The crux of medical fitness to drive is the risk of incapacitating arrhythmias

The freedom that driving a car gives the individual is a highly regarded privilege, some would say a right. Yet it is an inherently dangerous activity associated with significant mortality and morbidity, leading to 3500 deaths and 40 000 serious injuries from road traffic accidents in the United Kingdom each year.1 This appears to be acceptable as a reasonable price to pay for the lifestyles and employment practices we choose. Society makes a judgment balancing risk and reward arising from any individual's activity that encroaches on others' lives. This risk analysis leads to legislation—on compulsory ability testing, adherence to the highway code, and medical fitness to drive.

In the United Kingdom, as in much of Europe and North America, there is a two-tiered approach to medical fitness to drive. Those who drive heavy goods or public service vehicles must conform to stricter requirements than those who drive small vehicles. This is sensible as the danger to others relates not only to the likelihood of incapacitation but also to the time spent driving and the potential for lives to be lost in the event of an accident, factors that are clearly greater with vocational driving.2 The current licensing authority medical standards of fitness to drive relating to cardiac disease for non-vocational drivers …