Distrust of Authorities: Experiences of Outcome and Processes of People Who Had Their Driving License Withdrawn Due to Visual Field Loss

Abstract

Citizens’ trust of authorities is of general importance, as it can affect trust in society as a whole. The Swedish Transport Agency is a state administrative authority responsible for driving license withdrawal. If withdrawals are experienced as unfair by those affected, this might lead to decreased trust in the agency and in other actors involved. This study accordingly examines how the experiences of people who have had their driving license for a private car withdrawn due to visual field loss might affect their distrust of the authorities, as related to outcomes and processes. Follow-up interviews were conducted with nine people from a previous study. Content analysis revealed one overarching theme, struggling for justice within a system perceived as unfair, which comprised four identified categories: preparedness for and understanding of the withdrawn driving license (WDL); perceptions of assessment methods, reactions and actions regarding the decision, and perceptions of the authorities’ performance. In sum, the vision tests on which withdrawals are based were perceived as unfair, as they did not measure individual driving ability. Furthermore, rejections of appeals led to feelings of hopelessness. Distrust regarding outcomes and processes related to the withdrawals was also fueled by experiences of deficiencies regarding, for example, performance and information.

Highlights

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Assessment methods and therefore outcomes are perceived as unfair.

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Perceived hopelessness arises in the struggle to regain the driving license.

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An individual perspective and transparent treatment are important in the process.

1. Introduction

Citizens’ trust of the authorities is of general importance as it can affect the level of trust in society as a whole regarding the effectiveness of governance, legal systems, and institutional and social systems (Bornstein and Tomkins 2015; Rothstein and Steinmo 2002). Citizens’ trust has two manifestations, as both input to public sector reforms and the outcome of such reforms, for example, in the form of compliance with regulations (OECD 2013).

The concept of trust is used in several disciplines and defined in different ways (PytlikZillig and Kimbrough 2016) but is often understood as defined by Rousseau et al. (1998) as “a psychological state comprising the intention to accept vulnerability based upon positive expectations of the intentions or behavior of another” (p. 395). Conversely, negative expectations arise when someone is unwilling to trust, or when trust is disappointed by negative experiences of, for instance, institutional performance (Viklund 2003). Negative experiences have a stronger impact on trust than do positive experiences, as trust is easier to destroy than build (OECD 2013; Slovic 1993). Also, citizens’ trust depends on what citizens themselves perceive as fair and unfair (Bouckaert and Van de Walle 2003) and on whether they feel that they have been treated fairly (Tyler 2010). Additionally, previous experiences and the degree of dependence on the authority in question can affect trust in the future and are therefore important (cf. OECD 2013).

Trust is especially important for authorities who design rules and grant permits that affect individuals, and where the exercise of authority can have negative consequences in addition to positive ones for the individual and society. The Swedish Transport Agency (Transportstyrelsen) is a state administrative authority that, in addition to other tasks, is responsible for driving license withdrawals if, from a traffic safety perspective, the requirements for holding a driving license are not met (SFS 1998a). One example is withdrawn driving license (WDL) due to visual field loss (VFL). How the WDL decision is received and understood might be affected by how the processing performance has been understood and experienced and by whether the assessment procedure and decision are perceived as fair, factors that can affect trust in the decision-making authority and in other actors involved (cf. Bouckaert and Van de Walle 2003). Accordingly, in institution-oriented research, five key factors are considered important for understanding citizens’ trust and distrust (see, e.g., Stahl et al. 2011). These factors concern how citizens perceive: (1) benevolence—whether the authority understands the individual’s situation, conditions, and needs; (2) openness—whether the authority understandably explains and justifies its regulations, methods, and criteria for decisions; (3) integrity—whether the authority performs its tasks independently, fairly, and consistently; (4) value congruence—whether the authority’s values and cultural characteristics are shared with citizens; and (5) ability—whether the authority performs a professional job. These factors can be related to trust regarding people’s experiences of outcomes, events, and processes regarding WDL due to VFL, deepening our understanding of how and why a lack of trust arises.

