Reporting impaired drivers; suitability of patient gifts

Ethics Forum. Nov. 6, 2000.

Scenario: What are the guidelines for reporting impaired drivers?

A physician called asking what were his ethical responsibilities regarding a patient employed as a bus driver who has completed a rehabilitation program for alcohol abuse.

Reply:

In this country, we usually do not restrict activities that present a risk to only the participants. Activities such as mountain climbing, parachuting, etc., generally are accepted, although regulations (e.g., helmet laws, off-limit areas, etc.) may be enacted to offer some measure of protection.

However, driving a motor vehicle may be dangerous to both the driver and others. Therefore, driving -- as well as other similar activities -- is carefully regulated, and not all who wish to participate are permitted. Society has assumed the role of protector of innocent victims.

The doctor is placed in a difficult position when a patient threatens the safety of others. The patient-physician relationship is based on trust that information revealed by patients to doctors will remain private. Nevertheless, it is well established that a real threat by a patient to physically harm an identifiable person warrants a breach of confidentiality.

In some of these conflicted situations the law prescribes our obligations. For instance, in cases of child and elder abuse, physicians usually are required to breach confidentiality and report the information to the appropriate authorities. Similar considerations may apply to physicians who treat certain injuries, such as gunshot and knife wounds. [...]