nd Edition Edited by: M. M. Stark © Humana Press Inc., Totowa, NJ

Requirements vary in different countries and in different jurisdictions within the same country. When in doubt about the appropriate course of action, physicians should consult the appropriate guidelines. In the United Kingdom, the Driver and Vehicle Licensing Agency (DVLA) has made available the At-a-Glance Guide to the Current Medical Standards of Fitness to Drive (3). In Australia, the Austroads Guidelines for Assessing Fitness to Drive provides similar information (4). In the European Union, where European Community directives have developed basic standards but allow different countries to impose more stringent requirements, there is still variation from country to country. The situation is even more complicated in the United States, where each state sets its own rules and where federal regulations for commercial vehicles apply as well. Often, much of the required regulatory information can be acquired via the Internet or from organizations and foundations representing patients who have the particular disease in question.

It should be assumed that all adults drive; drivers with disabilities should be given special consideration and may require modification of their vehicle or have certain personal restrictions applied.

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