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The apparently deliberate crashing of a packed Germanwings jet by a pilot who had previously experienced suicidal tendencies has triggered debate about whether airlines should get access to the medical history of their employees.
Andreas Lubitz, 27, who suffered an episode of severe depression during his training, had been excused from work by doctors for an unspecified illness on the day of the crash — a fact he appears to have concealed from the airline, according to prosecutors.
Cockpit voice recordings suggest the first officer deliberately crashed Flight 4U9525 into the French Alps on March 24, killing all 149 others on board.
The crash has thrown a spotlight on the opaque world of mental health screening for pilots, who face regular physical testing but are often expected to self-declare illnesses such as addiction or depression.
German lawmaker Dirk Fischer, transport expert for Angela Merkel’s CDU party, is calling for airlines to have mandatory access to the medical records of all pilots.
“In an employment contract … it should be defined that the pilot releases the company-mandated doctor for medical confidentiality,” Fischer told the Rheinische Post.
U.S. pilot health screening, which has changed little in recent decades, is ripe for review according to Illinois-based aviation psychologist Diane Damos.
“Twenty or 30 years ago almost all of our civilian pilots with major airlines were ex-military so they went through a military selection process and had flown for years as military pilots,” she told NBC News. “These people had been closely observed for a long period before they came to major airlines in the U.S. That is no longer true, particularly for regional airlines.
Damos added: “It’s possible for somebody to go to their local airport and get their [certification] and then work as a flight instructor or cargo pilot and then they join a regional airline and that person is, in lot of ways, unknown. Because the change has been gradual, I don’t think the airlines or the government have really thought through the difference.”
However, many experts and pilot groups say surrendering medical privacy is unnecessary — and could even force any future cases reminiscent of Lubitz to stay under the radar.
“A knee-jerk reaction to the tragedy in the Alps is not appropriate, wise or necessary,” former Airbus A320 captain John Cox told NBC News. “It would be a mistake, a large mistake, to dramatically change the existing process until a careful review, discussion, and evaluation is undertaken.”
He added: “It is not a simple case of a doctor picking up the phone can calling the airline. There is nothing simple about the process whereby a doctor violates a patient’s confidence, or the subjectivity involved.”
There is no global consistency across the aviation industry for dealing with pilot health certification.
"The system is entirely reliant on self-declaration"
In the U.K. and Germany, commercial pilots have their mental health assessed during each medical exam, which is typically done every year. Pilots give permission for aeromedical examiners — but not airlines — to access their medical records.
In the U.S., the Federal Aviation Administration requires captains to have a first-class medical certificate renewed every year if the pilot is under-40 and every six months if the pilot is 40 or older. Psychological checks aren't required. However, concerned doctors could order pilots to undergo testing for "emotional stability and mental state."
Pilots must disclose all relevant conditions or face an FAA fine, but assessing mental health is a tougher task than physical health and a pilot who doesn't raise any obvious red flags is free to keep flying.
"The system is entirely reliant on self-declaration,” Damos said. “The medical examiner doesn’t have access to anything until the person comes in for their physical medical check.”
Germanwings’ parent company, Lufthansa, requires pilots to undergo regular psychological assessment — a system more rigorous than most but which still relies on doctors being able to spot signs of trouble.
Medical ethics experts say doctors and nurses are already obliged to intervene if they think public safety is at risk from a patient, regardless of confidentiality laws.
“There is always an ethical duty to breach privacy if a doctor feels that a life or lives are in imperil,” said Arthur Caplan, bioethics professor at New York University’s Langone Medical Center. “Ethically there is a duty to warn if you think your patient is suicidal or is going to harm others — no question in my mind. If you mandate access [to medical records] you will find people hiding info or going under assumed names or off the books."
Is the risk of a repeat of the Germanwings crash high enough to justify a change in medical confidentiality?
An FAA study of the period 2003-2012 found that eight of the 2,758 fatal aviation accidents in the U.S. were aircraft-assisted suicides, all involving the intentional crashing of a small single-person aircraft. It is half the number found in the agency’s previous 10-year review.
The occurrence of pilots sabotaging commercial planes is rare. In 2012, a JetBlue flight was diverted after leaving New York City when the captain began pounding on the cockpit door and yelling threats. In February 2014, a co-pilot of an Ethiopian Airlines flight took control of the plane, locking his co-worker out of the flight deck in order to demand political asylum.
And the March 2014 disappearance of Malaysia Airlines Flight MH370 has led some aviation experts to speculate pilot suicide.
Previous deliberate crashes — the 1994 attempted downing of a FedEx cargo jet at Memphis by a disgruntled pilot, and the 1987 crash of PSA Flight 1771 by an airline employee who shot the pilots dead — both resulted in security loopholes that have since been closed, forcing pilots to undergo the same airport screening as passengers.
In Germany, where data protection and personal privacy is a hot issue, calls for access to records seem unlikely to be heeded.
The Federal Representative for Data Protection, Andrea Vosshoff, told Berlin’s Tagesspiegel newspaper: "The airplane tragedy and the background that has become known so far, should not lead to a premature demands for the loosening of data protection.” He added that it would be “mistaken to question the high protection which health data rightfully enjoys.”
Ilja Schulz, president of the of the German pilot union, Die Vereinigung Cockpit, said fixed-term psychological assessments by doctors also provided only a "snapshot“ of mental health.
"If dramatic experiences occur — for example a death or a marital crisis — the state of a person can change in the shortest time period. Far more important is the continuous, already-established assistance [already provided by airlines],“ he told the Rheinische Post.
Rainer Richter, a professor and president of Berlin’s Federal Chamber of Psychotherapists, told NBC News that “medical confidentiality is enormously important," especially when it comes to mental illness.
“In this field, it is often difficult to get patients to talk at all and it is important that the patient can 100 percent count on the doctor not to pass on confidential information,” he said, describing debates over medical confidentiality as “a complete overreaction."
In the U.S., pilots who self-declare mental illness can do so without fear of termination, Damos said.
"It’s the same as if a person had a heart attack,” she said. “OK, you’re removed from flight status but you don’t lose your job or stop being paid. Anyone more than a year into the airline is typically entitled to some form of long-term disability payment."
Juergen Margraf, psychologist and professor at Germany's Bochum University, said tougher consequences for declaring a mental illness would be “another bad consequence of a ... tragic catastrophe,” saying that “people with mental problems will come under attack.”
“We need to realize that on average a person with depression is less likely to cause harm to others than people without depression,” he told NBC News. “The chances of killing others are higher for non-depressed than for depressed people.”
He added: “In the case of [Lubitz] I think there is a risk that we give up established standards too easily. You should look at the whole picture and the thing is you will never have 100 percent safety. That is just not possible.”