Is privacy to blame for the Germanwings tragedy?

Since it was revealed that Andreas Lubitz—the co-pilot thought to be responsible for voluntarily crashing Germanwings Flight 9525 and killing 149 people—suffered from depression, a debate has ensued over whether privacy laws regarding medical records in Germany should be less strict when it comes to professions that carry special responsibilities.

The belief that Germany’s privacy laws are to blame for the tragedy has been voiced repeatedly (explicitly and implicitly) in numerous newspapers and magazines. The Times, for example, published an article entitled “German obsession with privacy let killer pilot fly.” Similarly, Time published an article entitled “German Privacy Laws Let Pilot ‘Hide’ His Illness from Employers.” Dirk Fischer, German lawmaker and transport spokesman for the Christian Democratic Union (CDU), has called for airlines to have mandatory access to pilots’ medical records. He has told the Rheinische Post newspaper that pilots’ employment contracts should oblige them to see doctors who are nominated by the airline and who have the duty to inform the federal aviation authorities and the airline of relevant issues regarding pilots’ health.

Frank Ulrich Montgomery, president of the German Medical Association (BÄK), disagrees. He pointed out that, under current laws, aviation doctors are relieved of their duties of confidentiality if they think a pilot could put other people’s lives at risk. Under German law, there are two exceptions that allow for a breach of doctor-patient confidentiality: when it is believed a patient is planning to commit a serious crime, and when it is believed that the patient suffers from an epidemic disease. If Lubitz’s doctor did not alert Germanwings, it must have been because he or she did not believe Lubitz to be a threat. If Lubitz did not share symptoms with his doctor that would make him or her believe that the co-pilot might endanger other people, there does not seem to be a reason why Lubitz’s doctor should have informed the airline of  his depression.

There are two arguments for why Lubitz’s doctor did the right thing by not disclosing Lubitz’s depression to his employer. Firstly, if confidentiality between patients and doctors is not taken seriously, if it is breached in cases of mental illness, for example, patients will no longer trust their doctors. A lack of trust will almost certainly lead (at least some) patients to hide some of their symptoms or refrain from seeking medical attention altogether for fear of bad consequences, such as stigmatisation and work-related penalties. More dangerous than a pilot with a mental illness is a pilot who has a mental illness but will not seek treatment because he does not trust his doctor. For these reasons, philosopher Kenneth Kipnis believes confidentiality to be “far closer to an absolute obligation that it has generally taken to be.” He thinks doctors should honour confidentiality even in cases where the patient might harm a third party. If patients come to doctors for help, doctors have a chance at avoiding a possible catastrophe. If patients lose trust on doctors and do not ask for help, nothing will be gained—patients will remain afflicted by their illnesses, and people who might be put at risk by patients will remain at risk. Functional doctor-patient relationships depend on trust.

Secondly, Lubitz’s depression is far from obviously related to his crime. Professor Simon Wessely, President of the Royal College of Psychiatrists and an adviser to the British army, said to The Guardian that “there isn’t a link between depression and aggressive suicide.” Jürgen Margraf, psychologist and professor at Bochum University, likewise told NBC News that a person with depression is on average less dangerous to others than a person without depression: “The chances of killing others are higher for non-depressed than for depressed people.” People with depression might be more inclined to commit suicide, but committing suicide is a long way away from killing 149 people in the process. Most depressed people do not want to harm others. As Matt Haig, someone who has suffered from depression intermittently for 15 years, said: “The only life I’ve ever considered taking is my own.”

Since Lubitz’s depression has not been shown to be related to his role in the Germanwings crash, and is therefore not obviously in the public’s interest to know about it, I find it morally questionable that his medical history of depression has been exposed so freely. In Germany, medical confidentiality is valid after death. Publicly disclosing Lubitz’s depression harms the public trust in doctor-patient confidentiality after death, and it may stigmatise people who are suffering from depression but who would never hurt anyone (but themselves).

The avoidable death of 150 people is a calamity, and it makes sense to have a public debate about how to prevent future similar events from happening. Luckily, breaching confidentiality and endangering relationships between patients and doctors is not the only alternative to try and prevent future crashes. The simple rule of requiring two people in the cockpit at all times—a rule already applied in many US carriers—would have been enough to avert this disaster. As a reaction to the Germanwings crash, the cockpit “rule of two” is being implemented in several European and Canadian airlines; it will surely save many lives, and it will do so without violating anyone’s privacy.

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8 Responses to Is privacy to blame for the Germanwings tragedy?

  • dave says:

    sir Simon wesselys science opinions and the rest are rubbish and i wish he would get lost.
    stop supporting this bigoted man who treats ME CFS patients so badly.
    The science in America being done by Lipkin who disproved XMRV as the cause of ME now shows ME not to be psychological but a disease .
    thakyou Stanford university for your recent research .
    Simon calling ME a lifestyle choice insults me tell him to get lost.

  • Roland Nadler says:

    What a great post on a timely and important topic — thanks for this, Carissa. Adding to your argument, I’d just point out that the American legal profession over the course of its history has served as an apt illustration of what happens when those in charge of policy try to “root out” mental illness. Namely, it causes people to avoid seeking treatment altogether, to lie or withhold key information from their care providers, to self-medicate in dangerous ways, and so on. As a result the legal profession in the US is still recovering from decades of problems with untreated mental health issues and substance abuse; thankfully, policies have grown more sensible over time, although some state bar associations still ask all applicants whether they have a condition that could “interfere with” their practice of law — as though the big threat of interference comes from well-managed mental illnesses rather than from issues we incentivize people to hide away.

