Driving and Epilepsy: Ethical, Legal, and Health Care Policy Challenges

Joseph S. Kass, MD, JD, FAAN; Rachel V. Rose, JD, MBA Epilepsy p. 537-542 April 2019, Vol.25, No.2 doi: 10.1212/CON.0000000000000714
MEDICOLEGAL ISSUES
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Although the principle of autonomy allows patients to refuse interventions their physicians recommend, patients are not free to ignore legally mandated restrictions on driving, and physicians are ethically justified in constraining their patients’ driving rights in compliance with state law. Furthermore, the standard of care for treatment of patients with epilepsy includes counseling about lifestyle modifications that promote patient safety and compliance with the law. Neurologists should not only counsel their patients with epilepsy about legally mandated driving restrictions but also document this counseling in the medical record. Failure to counsel and to document may result in legal liability if patients experience seizures while driving and injure either themselves or third parties. The neurologist’s duty of care may be limited to the patient in some jurisdictions but may be extended to injured third parties in others. Furthermore, a patient’s own contributory negligence may limit or completely foreclose recovery against the physician to varying degrees, depending on the state in which the injury occurred.

Address correspondence to Dr Joseph S. Kass, Baylor College of Medicine, One Baylor Plaza M-210, Houston, TX 77030, kass@bcm.edu.

RELATIONSHIP DISCLOSURE: Dr Kass serves as associate editor of medicolegal issues for Continuum, as an associate editor for Continuum Audio, as a neurology section editor of Ferri’s Clinical Advisor for Elsevier, and as co-editor of Neurology Secrets, Sixth Edition. Dr Kass has received personal compensation for CME lectures from Pri-Med LLC. Ms Rose serves on the editorial board of BC Advantage and receives book royalties from the American Bar Association.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Kass and Ms Rose report no disclosures.

© 2019 American Academy of Neurology.