• Individual rights… up to a point

    I just got out of a fascinating talk that has me all fired up. Here’s the gist: should we restrict the rights of people on insulin for their diabetes to drive?

    It turns out that Indiana, where I live, restricts people on insulin from driving commercially. No truck drivers, ambulance drivers, etc. This is because there is a belief – not backed up by solid evidence – that people who have insulin are a significantly greater risk to themselves and others on the road, if they let themselves get hypoglycemic.

    I had no idea.  It’s driving me crazy.  Here are some of the questions I asked*:

    1. If I wear eyeglasses, I could potentially be at risk if I chose not to manage my terrible vision correctly. Shouldn’t I be similarly constrained then?
    2. What about the elderly? They are more likely to get in accidents, too. Shouldn’t they be restricted, too?
    3. People who are sleep deprived are also impaired (there’s research for that). Should we start restricting driving for people who don’t get enough sleep?
    4. Should we restrict gun sales to those with diabetes? They could also get hypoglycemic and shoot someone.
    5. Why, in the US, would we seek to restrict the rights of a group of people with no solid evidence behind it, let alone even with minimal evidence?

    Mind you, I live in Indiana. It’s a pretty conservative  state. Where are the people fighting against this? Where are the lawsuits?

    *Just so you know, I expect the answer to every one of these questions to be “no”. I just fail to see why they are different, and why we are singling out driving and people who take insulin for diabetes.

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    • A little surprising. I rarely see real hyploglycemic episodes anymore. Drug regimens and monitoring are much better.

      Steve

    • 1) Yes. You are restricted (at least in some states) have a sticker stating you must wear corrective lenses. Also, look at the example of pilots (like commercial drivers in the sky) they have strong limitations based on their vision or medical conditions.

      2) Yes. (At least additional testing). I believe there are studies supporting their unsafe driving, there is definitely anecdotal evidence. They just have a strong union that prevents this.

      3) Yes. Show how to prove this and many would probably support it, especially for commercial driving. And for commercial driving (and pilots) they limit their hours behind the vehicle to prevent this.

      4) Well this is just silly.

      5) No. If there is no evidence then I agree completely that there should be no limitation. But if there is evidence (as in your examples 1-3) then there should be limitations.

      Finally we are not talking about a “right”, driving is a priviledge. On top of that we are talking about commercial driving.

    • prefer not

      1) I have no problem with a sticker on the license for them. That’s not the same. They are prohibited completely from getting the license.

      2) So you’re fine with a class of people being left out because they don’t have a strong union?

      3) We could require people to prove through monitoring in their homes that they slept enough before driving. Of course we won’t do that. It’s ridiculous. But would we require similar monitoring of people with diabetes to prove they took their insulin?

      4) Of course it is. That’s the point.

      5) First of all, the evidence is sketchy. And, there is evidence for a whole host of things making you a bad driver. Getting older, not getting enough sleep, a host of other diseases, etc. Personally, I feel like you either pick on all of them, or none of them.

      I’m not declaring driving a right. You have to pass the test. You have to follow the rules. There are certain requirements. These regulations, however, target a specific treatment for a specific disease, in a case when proper management will allow you to function normally.

      Let me put it another way. The government is saying it doesn’t trust people with diabetes on insulin enough to let them drive. They are saying they don’t trust them to manage things correctly, and are therefore denying them the ability to drive for a living. This is in spite of the fact that the vast, vast majority of people with diabetes do the right thing.

      You’re comfortable with this?

    • I wonder if the era of insulin pumps (and thus much tighter control) would influence the (weak) evidence as most of it refers to much earleir time periods. I also wonder hopw to separate out vision problems (which we do test for) from hypoglycemic attacks if the evidence is at the population level.