The Goal of Special Issuance: Legal documentation of Risk

It's personal: After you inadvertently crash your aircraft into the child-care center, the Talking Heads and the NTSB will ask the director of aeromedical certification how he was justified in having issued you a medical certificate.
He is legally required to have an answer.
The process of special issuance is designed specifically to answer this question, so that after the unplanned catastrophe, the FAA aeromedical team will have a clear and defensible answer why you were given a certificate.

It's personal: After you inadvertently crash your aircraft into the child-care center, the Talking Heads and the NTSB will ask the director of aeromedical certification how he was justified in having issued you a medical certificate.