VFL can occur for reasons such as glaucoma or as a consequence of stroke or diabetes (Patterson et al. 2019). If, due to VFL, a patient does not fulfill the medical requirements for holding a driving license, the physician is obliged to report this to the Swedish Transport Agency (SFS 1998a), which will then start an investigation of whether the driving license should be withdrawn (TSFS 2010). During the investigation, the driving license will be temporarily withdrawn for road safety reasons. Furthermore, WDL decisions due to VFL are based on perimetry, i.e., examination of the visual field (TSFS 2010). Such standardized vision testing, performed by healthcare personnel, measures the VFL, but not in relation to individual driving ability (Bro and Lindblom 2018). The investigated person can submit new information to the Swedish Transport Agency that might affect its decision (Transportstyrelsen 2014). If the final WDL decision is not accepted, it can be appealed. It is also possible to apply for a dispensation, with driving being limited to certain conditions, such as not driving in the dark or only within a limited radius (SFS 1998b). Furthermore, starting in 2016, people with WDL due to VFL could undergo traffic simulator testing at the Swedish National Road and Transport Research Institute (VTI), the results of which the Swedish Transport Agency would consider in its dispensation decisions. However, these tests stopped in 2018 after an evaluation found that they cannot reliably show whether a driver can compensate for VFL (Transportstyrelsen 2020a).

The Swedish Transport Agency’s regulations and general guidelines concerning driving licenses—in this case concerning WDL due to VFL—are based on the minimum requirements of the European Commission’s directive on driving (Commission Directive 2009/113/EC 2009). The directive does not define what constitutes a visual defect and does not make it clear what methods are to be used to determine whether the requirements are met (Transportstyrelsen 2020b). This means that the structure and implementation of requirements can differ between countries, and the specifications and routines concerning WDL due to VFL are in some cases stricter in Sweden than in other countries (Bro and Lindblom 2018; Transportstyrelsen 2020b). For example, the Swedish Transport Agency is restrictive in granting dispensations (Transportstyrelsen 2019). Relatedly, while other countries (e.g., Finland, Norway, the UK, and The Netherlands) allow practical driving tests for decisions on dispensations after a WDL, this is impossible in Sweden, as Swedish regulations lack legal preconditions for such practical tests (Transportstyrelsen 2020b). Research on the connection to trust in this area is limited. While several studies have found that WDL is related to negative welfare consequences such as limited opportunities to participate in daily life activities, often generating feelings of dependence, isolation, and depression (e.g., Adler and Rottunda 2006; Chihuri et al. 2016; Davey 2007; Nyberg et al. 2019), less research has focused on WDL as related to trust. Although studies have revealed that people do not always understand the reasons for WDL, partly because they see themselves as safe drivers (e.g., Nyberg et al. 2019; Whitehead et al. 2006), the issue of trust has not previously been the focus. Overall, research on citizens’ trust in public institutions is common regarding social sectors such as school, health care, the social security system, the labor market, the legal system, and the police (see, e.g., Bouckaert 2012; Tyler and Huo 2002), but, with some exceptions, has rarely considered the transport sector.

Greater knowledge of the reasons for decreased trust in the authorities related to WDL, as expressed by those affected, can help the Swedish Transport Agency understand and handle expectations regarding its tasks (cf. OECD 2013). Relatedly, an investigation by the Delegation for Trust-Based Public Management (Tillitsdelegationen) revealed the importance of emphasizing an increased citizen focus, especially when it comes to authorities with direct or indirect contact with citizens (SOU 2019). Considering the previously described limited research on this subject, reinforced by the importance of trust in authorities from both the individual and societal perspectives, further research is needed to explore how the actions of the authorities can affect citizens’ trust.

This study accordingly examines how the experiences of people who have had their driving license for a private car withdrawn due to VFL might affect their distrust in the authorities, as related to outcomes and processes.

2. Material and Methods

A previous interview study of transport-related welfare consequences for individuals whose driving licenses were withdrawn due to VFL revealed that the respondents perceived the WDL as unfair (Nyberg et al. 2019). This indicated distrust in the Swedish Transport Agency and other actors involved in the processes. As distrust was not the focus of that study, qualitative follow-up telephone interviews were conducted with those respondents to further examine the matter of trust.

Qualitative content analysis was used to interpret the meaning of the empirical material (Graneheim and Lundman 2004). The five factors described above (i.e., benevolence, openness, integrity, value congruence, and ability) constitute a conceptual framework used in constructing the interview guide and as a tool to understand how the respondents’ experiences affect trust.

2.1. Participants and Procedure

Via a letter, the respondents from the previous interview study mentioned above were invited to participate in the current study. In line with the principal of informed consent (Swedish Research Council 2017), the request was attached to information about the study and its aim, confidentiality, and the use of the empirical material. The respondents’ written informed consent was obtained via a letter. In the previous study, the respondents were recruited from people who had registered to participate in simulator tests, as discussed above.

