Family history

[Martin1234]

JAR-FCL 3.120

(a) Information to be provided. The applicant for or holder of a medical certificate shall produce proof of identification and sign and provide to the AME a declaration of medical facts concerning personal, family and hereditary history.

How is the "obligation" to give out family and hereditary history practised? I am aware of the form to be filled out by the applicant, but I don't understand how it's justified to ask the applicant those questions - not from a medical point of view but from a legal.

The rulemakers have in all JAA countries I know of decided that medical confidentiality is applied. I understand that the applicant for a medical certificate need to give out information, concerning the applicant hiimself, that is otherwise under confidenciality. It is a completely different story if the applicant is "obliged" to give out confidencial information concerning someone else. The applicant can decide that he accepts the fact to give out confidential information about himself, but he can normally not decide to give out confidential information concerning someone else.

Can an applicant for a medical certificate be denied on grounds that he does not give out confidencial information concerning someone else? What about a suspision of a "family and hereditary history", is the applicant expected to make a research?

[Bob the Doc]

A positive family history for certain conditions is essentially a part of your medical history as you have inherited genes from each parent. I don't really see the problem. The records themselves are confidential

[A2QFI]

Devil's Advocate here! If one was a 25 year old applying for licences and had been orphaned at age 6 months, would one be obliged to have knowledge of, or to search for medical details, of one's deceased parents? Would their GP be entitled to give this information to you if you asked him and he still held it or had access to it? Just a legal quibble really!

[Martin1234]

A positive family history for certain conditions is essentially a part of your medical history as you have inherited genes from each parent. I don't really see the problem. The records themselves are confidential

Please read my original post where I stated that I didn't question what you say about "inherited genes from each parent". It is more of a legal question, as legally it doesn't matter if the applicant gives out medical information about his parents or the Pope. It shouldn't matter if the records of the AME are confidential, as you have still told someone!

To give you just one example so you understand the question.

A doctor that enjoys soaring the skies in the weekends one day gets a patient - the father of the doctor. During the visit the doctor learns that the father has a medical condition that the JAA medical examination form asks for under "family history". Before the father leaves the room he says "don't tell anyone about my medical condition, please remember the medical confidentiality".

What should the doctor state under family history at the renewal?

If one was a 25 year old applying for licences and had been orphaned at age 6 months, would one be obliged to have knowledge of, or to search for medical details, of one's deceased parents?

It's very hard for someone to require you to tell something you actually don't know of.

Would their GP be entitled to give this information to you if you asked him and he still held it or had access to it? Just a legal quibble really!

Depends which country you are talking about. If the parents are still alive and don't give their consent, there's no way that either you or the AME can access the medical records of the parents (in a legal way).

I think it's very interesting legal questions and I suppose that a medical forum isn't the best one - although someone working in the industry reading this might have came across the problem.

[Bob the Doc]

Firstly, it is frowned upon to treat family.

Doctors are bound by confidentiality not to reveal medical details about their patients but they are also bound by a responsibility to society to protect it from danger. If the doctor is aware of a diagnosis that the patient has kept from people who might need to know (eg epilepsy being kept from the DVLA/CAA) then his duty to society probably outweighs his duty of confidentiality to the patient.

If you want a specific legal opinion then ask a lawyer though!!

[Martin1234]

If the doctor is aware of a diagnosis that the patient has kept from people who might need to know

Please read my post again. I said that the doctor is the one that is applying for a medical certificate, not the father. I rest my case, I don't think that you've understood the crux of the matter.

If you want a specific legal opinion then ask a lawyer though

I think it's an interesting legal question but I won't pay any money to have it answered. However, I don't think that any lawyer has a definite answer but I do suspect that if it gets challenged in court, the applicant is probably not expected to give out confidential information regarding another person but himself.

[Bob the Doc]

I would disagree. I re-read your post a number of times before replying. You state that the doctor found out something about his own father during a medical consultation which implies he was treating a family member which is against GMC guidance hence my first point.

To clarify the other point (and my main reason for disagreeing), if an applicant deliberately fails to mention a feature of his medical history, of which he is aware (whether personal or family) then he is on very stick ground indeed. To use an example...

Huntingdon's Chorea is an inherited condition which often presents in late middle age and frequently after the 'victim' has had children. It leads to progressive deterioration in neurological function. I would be astounded if the CAA took anything other than an extremely dim view of any person who applies for a pilot's licence and fails to mention this inherited condition as its implications for that pilot's fitness to fly are immense.

I will concede, however, that a second cousin twice removed who once had angina does not in and of itself constitute a family history of ischaemic heart disease.

It's a matter of degrees. If the family history may impact on your ability to perform your duties as a pilot then it is relevant to the application and the CAA medical department have right to know. It's a matter of public safety where the needs of the public outweigh the individual's right to confidentiality

bob

[Martin1234]

Huntingdon's Chorea is an inherited condition(..)

