Sharing the responsibility for assessing the risk of the driver with dementia.

© 2007 Canadian Medical Association or its licensors 599 When the physician’s role of caring for patients collides with the duty of societal protection, a dramatic and controversial dynamic occurs that often strains the doctor–patient relationship. Nowhere is this more salient than in the case of a patient with mild dementia who the physician thinks may be an unsafe driver. In most Canadian provinces and all territories, physicians have a mandatory duty to report these patients to the relevant licensing authorities (Table 1). In Alberta, Nova Scotia and Quebec, the duty to report is discretionary. In British Columbia, reporting is mandatory if an unsafe driver continues to drive despite being warned of the danger. However, none of these legislations directly address dementia. Internationally, even wider variation exists among legislations and recommendations about drivers with dementia.