Right now, it’s leading most national and international news reports:
- WSJ: Lubitz Was in Treatment for Suicide Risk
- NYT: Co-Pilot Was Treated for Suicidal Tendencies
- NPR: Germanwings Crash: Co-Pilot Was Treated For Suicidal Tendencies
- BBC: Alps crash: Lubitz ‘had treatment for suicidal tendencies’
Which got me to thinking….
In our society, we make quite a fetish of medical privacy. Which makes me wonder — if we were all more open about our health conditions, including our psychological conditions, and didn’t have a legal climate that made disclosing patient information a cardinal sin for providers, might it prevent tragedies such as this one?
I’m not saying I have any idea how to bring that about — it’s so ingrained in us as a significant value. And true, it’s not every day that a pilot deliberately flies a plane full of people into a mountain.
It’s just an idle thought, and probably a complete non sequitur…
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It’s not going to happen while we have private insurance companies that can jack up your rates if/when they find out that you might have a health problem that could get expensive in the future, or even have a condition that might result in an expensive health condition.
Seems reasonable that anyone who is a pilot for commercial aircraft would simply sign a HIPPA waiver to allow the airline to regularly be updated of all health issues.
‘Cause having suicidal pilots is…bad.
I wonder if you can legally require someone to waive HIPAA rights as a condition of employment?
Of course, he was German, and Germany has a lot of privacy rights–in response to the extreme lack of privacy under the Nazis and Stasi.
Since there is a flight surgeon clearance, the better answer is to step up the scrutiny there, but there is already a downside to tight controls on depressed people who are getting treatment being grounded–smart pilots just don’t get treatment.
There’s a story out now that his girlfriend is pregnant, and he just broke up with her. If that is the problem, how do you screen for “life issues”?
The best solution I’ve seen is the US requirement that two members of the flight crew be in the cockpit at all times. If a pilot needs to leave, a flight attendant steps in.
Ultimately, you can’t control all risks.
No, you can’t control all risks. But wouldn’t it make sense that if you’re treating a guy for suicidal tendencies, and you see on his chart that he’s an airline pilot, you give his employers a heads-up?
If you give the employers a heads up, you can be assured that you will never treat another pilot for depression–which increases the chances of this sort of thing happening, not decreases.
This is not an accurate conclusion I think. The fear projected here is that any report to an employer would result in termination. The nuclear option. However, if people – pilots in this case – beliieved that their employer would evaluate each individual on the merits just as they do with other facet of their professional/personal file, then I would have to believe the vast majority of pilots would want the “unfit” to be removed from filing. The idea that other pilots WANT to protect and keep flying the technically incompetent, the interpersonally poisonous, the seriously addicted or the suicidal/psycho among them is not giving the professionals either the credit they deserve or the support they need to advocate for separating the wheat from the chaff.
I wonder if you can legally require someone to waive HIPAA rights as a condition of employment?
I’m not an expert on HIPAA law (nor do I want to be), but I would assume that if your health is really important to your job, then your employer could reasonably demand this.
Beyond this, it’s just weird how touchy we are about health issues.
Sure, I can understand being delicate and discreet about some diagnoses, such as STDs. But it seems as though we treat ALL health problems, particularly the deadly ones, as somehow scandalous.
I mean, what’s with this business of not including the cause of death in an obit? It’s extremely noticeable to me because generally the first thing I want to know in an obit about a person under the age of 90, or perhaps the second thing after the fact of the death itself, is what caused this person’s demise. But it’s just understood that it’s not included most of the time.
This is something that used to bug me when obits were news copy. Now that they are ads, controlled by the family and funeral home rather than the newspaper, it bugs me a little less. But why NOT include the cause?
People end up playing a guessing game. If contributions to the American Cancer Society are requested in lieu of flowers, we all surmise that was the cause of death. But why be coy about it?
“After a long illness” is about as specific as most obits get.
“After a long illness” is to obits what “leaving to pursue new opportunities” is to memos about people leaving a job…
I am not a particularly private person, and almost anything in my medical records could be published in the paper for all I’d care, but I am insured through my husband’s job, and not beholden to an employer. I can see where lots of people feel differently.
It would be nice if we could be sympathetic to people who commit suicide, people who have Alzheimers, people who die of lung cancer and were heavy smokers, people who die of cirrhosis and were heavy drinkers, but this is not the world we live in.
If someone commits suicide, slowly or abruptly, that’s between the person and their family. It is of nothing but prurient interest to the rest of us.
A guy who murders 149 innocent people because he is having a hard day is not someone who committed suicide. He is a mass murderer. Period. Stop reporting his name. Stop giving a flying f$&@ about him. He is nothing and was nothing. Erasing these people is the only way to slow future one-upping actions by other selfish lunatics. 149 people died on that flight that crashed. Those people are worth remembering.
