Originally published December 2010 / Revised October 2016
Joe gets claustrophobic when wearing a seatbelt. Amanda is pregnant and worries that a seatbelt might injure her baby. Another patient claims the seatbelt doesn't fit properly. The common denominator is that each of these patients wants you, their physician, to write a note supporting their exemption from wearing a seatbelt. You should be aware of the risks you may face if you agree to these requests.
The Canadian Medical Association states that "[t]here are no medical conditions that justify exemption from wearing a seat belt."1 Many provincial/territorial medical associations have endorsed or adopted this statement, as have at least two regulatory authorities: the College of Physicians and Surgeons of Manitoba, and the College of Physicians and Surgeons of New Brunswick. It is therefore important for physicians intending to deviate from this position to carefully record the medical condition and rationale in support of a patient's request to be exempted from wearing a seatbelt.
All Canadian provinces and territories have legislation in place requiring drivers and passengers to wear seatbelts, though most seatbelt laws allow exemptions under certain conditions. In some jurisdictions, including British Columbia, "medical conditions" are not acceptable reasons for an exemption. Other jurisdictions have designated a government official to authorize exemptions—in these jurisdictions, the physician only provides patients with a medical certificate or letter supporting their application to be exempt from wearing a seatbelt. In yet others, patients may be exempted by producing a "medical certificate" signed by a qualified medical practitioner certifying they are unable to wear a seatbelt for medical reasons, including physical characteristics.
In some circumstances, patients may be unhappy if a physician does not provide a medical certificate for an exemption. Such patients have sometimes complained to the College. Conversely, if a patient who had received an exemption were to be injured while unrestrained, the physician may be subject to a College complaint or litigation.
Although physicians have a general obligation to help patients by providing a medical report or certificate when warranted, they are also responsible for giving sound medical advice. Physicians who receive a request from a patient for a seatbelt exemption certificate should grant the request only if the exemption is clinically indicated and in keeping with published guidelines. If the exemption is not indicated, the physician should explain, in a compassionate and professional manner, why the request cannot be granted.
An appropriate notation in the medical record of the discussion with the patient, including the basis for providing or refusing the exemption, will be invaluable in responding to any later challenge of the action.
The CMPA is not aware of any litigation that has resulted from providing or refusing to provide an exemption. There have been complaints to Colleges, but the Association is not aware of a physician having been criticized for refusing to provide such a certificate, when it has been done in a professional manner. However, Colleges have questioned the rationale of physicians who have provided certificates.
The bottom line
When a patient requests a seatbelt exemption:
- Verify that your College or medical association endorses the CMA position on seatbelt exemptions.
- Verify whether legislation in your province or territory permits such exemptions, and if so, what information you should provide.
- Carefully consider the patient's condition and concerns from an objective medical perspective and reach a clinical decision on whether the patient is unable to wear a seatbelt.
- Explain to the patient what factors you consider relevant, and provide advice that is appropriate in the patient's situation.
- If you believe the patient should be exempt from having to wear a seatbelt for medical reasons, state in the letter or certificate how long the patient's condition is expected to continue to justify such an exemption.
- Sufficiently document in the medical record the discussion and the rationale for your advice to the patient.
- Canadian Medical Association. CMA Driver’s Guide, 8th edition [Internet]. [cited 2017 Feb 24]. Available from: https://www.cma.ca/En/Pages/drivers-guide.aspx