Nine of a total of 14 respondents from the previous study consented to be interviewed; two respondents declined to participate and three did not respond to the request, despite a reminder. Plausible explanations for dropouts might concern the time span of three years since the first interviews were conducted: events concerning the WDL could have evoked negative emotions, making it too difficult to participate, or, on the contrary, the respondent might have regained a driving license/got a dispensation and therefore did not see the need to participate. The number of respondents was considered sufficient in light of what had emerged about distrust in the previous interviews. Still, the follow-up interviews offered a thoroughgoing study of the subject. The respondents had various backgrounds regarding profession and family situation, and they lived in different parts of Sweden, in both urban and rural areas (further details in

Table 1. Respondents: background information.

Respondent (Pseudonym)	Sex	Age	Impairment and Cause of VFL	Year of WDL	Year of Dispensation after Simulator Test	Year of Dispensation/Regained Driving License Due to New Rules
Simon	M	31	Brain tumor	2013	2017
Lars	M	64	Glaucoma	2013	2017
Roland	M	73	Diabetes	2013	2017
Bertil	M	85	Glaucoma	2013
Malin	W	32	Cause unknown	2017		2018
Sara	W	42	Congenital VFL	1999		2017
Maria	W	51	Stroke	2014
Lena	W	54	Stroke	2012
Birgitta	W	78	Glaucoma	2017

).

Semi-structured interviews were conducted. The interviews allowed the respondents to talk freely, yet use of an interview guide ensured coverage of questions relevant to the study. These questions concerned each phase generally seen in the process of medical WDL, as well as subsequent processes related to WDL: the physician’s information about reporting to the Swedish Transport Agency; perimetry; the Swedish Transport Agency’s written information about investigation; the possibility of the person involved submitting new information to be considered in the investigation; the Swedish Transport Agency’s written information about the WDL decision; the person’s appeals against the WDL; the person’s application for a dispensation; and the person’s appeal of a rejected application for dispensation. For each phase, questions were raised based on the five factors of the conceptual framework described above. For example, regarding the occasion when the physician informed about reporting the VFL to the Swedish Transport Agency, the respondent was asked to describe his or her experiences and perceptions of the meeting (“How did you experience the physician’s understanding of your situation?”). To test the interview guide, a pilot interview was conducted.

The telephone interviews were conducted by the same interviewer (JN) as in the previous study, which had been conducted face to face. The interviewer therefore had a pre-understanding of the respondents’ life situations, the consequences of the WDL for them in daily life, and their perceptions of the WDL handling (see above). Regarding the WDL, any new events since the first interview were considered.

The interviews lasted 40–90 minutes and were conducted between February and May 2020; the interviews were recorded digitally, with respondent approval. The study was approved by the Regional Ethics Board of Linköping (reference No. Dnr 2019/0100:3).

2.2. Analysis

The interviews were transcribed verbatim and then analyzed using content analysis, following the analytical steps described by Graneheim and Lundman (2004; see

Table 2. Examples of steps in the analytical process (Graneheim and Lundman 2004).

Meaning Unit	Condensed Meaning Unit	Code	Sub-Category	Category
Birgitta: And I just thought that he [i.e., the physician] would measure the pressure [in my eyes]. So when he said, “Has anybody talked to you about your driving license?” I said, “No, absolutely not.” And then he said, “You should not drive a car.” So, he pulled the rug from under my feet /…/ Straight off. And then I was so shocked that I said I needed to go home.	The physician said she should not drive, which no one had talked about before, and she became shocked.	Become shocked	Awareness of the significance of VFL	Preparedness for and understanding of the WDL

). First, an overall sense of the material was gained by reading and rereading the interviews. Second, pertinent sentences or phrases relevant to the research question were sorted out to form so-called meaning units, which were then shortened into condensed meaning units. Third, codes were created to label the condensed meaning units. Fourth, the codes were arranged into sub-categories and categories describing the manifest content of the material. Fifth, building on the categories and sub-categories, a theme was constructed capturing the latent content of the material, constituting “a thread of an underlying meaning through condensed meaning units, codes or categories, on an interpretative level” (Graneheim and Lundman 2004, p. 107).

The analysis was initially performed independently of the first author (JN). Thereafter, the sub-categories, categories, and theme were discussed by all authors (JN, LL, KL, TS) to reach agreement (Graneheim and Lundman 2004).

3. Results

The content analysis resulted in 10 sub-categories, four categories, and one overarching theme, as illustrated in

Table 3. Sub-categories, categories, and theme.

Sub-Categories	Categories	Theme
Awareness of the significance of VFL Perception of their own driving ability	Preparedness for and understanding of the WDL	Struggling for justice within a system perceived as unfair
Quality of existing vision tests Alternative assessment methods with an individual focus	Perceptions of assessment methods
From hope to hopelessness Seeking confirmation Illegal driving	Reactions and actions regarding the decision
Information and communication Competence Coordination and time aspect	Perceptions of the authorities’ performance

.

