2024 Law-Medicine Conference: Cognitive Decline and the Law

As the American population ages, a growing number of people will suffer cognitive decline. Cognitive decline may affect individuals’ ability to work, drive, obtain medical care, manage their finances and engage in other activities of daily living. As cognitive decline becomes more prevalent in American Society, legal experts and policy makers will need to grapple with its implications. This conference will explore a variety of legal and policy challenges associated with cognitive decline. Topics will include medical decision-making, guardianship, cognitive decline among incarcerated individuals, family caregivers, telemedicine and much more. Agenda and speaker biographie

Patient Autonomy, Public Safety, and Drivers with Cognitive Decline

With a growing elderly population, cognitive decline in drivers has become a significant public safety concern. Currently, over thirty-two million individuals who are seventy or older have driver’s licenses, and that number is growing quickly. In addition, almost ten percent of U.S. seniors (those sixty-five and older) have dementia, and an additional twenty-two percent have mild cognitive impairment. Between a quarter and a half of individuals with mild to moderate dementia still drive. As cognitive abilities such as memory, attention, and decision-making skills deteriorate, a driver\u27s ability to operate a vehicle safely can be compromised. This not only puts the driver at risk but also endangers passengers, other motorists, and pedestrians. As the population ages, the number of drivers experiencing cognitive decline is increasing, escalating the risk of accidents.For many older adults, however, driving is a key aspect of independence and mobility. Losing the ability to drive can lead to social isolation, dependence on others, and a decline in overall well-being. Understanding and addressing the challenges of cognitive decline in relation to driving is crucial for maintaining elderly individuals’ quality of life. Nonetheless, determining when someone should stop driving due to cognitive decline is especially difficult because cognitive decline often progresses gradually and is challenging to assess.Current legal mechanisms fail to resolve the tension between promoting personal autonomy and protecting public safety, and existing approaches to the problem are unsatisfactory. Requiring road tests of every older adult is both overly intrusive and economically inefficient. At the same time, however, revoking driving privileges only after an accident has occurred creates a public safety hazard. Without an effective system of regulation, informal practices emerge. Medical professionals who recognize that a patient’s driving is likely to create a safety risk may either ignore the matter entirely or pressure family members to take the keys away from their loved one. And when accidents do happen, family members are sometimes sued for failing to prevent their loved one from taking the wheel.This Article recommends a framework for enhanced medical and regulatory protocols to navigate the intricacies of driving with cognitive decline. It recognizes that earlier efforts to solve the problem have often failed because they relied too heavily on a single point of responsibility. Our proposed framework, by contrast, creates a connection between the medical provider and the motor vehicle regulator and sets out clear lines of responsibility. The Article develops recommendations for effective interventions, analyzing the role that physicians should play and proposing legislative changes. Driving with cognitive decline is a multifaceted challenge that impacts public safety, personal independence, family relationships, legal rights, and healthcare practices. Addressing it effectively requires a balanced and thoughtful approach that considers the needs and rights of all stakeholders