Confidentiality and fitness to drive: Professional, ethical, and legal duties in the case of the diabetic bus driver.

Abstract

Patients who pose a risk of serious accidents present a difficult ethical problem for medical practitioners. The duty to maintainconfidentiality is an ancient and weighty obligation and has many beneficial consequences for patients and society generally. Similarly, theduty of care towards a patient militates against disclosing details that could remove his or her source of income and imperil physical andmental wellbeing. However, in cases where maintaining confidentiality can result in severe harm to the patient and the public, the benefitsof confidential practice may be outweighed. While many publications on this topic provide clinical criteria for determining the unfitness ofa diabetic patient to drive, the focus in this article is on ethical, professional, and legal responsibilities after a practitioner has decided thata driver poses a significant danger.