Australia and diabetes release

[Cacia]

please do not anyone misunderstand me. I am not saying Diabetics should dive. I am saying it is not up to the operator. I do not think it is lying becuase I do not see that they have the right to the information.

If this is inappropriate to discuss in a forum for dive medicine professionals, maybe we could move it?....and let it continue in the context of what dive operators want and what we are obligated to divulge. This way we could leave diagnostics out...more of a bioethics discussion....or was it already moved ? (I am confused)

 

[DocVikingo]

Organized scuba has done a near miraculous job of self-regulating, thereby almost entirely staving off the imposition of laws, regulations and standards by federal, state and local governments.

This accomplishment is in no small part due to divers following industry rules in an honest and ethical manner, such as being forthright in completing medical questionnaires.

If and when enough divers lie accidents will occur and they eventually will catch the eye of federal, state and local government. When that happens, laws will be passed, such as the mandatory medical examinations in Queensland, Malta and other venues.

It's instructive that a number of preventable diver deaths due to medical reasons have occurred in Australia over the past several years. Many of these were the result of divers not being truthful about their medical status and made the news. Now the Queensland government is considering more rules and tighter enforcement.

I repeat, it's prudent to report diseases and disorders because these are the uniform rules of organized scuba, a pursuit in which you have voluntarily chosen to participate and whose overall welfare is in your best interests.

Regards,

DocVikingo

 

[divingjd]

As usual, DocVikingo is right. It is not just you, it is the people you are diving with and the operator. I know that you say you are making the decision and you are taking responsibility for yourself, but if you drown while diving, or have an embolism or near-drowning incident and are unconscious, other people are going to make the decisions, not you. Chances are your grieving relatives are going to sue the dive op. Even if the dive op is eventually successful in defending itself, it will have incurred thousands, if not hundreds of thousands, of dollars defending itself. And that does not even take into consideration the time and effort required of the owner, instructor/divemaster, or anybody else involved. These people will be distracted from their livelihood, which is likely pretty meager to start with. If I found out someone lied on the medical form for my class, I probably would not continue to teach them and they would never dive with me. Doc's right that it is just part of the agreed ground rules of this obsession we all have. It is not fair or responsible to your fellow divers or a dive operator.

 

[mandjrae]

Docvikingo and divingjd, while you make some good points, let me make mine. First of all, my dive buddy, who also happens to be my wife, knows darn well of my condition and is there to act or alert anyone of any potential problems that may arise with me, a diabetic diver. I do not depend on "other divers", with the exception of my buddy, to know of, or treat, my condition. Second, before each dive I check my sugars to make sure I am within the proper range. My diving experiences have taught me that I use up sugar very quickly underwater and I need to start with higher glucose and a supply of complex carbs within my GI tract. Third, I carry a bottle of squeezable glucose in my vest underwater in case of need. Fourth, alerting a dive operator to my condition will most likely result in me not being able to dive; my disease is a manageable condition of which I keep very knowledgeable about, not something that will keep me from doing what I love. The liability waiver forms are pretty much standard whenever one signs up for a dangerous sport, when I do not check off diabetes, I am explicitly acknowledging my assumption of risk. I'm not going to sue.(Divingjd, I'm one as well; you know what I'm talking about.) Fifth, my doctor has cleared me; somehow I don't think that will fly with the dive operator, who is only concerned about liability (see 4th point). It's so easy for those with no health problems to discriminate against to take the high road and say that everyone should be truthful and such. But then again, they do not have to deal with the discrimination that comes with being a diabetic who is seen using needles and is viewed as somehow different and unable to dive. I drive every day, would you have me take a bus because there is the possibility that I may black out and kill someonw. I don't ask for any special treatment, just to be allowed to do what I love. Respectfully, give me and all us diabetics who are knowledgeable about, and control their disease, a break.

 

[ItsBruce]

This is a tough issue with good points on both sides. On the one hand, I'm not sure I want the dive operator to know my very personal business. On the other hand, the dive operator has a right to know what he/she/it is signing on for. For example, the operator might have to perform a rescue, an assigned buddy might have to perform a rescue, thereeby ruining his dive; an assigned buddy may need assistance, but might not get it from a diver who has his or her own problems. At a minimum, a problem could ruin the dive for everyone.

Still, if the dive operator can inquire about diabetes, where is the limit on what the operator can ask about?

