Should safety trump medical confidentiality?

The case of the Germanwings co-pilot reminds us of the important ethical challenge of deciding when public safety should override the fundamental right of any person to keep their medical information confidential.

In this specific instance, it is being alleged the co-pilot purposely took exclusive control of the plane, kept the captain locked out of the cockpit and deliberately crashed the plane into a mountain in the French Alps.

It is further being unofficially reported that documents found in his and his family’s homes indicate beyond a shadow of a doubt that the co-pilot has been receiving the medical attention of psychiatrists and neurologists for illnesses that affected his mental health and therefore his ability to perform his pilot’s duties with the physical and mental competence that is required.

Moving from danger to tragedy, we are left with troubling new information from the airline conglomerate (Lufthansa owns Germanwings) for which he worked: Lufthansa did have in the records of their training school a 2009 communication from the co-pilot advising them of a “serious depressive episode” around the time when he interrupted his training for some months, but since then they had no knowledge of any of his current medical illnesses.

After that “gap” in his training, he passed all the professional and medical tests and was granted his pilot’s licence. Consequently, the big issue is whether the doctors who were treating the co-pilot in recent years should have freed themselves of their “normal” and ethical duty to maintain secrecy about his mental health illnesses, in the greater interest of public safety.

How can medical confidentiality be more important than the lost lives of the 150 passengers and crew (including the co-pilot himself), in addition to the safety of all those other passengers and crews of other planes in the air and of all those persons on the ground in the Germanwings plane’s flight path?

The “authoritative” answer to those life-and-death questions is that, depending on the country involved, there can indeed be legally recognized exceptions to the rules of medical confidentiality.

In the U.K., there is a clear precedent, in the case of W v Egdell (1990) 1 All ER 835, for public safety to be accepted as one such exception.

Even though the patient may not have explicitly declared an intention to expose himself or any other person to harm, his personal doctors are not absolutely forbidden by law and professional ethics from spilling the beans. If, in their view, he represents a distinct danger to himself or to others, they can make the information on that specific danger known to the relevant authorities.

In that regard, we will have to await the eventual outcome of the German government’s official investigation into the Germanwings crash and, especially, the German authorities’ interpretation of German law and regulations as these relate to medical confidentiality and hence to any legal liability that may or may not fall to the co-pilot’s personal doctors.