Initially, the manifest content is presented by the four categories, structured by their respective sub-categories. Finally, the overarching theme is described, constituting the latent content that underlies the categories and sub-categories.

3.1. Preparedness for and Understanding of the WDL

According to the interviews, the respondents did not understand why their driving licenses were withdrawn. This could be related to lack of preparedness for the risk of WDL due to their diagnosis and/or VFL, and to perceptions of their own driving ability.

3.1.1. Awareness of the Significance of VFL

The starting point of the WDL process was the occasion when the physician/healthcare staff member announced that the VFL would be reported to the Swedish Transport Agency. The following quotation of Birgitta exemplifies how this situation was experienced by several respondents:

And I just thought that he [i.e., the physician] would measure the pressure [in my eyes]. So when he said, “Has anybody talked to you about your driving license?” I said “No, absolutely not.” And then he said, “You should not drive a car.” So, he pulled the rug from under my feet /…/ Straight off. And then I was so shocked that I said I needed to go home.

Some respondents were unprepared for the announcement, as they did not know or had not received indications that the current diagnosis and/or VFL could mean a WDL. This made it difficult to understand the announcement, and the respondents described how it came as a shock.

The respondents’ descriptions of their shock at the announcement of the reporting to the Swedish Transport Agency were in several cases connected to their perceptions of the mediator. The way the physician/healthcare staff member announced the reporting was often described as clumsy and insensitive. Birgitta, for example, stated: “I cannot imagine any more un-psychological a physician than the one I had.” Additionally, Lars described how the healthcare staff member spoke over his head when he was “sitting just two meters away from them.” The respondents said that they had wanted more time to comprehend the information, and not just a few minutes, as several respondents described it. Furthermore, a personal meeting with the physician was highlighted as important by some respondents who had not had that opportunity. Some respondents said that after the announcement of the reporting, they had chosen another physician due to their negative experience.

3.1.2. Perception of Their Own Driving Ability

All respondents saw themselves as good drivers, and some also said that they compensated for their VFL when driving. The respondents compared their own driving ability with that of drivers whom they thought did not drive safely, but who nevertheless had the right to a driving license. As examples, the respondents cited older people, people with impairments other than VFL, and drivers who generally drove carelessly. Relatedly, some respondents claimed that even though an authority responsible for traffic safety was necessary, the Swedish Transport Agency had the wrong focus in its traffic safety work, according to their experiences and perceptions of their own driving ability. This was expressed by Roland:

In general, I understand very well that there must be an overarching authority responsible for traffic… it’s clear. /…/ But I think they [i.e., the Swedish Transport Agency] have handled it very strangely. /…/ It’s like “We do something and then we trust it one hundred percent, then we just snatch the driver’s license.” /…/ And I have lost trust. /…/ Not before. I’ve never fallen out with someone when it comes to traffic laws or anything. Except this—it was the first time in my life that I had a really bad experience and was treated this way.

As illustrated by the quotation, Roland said that his experiences had led to a general decreased trust in the authorities.

3.2. Perceptions of Assessment Methods

Related to the respondents’ perceptions of their driving ability were their perceptions of the assessment methods that constituted the basis for deciding on potential WDL. In the interviews, the quality of existing vision tests, as well as alternative assessment methods, were discussed.

3.2.1. Quality of Existing Vision Tests

The respondents perceived the vision tests to be unreliable and unfair, as they did not measure actual driving ability. This was described by Lars:

Doing the visual field test, you stare straight ahead. You kind of lock your eyes and just look straight ahead at a yellow dot. /…/ This is not the case when you drive a car. /…/ I can compensate for my visual impairment. You glance sideways with your eyes, and you have a neck that still functions. /…/ But they only consider the vision tests. That is not right. /…/ These tests are not optimal to see if you can drive a car or not.

The respondents also referred to their own specific type of VFL, perceiving the testing methods as too rigid. This view is exemplified by Simon:

In my case, I do not think that my visual field loss disturbs at all. /…/ It’s completely unreasonable. What am I expected to see up there, where the sun visor is located, when I drive a car?

At the time of the interviews, some respondents had regained their driving license for a private car after having passed an approved simulator test at VTI, for example, obtaining a dispensation that had previously been rejected. For them, the simulator test was proof that they were safe drivers and that previous assessments were unfair.

