Monday 20 November 2017

Mind Matters: Germanwings Crash will shed light on confidentiality

Andreas Lubitz
Andreas Lubitz

Patricia Casey

There has been endless speculation and counter speculation about the co-pilot of Germanwings Flight 4U9525 which went down over the Alps just over a week ago. Tragically all 150 on board were killed.

The parts of the Black Box recorder that have been recovered seem to indicate that when the pilot briefly left the cockpit to go to the bathroom, his co-pilot colleague, Andreas Lubitz (pictured), deliberately locked the door to prevent re-entry.

It is alleged that Lubitz then knowingly put the controls into descent mode so as to cause the aircraft to disintegrate on impacting the mountains.

Very early in the investigation it was claimed that the co-pilot took 18 months away from his training programme in Arizona because of "burnout", while other reports speak of "suicidal tendencies".

According to reports he received psychotherapy during this period. There is no mention of medication at that time. Sick notes for the day of the crash were reportedly found ripped up in his apartment.

Reports also claim that he had tablets stashed in his flat but details of these have not been released.

Furthermore it is claimed that he was attending doctors with eye problems and some have speculated that concerns about the loss of his sight might have driven him to suicide. Other statements contradict this, saying he had no eye problems.

The word "psychosomatic" has been mentioned.

On the assumption that Lubitz had a mental illness, of some as yet unspecified or undisclosed type, questions arise as to the responsibility of his treating doctors to notify the German aviation authority of this.

And the issue is not his past history - which seemed to have resolved - but his current state. Clearly the authorities were aware of some difficulties during his training.

The laws governing confidentiality in Germany zealously guard the individual's right to privacy. This is stringently protected as a consequence of the mass surveillance carried out by the Gestapo in the Nazi era and the Stasi in post-war communist East Germany.

Under German law, employers cannot access employees' medical records, and sick notes excusing a person from work do not specify their medical condition. Pilots in Germany are required to inform examiners at their annual medical checks of any relevant health issues. Thus disclosure depends on the truthfulness of the examinee.

German doctors have definitively asserted that they can report a person under their care planning a serious crime or activities that could endanger the lives of others, but only in the most extreme circumstances, when a crime is imminent, according to Doris Berve-Schucht of the Health Ministry.

Violations of medical privacy can carry a prison sentence of up to five years and there is no legal obligation to do so, being left to personal judgement.

By contrast, in the US, where many states have a duty-to-ward, doctors who remain silent are exposed to lawsuits.

In Ireland, examiners at pilots' regular medical checks or when applying for a licence, can request specific information from the person's general practitioner and from any specialists they have been attending.

It is widely assumed in this country that doctor-patient confidentiality is absolute, but this is not accurate. Doctors are allowed to break this ethical code, in certain circumstances.

The Guidelines of the Irish Medical Council specify that the canons of confidentiality can be broken in situations where the safety of the individual or of others is at risk.

I have had to do this on a number of occasions recently, after careful discussion with colleagues.

This case raises a number of issues.

The first of these relates to the rigour of the evaluation of pilots carried out by the parent company Lufthansa. With this airline's track record to date, this is unlikely to be a consideration.

The CEO has outlined the details of pilots' assessment and it does not in any way deviate from international norms.

The second issue, and the most controversial, is whether the current laws on privacy in Germany deterred doctors from indicating their worries to the authorities, if they had any about Lubnitz.

Did they feel hide-bound by sacred laws?

Finally, and perhaps the most crucial, in my opinion, is the extent to which a specific psychiatric diagnosis was made during his earlier protracted period of illness when he was training, the appropriateness of his treatment, and the extent to which this is now a consideration.

Perhaps if no definitive diagnosis was made, his suicidality and "burn-out" may have been regarded as a lifestyle difficulty or an existential problem.

Nobody has the answers in this current, partial vacuum but ultimately the truth will emerge.

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