What Is the ethical (Not Legal) responsibility of a physician to treat minimal hepatic encephalopathy and advise patients not to drive?

Lauridsen, Mette Munk; Wade, James B.; Bajaj, Jasmohan S.

doi:10.1002/cld.501

Cited by 5 publications

(5 citation statements)

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“…Therefore, in addition to above causes multiple other factors can influence the driving skills in CHE patients (Fig. 1)[39]. This leads us to question the assumption that patients who test positive for CHE should automatically not drive as they are dangerous drivers[40].…”

Section: What Goes Wrong With Driving In Che: Fatigue Navigational Smentioning

confidence: 99%

“…In corollary, sole over-reliance on testing will result in some safe MHE patients being wrongly, labeled as unfit to drive (type 1 error) and vice versa (type 2 error) while as the vast majority of patient with MHE are safe to drive (Fig. 2)[39]. It is hoped that with advances in the field of MHE testing will result in finding some consensus towards the “gold standard” testing.…”

Section: What Is the Utility Of Screening/testing For Patients With Mmentioning

confidence: 99%

“…All of these factors can potentially lead to deleterious consequences to self and for the society if these patients keep on driving. This dilemma has been well captured in a recent review where in it has been argued that ethical principles (of beneficence, non-malfeasance, justice and autonomy) need to be adhered to while addressing the question of driving in MHE patients[39]. The physician has to be able to use his best judgment and be able to maintain a balance between his ethical duties to wards his patients and the society[39].…”

Section: What Are the Ethical And Legal Responsibilities For Physicians?mentioning

confidence: 99%

“…This dilemma has been well captured in a recent review where in it has been argued that ethical principles (of beneficence, non-malfeasance, justice and autonomy) need to be adhered to while addressing the question of driving in MHE patients[39]. The physician has to be able to use his best judgment and be able to maintain a balance between his ethical duties to wards his patients and the society[39]. This becomes more important as one examines the legality behind reporting the medically impaired drivers.…”

Section: What Are the Ethical And Legal Responsibilities For Physicians?mentioning

confidence: 99%

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Covert Hepatic Encephalopathy

Shaw

Bajaj²

2017

Journal of Clinical Gastroenterology

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Liver cirrhosis is a public health problem and hepatic encephalopathy (HE) is one of its main complications, which can be either overt meaning thereby evident and readily diagnosed, or covert/minimal (CHE) needing psychometric testing for diagnosis. Patients with CHE hepatic encephalopathy have deficits in multiple domains including visuo-spatial assessment, attention, response inhibition, working memory, along with psychomotor speed to name a few areas. These patients have poor navigational skills, get fatigued easily and demonstrate poor insight into their driving deficits. The combination of all these leads them to have poor driving skills leading to traffic violations and crashes as demonstrated not only on the simulation testing but also in real life driving events. There are multiple psychometric tests for CHE testing but these are not easily available and there is no uniform consensus on the gold standard testing as of yet. It does not automatically connote that all patients who test positive on driving simulation testing are unfit to drive. The physicians are encouraged to take driving history from the patient and the care- givers on every encounter and focus their counseling efforts more on patients with recent history of traffic crashes, with abnormal simulation studies and history of alcohol cessation within last year. As physicians are not trained to determine fitness to drive, their approach towards CHE patients in regards to driving restrictions should be driven by ethical principles while as respecting the local laws.

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Section: What Goes Wrong With Driving In Che: Fatigue Navigational Smentioning

confidence: 99%

Section: What Is the Utility Of Screening/testing For Patients With Mmentioning

confidence: 99%

Section: What Are the Ethical And Legal Responsibilities For Physicians?mentioning

confidence: 99%

Section: What Are the Ethical And Legal Responsibilities For Physicians?mentioning

confidence: 99%

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Covert Hepatic Encephalopathy

Shaw

Bajaj²

2017

Journal of Clinical Gastroenterology

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“…The association between cirrhosis and driving performance is of particular clinical relevance because of the life-threatening safety issues both for the driver with cirrhosis and the general public. The inappropriate restriction of driving privileges or underreporting of potential driving issues can have major individual and societal impacts and ethical repercussions (9). A number of studies have suggested that MHE negatively affects driving performance (3)(4)(5)(6)(7)(8), but the association has not been absolute (10), and most evaluations have used driving simulators as opposed to on-road driving tests (11,12).…”

Section: Introductionmentioning

confidence: 99%

The Assessment of Driving Fitness Using an On-Road Evaluation in Patients With Cirrhosis

et al. 2022

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INTRODUCTION:The association between cirrhosis and driving performance is of particular clinical relevance because of the life-threatening safety issues both for the driver with cirrhosis and the general public. Study aims were to assess (i) driving competency through the use of an in-office computerized battery and on-road driving assessment (DriveABLE) and (ii) the association between minimal hepatic encephalopathy (MHE), in-office paper-pencil tools, and additional measures (e.g., frailty, depression, cognitive testing) with unsafe driving.METHODS:Patients were prospectively recruited from 2 tertiary care liver clinics. In-office tests and in-office and on-road assessments of driving competence were completed. The χ2 test and 1-way analysis of variance were used to analyze differences among those with and without MHE. Logistic regression was used to evaluate predictors of an indeterminate/fail result on the in-office computerized driving assessment battery (DriveABLE Cognitive Assessment Tool [DCAT]).RESULTS:Eighty patients participated with a mean age of 57 years, 70% male, 75% Child-Pugh B/C, and 36% with a history of overt hepatic encephalopathy. Thirty percent met MHE criteria on both the psychometric hepatic encephalopathy score and the Stroop app tests. Only 2 patients (3%) were categorized as “unfit to drive” in the on-road driving test, one with MHE and the other without. Fifty-eight percent of the patients were scored as indeterminate/fail on the DCAT. This corresponded to a higher mean number of on-road driving errors (5.3 [SD 2.1] vs 4.2 [SD 1.6] in those who passed the DCAT, P = 0.01). Older age (odds ratio 1.3; confidence interval 1.1, 1.5; P = 0.001) and MHE by Stroop/psychometric hepatic encephalopathy score (odds ratio 11.0; confidence interval 2.3, 51.8; P = 0.002) were independently predictive of worse performance on the DCAT.DISCUSSION:Worse performance in in-office testing was associated with worse scores on a computerized driving assessment battery and more on-road driving errors, but in-office tools were insufficient to predict on-road driving failures. A diagnosis of MHE should not be used alone to restrict driving in patients with cirrhosis. At-risk patients require on-road driving tests under the supervision of driving regulatory agencies. Future studies should continue to refine and evaluate in-office or at-home testing to predict driving performance.

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Ethical Issues in Patients with Cirrhosis

Pappas

2018

Curr Hepatology Rep

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What Is the ethical (Not Legal) responsibility of a physician to treat minimal hepatic encephalopathy and advise patients not to drive?

Abstract: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2046-2484/homepage/6-4-reading-lauridsen.htm a video presentation of this article http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2046-2484/homepage/6-4-interview-bajaj.htm the interview with the author

Cited by 5 publications

References 10 publications

Covert Hepatic Encephalopathy

Covert Hepatic Encephalopathy

The Assessment of Driving Fitness Using an On-Road Evaluation in Patients With Cirrhosis

Ethical Issues in Patients with Cirrhosis

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