Doctor-patient confidentiality Do No Harm

Calls in the wake of the Germanwings crash for doctors to be forced to 'out' seriously ill employees will only lead to sick people avoiding medical help, afraid they could be dismissed.
An online memorial to the people who died in the Germanwings plane.


It seems so obvious: A sick pilot doesn't belong in the cockpit, a sick engineer shouldn't be driving a train nor should a sick bus driver be behind the wheel.

In order to prevent people who disregard their illness and go to work and endanger people, their doctor should have the right to inform their employer about their illness.

This would be regardless of whether the patient is a mentally ill airline co-pilot or a bus driver who, in a fever-induced delirium, runs a red light. Employer and doctor could then cooperate to ensure that danger to life is avoided and that the employee receives the necessary medical help. Such a practice would be workplace health care at its best, no?

But the reality is very different. Medical confidentiality was not invented to prevent compassionate employers, loving relatives and well-intentioned neighbors from supporting sick people and stopping them carrying out dangerous acts that could arise from their condition.

Confidentiality exists solely because some people aren’t noble, helpful and good. More than a few enjoy hearing about the troubles of others and indulging in vicious gossip when learning a neighbor or co-worker is receiving psychiatric treatment or battling alcoholism.

If an employer gets word an applicant has suffered from mental illness, the candidate is unlikely to be hired. In addition, while a severe illness, whether cancer or depression, is not in itself a reason to dismiss a member of staff, an employer who knows about such a diagnosis need only come up with a plausible-sounding economic justification.

Those who argue that airlines must now take away the license of any pilot who at some point in time was diagnosed as showing suicidal tendencies are wrong.

Rita Süssmuth has argued vehemently against the loosening of medical confidentiality laws in the wake of last week’s Germanwings crash. She knows a thing or two about the subject, having been Germany's health minister during the mid-1980s when the AIDS epidemic erupted.

At that time, people were afraid to go to the doctor and be tested for HIV because they feared their employers could be informed about a positive test. Indeed, there were several instances in which companies became aware of a diagnosis and the ill individual lost their job.

People whose infection became known were subject to massive ostracism and public abuse. So the principal purpose of medical confidentiality is to protect individuals from the maliciousness of others.

Even a company physician cannot inform his or her employer about a worker’s HIV status if the affected individual doesn’t give permission.

Things are different if the employee is a surgeon in a hospital. In those cases, the surgeon’s doctor must weigh the danger of hospital patients becoming infected against the right of the surgeon to confidentiality. In addition, a doctor who fails to inform the wife of someone infected with HIV is subject to prosecution.

If the doctor treating the Germanwings co-pilot Andreas Lubitz had known he planned to kill himself and everyone else on board by crashing his aircraft, he or she would have been required to inform the airline. But it seems that none of Mr. Lubitz’s doctors knew of any deadly intentions and were therefore obligated to remain silent.

There is a fundamental mistake in the current vociferous demands that doctors must inform employers when they put a patient who has a job in a “sensitive profession” ― for instance, a pilot or surgeon ― on sick leave. If this became standard procedure, then even more sick people would avoid going to the doctor out of fear they could lose their jobs.

Those who argue that airlines must now take away the license of any pilot who at some point in time was diagnosed as showing suicidal tendencies are wrong. The maxim “once suicidal, always suicidal” is incorrect.

There is only one way to avoid this sort of catastrophe in the future: The fostering of a culture of trust in companies so that, if worst comes to worst, a sick person can expect help rather than stigmatization.

That has what is now happening with people who have AIDS, which can now be treated medically. But when it comes to mental illness, it is not always the case. There is still a long way to go, and not just in the aviation industry.


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