In states without mandatory physician reporting of patients with seizures, the decision of whether to breach confidentiality and report a poorly controlled epileptic patient who continues to drive an automobile becomes an ethical dilemma.
In making this decision, one must consider the probability and magnitude of the potential harm.
If the probability and magnitude are both low, or the probability of harm is high but the associated magnitude is low, there is generally no moral obligation to breach confidentiality and report.
If the probability of harm is low but the potential magnitude of the harm is high, one should strongly consider reporting the case.
Each case should be handled on an individual basis, take into consideration the risks and benefits to the patient and society if reporting is ensued, and perhaps elicit the advice of risk management.
References
Ozuna. "Ethical dilemmas in epilepsy and driving." Journal of Epilepsy.
