As for the original question:
As a doctor myself I feel well qualified to know when I’m medically fit for flying and if not why not. If my “Fliegerarzt” took my medical away I could have a professional discussion with him and would probably follow his arguments and quit flying, unless they didn’t make sense from my medical point of view: in which case things would get interesting 
Incidentally I “only” have a class 2 medical because I didn’t need anything else and it was cheaper. But I have a rare condition which already made me “unfit for military service” (mainly due to the Bundeswehr physician not knowing the condition) and which made the AMC reckon that I could have difficulties obtaining a class 1 medical if I wanted one. IMHO that is disputable, I perform shift work caring for critically ill patients in intensive care or in the operating theatre day in day out. It’s not much different from a pilots job really as far as responsibility goes.
It’s not much different from a pilots job really as far as responsibility goes.
Regarding responsibility maybe. But the results you can obtain as pilot are far more drastic. With a PPL and a class 2 medical you can fly a PC 12 which seats 9 persons and can carry a ton of kerosene. Crash that into a fast-food restaurant (as has already happened more than once, but not with a PC 12) and you take out two dozen people with a single heart attack. It would take quite some effort to achieve the same in an emergency room i guess.
That is true in theory but in GA there are very very few cases of pilot incapacitation causing 3rd party casualties. It’s just an incredibly emotive issue, which is why the medical department is the most powerful one in each CAA. And very little has been achieved in Europe deregulating it.
what_next wrote:
It would take quite some effort to achieve the same in an emergency room i guess.
That is true. In medicine you rarely “take out” more than one person at a time through mistakes, neglegience or what have you. But it happens (relatively) often and much more subtle than in aviation. There is no crash, no explosions. Just people dying in a hospital which happens all the time (with society today having a big problem with their relatives dying at home even at ages where that is pretty natural, most people die in hospitals nowadays). So as a healthcare worker you sometimes even don’t notice that you may have contributed to someones death through mistakes and faulty decisions. Maybe they would have died anyways, maybe not. A pilot’s faulty decisions are usually much more apparent (and dangerous to himself/herself!)
what_next wrote:
Crash that into a fast-food restaurant (as has already happened more than once, but not with a PC 12) and you take out two dozen people with a single heart attack
So what do you advocate? 2 man rule for all airplanes?
From my own experience, medical screening even for a Class 2 is quite elaborate and sometimes over the top, unless you find a reasonable AME who knows what the real critical stuff is. In the end, it is sudden incapacitation which is the killer and IMHO that is what they should focus on instead of finding various other reasons why they can deny you a medical, sometimes even making up their own “rules”. There are massive differences between the different AMEs. I am very happy with the one I have now, not so with his predecessor.
Mooney_Driver wrote:
So what do you advocate? 2 man rule for all airplanes?
Of course not. But there are medical conditions which really are not compatible with flying. Losing one’s medical because of one of these and then continuing to fly is irresponsible, to say the least. I was once witness when a driver, who (as I later read in the newspaper) was suffering from diabetes fainted at the steering wheel and hit three other cars before being stopped by the guard rail. Luckily no one was hurt, but in an aeroplane he and everybody else on board would be dead.
The crash into a fast food restaurant happened close to where I am at the moment. It was a flight with an examiner from Luftamt Südbayern. 1987 and a Cheyenne II, if I remember correctly. Cause was an inappropriate sudden reduction of power by the examiner.
This thread was started 4 years ago and has nothing to do with my current situation.
mdoerr wrote:
Cause was an inappropriate sudden reduction of power by the examiner.
Yes. The examiner had a dozen or so typeratings in his license. Most of the types he flew only a couple of times per year from the right hand seat when doing checkrides. After this crash they changed the rules. Unfortunately it always takes a crash into a restaurant for things to change (another one was this one here: https://en.wikipedia.org/wiki/1972_Sacramento_Canadair_Sabre_accident which changed the rules under which historic aircraft are flown and displayed in the US).
what_next wrote:
Of course not. But there are medical conditions which really are not compatible with flying. Losing one’s medical because of one of these and then continuing to fly is irresponsible, to say the least. I was once witness when a driver, who (as I later read in the newspaper) was suffering from diabetes fainted at the steering wheel and hit three other cars before being stopped by the guard rail. Luckily no one was hurt, but in an aeroplane he and everybody else on board would be dead.
Sudden incapacitation is caused by very few medical conditions, the most common probably being:
Diabetes mellitus, as described in your example, usually doesn’t lead to sudden incapacitation, but the symptoms of hypoglycaemia can be ignored or overlooked by patients for too long, leading to the kind of incident you described. Epilepsy is rare and its first manifestation luckily rarely happens when somebody pilots a plane/car/train etc. I was once a crew member on an ambulance car and we dealt with an 21year old Lufthansa ATPL-Student who suffered from his first epileptic attack. Poor fellow, that day probably ruined his entire career.
Cardiac arrest or stroke however are much more common after a certain age and the major cardiovascular risk factors are nowadays known even by most laypeople: smoking, obesity, inactivity, high blood pressure and diabetes (the latter too resulting mainly from the first three factors). And of course genetics play a major role.
So how far do we go when we want to rule out people at risk of sudden incapacitation from flying a plane? If you want to be as safe as possible, you should make anyone who
fail their medical. This would be extreme and would probably rule out many of you guys, but this is meant to demonstrate how difficult it is to assess such risks from a medical perspective. 30 year old people do get heart attacks, I treated such patients myself in my as of yet short medical career of three years. Heck, one of our intensive care nurses suffered a stroke at 23 years old and she isn’t overweight nor has diabetes.
Difficult stuff, this! I’m glad most of my colleagues working as AMEs do a great job nevertheless!
It’s not hard to assess the risk of pilot incapacitation, the record shows it is negligible. For private pilots who are unlikely to hurt anybody regardless, the benefit of an AME medical is likewise negligible. My medical exam is trivial, 20 minutes at most, because I use an AME who does it that way. My real periodic medical exam is important, the AME exam (regardless of who does it, or how) is waste of time for everybody involved.
