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AN INCOME-TAX ANOMALY
310
Annotations AN INCOME-TAX ANOMALY
WE
hardly expect that our laws shall always be applied equally ; for their application depends on people, and people, as we know, are various. On the other can
hand we are entitled to demand that our statutes shall not discriminate against any group. A small but important instance of such discrimination is the inequitable income-tax law which is at present applied to doctors engaged whole-time in the National Health Service. The law is clear. Doctors who derive a substantial part of their income from private patients may, under Schedule D, offset against their income the cost of professional journals and books, and of attending scientific meetings. The whole-timers (under Schedule E) cannot do so-unless perhaps their contracts demand that they shall incur these expenses. The discrimination does not end there. For instance, the part-timer can claim for relief from income-tax the cost of professional motor-car expenses not covered by the official allowance : the full-timer cannot. The part-timer can likewise claim for some of the cost of entertaining overseas doctors who are visiting hospitals or attending conferences in this country : the whole-timer cannot. Besides whole-time consultants, other doctors and other professional groups are victims of this anomaly, which is not new but is felt more acutely than ever before because high rates of tax begin at lower real incomes. Rationally the discrepancy is indefensible. This was recognised by the Royal Commission on Taxation of Profits and Income in its declaration that " there is no good reason for treating Schedule E expenses less generously than Schedule D expenses, except to the limited extent that some difference of treatment is inherent in the nature of the two kinds of income." The Royal Commission concluded that the Schedule-E rule governing deductible expenses should be amended to permit the allowance of expenditure " reasonably incurred for the appropriate performance " of the duties of the office or employment. Owing to the rapid progress in diagnostic methods and in therapy, it is quite impossible for doctors to keep up a high standard without having books and journals at their disposal and without attending meetings of These expenses are an unfairly scientific societies. heavy toll on those who, unlike their colleagues, cannot set them against income. We earnestly hope that the Chancellor of the Exchequer will find it possible in the coming Budget to end this inequity.
How dangerous is the diabetic in charge of a motor vehicle ?‘ It is clear from the small number of cases that come before the courts that few diabetics are, in fact. On the other hand. a serious menace to their fellows. a potential hazard does exist, and it remains to assess its dimensions. In the first place, only those diabetics who require and receive insulin by injection are concerned. Despite learned counsel’s contentions, diabetic coma is always of slow onset, and most drivers would have time to relinquish charge of a vehicle in the several hours that pass before consciousness is lost. And insulin-requiring diabetics make up no more than 20-25% of the total diabetic population. Diabetics who do not need insulin may be given it in error ; but they are notoriously resistant to its action, and rarely suffer from glycsemia. Next, the great majority of insulin-requiring diabetics are well controlled, and, provided that they take their meals regularly and they do not engage in unusual physical exertion, they are not subject to attacks of coma. It must be remembered that it is no crime to be in charge of a motor vehicle while under the influence of a drug: it becomes a crime only when the drug’s action prevents the driver from having proper control of the vehicle. There are five different types of insulin available, one in three forms, and all in three strengths. Although dispensing errors are very uncommon, wrongly measured doses are by no means rare, and they account for most reactions in otherwise well-stabilised patients. Rarely, reactions occur for no detectable reason, and they are usually attributed to sporadic endogenous production of insulin. There remains a very small group of patients, chiefly young people, in whom control is difficult and who often suffer from hypoglycaemia and its consequences. It is to these patients that Lord Goddard’s remarks seem
hypo-
justly
to
apply.
