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Doctor-Patient Privacy vs Public Safety

Dragonfly

Dragonfly

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In light of this:
Investigators probe life of crash pilot Andreas Lubitz - CNN.com

(CNN)Investigators continued to work Saturday to piece together the secret life of Germanwings co-pilot Andreas Lubitz, who officials say was hiding an illness from his employers. He had been declared "unfit to work" by a doctor.
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Where is the line between doctor-patient privacy, and overall safety of the masses?

Protecting the patient is understandable, protecting everyone else seems to be an after-thought and I wonder why.

Where's the moral obligation to alert the employer of a diagnosis like this when the person in question has other people's lives so directly at his fingertips?

Do you feel that in some cases, the doctor-patient privacy "contract" SHOULD be abandoned when it comes to the greater safety of others?

Or, do you feel that no matter what risks other people might befall, the doctor-patient privacy contract should NEVER be broken regardless of the situation?

Specifically, should the doctor that determined this pilot was unfit to to work have contacted Germanwings and told them of his concerns?
 
Germany's "HIPAA" laws aren't the same as ours, apparently, and include postmortem privacy. I agree that now we need to talk about where an individual's privacy ends and the safety of hundreds of innocent others takes precedence.
 
nota bene said:
Germany's "HIPAA" laws aren't the same as ours, apparently, and include postmortem privacy. I agree that now we need to talk about where an individual's privacy ends and the safety of hundreds of innocent others takes precedence.
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Would a doctor in the USofA have the freedom and/or obligation to contact Delta or US Air in a similar situation????
 
Dragonfly said:
Would a doctor in the USofA have the freedom and/or obligation to contact Delta or US Air in a similar situation????
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Couple of issues. The patient is dead, in the US odds are the whole thing would end up in court and be a discussion between next of kin and whoever wanted the records released. HIPAA (and this element was not all that harmed by ACA) has a 50 year protection rule for individual health information following the death of the individual. During the period of protection, it would take a representative of the deceased to wave the right with regard to health information, disclosure of, or gaining access to. The only way around that is a court order, else all you are left with is speculation.
 
Dragonfly said:
In light of this:
Investigators probe life of crash pilot Andreas Lubitz - CNN.com



Where is the line between doctor-patient privacy, and overall safety of the masses?

Protecting the patient is understandable, protecting everyone else seems to be an after-thought and I wonder why.

Where's the moral obligation to alert the employer of a diagnosis like this when the person in question has other people's lives so directly at his fingertips?

Do you feel that in some cases, the doctor-patient privacy "contract" SHOULD be abandoned when it comes to the greater safety of others?

Or, do you feel that no matter what risks other people might befall, the doctor-patient privacy contract should NEVER be broken regardless of the situation?

Specifically, should the doctor that determined this pilot was unfit to to work have contacted Germanwings and told them of his concerns?
Click to expand...

Regardless of the situation the doctor should be severely punished for divulging patient information without her consent. That does not mean you need employ someone that does not consent.
 
Dragonfly said:
Would a doctor in the USofA have the freedom and/or obligation to contact Delta or US Air in a similar situation????
Click to expand...

No, under HIPAA, I don't think so. But this isn't my area of expertise; I'm clear on the electronic communications part (I think) , but pretty ignorant otherwise of this complicated Act. Doubtless, there are DP'rs who are going to be familiar with them, and I hope they'll catch me up to speed.
 
The problem with allowing doctors to tell employers is that the patient will just avoid going to doctors; they won't get treated. Normally, depression can be treated, and we want it to be.

In this case, he ignored his doctor's orders to stay home and went back to work with tragic consequences.

Maybe the "stay home" should have been given to the employer as well - but again, if people think that will happen, they may just avoid going to the doctor at all because they are worried about losing their job.

No easy answer.
 
nota bene said:
Germany's "HIPAA" laws aren't the same as ours, apparently, and include postmortem privacy. I agree that now we need to talk about where an individual's privacy ends and the safety of hundreds of innocent others takes precedence.
Click to expand...

I don't think so in these cases. Just don't employ people that don't consent to disclosure.
 
