Pilot Medical Privacy Laws and Germanwings Flight Crash
The crash of Germanwings flight 9525 en route from Barcelona-El Prat Airport in Spain to Dusseldorf Airport in Germany, which caused the death of 144 passengers and 6 crew members, is considered to be one of the grimmest aircraft crashes in European flight history. The sad reality of this event was that this mishap was caused by the deliberate attempts of a deranged co-pilot, Andreas Lubitz, who was being treated for suicidal tendencies and was also declared “unfit for work” by his doctor. The initial investigations done by the BEA (French Land Transport Accident Investigation Bureau) revealed that the co-pilot, Andreas Lubitz, locked out the captain from the cockpit while the aircraft was flying over the French Alps .
This incident served as the primary influence for the decisions taken by many aviation authorities to make it mandatory to have two authorized personnel inside the cockpit at all times. Also, the fact that the co-pilot, who caused this incident, was under severe medication including anti-depressants, sleeping aid medication, etc, generated questions about medical ethics that prevented the co-pilot’s psychiatrist from reporting his mental state to AME (or any aircraft authority). In the light of these facts, many recommendations were provided by the accident analysis team that included the need for reforms for issuing medical certificates to pilots who were previously diagnosed with mental sickness. The issue of upholding medical ethics in situations where public safety can be compromised was also mooted in this report .
Analysis and Impact
While overflying the French Alps, the captain of Germanwings Flight 9525 left the plane to run some errand. According to the cockpit door security measures, the door locks automatically from behind in a particular way that only the person inside the cockpit can open the door . According to the flight’s Cockpit Voice Recorder (CVR) which recorded various sounds from the cockpit, the copilot Andreas Lubitz did not respond to the buzzer call (to open the cockpit door) the captain made from the passenger cabin. Andreas did not even respond to the communication calls from the control center or French Aviation Security. The CVR recorded some other sounds similar to that of a door knock (supposedly from the Captain) during this time. But, neglecting every chance for distraction, Andreas deliberately inputted a descent protocol into the autopilot which caused the aircraft to descend from 24,000 ft to 100 ft before crashing into the French Alps. The figure below shows the flight path of Germanwings Flight 9525 during its collision course.
The investigation team was astonished to find along the way that two persons actually had an idea that such an event might occur but never did anything to prevent it. Apparently, the death of 150 people and the total destruction of a million dollar plane were not up to par with the medical ethics of a physician and a psychiatrist. Investigations revealed that the copilot, Andreas Lubitz, was under treatment for psychotic behavior and suicidal tendencies. He was actually prescribed various antidepressants, antipsychotics, and sleeping pills during the time he flew the Germanwings Flight 9525. An even grimmer realization that the investigation team stumbled upon was that the physician and the psychiatrist had issued a number of sick leaves for Andreas Lubitz during the course of his treatment but never reported any such issues to the AME (Aviation Medical Examiner) or Germanwings at any point. This raised serious questions about medical ethics that stand in the way of public safety.
But if we are willing to introspect further into the supposedly detrimental actions taken by the physician and the psychiatrist that treated Andreas Lubitz, it is apparent that they would have been put under a lot more severe scrutiny for revealing the medical condition of Andreas than this accident would ever have. The ethical code that all medical personnel are required to adhere to is often followed strictly in fear that their violations can land a lawsuit at any time. Most European states have provisions for dealing with privacy issues where public safety is a concern. In these states, there is usually a separate class of ethical laws, that governs practices by physicians and psychiatrists that treat pilots, which dictate what these practitioners are required to report and what they are required to keep confidential. But unfortunately for some other states, such as Germany, there are no provisions other than the general rules that apply to all citizens (not particular to medical personnel) in this regard . So in cases similar to this accident, these medical personnel are not ready to risk their profession for some intuitive knowledge as there is no definite assurance that a person would commit something by virtue of his mental condition.
So after further analysis of this scenario, BEA (French Land Transport Accident Investigation Bureau) reached a consensus that instead of blaming the psychiatrist and the physician for their silence on the condition of Andreas, they should try and make recommendations to various authorities to amend laws that could prevent medical practitioners from reporting patients that pose a threat to public safety. The Aircraft Investigation Report filed by BEA, on this incident, highlights the need for a reformation and reformulation of rules such that medical practitioners should not hesitate to report such situations in the future. In this regard, they directed their main recommendations to the World Health Organization. The BEA requested WHO to define clear rules in the realm of medical ethics that can help medical practitioners to make sound judgments in matters regarding public safety and stop worrying about their consequences.
BEA also made recommendations to the European Commission to coordinate with European Union member states to define clear rules that direct health care providers to inform authority when the condition of a patient is very likely to impact public safety . In the specific case of Andreas, he deliberately refrained from informing AME about his medical condition (as per self declaration law). This is believed to have risen from his fear of losing Pilot License and also having to pay the hefty fine in case his license ever got cancelled (from the sickness). So in this regard, the BEA made another important recommendation to European Commission and WHO that they should consider such issues while formulating these disclosure rules. If at any time these patients fear that seeking medical help can affect their career, they might refrain from ever consulting a physician . So all the rules made in this regard, should uphold the privacy codes of medical practitioners while making a provision regarding public safety .
The direct impacts brought by this accident was the formulation of a new rule that stated that at least two flight crew should stay in the cockpit at any given time. Many airline authorities in the European Union had issued this rule. Also British Psychological Society agreed to the psychological testing of pilots suggested by airlines but added that such testing cannot successfully forecast similar accidents from happening. But regarding the ethical laws that prevent medical practitioners from revealing matters regarding public safety, it is still under consideration.
Conclusion
In conclusion, deliberate attempts to compromise the safety of an aircraft can only be derailed by in-depth assessment of not only the passengers but also the fitness of the cabin crew. Mental incapacitation of the cabin crew should be given serious considerations as much as their physical incapacitation during any flight. Regulations on this front should ensure that AME (or any kind of medical assessment team) consider mental health as a priority during medical examinations as they are diagnostically more elusive than physical health. The story of the mishap of Germanwing Flight 9525 is yet another reminder that in case of aircraft safety, compromises cannot be made.
Bibliography
Bureau d’Enquêtes et d’Analyses. (2015). Final Report. Marseille: French Civil Aviation Safety Investigation Authority.
Bureau d’Enquêtes et d’Analyses. (2015). Preliminary Report. Marseille: French Civil Aviation Safety Investigation Authority.
Nussbaum, A., & Rothman, A. (2016, March 14). Germanwings Probe Urges Change for Pilots’ Medical Privacy, License-Loss Cover. Retrieved March 29, 2016, from Insurance Journal: http://www.insurancejournal.com/news/international/2016/03/14/401695.htm
Walker, K. (2016, March 13). Germanwings investigator urges changes to pilot medical privacy laws . Retrieved March 29, 2016, from Air Transport World: http://atwonline.com/labor/germanwings-investigator-urges-changes-pilot-medical-privacy-laws
