India Together: Fit to drive – 11 February 2008

11 February 2008 –

Universally, decades-old laws continue to flourish in socio-cultural conditions completely different from when the laws were conceived. The same laws,
when applied with equal stringency today, often infringe on the human rights of individuals. The laws concerning epilepsy and driving provide one such instance.

Despite improvements in epilepsy management, there has not been much progress in ensuring the basic rights of those with epilepsy. 30-40 years ago,
patients with epilepsy were not allowed to hold a driving license – not only in India but also in several parts of the world. Since then, newer and more effective
antiepileptic drugs providing better control of seizures have become available. This should have resulted in the relaxation of driving restriction for epilepsy
patients. However, archaic driving laws continue, without the benefit of the new scientific realities in epilepsy care.

It is true that people with epilepsy must drive with the anxiety of having a seizure – though the possibility of having one while driving is remote.
The rate of seizure related accidents is much lower than those caused due to careless driving, alcohol intake and even cell-phone use. It is the responsibility of the
medical practitioners to assess the risk involved depending on the type and frequency of seizures, regular drug intake, and general lifestyle of the patient. For
instance, according to specialists, the risk is reduced by 93 per cent if the seizure-free period is one year; by 85 per cent if the seizure-free period is six
months.

Laws in India

The government of India has no provision to issue special driving licences to People with Epilepsy (PWE), no matter how long they have been
seizure-free. But it is also true that PWE drive merrily without disclosing their epilepsy condition and history, causing considerable risk to their own safety and
those of others. This is partly because they know that even a slight reference to their medical history could cost them their driving licence. Only a differentiated
law which is sensitive to the actual condition and history of those with epilepsy can address the situation scientifically and justly. (A progressive example is the
latest decision of the Ministry of Health to modify the regulations concerning organ transplant – the stringency in which is the root case of undercover activities
like the Gurgaon kidney trade discovered recently).

The Indian Epilepsy Association (IEA) has been addressing various issues related to the right of epilepsy patients. The IEA is a
registered society established in 1971, with the objective of providing better treatment, care and rehabilitation to persons suffering from epilepsy and to improve
the overall welfare of their lives. The IEA is affiliated to the International Bureau of Epilepsy (IBE) and has been trying to better the lives of epilepsy persons
through required legal reforms.

According to the Hindu Marriage Act, 1955 and the Special Marriage Act, 1958, a marriage can be solemnised if at the time of marriage neither party
suffered insanity or epilepsy. There was an amendment to this Act in 1976. With persistent efforts from the IEA, the Centre passed a Bill in 1999 delinking epilepsy
from this law, allowing patients with epilepsy to have a legally valid marriage. Following this, the IEA has been working towards an amendment in the Motor Vehicle
Act too, in view of the changed scenario in the management of epilepsy.

The Motor Vehicle Act, 1939 empowered transport authorities to deny a driving licence to anyone with even a single seizure at any point in his/her
life. Following a series of modifications, current regulations require all applicants to fill up an ‘application cum declaration of physical fitness’ form. If
declared as having epilepsy, the applicant is required to undergo a medical examination. Even in the case of positive medical recommendations, there is no provision
to issue a driving licence if the person has epilepsy.

International scenario

In the last 10 years, the Maurice Parsonage Commission on Driving Licence Regulations of the International Bureau for Epilepsy (IBE) has given a set
of recommendations after studying the subject extensively. It has suggested that a limited restriction, for a period of 2 years following a seizure, (with
certain qualification) is adequate, and the period thereafter should be considered risk-free for issuing a driving license.

Most states in the USA permit a person to drive if s/he has been free of seizures for varying periods, between 3 and 18 months. In the UK, a driving
licence is granted if the person has been free from seizures for one year. In Australia, driving licences are issued to those who’ve been seizure-free for a period of
6 months to two years.

Legistlative course of action in India

In view of the above, the IEA approached the Indian government with an appeal to introduce amendments in regulations concerning driving and epilepsy in the Indian law. Addressing the Minister of Surface Transport in 2005, the IEA suggested the following course of action:

1. Issue of driving licence to PWE;

2. Issue of licence is qualified, in the sense that it is subject to certain conditions;

3. Licence should be issued to those who have not suffered an epilepsy attack in the last one or two years;

4. In the general interest of the public, licence should not be issued to drivers of public transport vehicles and heavy vehicles;

5. Make it mandatory for the person to inform the appropriate authority if he/she develops a seizure;

6. The doctor in-charge of the PWE should inform the appropriate authority if the person has seizures;

7. All doctors should have a copy of the guidelines on this issue – which can be supplied by the IEA.

The IEA also suggests an amendment in the form used as an ‘application cum declaration of physical fitness’. Instead of assessing the epilepsy
condition of the applicant in general, the form should ask specifically whether the applicant has suffered from epilepsy or from sudden attacks of loss of
consciousness during the last two years.

According to Dr Vinod S. Saxena, President of Indian Epilepsy Association, the Ministry of Surface Transport recently forwarded the application of
the IEA
to the Ministry of Health. The latter in turn, seeing the scientific merit in the case, worked out recommendations in consultation with IEA. According to these
recommendations, driving licences can be issued to those who have been fit-free for the past three years and if the doctor in-charge certifies that the EEG (Electro
Encephalogram) and MRI scan (Magnetic Resonance Imaging) show no abnormality. However, these recommendations have a long way to go before they are notified as
amendments in the law. They need to be approved by various other related ministries before they are tabled in Parliament for debate.

The fact that the recommendations are on their way towards parliamentary clearance, however, is itself a big advance, feels the IEA.
The association is actively engaged in the various procedural clearances to ensure that its recommendations for
change are not misinterpreted, intentionally or otherwise, by various stakeholders.
If the recommendations are eventually passed into law, it would a mark a rare
revision of Indian law to reflect contemporary realities.