Is driving a basic human right? I ask.

My opinion is – certainly not!

It’s a privilege. But if that privilege is taken away human rights issues can be raised about the process.

As readers of this blog will know, I have lost the right-hand side of my vision.

If you’ve ever been for an eye test they probably measured your visual field – roughly speaking how far left and right you can see without moving your eyes. You stare into a sort of big bowl with one eye at a time, and press a clicker whenever you see a small point of light flash for a moment somewhere at the back of the bowl. Have you looked into that bowl?

Here is a sketch of my hospital result. Black means I’m blind in that part of my vision.

Visual field

This condition is called homonymous hemianopia and typically results from stroke. In many countries it means you are automatically barred from driving.

This is a very serious loss, especially if you live away from big towns and cities, and have little public transport. Loss of mobility results in less independence, reduced job opportunities, and in lower quality of life.

It seems perfectly fair however that if a person’s vision loss makes them an unsafe driver they should not be driving. But there have been a growing number of challenges to the rule that homonymous hemianopia means a driving ban is imposed automatically without any other criteria being taken into account. It’s argued against as unconstitutional, or where there is no formal constitution, because it infringes human rights.

In 1999 Terry Grismer took his case to the Supreme Court of Canada.

As a result of a stroke he had homonymous hemianopia and his driver’s licence was taken away. He considered this was discrimination, because had compensated for the field loss by wearing special glasses with prisms that expanded to expand his field of view; by having extra mirrors fitted to his vehicle; and by systematically moving his head to take in a wider range.

In the circumstances he claimed should have been given the chance to take a driving test, not automatically barred. The court upheld his case.

More recently the Netherlands have accepted that someone with homonymous hemianopia could drive again, if they had a favorable opinion from a vision specialist and succeeded in passing an individual test (see my post Can I ever drive again? on this blog).

This willingness to rule on a less absolute basis seems to be becoming more common. In the UK the licensing authority (the DVLA) now accepts a more flexible approach. Its guidance provides for exceptional circumstances. In essence an applicant can be accepted if there is a favorable clinical assessment and they can pass an appropriate driving test.

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About partialinsight

One evening I had a stroke. Half my sight vanished overnight. Adapting made me grasp how amazing the visual system and brain are. It also taught me to understand disability completely differently and I'm grateful for the lesson.
This entry was posted in Blindness and visual impairment, Stroke, Disability, Cognition and tagged , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

13 Responses to Is driving a basic human right? I ask.

  1. Stéphanie says:

    That’s interesting. When having problem of vision myself due to M.E., I asked my G.P. if I was to mention it to the DVLA and if I should avoid driving. He told me I had no obligation to tell the DVLA and that I was the one to judge if I was well enough to drive…. My problems were not only down to vision, it’s also that my legs muscles can be quite unreliable after a while.
    Anyway, I decide myself not to drive when unsure about me or to go for shorter drive and to adjust my speed.
    That said, I think even if you feel you’re able to drive, and the DVLA let you drive, what about insurance? I guess you’ll have to mention it. If I remember correctly, if your condition needs to be told to the DVLA then you also need to mention it to your insurance, which might in turn have consequences. Your insurance refuse to insure you or raise their fees.
    A flexible approach is certainly the way to go, but will the insurance companies follow?

    • That’s very interesting too! With some eyesight problems it’s a matter for the individual’s judgement. Other conditions make not driving mandatory. If I were to get behind the wheel and drive I would commit an offence, and in fact from the moment I suffered the vision loss I ruled driving out. I was incredulous when someone at the hospital asked if I’d driven there, because I couldn’t possibly have seen well enough to do so!

      Motor insurance is a whole new angle that I hadn’t thought about. A quick internet trawl didn’t yield much but there must be lots of drivers with some degree of vision loss and if they attract an insurance loading there are many questions about whether this is fair, unless there’s evidence that they are riskier drivers as a consequence.

      • Steve says:

        An interesting read – and one that highlights the inequalities across different jurisdictions. I’m in the UK and have just been reissued with my drivers licence two years after a stroke left me with (left field) homonymous hemianopia. I took the ‘exceptional case’ route and used a raft of evidence to back it up – letters of support from my GP and from my consultant at my local eye hospital, together with evidence of functional adaptation (a years worth of daily cycle commutes through traffic, return to playing sport). My condition hasn’t improved over the last two years (I have close on complete loss of my left field peripheral vision ) but my functioning has got significantly better.
        I agree with the original post – driving isn’t a right but the process to identify when a licence is taken away (or indeed reinstated) must be fair and proportionate.
        For info, my insurance is no different now to what is was before my stroke. I have been completely open and honest with them so its not hat they ‘don’t know’. I fully expect that this is largely because, to get my licence back, I had to undergo an on-road practical driving assessment. Having passed that assessment the DVLA are effectively content to acknowledge that my driving skills are in no way compromised by my condition and therefore should not attract any additional loading as regards my insurance premium. I can only suggest that, to prevent insurance being declared null and void, anyone with a medical condition that MAY impair their driving declares it.

