[Emphasis mine] That's like trusting a truck driver to not be sleep-deprived and high on drugs before he crashes, killing four police officers... but never mind. Let's go!
There's been several cases of class one holders testing positive to drugs, alchohol and I can say many pilots have flown fatigued just to 'get home' or 'get the job done'. I know several class one holders that have had cardiac events within months of having ECGs. Class one medicals do nothing to stop these events they only control what happens afterwards once the case is known. Which is usually after the problem is solved so AvMed need not get involved. Heavy vehicle drivers are under the same scrutiny, you have to notify your local licence issuer if you have certain conditions and they will possibly notify you of licence cancellation until certain tests are complete. If you drive with a known prohibited condition you will be punished heavily and if someone dies as a result you will be charged with manslaughter. It's just with pilots you have to notify AvMed of your condition or you can choose to hide it and hope your medical professionals don't dob you in.
What stops a airline pilot flying severely affected by drugs or alchohol, not just damp, but the multitude of other people they have to work with who will notice the condition. What stops an outback Chieftain freight pilot from the same, nothing, the same as the truck driver.
The best person to assess your medical fitness is YOU!
The rules should be self certification with heavy penalties for not following disclosure rules.
There's only one area I disagree with full self certification and that is fatigue, as airlines can weasel the rules to make it difficult and almost punitive to use fatigue leave. So the rules need to be tight around mandatory rest periods and lengths of duty. FRMS as it is is a joke, compared to truck driving duty limits.
PS, just remember every time you take that overtime payment and extend into overtime tired, that data is captured by your companies FRMS which then extends the parameters by which they can roster you. Every time you call in fatigued within a normal roster cycle it shrinks the parameters. So doing lots of overtime tired is really going to count against you in the long run, so think about how much that OT is really worth over a long career.