Diabetics are not alone in their liability to abrupt loss of consciousness. Epileptics, for example, are similarly afrieted. And since heart-attacks may recur, and often do, at moments of stress, should a patient who has had a coronary thrombosis likewise be excluded from driving? What is the position of a patient who has spontaneous hypoglycaemic attacks ?’? Manifestly, the law needs some interpretation on this point, and de-jure -recognition of this is given earlier in the Act,3 where provision is made for the licensing of handicapped drivers in certain circum. stances-circumstances which would include all buta handful of diabetics. Moreover, it receives much wider de-facto recognition from most licensing authorities by the issue of licences to known epileptics, provided that they are reputably certified as having been free from attacks for at least three years and are otherwise suitable DIABETICS AND DRIVING persons to hold such licences. THE judgment described on p. 319 arose out of charges Clearly there can be no generalisations about diabetics, brought against a diabetic driver under the Road Traffic even insulin-requiring diabetics ; each case must he Act. The Lord Chief Justice said " this section (of the considered on its own, and although there are certainly Act 1) was designed for the protection of the public, and some diabetics who would be a danger to Her Majesty’s if people were in a condition of health which rendered when in charge of a motor vehicle, their number subjects them subject to comas, or the remedies for which might is undoubtedly small. As the British Diabetic AS&bgr;ocia. send them into comas, they ought not to drive because tion points out, one of the essentials for safety is that of the danger which resulted to the rest of Her Majesty’s the driver should be able to early the symptoms subjects."2 Quite so : the relevant section of the Act of hypoglycaemia, and thoserecognise few who cannot do so should says that " any person who when driving or attempting take medical advice before applying for a driving licence. to drive or when in charge of a motor vehicle on a road In fact, the small number to whom Lord Goddard’s or other public place is under the influence of drink or a applies are usually the first to wish to be prowarning drug to such an extent as to be incapable of having tected, and to protect the public, by not driving. There proper control of the vehicle shall be liable ..." ; and the isolated instance of the usually remains, however, there can be no serious contention that Lord-Goddard’s well-controlled diabetic who has a hypoglycsemic attack decision is anything but right in law. The widespread at the wheel. Provided it can be shown that the attach interest that his ruling has aroused serves not only to was unusual, unexpected, and in no known way attriwaken public concern over diabetic drivers but also to butable to the patient’s negligence, he should not br illuminate a rather unsatisfactory section of an Act which held responsible for its consequences, and the Act sho!:H daily increases in importance. be amended accordingly. ’
<
1. Road Traffic Act (1930), section 15 2. Times, Jan. 31, 1957.
(2). 3. Road. Traffic Act (1930), section 5 (2b).
Annotations AN INCOME-TAX ANOMALY
WE
hardly expect that our laws shall always be applied equally ; for their application depends on people, and people, as we know, are various. On the other can
hand we are entitled to demand that our statutes shall not discriminate against any group. A small but important instance of such discrimination is the inequitable income-tax law which is at present applied to doctors engaged whole-time in the National Health Service. The law is clear. Doctors who derive a substantial part of their income from private patients may, under Schedule D, offset against their income the cost of professional journals and books, and of attending scientific meetings. The whole-timers (under Schedule E) cannot do so-unless perhaps their contracts demand that they shall incur these expenses. The discrimination does not end there. For instance, the part-timer can claim for relief from income-tax the cost of professional motor-car expenses not covered by the official allowance : the full-timer cannot. The part-timer can likewise claim for some of the cost of entertaining overseas doctors who are visiting hospitals or attending conferences in this country : the whole-timer cannot. Besides whole-time consultants, other doctors and other professional groups are victims of this anomaly, which is not new but is felt more acutely than ever before because high rates of tax begin at lower real incomes. Rationally the discrepancy is indefensible. This was recognised by the Royal Commission on Taxation of Profits and Income in its declaration that " there is no good reason for treating Schedule E expenses less generously than Schedule D expenses, except to the limited extent that some difference of treatment is inherent in the nature of the two kinds of income." The Royal Commission concluded that the Schedule-E rule governing deductible expenses should be amended to permit the allowance of expenditure " reasonably incurred for the appropriate performance " of the duties of the office or employment. Owing to the rapid progress in diagnostic methods and in therapy, it is quite impossible for doctors to keep up a high standard without having books and journals at their disposal and without attending meetings of These expenses are an unfairly scientific societies. heavy toll on those who, unlike their colleagues, cannot set them against income. We earnestly hope that the Chancellor of the Exchequer will find it possible in the coming Budget to end this inequity.