In addition to the view that the test situation was far from the reality of car driving and traffic, the test results were considered to be affected by the daily condition (e.g., fatigue and/or stress) of the person conducting the test. It was also stressed that the results could be affected by an incorrectly calibrated testing machine, leading to incorrect results that in turn might lead to unfair WDL. Additionally, it was questioned whether a few minutes of testing should form the basis for whether a driving license should be withdrawn or not. For example, Birgitta said that “I will not become a completely incompetent driver overnight.”

3.2.2. Alternative Assessment Methods with an Individual Focus

The perception of unfair current assessment methods implied a demand for individual assessments, and several respondents said that they wanted the Swedish Transport Agency to investigate each person’s case, taking into account individual driving ability. The respondents regarded simulator tests, practical driving tests in real traffic environments, and consideration of a driving history without incidents or accidents to constitute a more accurate basis for assessment than the prevalent eye tests. Practical driving tests were highlighted by most respondents, regarding both the initial WDL decision and when applying for a dispensation. According to the respondents, practical driving testing was more reliable and fairer as it took into account individual factors concerning driving ability, for example, whether the driver could compensate for the VFL. According to some respondents, such assessments would entail acceptance of the WDL, as they did not want to expose others to risk in traffic. They wanted to be convinced that they were not safe drivers, as described by Lena in the following:

I would have preferred to hear “Well, we can test you [in real traffic], then we will see if you really can …,” because then I might have been able to be more accepting [of the WDL]—“No God, this does not work.”

3.3. Reactions and Actions Regarding the Decision

As shown above, WDL was perceived as unfair by the respondents. Thus, this led to different kinds of reactions, in order to be justified, but also to defy.

3.3.1. From Hope to Hopelessness

Opinions on the Swedish Transport Agency’s decision on investigation of whether the driving license should be withdrawn or not, appeals of WDL decisions, and appeals of rejected dispensation applications illustrated the respondents’ actions and reactions regarding the agency’s WDL decisions. The respondents initially had hope that such actions would lead to what they considered justice. In the case of Bertil, his lawyer advised him not to proceed with an appeal to the highest court, as no one had been granted driving rights in that instance. Several respondents had appealed both the initial WDL decision and rejected applications for dispensation; however, the appeals had been rejected, generating feelings of hopelessness. Relatedly, some respondents talked about how they felt powerless against the Swedish Transport Agency: “it was an uphill struggle,” as Malin described it. Overall, the agency was attributed great power, as described by Bertil:

Because they [the Swedish Transport Agency] have such power! /…/ It’s like being accused of murder: “He did it! He’s going to jail! He sees nothing!” In their opinion.

This quotation expresses a sense of being accused. This mutual distrust, namely, the authority’s distrust of the respondent and the respondent’s distrust of the authority, was something that also emerged in other interviews.

3.3.2. Seeking Confirmation

Some respondents searched for information about WDL due to VFL, finding that the testing methods used for WDL decisions had been criticized because they did not measure driving ability. This was mentioned by Roland:

Because I’ve read so much about it … there were some countries in Europe that skipped it [i.e., vision testing as the basis for WDL]. /…/ They skipped it because they didn’t consider it fair. /…/ It was a professor who spoke, he said that this machine is very good at detecting eye diseases, but not at assessing car drivers.

Roland compared Sweden with other countries; Bertil did the same, noting that in some countries people could take a practical test as the basis for WDL, which he perceived as a fairer system.

Some respondents said that they participated in various social media forums where people in the same situation shared their experiences. This was described by Maria:

I saw [on Facebook] that there were so many who had complained about exactly what I complain about, and something must happen, it must have some effect.

Respondents cited critical international research and noted that many are in the same situation with the same experiences and perceptions; this expressed a search for confirmation of their perception of an unfair system, and that it ought to change.

3.3.3. Illegal Driving

Some respondents continued to drive despite the WDL, as illustrated by Lena in the following quotation:

That’s why I say, like, “Fuck you, I’m driving because I can handle this.” /…/ But I mean, like, I, who have been driving for seven years [since the WDL], and nothing has ever happened, there has never been a problem. Then it’s, like … then I could have kept my driving license without any problems. /…/ Now I know that I can drive, that I trust myself. Otherwise, I wouldn’t have done it.

Lena’s illegal driving was based on her perception of being a good driver, and that the WDL was unfair. For Lena, driving has been an act of defiance. In the quotation she said that she would not take this kind of action if she were not sure that she posed no risk to others in traffic. Furthermore, she stated that her illegal driving had itself shown that she was a safe driver, as she had been involved in no accidents or incidents when driving.

3.4. Perceptions of the Authorities’ Performance

In the interviews, the respondents talked about how they experienced and perceived information/communication, competence, coordination, and time aspects related to the actors involved in the WDL processes.

