There was a derailment in Australia called the Waterfall derailment [1]. It occurred because the driver had a heart attack and was responsible for 7 deaths (a miracle it was so low, honestly). The root cause was the failure of the dead-man's switch.

In the case of Waterfall, the driver had 2 dead-man switches he could use - 1) the throttle handle had to be held against a spring at a small rotation, or 2) a bar on the floor could be depressed. You had to do 1 of these things, the idea being that you prevent wrist or foot cramping by allowing the driver to alternate between the two. Failure to do either triggers an emergency brake.

It turns out that this driver was fat enough that when he had a heart attack, his leg was able to depress the pedal enough to hold the emergency system off. Thus, the dead-man's system never triggered with a whole lot of dead man in the driver's seat.

I can't quite remember the specifics of the system at Waterfall, but one method to combat this is to require the pedal to be held halfway between released and fully depressed. The idea being that a dead leg would fully depress the pedal so that would trigger a brake, and a fully released pedal would also trigger a brake. I don't know if they had that system but certainly that's one approach used in rail.

Either way, the problem is equally possible in cars. If you lose consciousness and your foot goes limp, a heavy enough leg will be able to hold the pedal down a bit depending on where it's positioned relative to the pedal and the leverage it has on the floor.

The other major system I'm familiar with for ensuring drivers are alive at the helm is called 'vigilance'. The way it works is that periodically, a light starts flashing on the dash and the driver has to acknowledge that. If they do not, a buzzer alarm starts sounding. If they still don't acknowledge it, the train brakes apply and the driver is assumed incapacitated. Let me tell you some stories of my involvement in it.

When we first started, we had a simple vigi system. Every 30 seconds or so (for example), the driver would press a button. Ok cool. Except that then drivers became so hard-wired to pressing the button every 30 seconds that we were having instances of drivers falling asleep/dozing off and still pressing the button right on every 30 seconds because it was so ingrained into them that it was literally a subconscious action.

So we introduced random-timing vigilance, where the time varies 30-60 seconds (for example) and you could only acknowledge it within a small period of time once the light started flashing. Again, drivers started falling asleep/semi asleep and would hit it as soon as the alarm buzzed, each and every time.

So we introduced random-timing, task-linked vigilance and that finally broke the back of the problem. Now, the driver has to press a button, or turn a knob, or do a number of different activities and they must do that randomly-chosen activity, at a randomly-chosen time, for them to acknowledge their consciousness. It was only at that point that we finally nailed out driver alertness.

My point is that human-machine interfaces are really difficult to hammer out edge-cases in. Human behaviour is tough to deal with programmatically.

[1]: https://en.wikipedia.org/wiki/Waterfall_rail_accident
[2]: https://en.wikipedia.org/wiki/Dead_man's_switch#Vigilance_co...