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Abstract
European Union (EU) and non-EU countries have adopted different medical procedures for the issuance and renewal of a driver’s license showing relevant matters of concern. In Europe, EU directives have been only partially supplemented with national laws, and there is a paucity of evidence-based criteria and methods for fitness-to-drive assessment. For instance, there is no agreement on standards for establishing which is the competent authority charged with the medical examination. Furthermore, license conditions, restrictions, or vehicle modifications, which appear as “limited use” codes on the driver’s license are not regulated. This may generate confusion and deformity when it comes to the medico-legal evaluation, with potential ethical implications due to lack of transparency and equity and legal disputes between citizens and competent authorities. In this article, Italian experts on fitness-to-drive medical assessment highlight some major issues concerning the medical driving assessment activity in the EU. The Italian experience is shown as a case study, which is representative of other EU member states, for launching a call for evidence-based consensus documents and scientific guidelines on this topic, which may be helpful to international regulators and medico-legal stakeholders.
DISCLOSURE STATEMENT
No potential conflict of interest was reported by the author(s).
Notes
1 Morris Odell, Assessing Fitness to Drive—Pt.1, 34 Austl. Fam. Physician 359, 359-63(2005).
2 Thomas M. Meuser et al., Medical Fitness to Drive and a Voluntary State Reporting Law, AAA Found. for Traffic Safety (Oct. 2008), https://aaafoundation.org/wp-content/uploads/2018/02/MedicalFitnesstoDriveReport.pdf.
3 Doreen Huppert et al., Dizziness in Europe: From Licensed Fitness to Drive to Licence without Fitness to Drive, 265 J. Neurol. 9, 9-17 (2018).
4 Evelien Polders et al., The Implementation of Directive 2006/126/ECon Driving Licenses, European Comm’n (Nov. 2017), http://publications.europa.eu/resource/cellar/bbd8141d-e603-11e7-9749-01aa75ed71a1.0001.01/DOC_1.
5 Id.
6 Driving Licence, European Comm’n, https://road-safety.transport.ec.europa.eu/eu-road-safety-policy/priorities/driving-licence_en (last visited Feb. 4, 2024).
7 Getting a Driving Licence in the EU, European Comm’n, https://europa.eu/youreurope/citizens/vehicles/driving-licence/get-driving-licence/index_en.htm (last visited Feb. 4, 2024).
8 Getting a Driving Licence in the EU, supra note 7.
9 2014 O.J. (L 194) 10.
10 Reform of the European Union Law on Driving License—Answering Citizen’s Concerns, European Parliamentary Rsch. Serv. (Oct. 11, 2023), https://epthinktank.eu/2023/10/11/reform-of-european-union-law-on-driving-licences-answering-citizens-concerns/.
11 2014 O.J. (L 194) 10.
12 Sergio Garbarino et al., Motor Vehicle Accidents and Obstructive Sleep Apnea Syndrome: A Methodology to Calculate the Related Burden of Injuries, 12 Chron. Respir. Dis. 320, 320-28 (2015).
13 Id.
14 Juan F. Masa et al., Habitually Sleepy Drivers Have a High Frequency of Automobile Crashes Associated with Respiratory Disorders During Sleep, 162 Am. J. Respir. Crit. Care Med. 1407, 1407-12 (2000).
15 Sergio Garbarino, Excessive Daytime Sleepiness in Obstructive Sleep Apnea: Implications for Driving Licenses, 24 Sleep Breathing 37, 37-47 (2020).
16 Recepimento della direttiva della Commissione 2014/85/UE recante modifica della direttiva 2006/126/CE del Parlamento europeo e del Consiglio concernente la patente di guida, Gazzetta Ufficiale n. 9 del 13.1.2016 (Dec. 22, 2015), https://www.gazzettaufficiale.it/eli/id/2016/01/13/16A00299/sg.
17 SergioGarbarino, Apnee ostruttive nel sonno (OSA) e Sicurezzaalla Guida [Obstructive Sleep Apnea (OSA) and Driving Safety], 108 Med. Lav. 297, 297-303 (2017).
18 See Recepimento della direttiva della Commissione 2014/85/UE recante modifica della direttiva 2006/126/CE del Parlamento europeo e del Consiglio concernente la patente di guida, supra note 16.
19 Id.
20 Jacopo F. Imberti et al., Driving Restrictionin Patients with Cardiac Implantable Electronic Devices: An Overview of Worldwide Regulations, 17 Expert Rev. Med. Devices 297, 297-308 (2020).
