Art. 4478
European Review for Medical and Pharmacological Sciences

2016; 20: 491-497

Epilepsy-related automobile accidents
in Japan: legal changes about a precedentand penal regulations
G. IMATAKA1, K. ARISUE2
Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Shimotsuga,
Tochigi, Japan
2
Division of Sociology, Department of Law, Keio University, Mita, Minato, Tokyo, Japan
1

Abstract. – In Japan, having epilepsy was defined as an absolute disqualification for driving license in the Road Traffic Act enacted in 1960. In
view of subsequent changes in domestic road traffic conditions and advances in epilepsy treatment
and owing to efforts by interested parties, the 2002
revision of the Road Traffic Act conditionally permitted epileptic patients to obtain a driver’s license.
However, as fatal traffic accidents associated withdriving by epileptic patients continued thereafter,
their legal responsibility for driving a car was extensively discussed in newspapers and other media as well as in the Diet. In June 2013, the Road
Traffic Act was again revised to incorporate punitive clauses applicable to those with difficulty indriving (not limited to epilepsy only but including
various diseases and conditions) who falsely
claimed that they had no driving difficulty in theprocedure for obtaining or renewing their driver’s
license. With this revision marking a turning point,
the Act on Punishment for Acts That Cause Deathor Injury to Others by Driving a Car was enforced
as a new statute in May 2014. This paper presents
five cases of traffic accidents involved with epileptic patients to explain the impact of these accidents
on the 2013 legal revision and a subsequent trendof toughening of legal penalties.
Key words:
Epilepsy, Driving license, Traffic accident, Road
Traffic Act, Disqualification.

Introduction
The Global Trend of Driving LicenseStandards for Epileptic Patients
The legal standards of driving licenses granted to epileptic patients widely vary from country
to country. 1)-10) Globally, restrictions on epileptic
drivers’ licenses have been loosening. In Japan,
however, the seizure control period of two years
required for the grant of driving license remains
unchanged since 2002. Partly due to a series ofserious car accidents involving epileptic patientsin the recent years, the legal restriction on epileptic drivers has been tightening.
In the United States, the qualification standard for driving license was revised from absolute disqualification to relative disqualificationin 1949. As the American licensing system depends on each state government, the standards
vary from state to state. In many states, theseizure control periods required for the grant ofdriving license typically range from three to six
months1. The relative shortness of these periods
is based on the fact that the comparison of fatal
accident rates among states respectively adopting
three-month, six-month, twelve-month, and indefinite periods of seizure control requirementshows no significant differences2. As a whole,
the required seizure control period for an epileptic patient in the United States to be permitted todrive has been shortened.
In Canada, the seizure control period officially required for an epileptic patient to drive is six
months except for the Province of Quebec 3,
where its original stipulation requires one year ofcontrol period4. Despite the difference in the requirements, a study has demonstrated the absence of significant differences in accident rates
between different provinces5.
In Australia, the standard requirement for the
epileptic seizure control period is one year. 6)
While the same length of period is required in
New Zealand, it can be shortened down to six
months by a doctor’s diagnostic recommendation4.
European Union (EU) countries have been
moving towards the standardization of driving licenses across the member states to facilitate interstate travels of their citizens7,8. Under such trend,
an official notification was issued in 2009 to limit
the maximum seizure control period required for
epileptic patients to have driving licenses to one
year or less in Italy, United Kingdom, Germany,

