Pilot Health Issues and Ethical Issues in Aviation Medicine

Introduction

Warren Jensen’s analysis regarding pilot health stipulates that health-related issues are more sophisticated than the initially appeared. First, he highlights that with safety comes the mitigation of risk since we cannot eliminate it. One of the greatest challenges for aviation employees, according to Jensen is determining the variables which fall within the appropriate risks and which ones do not. He asserts that pilots have the mandate to assess medical conditions and consider how far they may be affected by the treatments they are undergoing (Hoppe, 2018, pg. 223).

Jensen also asserts that distinct sectors of the aviation industry handle medical readiness differently. The military paradigm is driven by a commanding authority which disregards the pilot’s discretion unlike in civil aviation. Eventually, in many areas of aviation, mitigating the risk is the amalgamation of guidance, rules, and procedures sprinkled with exceptional decision- making (Hoppe, 2018, pg. 223).

Proper risk management in the aviation industry demands that personnel in sensitive stations be physically and mentally able to perform sophisticated operations. It mandates individuals to self-evaluate their mental and physical conditions prior to duty. With respect to other factors, these decisions can be challenging and sometimes be made improperly. Jensen posits that aviation experts are often required to assess their capacity to perform when they plagued with potentially distracting influences such as fatigue, illness or stress (Hoppe,2018 pg. 223).

According to Hoppe (2018, pg. 223), Jensen contends that aviation professionals are medically screened every six to twelve months based on their duties. These exams evaluate their apparent conditions of health and screen for states that could influence their capacity to operate in the future. Concurrently, numerous conditions can disrupt their performance between these necessary medical screenings that do not need medical consultation. The process of determining their medical needs and making the proper decisions can be complicated and profoundly unclear (Hoppe, 2018, pg. 223).

Acceptable Risk

In Hoppe (2018, pg. 223), Jensen holds that the process to medically evaluate pilots is barely an exhaustive medical screening as it is a conscientious review and evaluations of the factors that would result in an impairment of the individual. The idea of acceptable risk depicts that some risk innate to medical conditions that may prevail albeit due diligence on the part of both the medical examiners and the pilot. For instance, at a certain age, pilots may suffer a heart disease resulting in a heart attack devoid any medical evidence or symptoms before the event. While this is a low degree occurrence, it is conceived to have sudden, unplanned negative impacts. Although the risk to the safety of operations, it is perceived as an acceptable risks (Hoppe, 2018, pg. 223).

Further, conditions such as a head injury may result in incapacitation during recovery from the injury. With the appropriate and timely medical evaluations, the risks can be identified although not completely eradicated. Jensen posits that, if pilots meet the apparent medical standards, they return to flight duty even when the risk of incapacitation is greater compared to individuals who have not suffered a head injury. The elevated risk as a result of prior injury is determined to be a very low-level event, similar to the innate acceptable risk in individuals devoid of substantial medical history. With the insight that humans are naturally susceptible to unintended medical events, they may be medically certified (Hadjimichael, 2009)

Hoppe (2018) on Jensen’s analysis notes that the Federal Aviation Regulations (FARs) were designed to enhance safe aviation, protect flight attendants, pilots and the general public from unnecessary risks. He adds that aviation medicine standards spell out rules for recognizing, characterizing and managing risks as a result of human physiologic performance. This process results in considerable discourse concerning the criteria that would entail an acceptable degree of risk impairment for individuals in safety-sensitive stations. Particularly, the problem faced by controllers, pilots, and their managers is whether a certain condition and its related performance challenges fall within an acceptable degree of risk (Hoppe, 2018, pg. 224).

Civilian Aviation

Hoppe (2018) asserts that the civilian aviation industry is guided by FAR 61.53 which states that an individual cannot act as a pilot in command while they are aware that they have a medical condition or under medication that would deter them from meeting the standards for the medical certificate necessary for pilot operation. He adds that the duty rests in the pilot to decide whether their state meets aviation medical standards, or otherwise, the capacity to hold an FAA medical certificate. Nay, the quality of this decision relies on the pilot’s capacity to assess their medical condition, the manner they will be affected by their problems and treatment and the apprehension of the applicable regulations (Helmreich & Merritt, 2017).

The basic guidance, in respect to medical states that influence human performance and flight, is provided in the inceptive flight training and through FAA publications. Jensen posits that rule-based decision guidance on some medical states, alcohol, and medications are found in the FARs and AIM (the Aeronautical Information Manual). He adds that not all medications have vivid guidance based on aids. Medical evaluations regarding non-rule based conditions may not be limited by cost or availability. As much as we may have remarkable guidance from the regulation regulatory, there still remains a gap in the information chain for traffic controllers and pilots attempting to assess the risks regarding their apparent medical condition. Albeit the efforts to avail guidance to pilots, numerous questions emerge concerning the risk evaluation predictable but unplanned challenges are a result of medical conditions (Hoppe, 2018, pg. 225).

Military Applications

Jensen, regarding the military aviation paradigm, the problem of medical readiness-to- perform is driven by a commanding entity without the pilot’s discretion. The responsibility of a military flight surgeon is to examine pilots who have consulted clinicians or experienced a medical condition before their return to flight duty. This necessity is vividly stated and provides limited room for discernment. The association between a flight surgeon and their unit is a thin line of enhancing performance and safety of the pilot and promoting health while identifying conditions that depict unnecessary risk in this demanding feature of aviation (Hoppe, 2018, pg. 225)

With this degree of control, decision errors sill transpire and often relate to the understanding of acceptable risk. Jensen posits that in the military paradigm, using flight medicine consultations has vivid benefits albeit it relies on the quality of decision-making of the involved personnel. He adds that in many parts of aviation, reducing risks is the integration of procedures, rules, and guidance grafted with good decision making.

The Nature of Fatigue and Stress

Hoppe (2018) asserts that various conditions have a substantial effect on human performance and are not regarded as illness or injury. Psychological stress and fatigue can influence decision making when operators start to change their risk assessments to stray from standard operating procedures. Fatigue and stress affect an individual’s capacity to monitor the quality of performance. This infers that stress and fatigue not only impact the quality of performance but also the capacity to assess it.

In his analysis, Jensen asserts that most people find it challenging to assess the performance effects of stress and fatigue According to a review of Aviation Safety Reporting, system data revealed that 20% of safety reports held that crew fatigue it a considerable factor.

Stress and fatigue are particularly common in the aviation profession and their impacts are regarded retrospectively. Jensen suggests that ethical decision-making demands that we understand the risks in real time situations. He also adds that it is the moral duty of decision- makers to practice due diligence in predicting the deleterious side effects of morally permissible action. Both traffic controllers and pilots ought to remain alert and standby to make a proper decision regarding their health and performance (Hoppe, 2018, pg. 229).