When my invitation arrived for an abdominal aortic aneurysm scan, offered by the NHS to all men in the year they turn 65, my first thought was what the hell is that?
It turns out that an AAA is a nasty bulge caused by a weakness in the walls of the main vessel supplying blood to the body. Though most people notice no symptoms, an aneurysm may burst — with fatal consequences — if it’s left untreated.
Well, like so many of my sex I’ve always been a bit of a coward where health matters are concerned, avoiding doctors where possible on the grounds that if there’s something seriously wrong with me, I’d rather not know about it.
But when the letter arrived, I resolved to be grown-up about this. After all, it was highly unlikely that I was among the 1.5 per cent of men aged over 65 found to have a worrying AAA (though, inevitably, smoking is said to be a contributory factor). But if I had such an aneurysm, it would probably be wise to have it detected and seen to. Better safe than sorry.
The NHS offer a abdominal aortic aneurysm scan to all men in the year they turn 65
Furthermore, the letter informed me the ultrasound scan wouldn’t cost me a penny, would be completely painless and was likely to last less than ten minutes, with the results available immediately.
Bombshell
Thinking it would be nice to be reassured I was one of the 98.5 per cent with nothing to worry about, I made up my mind to attend as instructed. There seemed nothing to lose, and possibly a longer life to gain. Little did I realise then the invitation would present me with a hugely uncomfortable moral dilemma, which has been troubling me ever since — as I suspect it has troubled many more 65-year-olds since the service was introduced.
It was only as the date for my appointment this Monday drew closer that I finally got round to reading the literature accompanying my health trust’s letter.
This began encouragingly enough, with the assertion only nine out of every 10,000 men who attend a screening — or 0.09 per cent — die within ten years because of an aneurysm. Apparently, this figure rises to 25 in every 10,000 (0.25 per cent) among men who decline to be screened.
But then came the bombshell. Buried in the small print was the warning: ‘Men with aneurysms 6.5cm wide or larger are advised to stop driving. Licences are reinstated if their aneurysms are repaired successfully.’
On further investigation, I found the word ‘advised’ was more than a little misleading. ‘Ordered’ would have been more accurate, since anyone aware of having a large aneurysm is obliged by law to declare it to the Driver and Vehicle Licensing Agency, or face a £1,000 fine. Doctors may also tip off the DVLA if they think a patient unfit to drive.
Indeed, the DVLA investigates many thousands of drivers’ medical records every year after being alerted by third parties such as health professionals. So much for doctor-patient confidentiality.
As for those who refuse a screening, on the other hand, they appear to be guilty of no offence — and their licences are not at risk — since they can’t be accused of withholding knowledge of an AAA from the authorities. In other words, if I went ahead with the screening I had an awful lot to lose, in the shape of the freedom, independence and sheer pleasure I get from driving.
I had visions of a bleak old age opening up to me, stranded at the top of my hill in South London, with the five-minute drive to the supermarket or butcher transformed into a major ordeal if I were forced to depend on unreliable public transport or Shanks’s pony.
At the same time, I would have to kiss goodbye to my dream of a retirement spent pottering around the great houses of Britain, which have been among my passions since my youth. There remain dozens I’ve yet to visit — many of them easily accessible only by car.
Of course, others who live in remote rural districts, served by buses that appear only once in a blue moon (if at all), have even more to lose if the DVLA confiscates their licences.
Aversion
The long and the short of it is that after wrestling with my conscience, I rang the number on the letter and said I wouldn’t be able to make it to my screening.
‘Shall I book you another appointment?’ asked the helpful voice at the other end of the line.
‘No, thank you.’
Smoking is said to be a contributory factor to the disease
As I saw it, the dilemma facing me boiled down to a matter of mathematical probabilities: was I really prepared to risk even the faintest possibility of losing my licence, on the off-chance of reducing my chances of dying from a burst aneurysm over the course of the next ten years from 0.25 per cent to 0.09 per cent?
God knows, I take huge risks with my health as it is, what with my smoking, drinking and aversion to exercise. I reckoned that one more was unlikely to make a significant difference. Now, at this point I’ll strap on my tin hat and cower in my trench. For I realise many readers will think me a vile, selfish brute for shirking my moral duty to find out whether or not I have I medical condition that could put other road users at risk.
On past form, some will post comments online calling me a ‘murderer’, while others will say that if a single life can be saved by confiscating a driving licence, then it’s worth it. I may even receive a heart-rending letter or two from people who’ve lost loved ones in road accidents caused by drivers with burst aneurysms.
To them, I can only reply that if I do happen to be among the unlucky 1.5 per cent who have an enlarged aneurysm (and I can’t stress too strongly I have absolutely no reason to believe I am), it’s still extremely unlikely it will rupture. Since I don’t drive often, it’s even less likely it will burst while I’m at the wheel, when it might cause someone else harm.
Yes, in very rare cases this does happen — though I can’t tell you how rare, since I’ve been unable to lay my hands on figures for the number of accidents caused specifically by rupturing AAAs.
Freedom
What I can tell you, with near certainty, is that the figure pales into insignificance beside the 22 per cent of fatalities on the roads of Great Britain that involve drivers aged between 17 and 24. Should we disqualify them, too?
Of course, if we were to go along with the ‘if-it-saves-a-single-life’ brigade, we would ban everyone from the roads — starting with the young and inexperienced, and perhaps moving on to the old and doddery. But realistically speaking, there must always be a trade-off between public safety and individual freedom.
My fear is that the balance is swinging too far against freedom, in our increasingly risk-averse society. And this tendency is all too evident in the official policy of keeping people with AAAs, which may be totally harmless, trapped in their homes — perhaps for the rest of their lives — by disqualifying them from driving.
I’m also unhappy about the way such policies are decided. Perhaps needless to say, the rules on notifiable medical conditions are set by an EU directive.
Meanwhile, panels of ‘experts’, who tend to cover their backs by putting safety above freedom, decide which disorders should be added to the list. Their recommendations are then rubber-stamped by the Transport Secretary. The democratic process doesn’t get a look-in.
I’m deeply uncomfortable, too, about the way these rules undermine doctor-patient confidentiality, turning medical professionals into coppers’ narks, or agents of the state.
Indeed, I leave you with this final thought. How many of those 25-in-10,000 scan refuseniks, who are doomed to die over the next ten years, declined to be screened because, like me, they feared the faint risk of losing their licences?
Could it be the policy of a driving ban for those unfortunate enough to have AAAs might cost as many lives as it saves?