Balancing Act: The Duty of Health Professionals to Patients and the Public When Assessing Fitness to Drive

Date published

17/03/2022

Sectors

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This article was co-authored by Jimmy Zhang, Paralegal.

In 2021, Victoria recorded 236 road deaths.[1]While safety on the roads is the culmination of many factors, a driver’s health is undoubtedly an important one. It is in this respect that the role of health professionals becomes paramount.

Patients place trust in health professionals to advise them of whether they can continue to drive safely, and in reliance on such trust patients will disclose sensitive information so that they can receive accurate advice. Health professionals are ethically and legally duty bound to maintain patient confidentiality, under federal and state legislation and in accordance with National standards. If that confidentiality is at risk of being breached, patients may choose not to be treated or modify the information they provide.

However, under certain circumstances disclosure of a patient’s information may be necessary in order to prevent the patient from placing another individual or the public at risk. Accordingly, a difficult ethical situation arises when a health professional has reason to doubt a patient’s ability to drive safely, as he or she must choose between protecting patient confidentiality and protecting public safety.

The expectations of health professionals faced with such a dilemma can be found in Assessing Fitness to Drive (AFTD), which outlines the medical standards for driver licensing in Australia. The latest edition of the AFTD was published in 2016. In 2021, the National Transport Commission reviewed the latest edition and proposed changes, which will be implemented in the publication of the new edition of the AFTD in March 2022. The proposed changes reflect advances in medical evidence and practice, and enhance the clarity and interpretation of guidelines.

The current edition of the AFTD relevantly states:

The health professional should consider reporting directly to the driver licensing authority in situations where the patient … continues driving despite appropriate advice and is likely to endanger the public.[2]

If the health professional does make such a report, without the patient’s consent but in good faith, they will be protected from criminal and civil liability.[3]

In deciding to make a report, the AFTD provides a range of factors that should be considered:

  1. the immediate risks to public safety;
  2. the risks of disclosure weighed against the consequences of non-disclosure;
  3. ethical and professional obligations; and
  4. whether there is a serious and imminent threat to the safety of any person.[4]

Proposed changes to the current AFTD guidelines appear to move towards imposing mandatory reporting. Where there is an immediate threat to public safety, such as high risk cases where a patient has a history of reckless driving or crashes, health professionals may be required to report the patient to the driver licensing authority.[5]

However, in order to minimise any harm to the doctor-patient relationship, the AFTD recommends that any action undertaken should be with the patient’s consent, or at minimum with the patient’s knowledge.

Ultimately, while a patient may resist against their licence being withdrawn or conditions being imposed on their driving, health professionals should lean towards reporting a patient to the driver licencing authority if they believe them to be unfit to drive. When managing the tension between the duty to maintain patient confidentiality and the protection of public safety, health professionals should keep in mind that the ongoing ability to drive safely is a critical issue for both the patient and the public.

This article was originally published in VicDoc March 2022, VicDoc is a magazine of the Australian Medical Association Victoria.

Read other items in the Australian Healthcare Brief - May 2022

References:

[1] https://www.abc.net.au/news/2022-01-01/increased-death-toll-on-victorian-roads/100734312

[2] AFTD guidelines 2016 page 17; draft AFTD guidelines 2021 page 32

[3] For example, see APP section 6

[4] AFTD guidelines 2016 page 18; draft AFTD guidelines 2021 page 32

[5] AFTD guidelines 2021 page 33