Investigation. Can a doctor report that someone has lost them? A multidisciplinary team from the University of Murcia proposes a modification of the law on Traffic, Circulation of Motor Vehicles and Road Safety
In Spain, the general rules and requirements for driving vehicles are set out in Royal Legislative Decree 6/2015, of October 30, which approves the revised text of the Law on Traffic, Circulation of Motor Vehicles and Safety Vial It is this text that establishes that the aptitude of drivers to drive vehicles must be guaranteed. For this, it is required to obtain a permit or license through an administrative process through which the requirements of capacity, psychophysical aptitudes, skills for driving vehicles or mopeds are verified, with successive periodic reviews from time to time (ten years , as long as they have not reached 65 years of age, and five years from that age). The examinations are carried out in authorized centers and during the process a deficit or impairment can be detected, as a result of an injury or some medical treatment, which can lead to the loss or decrease of skills with the consequent danger to road safety.
Now, what about the effects of age? Is there an age after which you should stop driving? The answer is negative and this is because there is a personalization in the aging process and age does not have to be a limiting variable for the handling of a vehicle.
At the University of Murcia, a normative proposal has been made that allows modifying Royal Legislative Decree 6/2015, of October 30, which approves the revised text of the Law on Traffic, Circulation of Motor Vehicles and Road Safety , within the framework of collaboration of two projects of the Faculty of Law: the EDEA Project, ‘The exercise of rights in the framework of active aging’, financed by FEDER / Ministry of Science, Innovation and Universities / State Research Agency, and of which are principal investigators Ascensión Leciñena Ibarra and José Antonio Cobacho Gómez; and the Project ‘Health data: ethical-legal keys for the digital transformation of healthcare’, financed by the Seneca Foundation, with Mª Belén Andreu Martínez as main researcher. In fact, the work is the result of the collaboration of six researchers from different disciplines: Susana Morales Saura, Mª Belén Andreu Martínez and Ascensión Leciñena Ibarra, from Civil Law; Julián Valero Torrijos, of Administrative Law; Eduardo Osuna Carrillo de Albornoz, from Legal Medicine and Inmaculada Méndez Mateo, from Psychology.
In the doctor-patient relationship, mutual trust is essential. However, confidentiality is not an absolute right and the obligation of secrecy may cede in situations in which there is a priority interest.
Eduardo Osuna, a member of the group, states that “according to the data provided by the DGT in Spain, the population comprising the elderly is characterized by an accident rate four times lower than that shown by younger populations. For this reason, advanced age, by itself, cannot lead to deprivation of a driving license. If this is the case, it would have a perverse and harmful effect on the quality of life of our elders, since driving provides them with independence, social participation and reinforcement of their self-esteem ».
Thus, the determining factor is the capacity, knowledge and skill requirements necessary for driving, regardless of age.
Of course, it is worth mentioning what happens when a decline in psychophysical fitness is detected during an examination. Well, if the deficit is detected in a driver recognition center, the procedure for obtaining or renewing the driving license stops. However, if it is detected in another health center, a conflict arises, when several legal rights collide: the right of all citizens to road safety, the doctor’s duty of confidentiality and the patient’s right to guarantee the secrecy of the information present in the clinical relationship.
Therefore, the researchers argue, “is the physician obliged to report this situation to the authorities? In the physician, the dilemma arises as to whether he should communicate such incident to the Provincial Traffic Headquarters or, on the contrary, remain faithful to the confidentiality imposed by his profession.
The book ‘The deterioration of the psychophysical aptitudes of the senior driver in the framework of active aging: road safety and the doctor’s duty of confidentiality’ has been published
They assure that “in the doctor-patient relationship, mutual trust is fundamental. However, confidentiality is not an absolute right and the obligation of secrecy may yield in situations in which there is a priority interest, such as the risk to the patient himself or to third parties ”.
Therefore, if the doctor, based on his clinical judgment, detects a risk, he must communicate this circumstance in a discreet, moderate, weighted and proportionate way, but only to whom it corresponds, to avoid any possible damage that may arise.