3.4.1. Information and Communication

Several respondents had not perceived that the driving license had been withdrawn until further notice while an investigation was ongoing. Furthermore, the respondents remembered differently whether the first letter from the Swedish Transport Agency informed them of opportunities to submit opinions on the investigation, make appeals, and/or submit applications for a dispensation.

To be prepared, several respondents wished that they had received information from healthcare staff at an early stage regarding the link between a diagnosis of VFL and WDL. Furthermore, they believed that the physician who informed them of a probable WDL should also have informed them of avenues for appeal or seeking a dispensation. This was articulated by Maria:

I wanted to hear about alternatives, such as “If you lose your driving license, you can do this or that …” It was just cut off. All possibilities were cut off from the moment you lost your driving license, it was just … it was stop.

The perceived lack of information was also evident in rejections of appeals and applications for dispensations as, according to the respondents, no explanations were given with the rejections. The answer was simply “No,” as Bertil put it.

3.4.2. Competence

According to some respondents, the Swedish Transport Agency may well have followed the rules, but it lacked competence when it came to understanding and listening to people with WDL. For example, when the interviewer asked Bertil what competence the Swedish Transport Agency should have, he answered as follows:

They could have listened to what I said. When they said, “You can’t see this,” I answered that I do see! /…/ They did not listen! They just turned it off.

Similarly, Lars considered that the healthcare staff lacked competence, as he perceived that their reporting his VFL to the Swedish Transport Agency had nothing to do with his driving competence, but was only an arbitrary, obligatory act. Thus, in the interviews, aspects of performance were linked to the perceived competence of the authorities.

Perceived incompetence was also expressed by Simon, concerning whether the Swedish Transport Agency’s investigators had adequate education for their work:

I noticed that my friend’s girlfriend, who works as an investigator [at the Swedish Transport Agency], her ability to drive a car is zero. What the heck, she got her driving license when she was twenty-seven or something! And they will investigate if others can drive a car… /…/ I don’t remember her education, but really nothing that has to do with… vehicles, or such things.

In this quotation, Simon expressed the expectation that those working on investigations concerning WDL ought to have competence in driving and vehicles themselves.

3.4.3. Coordination and Time Aspect

For respondents whose license had been withdrawn for several years, shifting responsibilities between authorities as well as new regulations led to an experienced and perceived lack of coordination between the authorities involved. One example was cited by Sara, who took an approved simulator test at VTI. To apply for a dispensation, in addition to the approved simulator test, she had to perform a new vision test. However, it subsequently turned out that, due to new rules, both eyes were tested together and not one by one as previously, so she would not have had to take the simulator test (which is paid for by the individual) or apply for a dispensation, as the new test results meant that she would have regained her driving license in any case. A desire for better coordination, in this case between VTI, where the simulator test was performed, and the Swedish Transport Agency, which made the licensing decision based on the simulator test, was described by Sara in the following:

And they do not work together, they work by themselves. /…/ So, when the rules were changed at the time when I did the [simulator] test, there should have been collaboration, to avoid spending [SEK] 19,000 [i.e., the cost of the simulator test].

One respondent, Roland, appealed the WDL decision but submitted the application too late, so it was not considered. Roland found the time allowed for the appeal to be too short, given that the WDL can mean “that you are so depressed that you actually need a little extra time to prepare yourself.” Overall, the respondents revealed a desire for more time to understand the WDL: “It all went very fast,” as Lars described it.

3.5. Struggling for Justice within a System Perceived as Unfair

The latent content of the interviews was condensed in the overarching theme struggling for justice within a system perceived as unfair. This theme included experiences of both outcome and process, intertwined experiences that evoked distrust within the actors involved concerning the system of license withdrawal. Experiences of outcomes (i.e., the WDL decisions) were primarily captured by the categories preparedness for and understanding of the WDL and perceptions of assessment methods. Experiences of processes (following the outcome) were related to the categories reactions and actions regarding the decision and perceptions of the authorities’ performance.

Perceptions of being a good driver, related to the opinion that the WDL decision was wrong as it was based on tests that did not measure driving ability, made it hard to understand and accept the WDL from the very beginning. The outcome was therefore perceived as unfair. Appeals were reactions to this perceived unfairness, struggles to achieve justice. Over time, feelings that nothing helps emerged, as the first WDL decision was found to be final. Furthermore, feelings of hopelessness and distrust were fueled by negative experiences and perceived deficiencies concerning, for example, performance and information. The experience of an unfair system was considered “confirmed” by many people in the same situation and by the critical international research that some respondents cited. The focus shifted from the individual’s own situation to concern about the WDL system at a societal level. Overall, the concern was about the legitimacy of authorities related to the performance of processes and the individual’s perceptions of outcomes.

