The argument that there might be some end-users unable to renew their prescription seems mostly used to gain sympathy. Also this will most probably not be “a large swath of internet users”.
I do hope Actalis step up their game and regain some trust. Or it may become the next symantec.
That statement "may cause significant harm" is what I expect weighed on the CA's mind. When revoking a certificate could kill someone, and there is still a high barrier to exploit (i.e. no "proven method that exposes the Subscriber's Private Key to compromise") it should be up to the CA to clearly explain the situation, and up to Ryan to accept the explanation given. ("It is our position that your CA is ultimately responsible for deciding if the harm [...] outweighs the risks")
Clearly Actalis was not in a position to articulate the harm, which is their fault.
That said, I'm fully aware of the compliance hoops that must be jumped through when providing updates to medical devices. If you have to distribute firmware to medical devices, 4 months can be a remarkably fast turnaround. But in that case, CA-issued certificates are probably inferior to self-signed certificates (on an organisational level) that are not subject to external revocation.
* The baseline requirement is 64 bits of entropy and Actalis were providing 63 bits, i.e. only short by a single bit. It would seem unusual if the baseline requirements were a mere one bit of entropy from insecurity.
* The requirement for 64 bits of entropy is to reduce the risk of hash collision attacks [1] - which have only ever been demonstrated for MD5 and SHA-1, neither of which are used to sign certificates any more.
If web security was a tightrope, this would be like hearing that the second safety net, underneath the first believed-to-be-robust safety net, was found to be strong enough to catch a 900 lbs person, when it was specified for 1000 lbs.
I didn’t find the arguments of severity convincing then either. But the gist was that they need to be completely consistent and rigorous so it does make sense even if it is a massive inconvenience for people. Again.
I believe this is due to Actalis misunderstanding the exception. Mozilla provides an exception for exceptional circumstances which Actalis's obviously were not.