Not surprisingly, the ideal would be for the individual himself to understand the dangers that driving vehicles entails, for himself, for the occupants and for other people, and, in this sense, the development of awareness campaigns, to generate A collective awareness of the risks of driving as a public health problem can be very useful.
The most difficult situation faced by the doctor is when he is dealing with a patient who does not have the psychophysical aptitudes, but who perceives himself as competent to do so. This complication can be increased when pathology detection is performed outside of the driver medical examination environment. In these situations, Ascensión Leciñena points out, “the right to freedom of the individual who wants to continue driving cannot take precedence over the right of the community to road safety. The regulations and the Code of Medical Deontology establish the possibility of disclosing information in the event of the possibility of harm to the patient himself, to other people or to a collective danger, but always in accordance with a principle of proportionality, weighing the risks and the benefits of prioritizing the measures to be taken ”.
In other areas, such as that related to professional drivers, it has been possible for Social Security to notify the Central Traffic Authority of the permanent disability of the professional driver by presenting a limitation that reduces or cancels their ability to drive (Royal Decree-Law 2 / 2021, of January 26, to reinforce and consolidate social measures in defense of employment that reforms Royal Legislative Decree 8/2015, of October 30, which approves the revised text of the General Law of Social Security ). With the same objective of channeling information from the medical centers to the Traffic Headquarters, in the Fiscal Report 2020 the Prosecutor of the Road Safety Chamber of the State Prosecutor’s Office proposed to reform article 70 of Royal Legislative Decree 6/2015, of 30 December October, which approves the Consolidated Text of the Law on Traffic, Circulation of Motor Vehicles and Road Safety and article 16 of Law 41/2002, of November 14, basic regulator of patient autonomy and rights and obligations regarding information and clinical documentation.
However, all the researchers involved agree that the analysis of the existing legislation leads us to the conclusion that there is no precise legal regime on professional secrecy and its exceptions that provides security to the healthcare professional. For this reason, Belén Andreu clarifies, the main objective of the normative proposal is “to establish an unequivocal legal obligation so that any medical professional who is aware of the existence of any of these diseases or deficiencies generates an alert to which only the body in charge of processing the procedure related to the authorization to drive. To this end, it is proposed to reform the Road Safety Law, to include an article 70 bis that complements article 70 on the procedure for the loss of validity of the authorization due to loss of psychophysical aptitudes ”.
It is not properly a disclosure, but a “shared secret”, since only the strictly essential data would be made available to other professionals or public entities who, for their part, would be equally bound to the duty of secrecy and to act for the benefit of the patient and of the community ”, according to Eduardo Osuna.
Specifically, it is a normative proposal to modify Royal Legislative Decree 6/2015, of October 30, which approves the revised Text of the Law on Traffic, Circulation of Motor Vehicles and Road Safety. “We are facing a clear example of knowledge transfer of great relevance for road safety, which arises as a result of the interaction of two research projects, which have a manifest interdisciplinary nature,” they explain.
As a result of the projects carried out by the University of Murcia team: ‘The exercise of rights in the framework of active aging’, financed by FEDER / Ministry of Science, Innovation and Universities / State Research Agency; and ‘Health data: ethical-legal keys for the digital transformation of healthcare’, financed by the Seneca Foundation, various scientific publications and presentations have been made at conferences.
As a result of these, the book ‘The deterioration of the psychophysical aptitudes of the senior driver in the framework of active aging: road safety and the doctor’s duty of confidentiality’ has been published, which includes the papers presented to the I National Congress, held in Murcia on November 13 and 14, 2014.
At this event, representatives of different professional sectors involved in road safety issues expressed their concern about the opportunity to address a possible regulatory proposal in relation to the intervention of the physician in the event of loss of psychophysical skills of senior drivers. And it was in view of this request, when it was decided to create a commission to prepare a legislative proposal that would allow modifying Royal Legislative Decree 6/2015, of October 30, incorporating into it the possibility that the physician could communicate to the Provincial Traffic Headquarters the loss of psychophysical aptitudes of the driving patients when, in the exercise of its assistance activity, it considers that the disease or pathology of the patient or the prescribed treatment could seriously jeopardize road safety.