The medical profession is almost unrecognizable from what it was in the 1950s. My grandfather (MD) said as much 15 years ago before passing away. It has only changed more since then. The FAA’s policies are based on 1950s medical knowledge and opinions.

If you spend any significant time in online aviation circles, medical issues come up daily. People who had a diagnosis of ADHD as a kid (when getting diagnosed with it was all the rage) have to jump through insane hoops if they disclose that on their FAA medical. Meanwhile, existing pilots often avoid going to a doctor or seeking help when they need it because of the possibility of losing their source of income, temporarily or maybe even permanently.

So, in many situations, instead of having healthy pilots, we have unhealthy pilots. The policy sometimes has the complete opposite effect of its intended purpose.

But first the regulator need to take action and keep doing it.

> In the aftermath of the crash, experts proposed various measures intended to reduce the risk of pilot suicide, including a rule that there must be two crewmembers in the cockpit at all times. …] Shortly after the crash of flight 9525, the European Aviation Safety Agency began encouraging the policy in Europe in order to gather data about its effectiveness, but after the trial period was over, the results were not encouraging. […] the policy leaves the cockpit door open for longer periods of time, increasing the risk of hijackings, which historically have been much more common than pilot suicides anyway.

This seems to be the crux of the matter.

I’ve seen it argued that the only sensible post-9/11 security measure was reinforcing the cockpit door. Extra screenings, shoes off, no liquids - all this seems secondary at best, security theatre at worst, when compared to denying an adversary control of an airplane.

Having said that, I’ve also heard the theory advanced that even a reinforced door isn’t needed: passengers mental models have shifted from compliance to active resistance, and 9/11 may be impossible to repeat as a result.

This has been known at least since Charles Whitman packed his trusty Dexedrine while shooting up U Texas in 1966, and all the Columbine kids were heavily medicated, as is likely for other "mentally troubled" mass shooters before and since.

The medications responsible for this used to carry appropriate black-box warnings, but since it was a bad PR move, the FDA permitted them to remove it.

So let’s reframe it as: should we expect people to tell the truth about things that mostly don’t matter at a personal cost of their entire career, and all training costs?

If you disclose, you are punished severely and may never go to work again with almost no recourse by a system which largely ignores medical science. If you withhold, as almost all pilots are advised by colleagues and the doctors themselves to do, nothing happens. (When I went for an aviation medical, the doctor said: I’m not your family doctor, only answer the question I asked. If I need more information I can ask for it)

When faced by a system so perverse is it really all that unethical.

Brainwashing alone does not an ethical system make. You generally have to act ethically in order to teach other people to do the same.

At this point, the flight crews are a bigger threat to passengers than terrorists. Since passengers won't sit still for a hijacking anymore, terrorists effectively aren't a threat.

You don't need a heavily reinforced door. You only need one that prevents entry for a few seconds while the passengers figure out that they need to subdue the attacker.