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22 See Recepimento della direttiva della Commissione 2014/85/UE recante modifica della direttiva 2006/126/CE del Parlamento europeo e del Consiglio concernente la patente di guida, supra note 16.
23 Brenno Mazzariol et al., Recent Medico-Legal Developments on the Issue of Epilepsy and Driver’s License Requirements in the Italian and European Legislation, 2019 Behav. Neurol. 1, 1-5 (2019), https://pdfs.semanticscholar.org/556c/468b59071db9b1acdaee00871e9779e08a31.pdf.
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26 Odell, supra note 1; Polders et al., supra note 4; Garbarino, supra note 12.
27 Nina Kobal & Marko Hawlina, Comparison of Visual Requirements and Regulations for Obtaining a Driving License in Different European Countries and Some Open Questions on Their Adequacy, 16 front. Human Neurosci. 1, (1-18) (2022), https://www.frontiersin.org/articles/10.3389/fnhum.2022.927712/full.
28 Id.; K.H. Lococo et al., Medical Review Practices for Driver Licensing Volume 1: A Case Study of Guidelines and Processes in Seven U.S. States, Nat’l Highway Traffic Safety Admin. (Oct. 2016), https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/812331-medreviewforlicensing.pdf; Visual Standards for Driving in Europe, European Council of Optometry and Optics (Jan. 2017), https://www.ecoo.info/wp-content/uploads/2017/01/Visual-Standards-for-Driving-in-Europe-Consensus-Paper-January-2017….pdf; Nat’l Transp. Comm’n & Austroads, Assessing Fitness to Drive for Commercial and Private Vehicle Drivers, 34-41 (Austroads Ltd 2022 ed., 6th ed. 2022), https://austroads.com.au/__data/assets/pdf_file/0037/498691/AP-G56-22_Assessing_Fitness_Drive.pdf.
29 Id.
30 Mazzariol et al., supra note 20.
31 Id.
32 Tatum et al., supra note 21.
33 Lococo et al., supra note 25.
34 Visual Standards for Driving in Europe, supra note 25.
35 Id.
36 Nat’l Transp. Comm’n & Austroads, supra note 25.
37 Roy G. Beran, Analysis and Overview of the Guidelines for Assessing Fitness to Drive for Commercial and Private Vehicle Drivers, 35 Intern. Med. J. 364, 364-68 (2005).
38 Kobal & Hawlina, supra note 24; Stefan K. Lhachimi et al., Evidence-Based Public Health, 2016 Bio. Med. Rsch. Int’l 1, 1-2 (2016).
39 Comm. on Clinical Prac. Guidelines & Inst. of Med., Guidelines for Clinical Practice: From Development to Use 1 (Marilyn J. Field & Kathleen N. Lohr, eds., 1992), https://www.ncbi.nlm.nih.gov/books/NBK234503/pdf/Bookshelf_NBK234503.pdf.
40 Beran, supra note 34.
41 Steven H. Yale et al., Neurologic Conditions: Assessing Medical Fitness to Drive, 1 Clin. Med. Rsch. 177, 177-88 (2003).
42 N. Magnavita et al., Lavoratori con Problemi di Alcol e Dipendenze. Documento di Consenso del Gruppo La. R.A. (Lavoratori Rischiosi per gli Altri) [Workers with Alcohol and Drug Addiction Problems. Consensus Document of the Study Group on Hazardous Workers], 99 Med. Lav. 3, 3-58 (2008); N. Magnavita et al., Gruppo di Studio Lavoratori Rischiosi per gli Altri. Alcol e Lavoro. Documento di Consenso del Gruppo La. R.A [Alcohol and Work. Consensus Document of the La. R.A. (Workers Representing a Risk for Others) Group], 105 Med. Lav. 3, 3-68 (2014).
43 Ramya Ramaswami et al., Precision Medicine from a Public Health Perspective, 39 Annu. Rev. Public Health 153, 153-68 (2018).
44 Id.
45 David J.M. Butcher, Fitness to Drive, 175 Can. Med. Ass’n J. 575, 575-76 (2006).
46 Carolyn A. Unsworth et al., A Systematic Review of Evidence for Fitness-to-Drive among People with the Mental Health Conditions of Schizophrenia, Stress/Anxiety Disorder, Depression, Personality Disorder and Obsessive-Compulsive Disorder, 17 BMC Psychiatry 318 (2017).
47 Sergio Garbarino, Excessive Daytime Sleepiness in Obstructive Sleep Apnea: Implications for Driving Licenses, 24 Sleep Breath. 37, 37-47 (2020).