An impaired judicial system
CMAJ 1997;156:1698
See also:
- Letter: Fitness to drive and the onus to report, P.J. Potter
"Weep for Adonais" (CMAJ 1997;156:889-90 [in brief / en bref]), by Nicole Baer, describes a tale too often told. An impaired driver not only kills 1 or more innocent victims but remains behind the wheel to kill or maim again. I suspect many physicians have had professional experience with the devastating impact of drinking and driving. How many emergency physicians have fought frantically to save the life of a drunken driver, reeking of alcohol and too impaired to be coherent, while his or her victim is sent to the morgue, not the emergency department?
I will always remember when a young woman and the child she was babysitting were struck by a car that had driven through a stop sign. All survived, but the young woman, bleeding from both ears due to a basal skull fracture, was evacuated for neurosurgical assessment while the impaired driver steadfastly refused to allow any blood to be taken.
The apparent inadequacy of the law in bringing justice to cases such as the one described by Baer is a challenge to the integrity of the legal profession. The legal fine points that ensure a fair trial seem immoral to anyone with personal or front-line experience with the problem.
The medical profession is well situated to deal with the social and medical problems arising from alcoholism, and assessments of the fitness of alcoholics to drive should be a routine part of caring for these patients. A recent history of heavy uncontrolled drinking, arrival at an appointment impaired or inebriated, or a history of blackouts should prompt a letter to the transportation ministry expressing concern about a patient's fitness to drive. This is in keeping with determinations of fitness to drive involving other recognized diseases, such as epilepsy or cardiac arrhythmia.
Physicians' obligation to serve a patient's interests and health does not require that they allow alcoholics to play Russian roulette with their own lives and the lives of others. Development of clinical guidelines to help us determine alcoholic patients' fitness to drive would be a welcome step forward. I would like to hear suggestions about how our profession should address this problem.
Stephen Workman, MD
Master's student
University of Toronto Joint Centre for Bioethics
Toronto, Ont.
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