4. Discussion

This study sought to examine how the experiences of people who have had their driving license for a private car withdrawn due to VFL might affect their distrust in the authorities related to outcomes and processes. The results will be described using the factors of the conceptual framework formulated for this study: benevolence, openness, integrity, value congruence, and ability. Finally, the complexity of the subject, as well as ethical issues, is discussed.

Several respondents had negative experiences of the performance of the physician/healthcare staff member who announced the VFL reporting to the Swedish Transport Agency, claiming, for example, that the physician was “un-psychological.” This experience concerns benevolence: the authorities’ understanding of the individual’s situation, conditions, and needs. Such experienced shortcomings concerning benevolence can negatively affect trust from the outset of the process (i.e., the WDL announcement). Presenting the WDL information constitutes a vulnerable situation, and as stated by Melander and Claréus (2019), a good encounter can positively affect trust, even if the outcome of a WDL decision is negative for the individual. In other words, a negative announcement can be mitigated by a good encounter, for example, in a personal meeting.

The interviews revealed denial regarding different events and situations concerning the WDL. These can be related to openness, i.e., whether the authorities understandably explain and justify their regulations, methods, and criteria for decisions. From the outset, the respondents did not understand why they had received the WDL decision. Several respondents stated that they did not know about the risk of WDL that their diagnosis could lead to; in combination with their own perception of being good drivers, this made the WDL decisions a shock. This result supports previous findings that most people do not consider or plan to stop driving as they view themselves as good drivers (Rapport et al. 2008; Whitehead et al. 2006). Altogether, this indicates a need for information and preparation at an early stage when considering a diagnosis of VFL and the risk of WDL. Furthermore, issues of openness and understanding are indeed related to outcome, as respondents did not consider that existing assessment methods justified the WDL decisions, since they did not measure individual driving ability. Existing assessment methods form the core of the perception of unfairness, and thus of the reduced trust in the WDL system. The respondents called for alternative methods, such as practical driving tests in real traffic. However, such tests are problematic regarding, for example, cut-off values (Bro and Lindblom 2018), and further research is needed. Additionally, as current Swedish regulations prohibit practical tests after receiving a WDL decision, the Swedish Transport Agency has proposed an inquiry to investigate the possibility of performing practical tests in connection with investigations of dispensations (Transportstyrelsen 2020b).

Appeals of WDL decisions are examples of justice-seeking acts. The respondents required reasons for the rejections, and they considered that the court judgments were biased and dependent on the Swedish Transport Agency’s initial WDL decisions, which they perceived as unfair. This matter concerns perceptions of integrity, of whether the authority is performing its tasks independently, fairly, and consistently. According to the respondents’ perceptions, the agency had not done fair and consistent work in that regard. Rejections of appeals worsened the distrust, and evoked feelings of meaningless struggles against a powerful authority. The WDL system was seen as arbitrary, rigid, and unfair as it was not based on individual perspectives and intelligible assessments. Yet, as Melander and Claréus (2019) noted, this entails a paradox, as an increased individual focus can lead to decreased predictability concerning the rule of law. Administrative law is about determining whether an authority has complied with regulations (Bendz 2010). Rejections of appeals mean that the authority, in this case the Swedish Transport Agency, has acted correctly on the basis of WDL regulations. Even though the process has gone correctly from a formal rule-of-law perspective, the outcome can still be perceived as unfair or unethical from the individual perspective, leading to negative perceptions of legitimacy (Bendz 2010). This situation might have been mitigated if the respondents had been aware of the formal rule of law, as described above. Such information should have been given at the very beginning of the WDL process by, for example, the Swedish Transport Agency or the healthcare staff member who announced the VFL reporting to the agency.

In general, the respondents considered that the Swedish Transport Agency has an important task in society concerning traffic safety. However, when it came to their experiences of WDL they perceived that the agency had the wrong focus: while they were trapped in a rigid system, losing their license on unfair grounds, other groups of unsafe drivers were still out driving. Overall, this concerns value congruence and the legitimacy of the Swedish Transport Agency. The results indicated that the respondents’ own experience of WDL can affect their overall trust in the Swedish Transport Agency as a state administrative authority. Further research is needed on this matter: according to Boyd-Swan and Molina (2019), the extent to which citizens perceive their values to be congruent with those of public administrators is an unexplored empirical area. Results of the authors’ own study support the hypothesis that increased levels of citizen–administrator value congruence are related to increased citizen perceptions of trust. However, in the case of WDL, the Swedish Transport Agency is not the only actor, as healthcare staff, the court system, and, in some cases, VTI are involved as well.

