The text of this paper is based on a presentation at the First International Congress of Maritime, Tropical,
and Hyperbaric Medicine, 4th July 2009, Gdynia, Poland. The assessment of fitness to work at sea is an
important aspect of maritime risk management. The risks in the industry, the approaches used for
assessment, and the evidence on which they are based have changed over time. The transition from an
industry in which the nationality of seafarers and the ships on which they worked were the same to one in
which ownership and crewing have become global means that, as is true for most other aspects of maritime
risk management, compatible international criteria for decisions regarding fitness to work are required.
Many parties, including flag states, employers and their insurers, and seafarers and their trade unions,
are involved in agreeing international medical fitness criteria. While all have a common interest in improved
health and safety at sea, each has their own more detailed agenda of sectional interests. The
scope for development of agreed standards and the role of the parties involved is reviewed, and the
current arrangements for taking this process forward are discussed.
Contributions from maritime health professionals and other medical and scientific experts are essential
to the development of rational and valid criteria, but the decisions on the level of authority to be given to
these and the means adopted for ensuring compliance with them are essentially political issues where
the voice of those with subject knowledge is only one among many in the processes for adoption and
implementation of any new arrangements