We don’t know if he committed suicide because he was having a “hard day” but there’s plenty of evidence that he had more serious stuff going on.
The people who died were random victims. I believe why we are discussing the pilot is because we are trying to figure out how to avoid this the next time. It’s just like the 9/11 goobers, the shoe bomber, the Boston Marathon bombers–we are trying to figure out how to prevent these events from happening again–if we can.
That’s no problem; I just don’t want him to have a name or face. That’s the glorification part that leads to other horrific events.
Attention is not the same thing as “glorification” — which I don’t see any evidence of in this case. It’s important that we understand the motivation/condition of the perpetrator. Mental illness is not evil and those who suffer from it — even those who commit terrible acts — deserve treatment, not vilification and, yes, may even be deserving of a measure of compassion — though their victims deserve a much, much greater measure of the same. One thing the latter generally do NOT need, however, is huge media attention.
Nope, pretty much anyone who would kill others just because they are having problems squaring themselves with the world is pretty much the definition of villainous evil. I have deep compassion for the ill and believe that far more help than we offer suffering people is something we should strive to provide. It can often make a real difference. But mass murder – or domestic murder – is a heinous crime that deserves nothing but societal contempt.
If the murderer receives attention, then the families deserve more – for the benefit of future potential victims/families maybe even more than the current actual victimized families. I understand they may want privacy in their time of loss. If their pain can lessen the pain others’ must feel down the road, where do we draw the line on this?
Well, Mark, I hope you never have to experience the grip of mental illness. It’s not “just because.”
Kathryn,
A lot of people have mental health struggles. It’s pretty common, maybe almost something a majority of people experience at one point or another in life. Some have longer and more difficult struggles. I can also empathisize with that.
What I cannot condone is someone who would harm others. It doesn’t matter what their state of mind; harmful, serious violence is never excusable. Mass murder definitely fits in that category for me.
We excuse and ignore too many cries for help. And just plain needs. This is a serious problem that we fail to socially address – it’s the replacement for the old cancer taboo. But for that very small percentage who would turn their pain into another’s suffering I really have no sympathy.
I’m in favor of not using the names of mass murderers or terrorists repeatedly. Let’s simply assign them code names and or numbers, and refer to them that way. The assigned monikers should be as boring as possible. Maybe if we stop giving these people fame, others will lose interest.
The German Pilots Association as well as the heads of the German Psychotherapy Association and the German Medical Association have all come out against any easing of doctor-patient privilege, arguing that it would have the effect of driving mental illness underground. So there’s unlikely to be any change there. Nor would it be the best approach. The easiest fix to the problem represented by this kind of air disaster is the one Ms. Fenner mentioned: requiring a second member of the flight crew to be in the cockpit anytime a pilot or co-pilot leaves. Had that rule been in effect at German Wings, it’s very unlikely this tragedy would have occurred. And it’s interesting that, in the wake of it, many European carriers put the rule into practice immediately.
One approach is the scalpel. Remove the cancerous bump. The other is the blanket approach of substantial cost and restriction to everyone just because one person, somewhere at some time, might possibly be a problem.
Since the vast majority of the world seems to think two people in the cockpit is a good thing, then it would seem worth the cost. However, that is an entirely different question than whether a healthcare system should be so removed from the larger social needs of a society that it would take the position that nobody should report what is in affect a highly contagious (and fatal) disease. That just makes no sense. Infectious diseases get reported. Sick people who have the capacity (and the distorted inclination, too) to kill others should be as well. That doesn’t seem to be a difficult distinction to draw outside of the labor union mentality of protection for the worker above all else.
I think that both here and in your reference to judging individuals on “the merits,” above, are an expression of 20/20 hindsight. Looking back, we say, “Man, how could they have let that guy into the cockpit?” But as professionals who deal with mental illness have pointed out, there is no evaluation or measure that can determine with any real accuracy how a person, even a sick person, will behave. From the news reporting I’ve heard, Lubitz had received or was receiving treatment, he was using anti-depressants. Neither is or should be cause for automatically grounding a pilot or for taking any other person off the job (even when they have the lives of many people in their hands). Folks looking for easy answers when it comes to human behavior are likely to be frustrated and disappointed.
Except that, according to the only reports any of us have seen, his mental healthcare provider had given him a “note” stating his diagnosis was that he was unfit to fly. A note which he tore up in his home least anyone see it. A note that should have gone not to him, but to an entity charged with protecting the flying public. It could have even gone directly to the pilot’s Union. Let them make the call. The point is, let someone other than a seriously mentally ill person decide.
There isn’t much 20/20 hindsight at play here; what there is instead is a systematic failure to acknowledge that when a person is not in “his right mind” then that person’s personal desires to do as he pleases are trumped by societies need to both protect himself and all of those around him. Or her.
The canary sang, the system in place simply was not listening – had consciously plugged its ears’ to the canary’s warning.
