Abstract
In states that do not have mandatory physician reporting of seizures, clinicians face the ethical dilemma of whether or not to breach confidentiality of poorly controlled patients who continue to drive. In making this deliberation, one should consider both the probability and magnitude of harm posed by continued driving of an individual patient. When probability and harm are low or when probability is high but harm is low, there is generally no moral obligation to breach confidentiality, and it would be wrong to do so. The most difficult situation is when probability of harm is low but magnitude of harm is high. Judgments to breach confidentiality in these situations should also include assessment of risks and benefits to the patient and to society by taking such action. Ultimately, each patient must be judged individually.
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