This report examines the current state of play in PIN countries regarding the assessment of medical fitness to drive, with reference to the 2006 EU Directive on Driving Licences which states that driving licences shall be issued only to applicants “who meet medical standards”. The EU is currently reviewing the Directive and a revised legal proposal is expected in 2022.
This report focuses exclusively on Category B driving licences, i.e. the licence required to drive a car, small van or minibus that can carry up to eight passengers.
Studies have concluded that specific medical conditions, substance abuse, mental disorders, epilepsy and diabetes are more important factors than age when it comes to medical fitness to drive. Mandatory age-based screening of older drivers has not been shown to be effective in preventing severe collisions. It may even have a negative safety impact, as older drivers become vulnerable road users.
Medical checks performed when obtaining a licence, renewing a licence or re-licensing can be useful for identifying medical conditions which may affect fitness to drive.
Of the PIN countries that responded to ETSC’s request for data, the majority of them require some form of medical check when first applying for a category B driving licence, beyond the sight test described in the Driving Licence Directive. The medical test required when acquiring a licence for the first time can vary from a self-assessment form filled out and signed by the applicant, to a medical examination carried out by a General Practitioner (GP) or a medical examination carried out by a specialist doctor or centre.
The EU Driving Licence Directive sets out standards for vision and lists a number of other conditions which may impact medical fitness to drive including: poor eyesight, locomotor disability, cardiovascular diseases, diabetes, neurological diseases and obstructive sleep apnoea syndrome, epilepsy, mental disorders, alcohol issues, drugs and medicinal product dependency and kidney disorders. The Directive states that if an applicant for a driving licence has any of these conditions, they must undergo a medical examination prior to obtaining their licence.
Member States can go beyond those minimum EU standards, and a majority do.
Data on the role played by medical conditions and disorders in road collisions are lacking. Pan-European in-depth collision data could aid the development of safety policy, vehicle regulation and technological advancement. Pan-European in-depth collision investigation data would also support the identification of the areas that need immediate attention in developing collision countermeasures and support the evaluation of measures implemented in the EU. Currently only a small number of European countries systematically collect such data.
Medical fitness to drive is a matter of judgement as well as science and the levels of training or guidance provided to those assessing medical fitness to drive in PIN countries vary. Eleven PIN countries help those assessing medical fitness to drive with a set of guidelines and seventeen PIN countries have a regulation which stipulates how fitness to drive should be assessed. A clear set of guidelines issued to those assessing medical fitness to drive is known to have a positive effect.
From the data that ETSC was able to gather from PIN countries for this report it seems that the number of licences removed for medical fitness to drive issues other than alcohol is small when compared with licences removed for driving under the influence of alcohol. It is fair to say, however, that detection levels for this offence are much higher than for most other medical fitness to drive conditions.
Driving while under the influence of alcohol poses a serious risk to road safety: 25% of all road deaths in the EU have been estimated to be alcohol related. Diagnostic, therapeutic and rehabilitation aspects of alcohol-use disorders have been neglected in the Directive and in many guidelines. The upcoming revision of the Driving Licence Directive represents an opportunity for review.
Alcohol interlock programmes give offenders who would normally lose their driving licence a possibility to continue driving, as long as their alcohol level is below a set value. But the EU Driving Licence Directive states that ’Driving licences shall not be issued to, or renewed for, applicants or drivers who are dependent on alcohol or unable to refrain from drinking and driving’.
When the Directive was adopted in 2006 alcohol interlocks were not widespread and very few Member States had programmes. The consequence today is that a significant group of potential participants are excluded from current alcohol interlock programmes and deprived an effective health tool. Including alcoholdependent offenders, with proper medical supervision, would increase participation and cut recidivism and driving without a valid licence.
The two most common ways of communicating the impact of a certain medicine on someone’s fitness to drive are through the prescribing doctor or via a visual notice inside or on a medicine’s packaging. 23 PIN countries reported that patients are informed by the prescribing doctor and a visual notice was available in 24 PIN countries. Eight PIN countries (Denmark, Finland, Hungary, Ireland, Israel, Lithuania, Spain and Sweden) reported that they have national guidelines on how a patient is informed of the impact of a prescribed medicine on their fitness to drive.
