Last week Germanwings Flight 9525 crashed in the French Alps killing all 150 people on board. In the aftermath investigators homed in on one copilot who may have deliberately barred the cockpit door and flown the plane into the Alps. The copilot, Andreas Lubitz, may have struggled with mental illness and reported having an episode of "severe depression."
Wednesday on Boston Public Radio, medical ethicist Art Caplan talked about the importance of mental health screening in high-stakes professions. Caplan also talked about medical disclosure, and whether or how doctors should inform employers about patients living with a mental illness.
Questions below are paraphrased. Caplan's responses are edited where noted [...].
How should airlines screen pilots for warning signs?
I think you've got to up the ante a little bit on the annual physical. [In the US] pilots do get tested every year, they get a physical. Actually, as they get older, I think it's over 55 they get tested every six months. They're looking for heart conditions and vision problems, things that might interfere. But the person who does the exam really doesn't do more than a few gentle questions about mental health, or addiction, and I think that needs to be beefed up. Probably need some training for the people doing the exams so they could ask better questions, if you will, or maybe even have a psychologist be part of that exam.
What happens when they detect some of these warning signs?
If you really fear that someone is going to hurt or harm someone, is suicidal, murderous, there is and has been for decades a recognized duty to tell others. [...] It's called the Tarisoff standard, it's been in place forever from a legal case in California back in the seventies. So no doubt, if you believe somebody is going to hurt someone, you have to say something.
Tarasoff is a US legal precedent, but what about in Germany — did German doctors fail by not reporting Lubitz's warning signs?
Yeah, if they didn't really call the airline and say, 'You know, Lubitz — one of your flight crew — is not fit to fly,' that is not honoring their ethical duty. [...] They do have to say something, they do have to speak up. That would be true in the US. Obviously Germany isn't bound by American court opinions. But that standard duty to warn has been adopted almost all around the world.
How do you prevent horrific incidents like Germanwings 9525 without stigmatizing those with mental illness? And, what can severely depressed people do if they find themselves in this situation?
I think they can unfortunately do very little if they're severely depressed. They're not really a threat to anybody. [...] The difference is, depression where you get suicidality, where you somehow or another are talking harm, and just people who are kind of feeling low and then up, manic depression, [you] kind of need to get them into treatment, see how that goes. And then you require that if they're going back to work they have to be supervised for a while.
And that goes for other high-stress, highly-important jobs too, right?
So you want to watch them, see how they're doing. That's what we do when we have a physician who's been through a drug rehab program. They can't operate by themselves. They can't treat people by themselves. They have to with somebody all the time.
It's not a career-ender for the most part, right?
For most of the mental health issues I think they can be managed pretty safely. I don't think the stigma that goes with this is enough to say, 'Nope, nope, once you've identified with any mental health problem you're out of the air.'