Corresponding Author: George Imataka, MD; e-mail: geo@dokkyomed.ac.jp491

G. Imataka, K. Arisue

France, the Netherlands, Spain, Switzerland, Belgium, and many other countries. In Poland, Portugal and Slovenia, however, the minimum requirement is two years, and Greece adopts the threeyear requirement4,9. The ground for the most EU
countries’ decision to adopt one-year or less standard is the statistic calculation demonstrating thatthe risk of traffic accident involving epileptic patients is not necessarily higher than that of people
in general10.
An Overview of Automobile Driving
by Epileptic Patients in Japan
On automobile driving by epilepsy patients,
our Road Traffic Act, instituted in 1960, sets out in
its Article 88 specifically that “those who fall under either one of the following shall not obtain adriver’s license: (snip) (2) Who are mentally ill,
feeble minded, epileptic, blind, deaf or dumb”.
Therefore, epilepsy is defined as an absolute disqualification for getting a driver’s license. However, due partly to repeated demands from epilepsy
patients, the government’s Headquarters for the
Promotion of Measures for the Disabled issued inAugust of 1999 “the Review of Disqualification
Conditions for the Disabled”, which eventually
led to the publication of the “Guidelines for Determining Driving Aptitude of Those with Epilepsy”
compiled jointly by the Research Committee ofLegal Issues of the Japan Society of Epilepsy, andthe National Police Agency11. Through such developments, in May 2002, the Road Traffic Act wasrevised and since June 1st of the year 2002, it has
become possible for epilepsy patients to obtaindriver’s license under certain conditions. The conditions were as follows12:
Operation Standards for Agreeing/Denying,etc. of Driver’s License for Those with Certain
Illnesses: Epilepsy (relevant to Article 33-2-3,
Clause 2, Item 1 of the Ordinance)(1) There shall be no denial, etc. in either of thefollowing cases;a. No fit has occurred in the last 5 years andit has been diagnosed by a doctor that “nofit is likely to occur hereafter”.
b. No fit has occurred in the last 2 years andit has been diagnosed by a doctor that “nofit is likely to occur within X years or so”.
c. After observation for 1 year, it has been diagnosed by a doctor that “a fit will be limited to simple partial convulsion withoutaccompanying disturbance of consciousness and there is no likelihood of aggravation of symptoms thereafter”.
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d. After 2 years’ observation, it has been diagnosed by a doctor that “a fit will occur
only in sleep and there is no likelihood of
aggravation of symptoms hereafter”.
(Notes: In the case of b. “No fit has occurredin the last 2 years and it has been diagnosed by adoctor that ‘no fit is likely to occur within X
years or so”, so an ad hoc aptitude test shall be
conducted every X years.)
The revision in the Act has paved the way for
epilepsy patients to apply for the driver’s license.
According to the National Policy Agency, however, the number of traffic accidents attributable
to the driver’s fit or illness amounted to 254 in
2011, of which epilepsy patients accounted for
73, with 5 accidents resulting in deaths. In thefollowing, we will take up traffic accidents involving epileptic drivers13.

(1) Five Cases of Traffic Accidents
Caused by Epilepsy Patients andTransition in Court Rulings14-18

Addressing the traffic accidents caused by
epilepsy patients, 2 cases stand out conspicuously: one happened in Kanuma City17 and the otherin Kyoto City18. Many more traffic accidents by
epileptic drivers preceded these two well-known
cases. In these accidents, one characteristic feature was that the court rulings split into not guilty
and guilty verdict.
Case 1: Accident in Miki City,
Hyogo Prefecture14
In 1999 in Miki City, Hyogo Prefecture, anepileptic woman driver had a fit while driving her
car and crashed into the queue of 3 elementary
school children on their way home. One childdied of whole-body bruises and 2 pupils sustained
serious injuries. The Kobe District Court pointed
out that “After examination, it was found highly
possible that the driver was attacked by a fit ofher chronic disease immediately prior to the accident, and the court entertains a reasonable suspicion for her responsibility capacity”, driver admitted her assertion of insanity, saying that “thedrug she was taking had no side effect in causing
acute drowsiness”, and ruled to acquit her with a
non-guilty verdict. One issue raised in regard to
the ruling for this accident in Miki City was that,
despite the Road Traffic Act still specified epilepsy as a disqualification for driver’s license inEpilepsy-related automobile accidents in Japan: legal changes about a precedent and penal regulations

1999, which the woman driver had not declaredin applying for the license. She caused the accident to happen, and yet the ruling did not touchupon her failure to make such declaration.
Case 2: Accident in Rittoh City,
Shiga Prefecture15
In 2002 in Rittoh City, Shiga Prefecture, anepileptic male patient had a fit of epilepsy whiledriving his car, diverted into the opposite lane
and collided head-on with a light truck, crushing
the truck driver to death with severe bodily bruises. The Ohtsu District Court found that “Whilethe defendant was aware of an onset of losing his
consciousness, it is possible that he lost consciousness before deciding to stop the car. Thereis no denying that the point at which the driver
became aware of the onset was possibly so close
to the place of the accident, thereby leaving reasonable doubt for the prosecutor’s assertion that
responsibility to avoid accident had already accrued with the defendant”, pointed out that there
was no negligence of responsibility for stopping
the car, and acquitted the defendant.
(Negligence of responsibility to suspend driving is suspected when, for instance, the driver
has kept on driving while he was feeling ill, thinking that no accident would possibly happen).
The issue in this accident in Rittoh City isthat, while the epileptic fit was a likely cause of
the accident, the court blamed the defendant only
for the negligence of caution in driving
Case 3: Accident in Nagano City,
Nagano Prefecture16
In 2004 in Nagano City, Nagano Prefecture,
an epileptic male patient had a fit of epilepsy
while driving his car and slammed into 5 carsfrom behind that were stopped for the signal tochange, evolving into a multiple-car collisioncase, killing one person from severe whole-bodydamage and hurting 6 others with light or heavy
injuries. The Nagano District Court, pointed outthat the defendant “had suffered on previous occasions from disturbed consciousness due toepilepsy, caused property damage accidents in1999 and was advised by his doctor to refrainfrom driving” and also that “he chose at his own
arbitrary judgment to lessen the amount of medication for suppressing epileptic fits, which wasprescribed to be administered 3 times a day, kept
on driving for diversion purposes and, as a result,caused the accident”, ruled and sentenced the defendant to 4 years in prison.