I have a problem with that. There are people who experience depression who are fully functioning and who aren't going to kill 149 people on the plane. There has always been a mental health stigma, and I think pilots (and others, of course, and particularly if they're male) are going to be even less inclined to seek help, much less disclose to their employers that they have a problem.
 
paddymcdougall said:
The problem with allowing doctors to tell employers is that the patient will just avoid going to doctors; they won't get treated. Normally, depression can be treated, and we want it to be.

In this case, he ignored his doctor's orders to stay home and went back to work with tragic consequences.

Maybe the "stay home" should have been given to the employer as well - but again, if people think that will happen, they may just avoid going to the doctor at all because they are worried about losing their job.

No easy answer.
Click to expand...

Yeah, that is my take. In the long run I think requiring doctors to inform on their patients will do more harm than good as fewer people would seek help. And if they don't seek help there is even a greater chance of such disasters happening.
 
OrphanSlug said:
Couple of issues. The patient is dead
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What I meant was - prior to something of this nature, should the doctor that declared this pilot unfit to work have had some obligation to tell the airlines of his concerns?
 
Dragonfly said:
What I meant was - prior to something of this nature, should the doctor that declared this pilot unfit to work have had some obligation to tell the airlines of his concerns?
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That depends on what the pilot signed as a condition of employment, otherwise HIPAA laws win out (I think.)
 
OrphanSlug said:
That depends on what the pilot signed as a condition of employment, otherwise HIPAA laws win out (I think.)
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That is indeed the question though.

He's a pilot. He has peoples lives in his hands. Should there be some kind of obligation to try to save those lives?
 
Dragonfly said:
That is indeed the question though.

He's a pilot. He has peoples lives in his hands. Should there be some kind of obligation to try to save those lives?
Click to expand...

Unsure you can craft such a thing when you really consider all the times your life is in someone else's hands, under your thinking just about anyone is subject to that. The only reason we are talking about this is the plane crash, where was this concern before that?
 
Dragonfly said:
That is indeed the question though.

He's a pilot. He has peoples lives in his hands. Should there be some kind of obligation to try to save those lives?
Click to expand...

It's up to the airlines to obligate the pilots to waive their right to privacy, and hire doctors that will comply with the airlines preferred pilot conditions.

Don't pilots need to under go frequent pre-flight physicals inside the airports?
 
OrphanSlug said:
Unsure you can craft such a thing when you really consider all the times your life is in someone else's hands, under your thinking just about anyone is subject to that. The only reason we are talking about this is the plane crash, where was this concern before that?
Click to expand...

Had the same concerns after Adam Lanza.

It's about learning from recent past and hoping to prevent future tragedies.

We can't undo something, but can we prevent the next something?

How'd you feel about going into surgery and then finding out the surgeon had been classified as "unfit to work", but the hospital did nothing?
 
Dragonfly said:
Had the same concerns after Adam Lanza.

It's about learning from recent past and hoping to prevent future tragedies.

We can't undo something, but can we prevent the next something?

How'd you feel about going into surgery and then finding out the surgeon had been classified as "unfit to work", but the hospital did nothing?
Click to expand...

You are missing the point, where do you draw the line? That is what we are asking you, repeatedly.
 
Dragonfly said:
I'm not missing the point, I'm asking the same questions.
Click to expand...

Then answer it, you proposed all this. Put something forward on where the line is for patient privacy to be voided for your concerns.
 
Dragonfly said:
Would a doctor in the USofA have the freedom and/or obligation to contact Delta or US Air in a similar situation????
Click to expand...

Yes. If the patient is a danger to themselves or others.

Btw, there is no federal statue protecting doctor-patient confidentiality. Each state rolls their own.
 
Last edited:
Dragonfly said:
In light of this:
Investigators probe life of crash pilot Andreas Lubitz - CNN.com



Where is the line between doctor-patient privacy, and overall safety of the masses?

Protecting the patient is understandable, protecting everyone else seems to be an after-thought and I wonder why.

Where's the moral obligation to alert the employer of a diagnosis like this when the person in question has other people's lives so directly at his fingertips?