  • David says:

    Fantastic post. People need to be reassured that this kind of horrible crimes do not repeat. Fine. But to blame privacy rules for them is just nonsense. As you show, breaching privacy is an irrational way to achieve the purpose of preventing massive killings, as it is both an unnecessary and an insufficient measure to get there. Furthermore, such measure would foreseeably have terrible consequences.

    • Carissa Véliz says:

      Thank you, David. Yes, that is the philosophical upshot: violating privacy is neither necessary nor sufficient to prevent future accidents. On further reflection, it occurred to me that another good policy might be that, when doctors issue a “stay-home” order for people who have high-responsibility jobs, the employer is notified without being told the cause of the incapacitation. That would prevent pilots from flying when their doctors think they should not without violating their privacy (without letting their employers know about the details of their health).

  • dave says:

    Im sorry but I don’t care what people think I am not going to put up and be stigmatized and bullied by a Maddox award winner for complaints by the public
    i am not going to be told what to think by an expert harassing journalists and behaving badly in the press.

    I don’t want this abusive creepy psychiatrist anywhere near me tell him to get lost

    Sonia Poulton 21 September at 06:30
    Woke to find a long e-mail from Professor Simon Wessley…for those who don’t know, he is the big State cheese when it comes to ME…for many people his name represents years of their personal misery.

    My recent article on ME, effectively, opposes his stance on the illness and I have been repeatedly warned that I can expect a communication from him…well it came…he says I ‘may be surprised to discover’ that he agrees with most of my article and then he goes on to detail how much of it he actually didn’t like at all.

    Professor Simon Wessely

    He didn’t like me blaming psychiatry for standing in the way of research and treatment…he didn’t like that I didn’t give him credit for his ‘contribution to the debate’ and he most definitely did not like the idea that I say graded exercise is detrimental to the patient…oh no! That did not impress him at all.
    He said it all in a very nice way but it doesn’t take much to pick up the true tone of how someone feels about you…anyway, he invited me to meet him for a coffee to discuss his stance further…I have pointed out to him that I am extremely busy at the moment but I will be back in touch.

    The truth is this…I have done my research, and he knows it, and while as a journalist I should always be prepared to hear the other side of the story (I am) there comes a point when you know what you know and no amount of sharp words can change that…

  • dave says:

    I don’t think i can trust these supposed experts such as Sir Simon Wessely with any vulnerable person or to protect privacy

    Notes Safety? An Uninformed Opinion from a Professor of Psychological Medicine at King’s College London
    Leave a reply
    Chris Smyth reports in the Times 18th February 2014: “Patients’ records ‘will be safer on database than in the GP’s surgery’”.

    “Patient records are more vulnerable in GP surgeries than on a controversial new database, a leading doctor says.

    Sir Simon Wessely, Professor of Psychological Medicine at King’s College London, condemned “paranoia” over an NHS plan to link up patient data, as the British Medical Association said that it was deeply concerned about the way the scheme was being handled.

    Sir Simon, president-elect of the Royal College of Psychiatrists, said fears that insurance companies would be able to identify individual patients was a “red herring” and that the benefits far outweighed theoretical risks.

    “There’s this sentimental belief that if the GP knows everything about me that’s fine, but I don’t trust the Man from the Ministry. The stuff is already sitting there in GP surgeries,” he said.

    “It will be bigger in this central database, but I imagine it would be safer. Now you’ve got laptops and files lying about in GP surgeries,” he added, pointing to figures last week showing that 2,000 NHS records a day had been lost in places such as shops and landfill sites.

    He said that “GCHQ could crack [the database] but probably no one else”, adding: “I think it’s wrong to claim that there will never be a mistake because mistakes happen everywhere. But I’m not aware of any [breaches] that have led to harm to individuals. There is the certainty that it might help against a possibility that it might be misused.”

    Health chiefs say that taking information from GP records and linking it up with data from hospital would save lives by helping to track the progress of diseases and spotting under-performance in the NHS. A similar system already operates with hospital records.

    “I’ve just done a study linking military data with criminal records. If I was a computer whiz, I probably could have worked out who they were. But why would I do that?,” Sir Simon said. “And the idea that drug companies would risk all by taking data illegally — why would they?

    “The legal framework for access to this kind of data hasn’t been changed. There are the same incredibly high hurdles that people like me have to get through, and the key is that it’s got to be for the promotion of health and social care. They’re not allowed to get data and use it for marketing. It’s illegal.”

    Sir Simon criticised NHS England for not making the case for the scheme and said it been caught up in the unpopularity of the Government’s Health Act, which gives legal powers to take the data. “It’s that general modern sense of paranoia and mistrust,” he said.

    NHS reality. An NHS soapbox. Speakers’ corner for the NHS.
    Trying to get reality into the NHS

    Chaand Nagpaul, chairman of the BMA’s GP committee, said: “GPs are telling us that large numbers of their patients have not received any information, while others remain worried about who will have access to it and what it will be used for.”

    NHS England said: “We are absolutely committed to ensuring the public understand the benefits of this important initiative.”

    I wonder if the honourable professor has ever worked in a GP surgery or listened to the discussion at a partners meeting? How can he, with his intelligence, suggest that putting all your eggs in one basket is safer than many. It’s the same principle as investing – spread your risk. When there is a disaster in the new system be assured it will be large and destructive,….

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