The ruling for the Nagano accident, in which
the defendant was held accountable for negligence in failing to take medication as prescribed,
is noteworthy as the judgment conflicts with thatof the Rittoh case, while the cause of the accidents was similar to each other.
In the foregoing, we looked into 3 cases. The
issue we could make out of these cases will be;“No penalty for the failed declaration of disqualification cause” and “no appropriate charge tocorrespond to traffic accidents caused by epileptic drivers”. Thus, in 2011 and 2012 consecutively, we witnessed the occurrence of two tragic accidents.
Case 4: Accident by a runaway
crane truck in Kanuma City17
In April 2011 in Momiyama-cho, Kanuma
City, Tochigi Prefecture, an epileptic male patient,then 26 years of age, was driving his 10-ton cranetruck, rammed into a file of elementary school
pupils (about 20-30) on their way to school en
masse and drove into the nearby house wall to astop. Six pupils were hit and died. The male driver
had chronic fits of epilepsy. Ever since he had obtained his moped license, he caused many accidents. Prior to the current accident, he hit an elementary school child and injured him seriously,
for which he was found guilty (on count of drowsing while driving) and put on probation. He had
caused a total of 12 accidents in the past. Despite
such record of accidents, he never declared hischronic disease when renewing his license, neglected taking medication as prescribed, and justbefore the accident he had been up late into thenight, and slept for 3 and half hours only.
The male driver was arrested and indicted for
manslaughter by automobile driving. This major
accident, where 6 pupils lost their lives, resulted
from the driver’s failure to take the curative medicine, so it was considered to charge with lethal injury by dangerous driving that has 20 years of
maximum statutory penalty. Since lethal injury by
dangerous driving presupposes reckless driving by“intent”, however, it was questioned whether the
negligence in taking medical care could be construed as intentional. The fact that the driver had
caused similar accidents repeatedly was mademuch of, but as lethal injury by dangerous driving
stipulates “a condition where normal driving isrendered difficult under the influence of alcohol ordrug”, the prosecutor had to give up proving “intent” ultimately. Hence, the charge was settled for
manslaughter by automobile driving.
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G. Imataka, K. Arisue

In July 2011, the Utsunomiya District The
court determined that, in light of the male driver
having neglected to take medication and caused
accidents in the past, the driver had a premonition of an epileptic fit. And, the court sentenced
him to 7 years in prison on one count ofmanslaughter by automobile driving. The defendant did not appeal by January the next year, andthe sentence was finalized.
Case 5: Accident by a runaway light
van in Gion, Kyoto City18
In April 2012, in Gion, Higashi-ku, Kyoto
City, Kyoto Prefecture, a 30-year old male recklessly ran a light van through a thoroughfare,killing 8 people including him, and injuring 11
street walkers. The cause of the accident was
tracked down ultimately to his chronic fits of
epilepsy. The male driver, since sustaining brain
contusion in a single motorbike traffic accident
in 2003, had been suffering from sequela epileptic fits. He did not declare his disease when renewed his driver’s license. In 2012, he had 2 fitsof loss of consciousness.
In August 2013, the Kyoto District Public
Prosecutors’ Office dismissed the case on account of the death of the suspect. The Prosecutors’ Office also decided not to prosecute thewoman president of the employer company ofthe male driver on grounds that she had not beencognizant of the driver’s chronic disease.
This accident happened only 3 days after the
bereaved family members of the Kanuma City
traffic accident had submitted to Minister
Ogawa, the Ministry of Justice, a petition signed
by a total of some 170,000 followers demanding
revisions in the Road Traffic Act to prevent recurrence of similar tragedies. The National Policy Agency had already indicated its intention tostart reviewing measures for traffic accidents related to epileptic patients. The revisions made in
2002 in the Road Traffic Act allowed epileptic
patients to obtain driver’s license under certain
conditions such as non-occurrence of fits within
the last 2 years and presence of a doctor’s diagnosis. However, there was still no penalty imposed on non-declaration of the chronic disease,and such declaration was left to the driver’s discretion. Driven by the active movements of the
bereaved families of traffic accident victims
across the nation, asking for revisions in relevantlaws to impose penalty relative to driving, ourfellow countrymen have started moving toward
strengthening the traffic regulations.
494(2) Bereaved Families’ Petitionin Kanuma City19 –Revisions in Penal Code and Driver’s
License Issue System

Petition of the bereaved families was twofold:
Revision in the Penal Code provisions (1) andRevision in the driver’s license issue system (2).
Let’s take a closer look at the petition. We refer tothe petition submitted by the “Rally of the Bereaved
Families of Kanuma Children Victimized in Fatal
Crane Truck Accident”. Motivated by this petition,and in line with the rising voices of the public asking for strict penalization, relevant laws have been
toughened. The issues in the Kanuma City accident
were “improper acquisition of driver’s license by
non-declared epileptic applicants” and “charging thedefendant for manslaughter by automobile driving,and not for lethal injury by dangerous driving”.
(1) Revision in Penal Code Provisions
They were petitioning for revisions in the Penal Code provisions to ensure application of
the charge of lethal injury by dangerous driving in cases of fatal accidents caused by holders of improperly acquired driver’s licenses
under no declaration of epileptic disease.
The Rally of the Bereaved Families asserted
that the perpetrator had acquired the driver’s license as well as a license for operating largesized special motor vehicles under false application, caused repeated traffic accidents, 12 times
in 10 years, concealed his chronic epileptic
episodes even during the court proceedings, andcaused yet another accident while on probation.
Could this be construed as mere “negligence”,
they questioned. They suspected something was
blatantly wrong when the court ruled, on
grounds that there was no provision to apply in
the Penal Code otherwise, to charge manslaughter by automobile driving, a crime that has the
maximum penalty of 7 years in jail. The petition
called for revised provisions that allow for
charging lethal injury by dangerous driving as apotential means to deter criminal offenses bymalicious drivers such as those who defy laws
by non-declaration, etc.
(2) Revision of Driver’s License Issue System
They petitioned for building a system of issuing the driver’s license that can effectively
exclude improper applications and acquisitions and deal with driver’s license issue on
self-declaration of epileptic disease.
According to the Bereaved Families Rally, after the crane truck accident the National Police

Epilepsy-related automobile accidents in Japan: legal changes about a precedent and penal regulations

Agency reportedly put in place some measures
like “setting up consultation desks”, “putting
up posters”, “inducing declarations”, “probing
thoroughly into asserted dozing- off while driving”, “soliciting collaboration with relevantbodies”, etc.. The Rally suggested that, whilethese measures may result in reducing the number of traffic accidents, they may not contributeas much in preventing the accidents. For thatreason, the Bereaved Families Rally called forrevising the system in such a way as to winnow
out improper acquisition of the driver’s license
by undeclared applicants.
The police reported that 2,430 epileptic drivers
made their declarations during the period of
2011 and 2012. The Rally assumed that, by taking the maximum 5-year term of the gold driver’s license as a yardstick, 5 times the total
number of declarants, about 12,000 that may
represent the total universe of epileptic declarants. On the other hand, however, it is reported
that there is one epileptic patient in 100 people,
amounting to 1 million to 1.2 million patients
nationwide. Assuming that one-third of them
are adults, the total number of epileptic drivers
would be 400,000, which means that only about
3% of them (12,000) have actually declared.
Accordingly, they proposed introduction of a“doctor’s reporting system” similar to the one
already in practice in California, USA. Under
this system, doctors would be required to reportto public security authorities about “all patientsand people suspected of epilepsy”, thereby providing the authorities with such benefits as tocatch those who have failed to declare and toprobe into cases of drowsy drivers.
Since the Road Traffic Act was revised, The
Japan Society of Epilepsy has continued conducting periodic questionnaire surveys on thecurrent status and questions of driver’s license issue relevant to epileptic drivers20. In
the meantime, the National Police Agency
had filed a request with the Japan Medical
Association for its member doctors to preparea reporting guideline for the National Public
Safety Commission21.

(3) Revised Road Traffic Act
and Strict Legal Penalty

In the following, we will address how strictlegal penalty is to be enforced.

In June 2013, the Road Traffic Act was revised and as a measure for drivers with certain
diseases etc., penalty provisions have been newly
introduced for false applications made at the timeof acquiring or renewing the driver’s license.
A specific system of questionnaire has been
implemented by the Public Safety Commission
on medical conditions of the applicants etc. fordriver’s license, and penalty of imprisonment for
1 year or less or a fine of \300,000 or less will be
imposed on those who have responded with false
replies. A reporting system has been introduced
on a voluntary basis for doctors who examinedthose with certain diseases, etc. Legislation has
well arranged for doctors to be exempted from
confidentiality obligations.
Provisions have been set forth to cause temporary suspension within the limits of 3 months
as the doctor finalizes its diagnosis for those suspected of certain diseases, etc.
These revisions, however, have not lived up
to the expectations of the bereaved families in
Kanuma City. Yet, the penalty created for false
applications and the doctor’s reporting system,
albeit voluntary, of epileptic patients will go along way toward furthering future policies.
In May of 2014, the Law Regarding Punishment of Death Causing Acts, etc. by Automobile
Driving (Hazardous Driving Punishment Law)
was enacted and implemented after a series ofcontroversies.
Previously, we had 2 charges against those
who committed wrongdoing in causing traffic accidents by automobile driving; “manslaughter byautomobile driving” and “lethal injury by dangerous driving”. On November 27 2013, a newlaw was enacted under the “Hazardous Driving
Punishment Law” and it has gone into effectsince May 20, 2014. The new law deleted provisions for “manslaughter by automobile driving”
and “lethal injury by dangerous driving” in theold Penal Code, and is replaced with a new provision for traffic accidents causing people’s
deaths and injuries. The old charge formanslaughter by automobile driving was subject
to a “condition that makes normal driving difficult” and judgment was focused on the dangerous behaviors while driving the car and not on
the aptitude, duty, qualification or responsibilityof the driver. Thus, it created a wide disparity between the legal concept of dangerous driving andthe general public view of dangerous driving.
Conditions for application of dangerous driving
behaviors were broadened from previous scopes495

G. Imataka, K. Arisueof drunk driving, uncontrollable driving and immature driving to include driving without licenseand driving by drivers with undeclared illnesses
such as epilepsy, etc. The diseases referred here
as “ones suspected of causing hazards in driving
the car” include epilepsy, schizophrenia disorder,
recurrent lipothymia, asymptomatic hypoglycemia, bipolar depression, and sleep disorderaccompanied by severe drowsiness. The punishment under the new law will be imprisonment for
15 years or less in the event the victim died and12 years imprisonment or less for inflicting injuries in “fatal accidents caused by drivers including epileptic patients in such conditions as
suspected of inducing hazards in normal driving(under the influence of alcohol, drug or diseases
designated by ordinance or decree)”, for which
punishment is much heavier as compared to thepenalty for manslaughter by automobile driving.
In 2013 and 2014, much controversy flared up
with regards to intensifying the regulation ofdangerous drugs and the reckless driving practices by drug-users, adding to the momentum of
expanding the hitherto limited category of “dangerous driving”. This was a piece of gratifying
news not only to those families of victims in traffic accidents caused by epileptic patients but also
to other bereaved families of traffic accidents
caused by unlicensed drivers and reckless addicts
of unlawful drugs. While these revisions in law
are still short of bringing the maximum 20 yearsof penalty provided for lethal injury by dangerous driving, it is certain that the will and reportage of the Bereaved Families Rally in Kanuma City and the backup support by the public
have well been reflected in these revised laws
and newly implemented traffic safety measures.
In September 2014, the Japan Medical Association published the “Guidelines for Voluntary
Reporting to Public Safety Commission by Doctors Examining Those with Certain Symptoms,
etc. under Road Traffic Act”21-23.

Conclusions

As touched upon earlier, the biggest issues inruling the traffic accidents caused by epileptic patients were twofold; one was that “no penalty provision existed for non-declaration and declaration
was left to the patient’s discretion. Therefore, incase of an accident, the driver could not be prosecuted for such non-declaration”, and another wasthat “only the charge for manslaughter by auto496

mobile driving could be applied, with little regard
to the sentiments of the bereaved family of thevictim, in an accident caused by the epileptic patient who kept on driving, knowing the possibilityof having a fit while driving, which should obviously constitute dangerous driving”. However, after all, the pleas and petitions by the Bereaved
Families Rally in Kanuma City and other bodiesof the bereaved families of traffic accident victims, etc., have culminated in revisions of the relevant laws to resolve these issues, and punishment has been instituted for non-declarants, andthe scope of dangerous driving is expanded.
–––––––––––––––––––-––––
Conflict of Interest

The Authors declare that there are no conflicts of interest.

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