How dangerous is the diabetic in charge of a motor vehicle ?‘ It is clear from the small number of cases that come before the courts that few diabetics are, in fact. On the other hand. a serious menace to their fellows. a potential hazard does exist, and it remains to assess its dimensions. In the first place, only those diabetics who require and receive insulin by injection are concerned. Despite learned counsel’s contentions, diabetic coma is always of slow onset, and most drivers would have time to relinquish charge of a vehicle in the several hours that pass before consciousness is lost. And insulin-requiring diabetics make up no more than 20-25% of the total diabetic population. Diabetics who do not need insulin may be given it in error ; but they are notoriously resistant to its action, and rarely suffer from glycsemia. Next, the great majority of insulin-requiring diabetics are well controlled, and, provided that they take their meals regularly and they do not engage in unusual physical exertion, they are not subject to attacks of coma. It must be remembered that it is no crime to be in charge of a motor vehicle while under the influence of a drug: it becomes a crime only when the drug’s action prevents the driver from having proper control of the vehicle. There are five different types of insulin available, one in three forms, and all in three strengths. Although dispensing errors are very uncommon, wrongly measured doses are by no means rare, and they account for most reactions in otherwise well-stabilised patients. Rarely, reactions occur for no detectable reason, and they are usually attributed to sporadic endogenous production of insulin. There remains a very small group of patients, chiefly young people, in whom control is difficult and who often suffer from hypoglycaemia and its consequences. It is to these patients that Lord Goddard’s remarks seem
hypo-
justly
to
apply.
Diabetics are not alone in their liability to abrupt loss of consciousness. Epileptics, for example, are similarly afrieted. And since heart-attacks may recur, and often do, at moments of stress, should a patient who has had a coronary thrombosis likewise be excluded from driving? What is the position of a patient who has spontaneous hypoglycaemic attacks ?’? Manifestly, the law needs some interpretation on this point, and de-jure -recognition of this is given earlier in the Act,3 where provision is made for the licensing of handicapped drivers in certain circum. stances-circumstances which would include all buta handful of diabetics. Moreover, it receives much wider de-facto recognition from most licensing authorities by the issue of licences to known epileptics, provided that they are reputably certified as having been free from attacks for at least three years and are otherwise suitable DIABETICS AND DRIVING persons to hold such licences. THE judgment described on p. 319 arose out of charges Clearly there can be no generalisations about diabetics, brought against a diabetic driver under the Road Traffic even insulin-requiring diabetics ; each case must he Act. The Lord Chief Justice said " this section (of the considered on its own, and although there are certainly Act 1) was designed for the protection of the public, and some diabetics who would be a danger to Her Majesty’s if people were in a condition of health which rendered when in charge of a motor vehicle, their number subjects them subject to comas, or the remedies for which might is undoubtedly small. As the British Diabetic AS&bgr;ocia. send them into comas, they ought not to drive because tion points out, one of the essentials for safety is that of the danger which resulted to the rest of Her Majesty’s the driver should be able to early the symptoms subjects."2 Quite so : the relevant section of the Act of hypoglycaemia, and thoserecognise few who cannot do so should says that " any person who when driving or attempting take medical advice before applying for a driving licence. to drive or when in charge of a motor vehicle on a road In fact, the small number to whom Lord Goddard’s or other public place is under the influence of drink or a applies are usually the first to wish to be prowarning drug to such an extent as to be incapable of having tected, and to protect the public, by not driving. There proper control of the vehicle shall be liable ..." ; and the isolated instance of the usually remains, however, there can be no serious contention that Lord-Goddard’s well-controlled diabetic who has a hypoglycsemic attack decision is anything but right in law. The widespread at the wheel. Provided it can be shown that the attach interest that his ruling has aroused serves not only to was unusual, unexpected, and in no known way attriwaken public concern over diabetic drivers but also to butable to the patient’s negligence, he should not br illuminate a rather unsatisfactory section of an Act which held responsible for its consequences, and the Act sho!:H daily increases in importance. be amended accordingly. ’
<
1. Road Traffic Act (1930), section 15 2. Times, Jan. 31, 1957.
(2). 3. Road. Traffic Act (1930), section 5 (2b).