Germanwings disaster: Time to stop protecting medical privacy of pilots, others who hold our lives in their hands

We don't yet know the exact medical condition that Germanwings co-pilot Andreas Lubitz was hiding from his employers.

But we do know that he had a medical condition, and that he tore up some of his doctor’s notes, including one that excused him from working on Tuesday, and that he went to work in the morning instead of staying home.

The relationship between mental illness and mass murder – whether by guns or by terrorism or by airplane – is indisputable, and the time to take measures to prevent deaths caused by that relationship is long past due.

And we know that later that morning, 30 minutes after takeoff, he locked the pilot out of the cockpit and crashed an Airbus A320 into a mountain in the French Alps, killing himself and all 149 others onboard.

The relationship between mental illness and mass murder – whether by guns or by terrorism or by airplane – is indisputable, and the time to take measures to prevent deaths caused by that relationship is long past due.

And this forces us to ask two very disturbing questions:

1. How do we know that the people who hold our lives in their hands – our pilots, our bus drivers, our train engineers, our ferry captains, our bus drivers, even our Uber taxi drivers – are mentally and physically up to the job?
2. And how far are we willing to go to protect the privacy of strangers whose physical and mental condition are unknown to us, and possibly to their employers too, when they are responsible for our own safety and well-being?

A Germanwings spokesman said Friday that its pilots receive medical exams at least once a year, but that they’re primarily physical checkups. When it comes to psychological fitness, pilots are given a questionnaire that they fill it out and sign “on their honor.”

Effective immediately, that’s not good enough anymore. The relationship between mental illness and mass murder – whether by guns or by terrorism or by airplane – is indisputable, and the time to take measures to prevent deaths caused by that relationship is long past due. The health issues of individuals that put the public at risk simply have to be addressed, even if it means sacrificing some personal privacy. Self-reporting just won’t do.

As an ophthalmologist, when I treat someone who is visually impaired, I take into consideration the impact of his illness on his daily life and performance, and I make a judgment on his ability to function. But I am not allowed to notify my patient’s employer, without his permission, if I feel he is unable to perform his job. It’s ultimately up to my patient to decide whether doing his job will put others at risk.

Every physician today faces this concern. We have to follow the oath of “first do no harm,” and we have the responsibility to maintain patient confidentiality. But we are not taught that there’s a broader perspective, a downstream effect. Our patients may have functions and responsibilities that affect the day-to-day lives of others. So when a doctor gives a patient a note excusing him from work, should he also have a responsibility to inform the patient’s employer? Should he be obligated to report that his patient could be putting others in harm’s way?

The answer right now is no. But the crash of Flight 9525 means we have to find a way to balance private privacy with the public health issue of nondisclosure and make the answer yes. We have to find a way to exchange personal health information between responsible parties that maintains confidentiality and also ensures that all parties are aware of a situation that could lead to a disaster.

Going forward, it’s obvious that employers will have to set higher standards in terms of what they require of their employees on the “front line.” Clearly, we can’t wait for pilots to “self-report” psychological impairments anymore. But patients also need to know that their job status won’t be affected if their condition is revealed.

One obvious solution is to take greater efforts to reduce the stigma that remains attached to mental illness. We need to provide more resources and greater support so that patients will be comfortable communicating their distress and can get the help they need to recover.

Another is to employ third-party systems – ancillary workers and social workers – who can serve as intermediaries between employers and patients, working to ensure that employees with health issues have a network of providers available to them, and that they can still maintain their privacy.

Finally, workers on the “front line” – the pilots and bus drivers and train engineers and cabbies in whom we place our lives daily – need to have regular health evaluations that include psychological screening. If a condition is identified, then third-party providers that offer therapy or counseling can be buffers between employers and patients without risking too much privacy.

In addition to Andreas Lubitz, 149 people lost their expectation of fruitful private lives on Tuesday. This is all the proof we need that we may have to sacrifice a little privacy for a few to ensure the continuing privacy of so many others.