I believe you’re making assumptions about things that are at this point still unclear. It appears, for instance, that the “note” you mention was simply a so-called “Krankenschein,” which are provided to any German worker by his or her physician when there is a medical reason for that employee missing work. It doesn’t usually indicate what the specific reason is (which is often nothing more than a bad head cold) and is not meant to tell anyone that they can’t work and is only meant to provide them with doctor certification for a work absence (required by most German employers from employees who miss 2 or 3 days of work). If this is what’s being referred to, we shouldn’t make too much of it. The certificate definitely wouldn’t have declared him incompetent, let alone “not in his right mind.” Again, all those people could’ve been saved very easily if German Wings had simply applied the 2-person cockpit rule.
I don’t believe in single layers of defense. Or anything else. We need layered approaches from lenient to restrictive.
This would include screening pilot’s for mental health as well as physical issues. It is just plain sensible as one of a number of approaches. This pilot’s issues did not just appear without warning to people around him. Those people deserved to have a system that facilitated identification and treatment long before a cockpit door was latched.
All the things you ask for were done: pilots are screened for mental health; Lubitz was receiving treatment (and medication, apparently). Plus, even under current law (including in Germany), physicians are allowed to notify authorities if they believe a patient poses an immediate danger to himself or others. All the layers you ask for are already in place. But as I said before, none of them can provide a perfectly transparent window into the human soul.
I don’t believe the actions qualify as “mass murder,” either–the requisite intent was almost certainly missing. If he was so depressed as to be suicidal–which we don’t know was the case–he was in such a self-absorbed hole, he likely gave no thought at all to the other passengers. Depression is a self-centered disease.
Mass manslaughter, sure.
If we don’t start thinking of it as murderous we will never make any more progress toward stopping this evil selfishness. Manslauter is excusing the behavior.
If he was in such a bad place that he gave no thought to the 149 people on board then he had exhibited behavior that should have raised alarms long before takeoff. I’m not blaming those around him, but our societal focus needs to be on bringing attention to these needs – not pretending that privacy is more important than care.
Many of the professionals in the field are telling us that privacy IS care.
You can ramp up the rhetoric, but it doesn’t make it “murder” if there was no intent. I’m don’t think calling depressed behavior, if that’s what it was, “evil selfishness” leads to progress.
I agree that this is a very important issue which needs to be dealt with with a great deal of discretion and respect for those who suffer from mental health issues.
I would say that as far as depression goes, it is almost such a common malady for people to encounter at some point in their lives that I think it could be a majority of people who have experienced a depressive episode. I would also say that a smaller percentage of people also experience chronic depression, and some of these can be quit severe and persistent. I can empathize with all of these people, especially those who are not simply passing through a life event – though they too deserve to both seek and receive care and support.
However, I am trying to make a point about something different. We as a society have become programmed to accept depression as a quid pro quo: keep quiet about your suffering (or if more “progressive” one could say keep it between you and your doctors or counselors) and in turn we will give everyone a free pass on anything done while depressed.
This is the paradigm that I am uncomfortable with us continuing to gloss over. I do not believe that personal accountability flies out the window when the mental health flag, especially with regard to depression, is waived. Of course, depressed people do, say, and think things which they would not if not suffering from depression. Sometimes this results in profound art, literature, music and other forms of expression. But the vast majority of the time it leads to suffering, pain and despair for the person and those around them. While I do empathize with this, the need to maintain standards and not make too great of allowances for depressed behaviors can actually help both depressed people and those around them.
But here is the zinger: I feel like depression in particular (among mental health issues) is treated the way SC has, as a society, dealt with drunk driving. We are apologists for it. This is, to me, extremely unhealthy for all.
Last night I read a disturbing article in the Wall Street Journal about the co-pilot. In it, a representative of the U.S. pilots union was discussing the program that they have instituted to help pilots with “issues”. He said that [even in the program] “95% of their efforts are directed at 5% of the participants”. My point is not that way we shouldn’t help this 5% the way they need to be helped; it is that maybe this is where we ought to say the people who, even within a program designed to assist those who have been identified as being likely to benefit from mental health care, consume the vast majority of care ought not to be flying.
There are degrees to everything. For instance, with this co-pilot, is the real issue his depression, or is it instead the likelihood that he was a psychopath the thing that should have removed him from the cockpit? In this case we are talking about a murderous and evil individual. This in no way reflects upon the vast majority of people who suffer from depression. They are not like him and I do not understand why we (collectively) try to put everyone in one single box. To me, that isn’t healthy or productive for anyone – and it gives the seriously disturbed the room to wreck their carnage and paints the vast majority with imagery unrelated to their own struggles.
This is a very important issue that deserves a sustained, thoughtful and compassionate dialogue. We can do better for all by honestly approaching this from all three sides that need to be heard – the person, their family and our society.