Honestly reconciling 1 and 4 is not possible unless you are a younger person who appears and feels relatively healthy and has not seen a doctor since childhood. There is no allowance on the form (1) for personal judgement for disclosure (4). I think that is where the debate lies. If it’s understood that the form is a liability release, then choosing 4 over 1 seems reasonable.
Yeah, and I don't think that I'm explaining myself that well. I guess what I'm saying is that there are two things - the paperwork that you need to train, and stuff that you need to disclose to people who are diving with you.
So I don't see why - if you have a medical clearance note - you need to give RSTC or PADI or your instructor information about your history of depression or recreational marijuana usage, especially since you have no way of knowing how that will be stored or disclosed in the future. The note should satisfy those entities from a liability point of view, and ideally would also be good medical care, since you would have had whatever workup your doc felt necessary to clear you.
However, if you are, say, allergic to peanuts and carry an epi-pen, I think that it's a good idea for anyone you are spending any time with to know about that.
So as far as reconciling #1 and #4, I would just do like @rsingler said upthread and have a good honest consultation with a qualified doc (based on your particular medical needs), and have them decide if you were fit to dive. If so, they would sign the form and then you can do the training. And if you had a specific thing that your dive buddies needed to know about, I would share that information with them. Why is that a conflict?
Now, I do understand what I think is your point - if the training agency insists on you disclosing PHI even IF your doctor has cleared you, then you have an ethical issue if you say "no" when something should be "yes". From the discussion upthread, as per @tridacna's conversation with the PADI training director, if you have the docs signature, then you don't need to fill out the questionnaire. I'm assuming that's the case, but even if it wasn't, the issue that I had about lying on the form was that you shouldn't lie to get OUT of a medical consultation and clearance.