Do you feel that in some cases, the doctor-patient privacy "contract" SHOULD be abandoned when it comes to the greater safety of others?

Or, do you feel that no matter what risks other people might befall, the doctor-patient privacy contract should NEVER be broken regardless of the situation?

Specifically, should the doctor that determined this pilot was unfit to to work have contacted Germanwings and told them of his concerns?
Click to expand...

If you want to talk about this in an abstract sense then fine BUT, if this is going any further on the basis of this case you need to show that someone suffering clinical depression would do such an act.
 
Dragonfly said:
In light of this:
Investigators probe life of crash pilot Andreas Lubitz - CNN.com



Where is the line between doctor-patient privacy, and overall safety of the masses?

Protecting the patient is understandable, protecting everyone else seems to be an after-thought and I wonder why.

Where's the moral obligation to alert the employer of a diagnosis like this when the person in question has other people's lives so directly at his fingertips?

Do you feel that in some cases, the doctor-patient privacy "contract" SHOULD be abandoned when it comes to the greater safety of others?

Or, do you feel that no matter what risks other people might befall, the doctor-patient privacy contract should NEVER be broken regardless of the situation?

Specifically, should the doctor that determined this pilot was unfit to to work have contacted Germanwings and told them of his concerns?
Click to expand...

I'm cold-hearted enough to answer this despite the recent tragedy. The Lufthansa spokesman was wrong when he said their company shouldn't change policy from this one incident, but regarding your question he was right. Murder-suicides are extremely rare, and even though this time it took out 150 lives it is still the lesser of two evils.

Think about what will happen if you require doctors to tell everyone when there's a public danger. If you're a pilot with a vision problem or a mental illness you're either not going to seek help at all, or you're simply going to say that you are a custodian. The reason we have doctor-patient confidentiality laws is so that people can be honest with their doctor. It doesn't help anyone to encourage people to lie to their doctor. Requiring doctors to identify public health threats of this nature does little to actually protect us, and does a lot of harm by eliminating trust between a doctor and a patient. There are a lot more patients out there than there are crazy suicidal pilots, and dissolving this form of privacy does more harm than good.
 
Tsunami said:
I'm cold-hearted enough to answer this despite the recent tragedy. The Lufthansa spokesman was wrong when he said their company shouldn't change policy from this one incident, but regarding your question he was right. Murder-suicides are extremely rare, and even though this time it took out 150 lives it is still the lesser of two evils.

Think about what will happen if you require doctors to tell everyone when there's a public danger. If you're a pilot with a vision problem or a mental illness you're either not going to seek help at all, or you're simply going to say that you are a custodian. The reason we have doctor-patient confidentiality laws is so that people can be honest with their doctor. It doesn't help anyone to encourage people to lie to their doctor. Requiring doctors to identify public health threats of this nature does little to actually protect us, and does a lot of harm by eliminating trust between a doctor and a patient. There are a lot more patients out there than there are crazy suicidal pilots, and dissolving this form of privacy does more harm than good.
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Meh, the medical disclosure limit has always had these exceptions. Yes there are pros and cons, but the public safety takes precedence over the individual's ability to hide their damage. For instance, gunshot wounds are reported, in all states. Does this keep some with gunshot wounds from seeking medical care? Probably.
 
Without strong protections of confidentiality, it's quite likely that many patients would keep things from their doctors, and that would likely compromise the care they receive. As with lawyers, confidentiality should really only be broken in the face of imminent harm to someone.
 
Paschendale said:
Without strong protections of confidentiality, it's quite likely that many patients would keep things from their doctors, and that would likely compromise the care they receive. As with lawyers, confidentiality should really only be broken in the face of imminent harm to someone.
Click to expand...

To be fair, legal confidentiality has a few exceptions as well. A lawyer must disclose criminal activity if they are aware of it. As a lawyer you can ignore the feeling that your client is probably guilty, but if they present you with evidence of their guilt you cannot rely on the shield to protect you if you get caught calling them innocent and failing to disclose. Lawyers will tell you, "I don't want to hear that".
 
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