Introduction
The Canadian Charter of Rights and Freedoms which was enacted in 1982 has a number of human rights
provisions, one of which states that “no person shall be discriminated against on the basis of disability”.
Given this constitutional background there have been an increasing number of challenges in the Courts and
Human Rights Tribunals on refusals to medically certify applicants with neurological disorders.
Aeromedical “unfit” assessments must therefore be based on current scientific “state of the art”
knowledge.
In the aviation environment neurological disease is a recurring concern for those involved in aeromedical
certification. The mode of presentation may vary from full-blown grand mal seizures or massive stroke
to the insidious onset of cognitive impairment in conditions such as multiple sclerosis and Alzheimer’s
disease. The prevalence and marked variability in severity of migraine has caused difficulty in
objectively deciding where the line should be drawn between “fit” and “unfit” assessments. The person
who has sustained a significant head injury is subject to the dual dilemma of risk of
posttraumatic seizures and also of cognitive impairment.
In 1977 in the United States, the Federal Aviation Administration solicited a proposal from the
American Medical Association (AMA) to produce an authoritative report on neurological disorders and
aviation safety. The AMA in conjunction with the American Academy of Neurology and the American
Association of Neurological Surgeons convened a series of meetings with experts in the field which
resulted in the publication in 1979 of a special issue of the Archives of Neurology, entitled “Neurological
and Neurosurgical Conditions Associated with Aviation Safety”. This document served as one of the
primary resources for Canadian aeromedical certification decisions on neurological disorders
throughout the 1980’s.
Advances in diagnostic imaging and the management of neurological and neurosurgical disorders over the
intervening years indicated that more current references were required. In order to address these
issues, Health & Welfare Canada’s Civil Aviation Medicine Division held a conference in June 1992 in
Ottawa, inviting experts in the field of neurology to
discuss the more common neurological disorders and their relationship to aviation safety.
The conference served as a basis for the series of guidelines published below.
It should be pointed out that this document is only guidance material and that each decision will be
based on the individual circumstances of the case.
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