I've never questioned the medical relevance of family and hereditary history.

It's a matter of degrees. If the family history may impact on your ability to perform your duties as a pilot then it is relevant to the application and the CAA medical department have right to know. It's a matter of public safety where the needs of the public outweigh the individual's right to confidentiality

Now you are talking about the confidentiality of an individual (the family of the applicant) that might not fly and never applied for a medical certificate.

As mentioned, the applicant can only decide to give up confidentiality voluntarily (e.g. applying for a medical) regarding someone he can decide about. He can only decide about himself. That's why neither he or the AME can access medical records regarding a family member. Having said that, common sense says, as Bob the Doc states, that the AME can make a better medical assessment if family history is known.

If public safety never is to be compromised we can't live in what we define as a "civilised society". Why do you think that the police can't detain you for more than a certain period of time without a court proceeding? If the police thinks you are a hazard to the public safety, isn't it safer for the general public to just throw the key away?

Anyhow, isn't it possible to detect something like Huntington's Chorea by analyzing the blood of the applicant? I read that HIV is disqualifying for single pilot ops. HIV can be detected by analyzing the blood but those tests are normally not performed as part of aviation medicals. Does that mean that pilots are encouraged to have HIV tests done if they know that a positive result will give them an OML restriction? It's probably cost prohibitive to perform HIV and other tests on all applicants. I guess that it's a compromise between public safety and the integrety and economical burdan of the applicant, where the latter outweighed in accordance with the rulemakers.

[pofine]

If your family history is positive, then i guess you have a high chance of having that same disease in your genes... my parents are both diabetic and that's why i am too... i want to go to Maldives but i see that there is no pharmacy there.. i'm really sad!:( i've looked everywhere.. i only found empty pharmacy directory at http://www.drugdelivery.ca/xx-MV-01-A-xx/Seenu-Pharmacy.aspx ... if you find any hospital or pharmacy in Maldives, please let me know! thanks..

[Bob the Doc]

Anyhow, isn't it possible to detect something like Huntington's Chorea by analyzing the blood of the applicant?

Yes it is but you wouldn't do the test unless the patient had symptoms (in which case they wouldn't get a pilot's licence until the test had come back) or if they volunteered a family history of the condition.

AMEs take chances all the time. They sign people medically fit on day x but they could start having angina on leaving the consultation and it wouldn't affect their licence until their next medical. We can't test for everything in every patient because

1. it would be prohibitively expensive and
2. tests are neither 100% sensitive or Specific (both false positives and false negatives) so some people will be labelled (and refused licences) inappropriately

Is there a question in the medical history section that says something like 'Is there anything that may affect your fitness to fly?' if you know of a positive family history and then say no then you are lying on the form.

This is a bit of a legal minefield but that is the best answer I can give. If I speak to a medical law specialist I will ask them.

[obgraham]

Over here we're used to seeing lawyers nitpick the laws to justify their position. I'm sure, given high enough stakes, it would be no different in the UK.

Speaking with no specific knowledge of JAA rules, I think BobTheDoc's explanation is correct. I'm sure, however, one could find a case which would render that advice totally incorrrect. You cannot make a rule which will apply to every case -- we can only speak "in general".

That's true for almost everything in medicine!

[BeechNut]

Devil's Advocate here! If one was a 25 year old applying for licences and had been orphaned at age 6 months, would one be obliged to have knowledge of, or to search for medical details, of one's deceased parents? Would their GP be entitled to give this information to you if you asked him and he still held it or had access to it? Just a legal quibble really!

This is my situation exactly. I was adopted as an infant. I don't know what the situation is in the UK, but here in Canada, when I am asked about family history, I simply tell the examiner that I was adopted as an infant. He puts that down on the form, and that's the end of it.

It really is only so that the examiner can watch for signs of similar conditions to what your parents had, for example heart trouble if your father had a history of same, diabetes, etc. It won't "fail" you unless you happen to show signs of the same condition, but will enhance vigilance for the same conditions.

Beech.

[Bob the Doc]

Same in UK. If you're adopted or orphaned and you have no information, there is nothing that can be done and you have to hope there was nothing in the family history!

That said, the medical records of deceased people are kept for a period of time (I forget how long) so if you find out who your parents are/were, you can get the information if you need it.

[gingernut]

Unfortunately, nothing in medicine is absolute, and you will find the phrase "never say never, and never say always," banded around quite a bit in medical training establishments.

Most docs are probably better risk managers than they are technicians, and as Bob states, a clean bill of heath doesn't stop you dropping dead the next day.

The question of famiily history and confidentiality is interesting, and it may pay to remember that the communication between parent and child can not always be relied on. (Do you really know your fathers medical history?)

Referring to your original question Martin, there is no duty of confidentiality between son owed to father.