| Previous Section | Index | Home Page |
1.43 pm
Mr. Edward O'Hara (Knowsley, South): I shall speak briefly in support of my hon. Friend the Member for Knowsley, North (Mr. Howarth). I feel a strong sense of involvement with the case, for several reasons. First, the M62 motorway passes through my constituency at the point where the tragic accident happened. Secondly, although Mr. Scarisbrick and his family are now my hon. Friend's constituents, after the boundary changes they will become my constituents. Most importantly, their late son was a close friend of my children and their friends; they all went to school together, and I know how devastated that small community of decent young people was by the accident.
The Parliamentary Under-Secretary of State for Transport (Mr. Steve Norris): I am grateful to the hon. Member for Knowsley, North (Mr. Howarth) for raising this important subject. As he said, I met Mr. and Mrs. Scarisbrick when they came with him to see me last year, and we had a meeting at which useful progress was made. I welcome the further opportunity given by today's debate, because this is a problem to which at least part of the answer lies in publicity, whereby doctors and the public at large will become aware of the issues and be able to act more appropriately.
There are two things to say at the outset. First, my right hon. Friend the Secretary of State and I very much sympathise with the Scarisbricks in the sad loss of their son in an accident caused by a driver suffering from Alzheimer's disease travelling in the wrong direction on a motorway. That is a dreadful human tragedy that no words of ours can mend. Secondly, we greatly appreciate the way in which the Scarisbricks have pressed us to take measures to reduce the likelihood that further blameless drivers will suffer in a similar way in future. If they feel that, in some way, some good may come out of the terrible tragedy that befell them, I entirely share that sentiment.
Let us examine the legal position and consider recent developments, and then I shall say a word about the hon. Gentleman's proposition about doctors being liable--a suggestion endorsed by the hon. Member for Knowsley, South (Mr. O'Hara). All drivers are under a statutory obligation, when applying for a licence, to declare whether they are suffering from relevant or prospective disabilities. They must also notify the licensing authority if they subsequently become aware that they are suffering from such a disability.
The licensing authority has the power to refuse an application or revoke a licence, and can require a person to give consent to the provision of such medical reports as are necessary. Ultimately, it is the licensing authority's decision, not that of a patient's doctor, whether an
individual is fit to drive. Problems of the sort that we are talking about today arise when a driver is not aware of his incapacity and does not accept advice from his doctor, or indeed, from his family and friends, that he should notify the DVLA, but continues to drive.
Last year, the Medical Commission on Accident Prevention issued a revised guide entitled "Medical Aspects of Fitness to Drive", edited by the former chief medical adviser at the Department of Transport, Dr. John Taylor. That guide, which is available to all doctors, addresses those issues, and I have sent the hon. Member for Knowsley, North a copy.
It is important to underline the fact that, in his introduction, Dr. Taylor picks out for specific attention the problem that we are discussing, and refers to the unhappy case of Paul Scarisbrick. He advises doctors:
Confidentiality is a fundamental principle on which patient-doctor relationships rest, but the guide recognises that there are circumstances in which it is right that doctors should breach that confidentiality in the public interest if the result of not doing so would be to place someone else, or, indeed, patients themselves, at risk of serious harm or death. Such circumstances do not arise often, but cases involving patients with Alzheimer's disease might well be among them.
Since the issue of the guide, the General Medical Council has amplified its guidance to doctors, emphasising that, where patients continue to drive against advice when medically unfit to do so, doctors should pass information to medical advisers at DVLA without delay. The guidelines set out in some detail the steps that a doctor should take. Where the patient cannot understand the doctor's advice--for example, because of dementia--the doctor should inform DVLA immediately.
Where a patient understands the advice but refuses to accept it, doctors should suggest a second opinion, and if that does not do the trick, approach the patient's next of kin. If those efforts of persuasion fail, the doctor should pass the information in confidence to DVLA. Those guidelines, which were approved by the General Medical Council about a year ago, give doctors clear guidance on their responsibilities--both to their patients and the public at large--when faced with such circumstances, which are often very worrying.
The hon. Member for Knowsley, North made an extremely important point when he mentioned the family who were upset because they had to advise an elderly member of the family that he should not drive. There is no doubt that that is precisely the sort of circumstances in which relatives are extraordinarily diffident. Friends, too, are diffident about insisting that someone--perhaps with whom they live--should give up a facility from which they derive great practical benefit, which represents a final sign of aging or of suffering from a particular ailment that is unlikely to improve. That is a traumatic and difficult time.
There is clear advice from the GMC that, if relatives' efforts of persuasion and second opinions fail or advice is understood but simply not taken, the doctor personally
should pass the information in confidence to the DVLA. It has been put to me very clearly by a doctor with whom I recently discussed the matter that, bluntly, that is what doctors are there for. In such circumstances, they have to be clear where their duty lies.
The hon. Member for Knowsley, North has suggested--his private Member's Bill incorporated the suggestion--that there should be a specific statutory obligation on doctors to refer cases to the DVLA when they believe that a patient is unfit to drive, which would go beyond the principles that I have described and, in a sense, apply a sanction to a doctor who was deemed not to have made a suitable notification. I understand that there is such legislation in north America, but our research suggests that, in practice, it has not been effective. The reason is fairly straightforward.
It would certainly be very difficult to frame legislation that avoids a potential effect on the confidential doctor-patient relationship, but, more importantly, there is a risk that such a statutory provision would discourage patients from taking their problems to doctors. It is entirely predictable that patients whose condition varied would, if they did not feel particularly well on the day that they were due to be examined by their doctor, find some reason for cancelling the appointment and present themselves only when they felt that they were at their best. Doctors would rapidly develop a risk aversion, which would not be helpful either to them or to their patients.
I know of at least one case of a patient being examined by a doctor who came to the conclusion that, on balance, the patient ought to be allowed to drive. That patient subsequently caused a death due to dementia or psychosis that rendered him incapable of driving, yet the doctor had exercised his judgment and there was no suggestion that he did it with other than total responsibility and professionalism.
My Department and I have taken the view that, in such circumstances, it is intolerable to expose doctors to the risk of penalty or litigation when, in effect, the law is exercising that marvellous commodity known as 20:20 vision hindsight. On that basis, and bearing in mind the strong advice that I have described, we have so far remained unpersuaded that legislation such as that suggested by the hon. Members for Knowsley, North and for Knowsley, South is desirable.
Mr. George Howarth:
The difficulty that I have with that concept is that, for whatever reason, some doctors will take what I consider a misguided ethical position on doctor-patient confidentiality. Although that is one problem, I must be honest and say that some doctors are so hard-pressed that they take the line of least resistance. There must be some compulsion on doctors in such circumstances so that they feel that, on balance, it is better to take the decision than, on balance, leave it on one side.
"where a patient's disorder makes him manifestly dangerous as a driver and his condition renders him incapable of taking advice that he must inform DVLA, or where he refuses to do so, practitioners have a civil law duty to immediately inform DVLA medical staff."
That is a statement of the law as it stands today. The doctor is under a civil law duty to inform DVLA.
| Next Section
| Index | Home Page |