      • Oh congratulations Steve,

        Thanks so much for writing in, it’s great to hear from someone with HH who has successfully recovered their licence. It’s very reassuring that the system seems fundamentally fair in the UK, and also that there is no insurance loading.

        What you say about the evidence is also very interesting. I gather from the timing that there was some delay before you were ready to get back on your bike, but after that you rode in commuter traffic for a year, which is pretty strong evidence of competence on the road! I’ve never been a bike rider so that can’t be my route but I guess if aiming to regain my licence I should start a diary of ways in which I’ve adapted functionally.

        I was interested in the practical driving test. Presumably this was like any ordinary driving test (?) but how did you prepare for it and what did you take it in, what were the practicalities?

        All this has reminded me that although I haven’t driven at all since the stroke I need to hand my badge in, so on Monday I shall complete and send a form I’ve just downloaded, rather dramatically titled DVLA surrender.

      • Steve says:

        Hi – for info, I am currently 49 years old and have held a full licence since 1986. My stroke (which was a complication arising during/after heart surgery to replace leaky valve in December 2011) wiped out my left-field peripheral vision. I have made a full recovery from my surgery and (with the exception of the hemianopia) from any of the effects of the stroke. I informed the DVLA of my loss of peripheral vision very early on (Jan 2012 or thereabouts) and they responded by revoking my licence. This compounded my already depressed state which had initially been kicked downhill by my consultant neurologist who had told me, within hours of me having been diagnosed as having had a stroke, told me I’d never drive again. Great.

        Anyway, undeterred, I found the following from the DVLA website – which gave me hope through some pretty dark periods … (although it may have moved now and you may need to hunt for it, it is probably still valid and is useful to know):

        “GROUP 1 drivers who have previously held full driving entitlement, removed because of a field defect which does not satisfy the standard, may be eligible to reapply to be considered as exceptional cases on an individual basis, subject to strict criteria:
        – The defect must have been present for at least 12 months;
        – The defect must have been caused by an isolated event or a non-progressive condition;
        – There must be no other condition or pathology present which is regarded as progressive and likely to be affecting the visual fields;
        – The applicant has sight in both eyes;
        – There is no uncontrolled diplopia;
        – There is no other impairment of visual function, including glare sensitivity, contrast sensitivity or impairment of twilight vision; and
        – There is clinical confirmation of full functional adaptation.
        If reapplication is then accepted, a satisfactory practical driving assessment, carried out at an approved assessment centre, must subsequently be completed.”

        I approached the DVLA to ask about driving again around March 2012 (so giving myself a good year of recovery and adaptation). I completed a series of medical questionnaires and went for a (binocular) visual fields test. On the basis of the results of this test DVLA wrote to me to inform me that I failed to meet the criteria for the total field width of 120 degrees and the need for a field of at least 50 degrees on each side of fixation (manage about 10 to 20 degrees to my left). SO was not able to drive. However, in line with guidance that was then on the DVLA website (but has since moved or been removed?) I wrote to the DVLA to inform them that I wished to appeal against their decision and to be considered as an ‘exceptional case’.

        My main issue was how to get ‘clinical confirmation of full functional adaptation’ – which was where my other activities (esp cycling) and a supportive GP came in. Even if you don’t ride a bike I’d suggest giving it a go on a quite lane somewhere. After all, if you can’t cycle safely on your own, maybe you shouldn’t drive? Anything else you can do (any sports that require hand-eye coordination, such as badminton maybe – or anything with people moving around you, such as dancing) is worth emphasising. In the end, a letter from GP to say he/she believes that you are able to demonstrate full functional adaptation is a must. (Even though there are no formalised, strict criteria for what full functional adaptation actually means – an issue I believe the DVLA standing medical committee on vision and driving is looking at.)

        I was finally offered an on-road driving assessment (which is done by an independent ‘motobility’ group) in late November 2013. It was an assessment NOT a driving test. I was out on the roads for about an hour and 10 minutes and two instructors were observing how observant and safe I was. They didn’t really give a hoot about my speed or my driving with one hand resting on the gear lever (!) but were concerned with HOW SAFE I WAS – both for myself and for other road users.

