Commentary: driving and psychiatric illness.

The article by Snyder and Bloom highlights the importance of physicians’ actively participating in the legislative process when medicolegal issues are involved. The specific forensic questions addressed by the authors focus on physician reporting of potentially impaired drivers—a problem that has been precipitated by the complexities involved in determining fitness to drive in the elderly. It is no surprise to forensic psychiatrists, especially those in Oregon, that litigation involving motor vehicle accidents continues to lead to novel legal theories within tort law. The Oregon case of Cain v. Rijken initially resulted in Oregon psychiatrists’ being obligated to assess their patients’ competency to drive, until Oregon psychiatrists were able to work with the Department of Motor Vehicles (DMV) to establish a more reasonable process. This process (now superseded by the legislation referenced by Snyder and Bloom) required, under certain circumstances, that physicians provide relevant information to the DMV, which makes the ultimate decision about licensure. Legal precedents in other jurisdictions demonstrate that in some cases, physicians can be held liable for a patient’s car crash and for thirdparty injuries caused by the patient. Several cases have found physicians liable for third-party injuries because they failed to advise their patients about a medication’s side effects, medical conditions, and medical apparati that may impair driving performance (Ref. 14, pp 69–73). There is no mystery to why physicians nationwide have been wrestling with these matters for many years. Deaths and injuries resulting from motor vehicle crashes are the leading cause of death in persons aged 2 through 33 years (based on 2000 data). Motor vehicle injuries are the leading cause of injuryrelated deaths among 65to 74-year-olds and are the second leading cause after falls in the 75-year and older age group (Ref. 14, pp 9–13). The combination of alcohol and speeding is established as a cause of many traffic accidents. Certain medical conditions can also contribute to motor vehicle accidents. A significant, although often flawed, body of literature is available concerning motor vehicle accidents and mental disorders. What is the role of psychiatrists, who, like other physicians, often assess and treat persons who may be impaired in their ability to drive? The American Psychiatric Association’s 1993 Position Statement on the role of psychiatrists in assessing driving ability recognized that persons who have mental disorders may experience symptoms that can interfere with their ability to operate a motor vehicle safely. The APA position statement further states: