European Review for Medical and Pharmacological Sciences

2017; 21: 3098-3104

Sociological histories on epilepsy as“causes for disqualification” stipulated in
the Japanese Road Traffic Act of 1960 andRevised Road Traffic Act of 2001
G. IMATAKA, S. YOSHIHARA
Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Shimotsuga,
Tochigi, Japan

Abstract. – In the wake of successive casesof fatal accidents caused by patients behind thewheel whose driving was likely to be hindered
due to paroxysmal diseases, including epilepsy,
there has been an outcry from victims demanding stricter criminal penalties against the perpetrators due to negligence. As a result of this action, a revised Road Traffic Act was put into effect in Japan on June 14, 2013. This act established new penal provisions against any person
who provides false statements on his/her medical condition(s) when acquiring or renewing adriver’s license.
In this paper, the social circumstances will
be introduced regarding road traffic in Japan
when the Road Traffic Act, the origin of today’s
revised Road Traffic Act, was enacted in 1960.
An overview of the reasons behind the enactment of the original act will be provided. Additionally, the handling of patients with “provisions for disqualification,” whose driving is likely to be hindered due to paroxysmal diseases,
including “epilepsy,” will be reviewed. This handling attracted repeated controversy during theenactment of the original act and will also be
reviewed. One significant change in wordingfrom “absolute causes for disqualification” in
the Road Traffic Act of 1960 to “relative causes
for disqualification” in the Revised Road Traffic
Act of 2001 also will be discussed from a medical sociology perspective. Finally, the social status and socio-economic position of drivers withparoxysmal diseases, as it pertains to influences on lawmakers, will be discussed.
Key Words:
Epilepsy, Automobile accident, Road traffic act, Revised road traffic act, Road traffic control act.

Introduction
In recent years, several evidence and investigative research on driving a car by a person with3098

epilepsy have been reported1. According to it, it
has been proved that antiepileptic drugs are taken and the recurrence rate of seizures in people
without epileptic seizures for about 2 years is low.
Following this, since the 2000s, laws on driving
licenses for people with epilepsy in each country
advanced2. In the QOL such as driving licenses3,social employment4, play sports5 and others ofpeople with epilepsy, it is a big concern whether
the driving of the car is possible or impossible, and whether there is legal maintenance fordriving. In this review, we outline the historicaltransition of legislation for people with epilepsy
in Japan to obtain driver’s license with literature
review2,6,7.
Overview of Enactment of
the Road Traffic Act
Thanks to the growth of automobile use,caused primarily because of the postwar economic growth of Japan, not only had the number of automobiles in use increased, but also
the number of fatalities from traffic accidents
increased substantially during the latter halfof the 1920s. This is known as the Showa Era.
Decades later, the number of registered automobiles increased from just over 200,000 in
1948 to 1 million in 1953 and to more than 2
million in 1957. When motorized bicycles areincluded, the total registrations reached morethan 3 million. In 1957, nearly 920,000 motorized trucks more than 2 million automobiles.
These trucks were driven on ordinary roads allover Japan, many of which were insufficient as
part of a good traffic infrastructure. In thosedays, more than 1 million motorized bicycles
were used as a major means of transportation for
the general public.

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

Histories on epilepsy in the Japanese road traffic act

Under such inferior traffic circumstances, including poor road conditions, undeveloped traffic safety facilities and other factors, the numberof traffic accidents kept increasing. While thetotal number of traffic accidents with injuries ordeath had been 93,869 (6,374 killed and 72,390
injured) in 1954, that number rose to 168,000(8,248 killed and 145,000 injured) in 1958. This
indicated that the number of the people injured
or killed had risen nearly 79 percent over four
years. The number of people killed in traffic
accidents started to increase sharply after 1948,
when the current statistical system launched inJapan. Annual deaths rose from over 4,000 in
1948 to over 5,000 in 1950. In 1960, they roseto over 10,000, when the Road Traffic Act wasenacted. Furthermore, since 1960, such deaths
have continued to rise. Although the numberof fatal accidents decreased by a small margintemporarily in 1963, the number of people killedincreased to 16,765 in 1973. This was the worst
year ever since the launch of Japan’s statisticalsystem.
Overview of Enactment of the Road
Traffic Act of 1960
In 1960, the Road Traffic Control Act was repealed as the Road Traffic Act was established.
As for laws related to traffic enforcement, theRoad Control Ordinance and Automobile Control
Ordinance existed before World War II, whichbegan in 1941. Conversely, the Road Traffic Control Act and Road Traffic Control Ordinance (Interior Ministry Ordinance) went into effect after
the war. Among others, the Automobile Control
Ordinance established in 1933 had been the foundation of regulations such as the Road Traffic
Control Act and Road Traffic Control Ordinance.
Much of its contents also was brought into theRoad Traffic Act. Now, the Traffic Control Ordinance is the fundamental law of road traffic thatis observed for people and vehicles to use roads
safely in Japan.
Before establishing the Road Traffic Act, theNational Police Agency started developing a newbill at the beginning of 1957.
September 1957 Milestones
The “Outline of Revision in Road Traffic
Control Act” started to be prepared as a response to the “Outline of Measures to Prevent
Traffic Accidents,” which had been presented
by the government to the public. The principle
reason for this revision in the proposed outline

is as follows in this 1957 bill: “Considering thecurrent state of road traffic in these days and forthe purpose of dealing with future road trafficand enhancing the measures that seek hazard
preventions and smooth traffic on the road, theauthorization of control and regulation shall be
intensified; penalties strengthened; and the law
system organized.
The purpose of the Road Traffic Control Act
and the Road Traffic Act are herein compared asfollows:
Materials
Road Traffic Control Act (1947)
Article 1. The purpose of this Act is to secure
hazard prev.entions on the road and other traffic safety.
Road Traffic Act (1960)
Article 1. The purpose of this Act is to secure
hazard preventions on the road and other traffic safety and smooth traffic.
Comparing the purpose of the Road Traffic Control Act with that of the Road Traffic
Act, it is evident that both sought to achieve“hazard prevention on the road.” However, theRoad Traffic Act intended to secure traffic safety, smooth traffic flow and prevent disturbances
due to road traffic. In addition, the act contained stipulations for pedestrian traffic ways;
vehicular and tram traffic ways; obligationsof drivers and employers; road use; drivers licenses; training courses; and fine systems fordrivers of automobiles and motored bicycles.
During high economic growth, the rapid development of roadway systems never stopped. In
accordance with the traffic circumstances at thetime, which had undergone accelerated change,
more detailed provisions were incorporated tosecure safe and smooth traffic flows. The further
organization of laws and regulations was started
to include the strengthening of authority to enable
police officers to take measures for hazard prevention, the preparation of provisions concerning
vehicular traffic, the prohibition of drunk driving,
the intensification of penalties against the serious
violation of laws and regulations, the enhancement of administrative actions regarding drivers
licenses, and the handling of legal violations byjuveniles as drivers of automobiles (exclusion of
the application of the Juvenile Act).
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G. Imataka, S. Yoshihara

December 1958 Milestones
Using the “Proposed Outline of Revision inRoad Traffic Control Act” as a basis for discussion, considerations were given to the respective
viewpoints of the National Police Agency, theMetropolitan Police Department and other prefectural police departments. Among the considerations that were presented as “Matters to be
Addressed in Preparing for Proposed Outline of
Revision,” there were proposals as follows:
1. Because of the variety of contents, they should
be categorized and organized into a few laws:
added by the establishments of “Traffic Regulation Act” on traffic regulations and “Driver License Act” concerning driver licenses,“Traffic Laws” shall be organized as a compilation of the three Acts.
2. Due to regional differences in actual conditions of road traffic, special laws should beenacted.
Although the above two proposals were neverpassed, they were considered several times thereafter.
January 1959 Milestones
The “Proposed Principle of Revision in Road
Traffic Control Act” was prepared. This law had
been newly set up by adjusting the accumulated
results of year-long discussions based on the“Proposed Outline of Revision in Road Traffic
Control Act.”
The principles of revision are stated below.
To cope with the development and transformation of traffic circumstances nowadays andthe further complicated traffic circumstances
expected in the future, a full-scale revision
shall be made because a partial revision is nolonger enough to deal with them. Along with
this, the contents of stipulations shall be contemplated with considering, besides with using
law and regulations of foreign countries asreferences, the relation to ‘Convention on Road
Traffic’ that is scheduled to be acceded in thenear future.
Among the items to be revised pursuant to theseprinciples, representative ones are as follows:
1. To change the name to “Road Traffic Act” byremoving the word of “Control”;
2. To simplify the terms as much as possible forthe laws and regulations to become more familiar with;
3100

3. To organize in preparation for the accession to“Convention on Road Traffic”;
4. To make it possible for National Public Safety
Commission to conduct the traffic regulations
on its own discretion regarding the national
expressways as nationwide arterial roads, themotorways across the prefectures and important first-class and second-class national
highways;
5. To clarify the authorities of police officers on
traffic controls and seek strengthening of them;
6. To examine the details of the prohibited acts on
the road and specify legislative regulations onthem;
7. To consider the traffic ways with vehicles etc.
and at the same time intensify the penalties forthe malicious violation of laws and regulations;and8. To set up a system where a civil fine is able
to be collected by the speedy procedure for aminor violation of laws and regulations.
August 1959 Milestones
The National Police Agency had developed
final versions of the “Principle of Revision” and“Proposed Outline.” Besides being a legal framework, the “Proposed Outline” provided the following:• The protection of pedestrians (to clarify trafficprinciples for them)• Stipulations on hazard prevention (to specify the definition of “driving under the inf luence of alcohol” and about the use of theroad)• Provisions concerning the roadways (especially concerning parking and stopping and measures for improving the current chaos)• Provisions about traffic regulations (to establish the definition of the term “road signs” andto regulate minimum speed)• Driver license systems• The responsibilities of employees• Penalties (In addition to strengthening penalties for serious violations, special penalties
shall be stipulated for death or injury and accidents causing damage to buildings, etc. Penalties shall be aggravated for drinking whiledriving.)
After five months of examination by the Cabinet Legislation Bureau, from September 1959 to
February 1960, the Road Traffic Act was submitted to the Diet (Japanese Parliament).

Histories on epilepsy in the Japanese road traffic act

Comparison of Handling of Epilepsy inProvisions for Disqualification Between
the Road Traffic Act and Revised Road
Traffic Act
Provisions for disqualification in laws refer tothose which impose certain restrictions on a person with respect to his/her occupational choiceand qualification acquisition due to his/her individual disorders and social circumstances. The
provisions of causes for disqualification regarding automobile drivers licenses of people withepilepsy set up in the two kinds of Road Traffic
Acts. The absolute causes for disqualification in
the Road Traffic Act of 1960 as it was establishedare stated below:
Materials
Road Traffic Act of 1960
(Causes for Disqualification of Driver License)
Article 88
1. A driver license may not be provided to aperson who falls into any of the following
items: (1) persons less than 18 years of age as
it concerns a large-sized motor vehicle license(including a provisional license for large-sizedautomobiles), an ordinary motor vehicle license (including a provisional license for ordinary automobiles) and a license for specialized
vehicles; persons less than 16 years of age
as it concerns a license for motored tricycles(including a provisional license for automatic
tricycles), a license for motorcycle, a license
for light motor vehicles, a first-class license formotorized bicycles and a second-class license
for motorized bicycles; (2) mentally ill persons,mentally retarded persons, persons with epilepsy, visually impaired persons, hearing-impaired persons or deaf-muteness persons; (3)persons with a physical disability stipulated inlaws other than those listed in the immediate
preceding item; (4) persons addicted to alcohol, narcotics drug, cannabis or stimulants; or(5) persons whose license have been rescinded
less than 1 year from the day of rescindment
pursuant to Article 103, Paragraph (1) or those
whose license are being suspended.
2. No one may not receive the same kind of license
as he/she currently possesses. Provisions fordisqualification stipulated in 1960 that a driver’s license may not be provided without any
exception to “mentally ill persons, mentally re-tarded persons, persons with epilepsy, visually
impaired persons, hearing-impaired persons ordeaf-muteness persons.” (Article 88, Paragraph(1), Item (2) (absolute disqualification).
The moves toward the revision of provisions fordisqualification were initiated in1999. In August
1999, Task Force on Policies for the Disabled issued a decision titled “On Revisions of Provisions
for Disqualification Regarding Disabled Persons,”
and the subsequent status is now as follows
Materials
Road Traffic Act after Revision in 2001
(Refusal of License, etc.)
Article 90
A Public Safety Commission is required toprovide a license to the person who has passed
the driver license test (limited to those who took
the aptitude test related to the said driver license
test less than 1 year before passing such driver
license test as concerns a first-class license anda second-class license; less than 3 months asconcerns a provisional license) stipulated as in
Paragraph (1) of immediately preceding Article;
provided, however, that a person falling under
any of the following items may not, pursuant tothe standards set forth in the Ordinance, be provided a license (excluding a provisional license;
The same shall be applied to this Paragraphthrough Paragraph (12).) or may be withheld alicense within the extent of 6 months.
1. The persons with any of the disorder listed
below:a. mental disorders with the symptom of hallucination that are listed in the Ordinance;b. disorders causing consciousness disturbanceor motor disturbance with a seizure that arelisted in the Ordinance; orc. disorders listed in the Ordinance that arelikely to impede the safe driving of automobiles, etc., other than as prescribed in (a) and(b).
In contrast to “‘absolute disqualification,’
which means not providing a license without
any exception” as it was stipulated in 1960, theabove is defined as “‘relative disqualification,”
which refers to judging according to “each individual’s capacity.” Epilepsy falls into “(b) disorders causing consciousness disturbance or motor
3101

G. Imataka, S. Yoshihara

disturbance with a seizure that are listed in the
Ordinance.” Guidelines for judgment and otherfactors on drivers licensing concerning epilepsy
are as listed below.
Epilepsy (Regarding Article 33-2, Paragraph (2), Item (1) of the Ordinance)
1. Refusal, etc., are not allowed if any of the following is applicable:
a. If a seizure has not occurred within the last
5 years and a doctor has made a diagnosis
to the effect that a seizure is not likely tohappen from then on;b. If a seizure has not occurred within the last
2 years and a doctor has made a diagnosis
to the effect that a seizure is not likely tohappen about within the next X years;c. If, after a watchful waiting for 1 year, a doctor has made a diagnosis to the effect that apossible seizure is limited to a simple partial
seizure without consciousness disturbanceand a medical condition is not likely to become worse from then on; ord. If, after a watchful waiting for 2 years, adoctor has made a diagnosis to the effect thata possible seizure is limited to a seizure occurring during sleep and a medical condition
is not likely to become worse from then on.
Note: In a case where: If a seizure has notoccurred within the last 2 years and a doctor has
made a diagnosis to the effect that a seizure is not
likely to happen about within the next X years;”
is applicable, a special aptitude test shall be conducted every X years.
In short, the three conditions under which an
epilepsy patient is allowed to obtain a driver’s
license can be summarized as follows: (1) “A
seizure will not reoccur”; (2) “Even if a seizure
reoccurs, it will not bring about consciousness
disturbance or motor disturbance”; and (3) “A
seizure reoccurs only during sleep.” Epilepsy isa disorder that can be controlled with medicinesand varies considerably between individuals. For
example, there are epilepsy patients who experience a seizure just once every two years and thenthere are those who experience a seizure nearly
every day. The reality is that most patients enjoy asocial life that is no different than that of ordinary
persons. It can be said that, under the revised
Road Traffic Act, the judgment shall be based on
respective cases while paying attention to suchindividual differences.
3102

Discussion
The Road Traffic Act has, after experiencing several partial revisions since its issuance of 1960, come to what it is today while
maintaining its basic legal framework. The
issuance year was the same year when the Ikeda Cabinet announced the “Income DoublingPlan” that aimed for high economic growth.
In the more than 55 years since the law was
passed, vehicles have been transformed frommoving objects, which had been originallydeveloped since the Meiji Era for entertaining peerage and imperial family and for theJapanese Army to use them for the war, intoimperceptibly “passenger vehicles” and “private vehicles” that are social instruments used
for general citizens to pursue convenience.
Now, in the context of the usage of vehicles
as instruments by general citizens, the stipulations enshrined at the time of enactment in1960 are going to be reviewed. Of such stipulations listed, “(ii) mentally ill persons, mentallyretarded persons, persons with epilepsy, visually impaired persons, hearing-impaired persons
or deaf-muteness persons,” are absolute causes
for disqualification. A law under which mentally ill persons, mentally retarded persons, hearing-impaired persons, deaf-muteness persons
and epilepsy patients are handled with the same
standards, without any flexibility is and whenviewed from the perspective of today’s medical
insight, should be considered an oddity.
At present, the diagnosis of mentally ill persons has changed to “integration disorder syndrome” in certain medical circles in Japan.
Mentally disabled persons would be considered
intellectually disabled people or people with
developmental disabilities. Hearing-impaired
people and deaf-mute people are nominal designations in Japan that refer to physically disabled
people who have difficulty concerning the function of a part of their bodies. More specifically,“epilepsy” is a general term for pathologicalconditions where various types of seizures occur due to the brain’s chronic electrophysiological abnormality. The spectrum of epilepsy, interms of its degree of severity, covers a broad
range. These conditions range from patients who
are not required to take medicines or hinderedin everyday life to serious cases where patients
suffer severe impairments in psychomotor development and therefore are classified as having
severe disorders.

Histories on epilepsy in the Japanese road traffic act

Looking back with today’s perspective, theRoad Traffic Act prepared in 1960 was characterized by the fact that it dealt with all of theabove mentioned disorder groups in a single uniform way, instead of handling them individually,and defined them as “absolute disqualifications.”
The contents of the act ignored the fact that
individuals should be respected by being given
considerations to their aptitudes for driving according to their respective degrees of severityof disorders and clinical conditions. It cannot
be denied that, when using modern standards,
the legal disparities in human rights or the discrimination against people with these disorders
would even exist as social debates today. After
more than four decades since 1960, in 2001, thesame stipulations applied to the same matters in
the Revised Road Traffic Act. With the revised
act put into effect, the stipulations of “absolutedisqualification” transitioned to causes for “relative disqualification” associated with respective
clinical conditions.
Epilepsy patients and others with similar conditions have built strong advocacy groups since1960 that help ensure the rights of these people
are equal in all parts of society. These groups also serve to enlighten legal and regulatory bodies
about the various social disadvantages that thesepeople have gone through in the past to help
ensure similar disadvantages are not placed onthem in the future. The Association of Parents
with Children with Epilepsy and the Association
to Protect Epilepsy Patients were set up in 1973
and 1976, respectively. These two associations,by cooperating with each other, initiated theactivities for improving the social disadvantages and addressing various concerns and social
problems that epilepsy patients and their families
were facing.
The first half of the 1970s was a period when
the protection of human rights and livelihood supports for persons with various disorders and disabled persons were strongly advocated and drew
international attention. At the time, the United
Nations started to make resolutions and spread
enlightenments in relation in the promotion ofpolicies for the disabled. In 1976, it designated theyear 1981 as the “International Year of Disabled
Persons.” Additionally, the United Nations required member countries to submit their current
efforts with the policies for the disabled by such
year. Following this requirement from the United
Nations, the government of Japan, with a view
toward promoting relevant policies by such year,

advanced various revisions by adopting the “On
Implement Measures for the International Year of
Disabled Persons” at a Cabinet meeting in March
1980. This began the launch of the Task Force on
the International Year of Disabled Persons at theGeneral Administrative Agency of the Cabinet.
The International Year of Disabled Persons was
not only successful in promoting the understandings of the disabled, but became an opportunity
for organizations and advocacy groups for thedisabled to work cooperatively.
Following these trends, the Japan Epilepsy
Society (JES) was established as a result of theintegration of the two epilepsy associations previously noted. The new organization was authorized by the Health and Welfare Minister. The
establishment of this new and effective advocacy
group was widely credited to the InternationalYear of Disabled Persons in 1981 and United
Nations’ support activities. JES further pushed
the comprehensive promotion of policies for thedisabled by the government of Japan. Since its
beginnings, JES has been developing various activities to help ensure the advancement of people
with epilepsy. In 2001, with the power of the morethan 6,800 JES members, the revision of the Road
Traffic Act was achieved.

Conclusions
The legal stipulations on automobile driving
by epilepsy patients as “absolute causes for disqualification” in the Road Traffic Act of 1960
were simply based on the disease name. At thetime, epilepsy was applied to a broad range ofsimilar disease conditions. This created “relativecauses for disqualification” in not only the Road
Traffic Act of 1960 but also in the Revised Road
Traffic Act of 2001. The previously described organizational efforts and forces directly led to therevisions of the stipulations in the Road Traffic
Act in 2001. For example, the Japanese Cabinet
Office is credited with promoting eventual societal shifts that enabled changes to the Road Traffic
Act when it responded to the United Nation’s initiative to name the year 1981 as the InternationalYear of Disabled Persons.
After further revisions of the Road Traffic Act
in 2002, legal action related to automobile accidents caused by people with epilepsy continued
to be a source of contention, but no new stipulations were added. Further revisions made in June2013 added penalties in cases where people who3103

G. Imataka, S. Yoshihara

violated driving laws made false statements atthe time of their license acquisition or renewal.
In May 2014, the Act on Penalty of Activities
Causing a Person to Be Dead or Get Injured by
Automobile Driving was passed as a newly established law. Due to these 2014 revisions, stricter
legal penalties were imposed on epilepsy patients
who neglect taking their medicines and drive
recklessly with an awareness of danger.
Roads are supposed to be safe places as publicsocial environments. Because so many people use
roads daily, the importance of fair and balanced
driving laws is of widespread interest for discussion as these laws evolve over time and with
better knowledge of medical conditions such as
epilepsy and similar diseases.
For the purpose of writing this paper, we
referred to the contents of the Internet site described by the following Japanese.
• The society for road traffic affairs. Overview
of history of road traffic policies. Taisei Publishing 1994.
• Transition of road traffic regulations in Japan. (online) http://members.jcom.home.ne.jp/
kinmokusei/jpn_law/history.html#DOKO_0 /(accessed 2015-10-06).
• Materials used at the first meeting of expert
panel on ideal driver license system related
to certain diseases (online). https://www.npa.
go.jp/koutsuu/menkyo4/siryo.pdf / (accessed
2015-08-06).
• Japan Association for Mental Health (public
interest incorporated foundation). http://www.
jamh.gr.jp/kokoro/158_kan.html(accessed
2015-10-12).

3104

Cabinet Office. After the international year of
disabled persons and United Nations decade of
disabled persons 1983-1992.
http://www8.cao.go.jp/shougai/whitepaper/h26hakusho/zenbun/h1_02_01_03.html.
(accessed 2015-10-12).

Conflict of Interest

The Authors declare that they have no conflict of interests.

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