        The problem is that the DVLA give you a provisional licence so you can take the assessment – but the licence is ONLY valid for the period of the test. This means you can’t practice! I was as nervous as heck having not driven for two years but (sweaty palms notwithstanding) I was fine. I managed to find on off-road driving school (on a disused airfield) so was able to have a couple of hours familiarisation the week before (although with no proper road, parked cars or other road users it was a bit of a hollow experience). I think you just have to trust that it’s a skill you don’t forget! The cycling certainly gave me confidence though as it proved to ME that my ‘road sense’ was still effective and my (self preservation) observational skills regarding other road users was also up and running. Because I needed to get to & from work I’d spent a year plus cycle-commuting (but I’ll admit that the first time I road my bike post-stroke was weird sensation!).

        Before the on-road assessment the assessment folk also do a series of cognitive tests with you. They need to check your memory skills, observational skills, reaction speeds and cognitive functioning (as these can all be affected and impaired by the effects of a stroke). Luckily (although I know I was initially impaired a bit by my stroke – with my visual processing being particularly affected) my recovery from everything except the hemianopia was fairly quick (a few weeks maybe).

        My licence was returned in mid December – and, after a hesitant and somewhat nervous start, my driving since then has got back to pretty much the standard it was before my stroke. Big ‘thumbs up’!

        I know it’s a bit long-winded, but I hope some of this helps you, and others. Please feel free to copy and circulate as appropriate. Good luck and stay well.

        Best regards – Steve

  2. Thanks Steve, that is all marvellous. You have mapped out so clearly what is needed for someone in the UK with hemianopia to regain their driving license. I hope I can pass your information on to others, I’ll certainly do my best. Thanks again!

  3. Martin Watkins says:

    Hi, I have just come across this site. At last a speck of light at the end of the tunnel. I too have been left with a partial hh following a stroke in August last year. My licence has gone. I live in a village with no shop, no bus route and no other public transport. I have to be taken eveywhere by my wife or neighbours. I work about 7 miles away….well you’ve experienced it so you know.
    I have been getting pretty down lately, lower than I thought I could go, but hearing from someone who has done it, that it’s possible, just possible, that I may get my licence (and life) back, has given me more of a lift than all the anti depressant pills put together.
    I don’t know if others feel like this but if I were to be assessed and found to be unsafe, then thats it. I can accept it. I definitely don’t want to be a danger to anyone. My absolute frustration is borne of the fact that I know I could drive safely if only I could be allowed to prove it.
    Once again thank you. Its the first time I been in contact with anyone who has experienced hh.
    Martin

  4. lins w says:

    This is useful and encouraging. I have hh after stroke 15 months ago and am applying to dvla. First applied 3 months ago and had to fill in forms repeatedly as they lost them etc. Had letter from them a few wk ago stating they had rejected my application. When i phoned to discuss this i found out they had managed to lose my gp letter which stated why i could apply under “exceptional circumstances”. I am looking forward to the driving assessment i presume i will be offered. Also agree riding a bike through town would be good training but i have never riden bikes as i worry it is dangerous! It is encouraging that dvla have passed some applicants.

  5. Kathryn says:

    I have just come across this site and have found the posts very interesting – I don’t know anyone else who has this condition. I had a stroke following routine abdominal surgery 16 months ago, aged 49,causing HH. I am a nurse and was working in the community prior to the stroke, so having my licence revoked has affected my working as well as my personal life. I am currently applying for my licence to be returned as an “exceptional case”. The DVLA has refused this as I was registered as partially sighted when I left hospital. My GP has supported me by writing a letter to them, stating I should be allowed a driving assessment. I have not been offered this, so have applied to have one in Derby which I will pay for myself. I have also had further visual field tests done to prove my condition is static. I have been encouraged by the posts on this site – I just want a chance to see whether I would be safe to drive again, because I feel I would be. If I fail the assessment then I will accept this.

  6. Kathryn says:

    Hi, I have paid £60, which is a subsidised fee, usually about £95 I think, I am just waiting to hear from them. I (naively) expected that this would be part of the process via the DVLA before my licence was revoked………This has been a steep learning curve!!! The assessment centre is in Derby and this is fairly local to me – DrivAbility Centre – I believe there are other centres around the country.

  7. Thanks, that’s very useful to know! I had no idea these centres existed.

  8. katran64 says:

    Just an update – I had a positive off road assessment at Derby at the end of March. I sent the report to the DVLA and requested to be given an on road assessment. I finally had the on road assessment at the end of September, after not driving for almost 2 years. I had a couple of driving sessions on a disused airfield in Sheffield prior to this. I am pleased to say that my driving licence was returned to me 10 days ago and I am over the moon !!! I wanted to encourage others not to give up and accept that people with HH can never drive again. This should be assessed on an individual basis, but this was never suggested by the DVLA. I was really well supported by the team at the Derby DrivAbility Centre, who gave me so much advice and information. My life is so busy at the moment, so I have had no choice but to get straight back into driving, including long journeys on the motorway. I have not encountered any problems relating to car insurance either. Good Luck to anyone going through a similar process.

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