Driverless cars hold great promise to reduce traffic collisions caused by human errors, such as rubbernecking, tailgating and aggressive and distracted driving. A report by consulting firm McKinsey & Co. estimates adoption of self-driving vehicles has the potential to prevent up to 90 percent of auto accidents in the U.S., saving thousands of lives and reducing damages and health care costs by up to $190 billion annually.
Until the era of the driverless car arrives, physicians have to address patients who have medical conditions that could impair their ability to operate a vehicle. The AMA Code of Medical Ethics provides guidance for keeping patients and the public safe in these situations.
In Opinion 8.2, “Impaired Drivers and Their Physicians,” the Code explains:
A variety of medical conditions can impair an individual’s ability to operate a motor vehicle safely, whether a personal car or boat or a commercial vehicle, such as a bus, train, plane or commercial vessel. Those who operate a vehicle when impaired by a medical condition pose threats to both public safety and their own well-being. Physicians have unique opportunities to assess the impact of physical and mental conditions on patients’ ability to drive safely and have a responsibility to do so in light of their professional obligation to protect public health and safety. In deciding whether or how to intervene when a patient’s medical condition may impair driving, physicians must balance dual responsibilities to promote the welfare and confidentiality of the individual patient, and to protect public safety.
Not all physicians are in a position to evaluate the extent or effect of a medical condition on a patient’s ability to drive, particularly physicians who treat patients only on a short-term basis. Nor do all physicians necessarily have appropriate training to identify and evaluate physical or mental conditions in relation to the ability to drive. In such situations, it may be advisable to refer a potentially at-risk patient for assessment.
To serve the interests of their patients and the public, within their areas of expertise physicians should:
(a) Assess at-risk patients individually for medical conditions that might adversely affect driving ability, using best professional judgment and keeping in mind that not all physical or mental impairments create an obligation to intervene.
(b) Tactfully but candidly discuss driving risks with the patient and, when appropriate, the family when a medical condition may adversely affect the patient’s ability to drive safely. Help the patient (and family) formulate a plan to reduce risks, including options for treatment or therapy if available, changes in driving behavior, or other adjustments.
(c) Recognize that safety standards for those who operate commercial transportation are subject to governmental medical standards and may differ from standards for private licenses.
(d) Be aware of applicable state requirements for reporting to the licensing authority those patients whose impairments may compromise their ability to operate a motor vehicle safely.
(e) Prior to reporting, explain to the patient (and family, as appropriate) that the physician may have an obligation to report a medically at-risk driver:
(i) when the physician identifies a medical condition clearly related to the ability to drive;
(ii) when continuing to drive poses a clear risk to public safety or the patient’s own well-being and the patient ignores the physician’s advice to discontinue driving; or
(iii) when required by law.
(f) Inform the patient that the determination of inability to drive safely will be made by other authorities, not the physician.
(g) Disclose only the minimum necessary information when reporting a medically at- risk driver, in keeping with ethics guidance on respect for patient privacy and confidentiality.
Chapter 8 of the Code, “Opinions on Physicians and the Health of the Community,” also features opinions on ethical use of quarantine, disparities in health care, promoting patient safety and required reporting of adverse events.
The AMA Code of Medical Ethics is updated periodically to address the changing conditions of medicine. The newest edition is the culmination of an eight-year project to comprehensively review, update and reorganize guidance to ensure that the AMA Code remains timely and easy to use for physicians in teaching and in practice.