Ethical Considerations Related to Impaired Driving After Orthopaedic Injuries.

A 35-year-old man sustained a right trimalleolar ankle fracture after a fall. He was treated uneventfully with open reduction and internal fixation. At his first postoperative appointment, he was transitioned out of a splint to a controlled ankle movement walking boot and was instructed to remain non-weight-bearing. The patient expressed relief to be out of the splint because he could now return to his job as a commercial bus driver. When the physician explained to the patient that he was not yet ready to drive, the patient reported that he had been driving with the splint in place and needed to work for the income. Despite the physician’s insistence that it would be unsafe to drive, the patient was emphatic that he must return to work. The physician understood the patient’s desire to drive, but was worried about the patient’s safety and the safety of others. Impaired driving is a major cause of morbidity and mortality in the United States. Accidents involving alcohol-impaired drivers were responsible for 10,076 deaths in 20131. Although driving under the influence of psychoactive substances constitutes the primary type of driving impairment, many other conditions (e.g., visual impairment, dementia, and seizure disorders) can cause impaired driving. Orthopaedic injuries can likewise cause impaired driving. Lower-extremity injuries and surgical procedures slow brake-reaction times2. It generally takes 9 weeks after an ankle-fracture surgical procedure for brake-reaction times to return to normal3 and 6 weeks for brake-reaction times to normalize after the initiation of weight-bearing after major lower-extremity trauma4. Brake-reaction times are also substantially impaired with knee or ankle immobilization5. In this case scenario, the patient intended to resume driving against medical advice, despite the inherent dangers. This scenario raises several ethical concerns related to autonomy, confidentiality, and safety. The ethical …