Should dive medicals be mandatory?
When discussing whether something should be mandatory, a big question is what it's intended to do, since that's to be weighed against imposing a requirement infringing the liberty of people who want to participate in the activity without having to do it. In these discussions the main focus tends to be on reducing death rates, but there's a lot more to it. From past discussions, I'll try to highlight a range of concerns. This may be a bit scatter-brained. My comment are solely regarding adults; minors aren't assumed to be legally competent and responsible to the extent of adults, so more regulatory oversight for them can be legit. I will assume 'dive medical' means get evaluated in-person by a physician of nurse practitioner to assess fitness for diving so this person can bar you from it if he/she considers you unfit for it. I'm talking about certified divers going diving, not people taking classes under the care of a dive professional, which introduces added ethical concerns.
1.) In theory, dive medicals are supposed to identify people at unacceptably high risk (which there seems to be no objective quantified parameter as to how, where and why that line is drawn) for diving. It is assumed the physician or nurse practitioner is competent in evaluating the matter and takes the time and effort to really understand this and thoughtfully perform the task and solely with the diver's interest in mind (often wrong), and that all good, right-thinking adults would of course defer to the professional assessor's judgment. There are a range of problems:
-----A.) Some care givers aren't knowledgable about diving, have busy caseloads, and will largely sign off quickly on the diver's say-so.
-----B.) Some care givers are intimidated at the prospect of putting themselves in the path of a potential malpractice suit if the diver dies diving, and may lean too far toward protecting themselves, or refuse to do it at all.
-----C.) For some people, getting such things is inconvenient and costs more time, effort and money than they care to pay.
-----D.) Some people are more willing to tolerate risk to do what they enjoy than 3rd parties (e.g.: care givers, dive op.s, dive op. insurance companies) would prefer, and wish to dive despite the recommendation.
-----E.) Not everyone is inclined to aid and abet a 3rd party over-ruling their personal liberty. This is similar to the seat belt and motorcycle helmet laws for adults - do you believe 3rd parties have a moral right to compel you to such when it's largely you who face the consequences? If motorcycles have higher fatality rates than cars, instead of requiring helmets, why not outlaw motorcycles? Is the discrimination rational or political?
I think this is a very important discussion the dive industry needs to have, particularly following a recent high profile death.
2.) The unspoken presumption that the relational scuba diving fatality rate is unacceptably high and must be reduced is not a given. Is it worse than rock climbing? What's the 'right' death rate? It won't be zero.
To put this in perspective, and with the disclaimer I don't know what recent high profile death you refer to, let's say I respond to you telling me there's been a death scuba diving by saying '
Gee, that's sad. So?' I don't think we're supposed to 'change the world' every time somebody dies pursuing a hobby. If there's an obvious lesson to learn, try to get the word out.
3.) Dive operators use liability waivers and medical questionnaires to protect themselves from potential lawsuits. Some don't seem to care whether you lie on your form, as long as they either have a form saying you had no issues of a care giver form saying your issues weren't issues for diving. Either way, their butt is somewhat covered.
4.) Dive insurance providers for dive operators. In America, our culture is often viewed as blame-externalizing and 'litigious' (i.e.: 'sue-happy'), prone to lawsuits without legitimate moral merit but extremely costly to defend against. Someone makes an informed decision to dive despite the risks and dies, the aggrieved family blames the operator rather than the diver despite that being silly and wrong, sues, and the dive operator could go bankrupt fighting even if it wins.
-----The is a legit concern, as it not only adds to operational expenses but it's become hard to some operators to even secure coverage! The issue is not exclusive to the dive industry.
-----So should we capitulate or refuse to capitulate, championing individual liberty and self-determination though we're probably not going to over-throw America's blame-externalizing, sue happy culture? (Disclaimer: not all dive-related law suits are without merit).
5.) If you dive with risk factors and die on a dive, a dive guide or buddy might pursue your sinking body, imperiling themselves with risk for the bends, etc... Your death may traumatize sensitive fellow divers (maybe even some staff), and disrupt their day trip or liveaboard. If you're hard to find, the search may be bothersome, time consuming, expensive and stressful.
6.) No man is an island - the diver might have a spouse, minor children, etc..., and what you do has indirect effects on others. But where does that stop? To what extent can regulators control your life choices because of indirect effects to others. This is often argued with helmet laws - the motorcyclist might be at higher risk to become a quadriplegic financial drain on the rest of us, etc... Seriously? Does that happen often enough to drive major health and legal policy?
7.) There's a perception the U.S. dive industry consumer base is shrinking and needs to more effectively draw in more business. Added hassle, expense, irksome demands and at times exclusion isn't conducive to that.
In addition to that, a related issue we go round-and-round about is whether checking 'no' to all questions on the health screening forms is morally reprehensible lying for selfishness, or preserving autonomy and confidentiality and resisting undue intrusiveness and unjust discrimination/burden. I'm talking about minor and/or well-controlled conditions, in some cases cleared by a care giver in the past with no changes but the form expired so it's a technicality, not epileptics, poorly controlled diabetics, etc... There are threads where we've fought that fight at length.
Getting back to your first question, should dive medicals be mandatory? I say no. But I must ask you...what purpose would you be trying to achieve by making them mandatory?