It is recommended that a standardised screening process be considered across all Member States when assessing a driver’s fitness to drive. The process should be based on international best practice and ideally, consistent across all jurisdictions.
KEY RECOMMENDATIONS TO NATIONAL GOVERNMENTS
• Develop and implement evidence-based screening tools and protocols based on international best practice to help medical professionals consistently identify medical conditions which may affect fitness to drive at all ages. Review the process for declaring medical conditions at licence application, renewal and for emergent conditions between licence renewals.
• Within national medical fitness to drive guidelines and regulations, stress the role of General Practitioners (GPs) as the primary point of call for identifying those who may be at-risk in terms of their fitness to drive, initiating an assessment of a person’s fitness to drive and influencing how long and under what circumstances a person continues driving. This influence can range from direct advice to the patient to discussions started by family members about a person’s challenges with driving.
• Develop (if not yet done) and mandate for medical professionals evidence-based training programmes which have been shown to be effective and are accepted in particular by family doctors (GPs) in assessing a person’s fitness to drive.
• As part of their initial and continuous training, inform and/or remind doctors of their duty to advise their patients on the impact of prescription medicines on driving.
• Apply the DRUID3 categorisation and labelling of medicines that affect driving ability and support information campaigns promoting awareness among medical professionals and among the general population.
• Make wider use of conditional licences (Codes 61 to 69 of Directive 2006/126/EC5) to allow those who may be at slight risk to continue to drive under certain circumstances. In the context of drink-driving, apply code 69 when a driver is restricted to drive only a vehicle equipped with an alcohol interlock.
• Establish and actively mandate the use of alcohol interlocks as part of rehabilitation programmes for recidivist and high-level first time offenders. Allow drivers with alcohol dependency to participate in a rehabilitation programme and be issued with a conditional licence with mandatory use of an alcohol interlock, as long as it is combined with medical supervision.
• Develop and promote materials to assist individuals (helped where appropriate by family members) in undertaking assessment of their own fitness to drive and in making an informed decision towards reduced driving and driving cessation if needed. Provide information about conditional codes giving entitlement to drive only under certain circumstances.
• Join efforts with local and regional governments to provide alternative transport options to the private car for those who cannot continue driving.
KEY RECOMMENDATIONS TO THE EU
As part of the upcoming revision of the 2006 EU Driving Licence Directive:
• Review and update Annex III on minimum standards of physical and mental fitness, in particular on alcohol abuse and neurodevelopmental disorders.
• In order to increase consistency in assessing driver’s medical fitness to drive across the EU, develop an effective and transparent screening protocol based on international good practices to help medical professionals detect potential medical conditions.
• Develop and promote evidence-based guidelines for family doctors and other medical professionals involved in assessing the functional capabilities of someone suspected of being an unfit driver.
• Support Member States in developing and evaluating educational programmes for GPs that are both effective and accepted by medical practitioners.
• Organise regular meetings of the Driving Licence Committee and facilitate the exchange of good practices between traffic medicine specialists and national driver licensing agencies as the evidence base continues to develop.
• Encourage Member States to make wider use of conditional licences (Codes 61 to 69 of Directive 2006/126/EC7) where possible and report to the EC the scale of their use, so as to aid monitoring and improvement. In the context of drink-driving, Member States should be encouraged to apply the code 69, under which a driver is restricted to drive only a vehicle equipped with an alcohol interlock.
• Allow drivers with alcohol dependency to participate in a rehabilitation programme, and be issued with a conditional licence with mandatory use of an alcohol interlock, as long as it is combined with medical supervision.
• Support Member States in developing and promoting materials to support successful drivers’ self-regulation and transition to reduced driving and driving cessation. These materials should be made freely available in all Member States, to assist individuals in undertaking assessment of their own fitness to drive.