If I am cleared by a good doctor who understands diving, that should be enough. In fact, any smart operator would be wise to leave it at that. Once the operator asks for medical information, it might have a duty to folllow-up with that info to ensure the information is accurate. Additionally, once the operator collects the info, it may have special duties to preserve it confidentially.

I'm inclined to answer "no"

 

[Cacia]

Thank-you both for posting and making articulate cases for your opinions. I was asked if "I even think about what I post?", and so of course I am pleased that my thoughts are apparently shared by some and may not be as "out there" as was implied.

I look forward to DocV making his case for where he will limit the access to medical information, and if I have a right to all of his which I deem relevant to his ability to be my physician without endangering me or others in some way.

Bruce, as usual, clearly sees all the issues and yet settles on the pragmatic, wisest view for the operator.-- It will be unwise and not in an operator's best interest to open Pandora's box. Along with the information comes the burden of responsibility and they are just in no way qualified to deliver that.

Manjrae: I will dive with you...you are probably more educated (certainly more "invested" in being a safe and prudent diver), than the average person. Managing blood sugar is similiar to gas management in the skills utilized and I bet you are safer than the average diver. More power to you for taking life on and remaining inspired and engaged in what you love! Your quality of life matters to me, and I will fight for your right to dive anywhere you and your hired medical opinion deem appropriate.

At the heart of this debate is a principle that rages across this country, presenting in different ways, but essentially a question of eroding personal freedom and individual rights. Yes, I think about what I post.

 

[DocVikingo]

The scuba diver voluntarily waives his or her "right" to keep personal medical information personal when they contract for training with a dive agency or for diving with an op. It is the agency's and op's perfect right to ask the diver to be honest with them regarding medical conditions that could mean additional risks to the business, other customers and diver himself. There is nothing illegal, inappropriate or unethical about this. From a legal standpoint, the businesses would be insane not to.

In fact, asking the customer to complete a medical questionnaire is consistent with the guidelines of The Recreational Scuba Training Council (RSTC), a worldwide organization which establishes minimum training standards for recreational scuba in order to promote public safety. PADI, SSI, IDEA, SDI, Y-Scuba and PDIC, amongst others, are members.

A diver's verbal assertions that "I'm capable of monitoring my own medical condition, "I won't sue," "I don't pose a risk to other divers," and the like are both practically and legally meaningless. Even if they weren't meaningless, they wouldn't be binding on the injured or deceased diver's relatives, estate or other entity with legal standing in a negligence or wrongful death suit.

The diver participates in recreational scuba on a voluntary basis. No one forces him to and it's not an activity that is essential to one's livelihood or fundamental well-being. It is a recreation, a past time, a fun thing to do. The individual who does not like the rules or legal maneuvers that the sport uses to protect the diver, other customers and the businesses that offer scuba services, rules and maneuvers like completing medical questionnaires, doesn't have to participate. He or she can find diversions whose rules better suit them, recreations which don't require them to divulge their medical history. Heaven knows there are dozens and dozens of them.

However, if you want to dive then accurately filling out the various forms, questionnaires and waivers required by scuba companies is part of what you must agree to. Lying (and make no mistake about it, it is lying) when completing the medical questionnaire is not an ethical or effective way to address concerns about limiting access to medical information.

Regards,

DocVikingo

 

[Diver Dennis]

I will not disclose any medical information to a dive op. If my doctor tells me I can dive, I will. (I have no health problems) Dive operators are not doctors so unless I have documentation from my doctor proving I am fit to dive they could just say no. I don't think many people would dive with a condition that a doctor told them could be fatal if they did so. Waivers are for protecting the dive op and by saying no on the form, they are covered. I'm not going to get into a debate with them about whether a medical condition should preclude me from diving.
I wonder how many scuba deaths can be attributed to a known, pre-existing condition that a diver was told could kill them if they attempted to dive?

 

[Cacia]

I believe in preserving some boundaries.

 

[ItsBruce]

A little off point: What is the effect of HIPA if a dive operator gathers medical information on a diver? I have not researched this yet, but I suspect the op is subject to it if in the US. I would guess that if the op were sued for violation of HIPA, its insurance would not cover it. (Note: this is only a guess.) If I were a dive op, I think I'd ask whether there was any known health issues that should preclude the diver from diving and leave it at that. If the diver lied, that would serve as a defense in the event of an injury.