Driving ban on epileptics smells like bigotry

REPORTS IN this newspaper spaced almost 10 years apart record an ongoing debate about whether epileptics are fit to drive.

Those arguing for include the Jamaica Epilepsy Association. Road safety officials in the Ministry of Transport and Mining, supported by some members of the medical fraternity, according to November 1, 2010, and February 17, 2019, Gleaner articles, are reportedly against.

Missing from the debate: The National Road Safety Council and insurance companies.

The former head of the ministry’s Road Safety Unit (RSU) and subsequently, director of the Island Traffic Authority, Paul Clemetson, said in 2010 that members of the medical fraternity have considered “what obtains, in other jurisdictions but are not presently of the view it should be accommodated in Jamaica and … we have to be guided by experts in that profession”.

No details were given why the experts he selected decided that all epileptics are unfit to drive. Also, he did not say if they would ever be allowed to do so.

The current head of the RSU, Kenute Hare, sees no reason for that policy to be changed despite the many scientific advances that have been made in medical science in the last decade.

“Lawmakers at the time [1938] thought it prudent to not issue drivers licences to … epileptics. I would not want to be in a situation and to have to deal with a case where somebody involved in a collision got an epileptic fit,” he said.

It is unclear why he buries his head in the sand.

The prevalence rate of epilepsy, according to Eulalee Thompson, (Gleaner, November 23, 2005), “based on data collected in other countries, is between one and two per cent”.

This means that there are probably 30,000 to 60,000 persons suffering from the disorder. Some of them are drivers.

Given that data, the long history of stigma that is associated with the condition and the RSU’s continued and strong opposition to allowing some epileptics to drive, today’s article will examine epilepsy as a risk for road accidents, discuss more broadly the insurability of epileptics, and, generally, try to raise the quality of the conversation.

The idea behind this article originated from one of my friends who is a neurologist. She provided two sources of reference: A pamphlet – The History and Stigma of Epilepsy; and a book – Medical Risks in Epilepsy. My friend also read drafts of this article.

My interest in the subject was also stirred by Clause 4.3 of the insurance regulator’s Market Conduct Guidelines. It imposes a duty on insurers and intermediaries under the Fair Treatment provisions to “give fair and equal treatment to all policyholders and are not to make or permit any unfair discrimination against any person or persons in respect of premiums charged, limitations placed on sums insured, or by refusal to renew an insurance contract”.

The book was published in 2001. Its editors are four Scandinavian specialists in epilepsy, neuroscience, and neurology. Epilepsy is a neurological disorder. Neurology is the branch of medicine that studies and treats disorders of the nervous system.

Some of the key points in Chapter 12 are:

1. Society accepts a certain degree of risk and some level of variation from the mean risk. The distribution of motor vehicle accidents in the general population includes accident-prone subpopulations (especially young men, and, in Jamaica’s case, persons who use electronic devices while driving, those who drink alcohol and smoke ganja and who continuously disobey the traffic regulations);

2. A 2000 study of road accidents involving collapse at the wheel reported by the British police found that 11 per cent of the cases involved an epileptic experiencing their first attack while driving. This compared

with 37 per cent for stroke, 24 per cent for a heart condition, and 44 per cent for unspecified blackouts (sic);

3. Not all types of epileptic seizures that can occur while driving are similar. Some, simple partial without important motor or sensory symptoms, “have no consequence for road safety”; 4. Several studies over the past 40 years have reported a higher accident risk in people with epilepsy than in control populations; and

5. It is estimated that 75-80 per cent of the people with epilepsy can achieve acceptable seizure control.

Annex III of the European Union Council Directive 91/439/ EEC of 29 July, 1991, states: “Driving licences shall not be issued to, or renewed for, applicants or drivers suffering from a serious neurological disease unless the application is supported by authorized medical opinion.”

Further, that “neurological disturbances associated with diseases or surgical intervention affecting the central or peripheral nervous system, which leads to sensory or motor deficiencies and affects balance and coordination, must accordingly be considered in relation to their functional effects and the risks of progression. In such cases, the issue or renewal of the licence may be subject to periodic assessment in the event of risk of deterioration.”

What are the real reasons behind the continued local ban against driving for all epileptics?

Individual life insurance covering the risk of premature death is usually granted in Finland for people with well-controlled epilepsy. A small additional premium is charged for those who have one to six seizures per year, and, in more severe cases, the premium is higher. In that country too, health, group life, travel, and workmen’s compensation insurances are also available.

If the existing rules that prohibit all epileptics from driving in Jamaica are to remain during the 21st century, the decision to maintain them must be supported by scientific evidence – not by vague references to unnamed “experts” or unwillingness to have fact-based discussions.

Prejudice against persons with epilepsy prevented them from marrying in some countries. In the United Kingdom, the law that prohibited marriage was repealed in 1970.

Title III of the Americans with Disabilities Act (ADA) or Section 504 of the Rehabilitation Act of 1973 apply to persons with epilepsy. Both federal laws protect “qualified individuals with disabilities” against discrimination by a public accommodation as well as family members and others who are discriminated against because of their association with a person with a known disability.

Medication and medical science have improved significantly since 1938. Persons with epilepsy that is well-controlled and who are under the care of doctors should be allowed to come out of the shadows and drive if the new Road Traffic Act is to be “groundbreaking”, as the minister of transport claims.