Ethical dilemmas in people with epilepsy who drive.

Concern about driving safety in people with epilepsy has been present since the automobile became a widely used source of transportation (Siegel, 1988). Unfortunately, we still do not have adequate means to determine who can and cannot drive. Clinicians must use their best medical judgment to make these determinations. They then must consider the aspects of their state's driving laws and legal consequences of their judgments. In the 44 states that do not require clinician reporting of seizures, they must deliberate about breaching or maintaining the confidentiality of patients with uncontrolled seizures who continue to drive. In making this deliberation they should consider both the probability and magnitude of harm posed by continued driving of an individual patient. Judgments to breach confidentiality should include assessment of risks and benefits to the patient and to society by taking such action. Ultimately, each patient must be judged individually.