The perceived shortcomings regarding openness, benevolence, integrity, and value congruence can be linked to ability, i.e., whether the authorities are seen to be performing their job professionally. Also, distrust of actors involved in the WDL processes was fueled by experiences and perceptions of deficiencies regarding, for example, performance, information, and coordination, all of which concern ability. According to the results, a more intelligible assessment procedure and more effective coordination between the actors involved in the processes related to WDL would be advantageous, as they could facilitate understanding and effectiveness and decrease distrust. Furthermore, the respondents stressed the time aspect in the situation of vulnerability that the WDL often created, such as the importance of having sufficient time to undertake appeals. The often highly promoted goal of effectiveness that characterizes administrative policy (e.g., Prop 2009) can therefore give rise to problems, and this should be taken into account by the authorities involved in the WDL processes.

The results of this study are largely consistent with the results of a study by Whitehead et al. (2006), although their study specifically concerned older people. In the study of Whitehead et al. (2006), the WDL was experienced as a shock, as the respondents were unprepared and considered themselves to be good drivers. They expressed feelings of powerlessness and believed the WDL to be unjust, and they wanted to challenge the WDL decision. However, over time, most respondents reconciled with the WDL, and the fact that they may not actually be safe drivers. Thus, this is not in line with the results in our study, as all respondents continued to consider themselves unfairly judged, even among those who had been without a driving license for many years. This might be related to the specific impairment, VFL, and to the perceptions of assessment methods not being appropriate.

One reaction to the perceived unfair outcome was illegal driving as a way to defy the authorities and express distrust in the legitimacy of the authorities involved in the WDL processes. Previous research found that a decline in trust can lead to a decline in compliance with regulations (OECD 2013). This stresses the importance of people perceiving administrative systems and outcomes as fair, to avoid illegal acts being committed. Overall, the respondents considered themselves to be safe drivers. Although it is well known in traffic research that people generally overestimate their driving ability, often perceiving themselves as better drivers than average (see, e.g., Amado et al. 2014), the question arises of whether it is ethically arguable to make WDL decisions to avoid any possible risks from a traffic safety perspective, if these decisions are not based on knowledge of the individual’s actual driving ability. This concerns the principle of proportionality, i.e., that the actions of an authority vis-à-vis the individual should not be unreasonable in relation to inconveniences that could occur for the individual (SFS 2017). The societal goal of overall traffic safety comes into conflict with the individual’s interests and desire for justice. Altogether, the results illustrate the complexity of WDL due to VFL, an issue that ought to be treated from several perspectives, concerning traffic safety, accessibility, and justice. This implies an interdisciplinary approach in which the perspective applied should be considered in relation to questions of, for example, regulations and implementation/performance.

The results might apply to people with impairments other than VFL, who also experience WDL due to medical reasons. The results might also be transferable to other social sectors dealing with decisions and processes that can affect individuals and thereby trust.

In this study, factors such as age, diagnosis, and gender were not considered and therefore might be of interest in further research regarding possible differential effects on trust in authorities.

Methodological Considerations

This study was limited to the experiences of nine respondents, who experienced different types and extents of VFL due to different causes. Also, the duration of WDL differed among the respondents. For those who had experienced WDL for several years, both regulations and the performance of the authorities might have changed over time. Furthermore, at the time of the interviews, some respondents had received dispensations or regained their driving licenses (due to simulator testing or new regulations). These aspects were not considered in the study, and this might constitute a shortcoming from a methodological point of view. Nevertheless, the results indicate a consistent picture regarding WDL experiences related to trust in the authorities involved. Even though the results cannot be generalized to a larger population, they still have validity related to the knowledge area, so the results might well be relevant to similar contexts. Additionally, a strength of this study is that it was based on previous research, meaning that the respondents had been interviewed twice; this makes the empirical material rich and credible as no contradictions were revealed over time. Still, a complementary quantitative study on this subject is proposed.

5. Conclusions

The respondents perceived the WDL decision as wrong and unfair. Furthermore, they perceived hopelessness in their struggle to regain the driving license, also having negative experiences concerning, for example, performance and information.

Altogether, the results reflect the importance of processes, taking into account an individual perspective, and a transparent treatment with regard to the individuals concerned, in order to avoid deteriorating trust in actors involved in the WDL process.

The results of this study should be of interest to both academia and a broader public (e.g., state administrative authorities).