Originally published in The Ottawa Citizen April 3, 2002

Sunday will mark the fifth anniversary of the death of my brother, Dr. Steven Dworkin, age 32. His senseless death continues to haunt me and I suppose will forever do so.

Earning his PhD in mathematics, an appointment to teach mathematics and physics at Rice University in Houston, married for less than a year and his wife recently accepted into medical school, it had all come together. His life had blossomed. That was until April 7, 1997.

My brother was run down in his bicycle lane near his home in Galveston, Texas, by a 72-year-old woman driving her car at a speed of 100 km/h. She stopped only after his body was thrown 125 metres down the road — this despite a damaged windshield.

The recent inquest by a Toronto coroner’s jury into the death of Beth Kidnie, dragged under the car driven by 84-year-old Pilar Hicks for almost a kilometre, produced three pages of recommendations to the Ontario government.

In these two instances elderly drivers were at fault. However, it is wrong to overgeneralize that all elderly drivers are suspect. There are excellent and poor drivers in every age group. Every driver should be evaluated equally under the law.

That being said, as a physician I know firsthand how the ravages of disease can compromise independence and normal day-to-day functioning. No physician is looking to recommend revocation of a patient’s driver’s licence. Indeed, many doctors fail to comply with the existing law to report “compromised” patients.

The reason is the definition of “compromised” is too broad. Taking a sleeping pill or breaking a leg would, under the law, require a letter to the Ministry of Transport attesting to the patient’s inability to drive.

It is important to be consistent and fair regardless of how painful reality can be. For those whose illness, despite treatment, continues to cause deterioration of their physical and mental capacities, there must be a means to determine their competence to drive. Accepting this premise means that the effects of aging must be taken into account.

It is not ageism to say that with age the incidence of stroke, deteriorating eyesight, slowed reflexes, dementia, heart disease and cancer among others, increase. Is this a reason to single out the elderly? No. It should be acknowledged that the process of aging presents challenging situations. The approach in the assessment of competency should be no different than it is for a younger driver who may suffer from a medical impairment. Driving competence should be viewed as a public health concern. Airline crashes make the headlines, but the carnage of our roadways far exceeds airline fatalities. All of us have a social responsibility to ensure we are prepared for any driving challenge.

The coroner’s jury in the Beth Kidnie case recommended graduated delicensing. This concept has merit for it would restrict driving under situations congruent with the driver’s medical condition irrespective of age. The goal is to maintain independence without compromising safety. The jury also recommended a review of road tests for drivers over the age of 80 and the content of indoor education sessions. They want a standard police form to report drivers suspected of having a medical impairment.

They also want new methods of screening drivers. If it is agreed that each driver is responsible for ensuring his competency to drive, then it follows that testing, education and skills upgrades are an acceptable means to achieve this goal. Drivers should be responsible for the expense just as they assume the cost of insurance and licensing. It is part of the deal.

Reporting a patient to the Ministry of Transport is a difficult process with the usual result being the destruction of the doctor-patient relationship. There has to be an independent means for assessing competency. Just as doctors order diagnostic tests for diseases, why not driver’s tests? If faced with a patient with a medical impairment, how better to assess their ability to drive than by sending them to an accredited driving evaluation facility?

Another approach could be standardized testing every five years for healthy drivers aged 16 to 60, from age 60 to 70, every two years and every year after 70. So long as the driver is able to meet the standard requirements for licensing based on an objective assessment, age becomes irrelevant.

If a person is unfit to drive, it behooves everyone to do the right thing. Denying reality helps no one. It certainly did not help Ms. Kidnie or my brother.