Confidentiality; a Flight Risk

A PHIL235 Case Analysis

By:

Zeth Oakes-Bryden (40078173)

A reasonable expectation of confidentiality in the healthcare setting should be a given,

but with it comes its’ necessary grey area for interpretation. In this case the mental aptitude of a

commercial airline pilot, Andreas Lubitz, was in question before he ultimately crashed and killed

everyone onboard his flight. This situation sheds light on the topic of how patients’

confidentiality needs to be considered given the individual circumstances, especially when those

circumstances involve risk to people other than the patient themselves. The patient’s autonomy

must be respected but at the same time the beneficent intentions of the HCP must be taken into

account, especially when competence is in question. Ultimately, this case boils down to two

schools of thought; one; where there is possibility of harm to others, then confidentiality may be

broken, and two; where under no circumstances should confidentiality be broken so as to protect

the greater order.

The first school of thought, being the one that gives leeway for the breaking of

confidentiality between patients and their HCPs, can be thoroughly defended through the concept

of the greater good. This implies that specifically in this case, to protect the greater good of those

plane passengers who are Lubitz’ responsibility, it is necessary to break confidentiality and

inform either a governmental authority, Lubitz’ employer, or both due to both his given line of

work and mental state. Although Lubitz’ doctors wrote him letters concerning his fitness for

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work, the doctors had no further recourse due to the conservative nature of medical

confidentiality law within Germany. Although they could not have known for certain what

actions Lubitz would take, it was evident that the medical professionals had questioned his

competency in piloting an aircraft with his given mental illnesses and yet the doctors were

unable to take a strong paternalistic role in making that decision for him. On the other hand,

having the reach of being able to break this confidentiality could have greater impacts outside the

scope of this case, where people are unfairly and inaccurately deemed unfit to work by their

HCP’s. With that being said, there must be room to judge these instances on a case by case basis

which might be difficult within the legal framework. David Thomasma argues; “When the

receiver of the truth is not in a state to act rationally and autonomously, others must act to protect

us from harm until one is able to regain an ability to cope with the truth”. From this, we gather

that the context within each case should be a driving factor in when to or not to break

confidentiality with aim of protecting the greater good, or preventing unjust harm onto innocent

people or the patient themselves.

The second school of thought is that of maintaining strong confidentiality between HCP’s

and their patients so as to respect their autonomy first and foremost. Having this sort of system in

place, like it was in the case of Lubitz and his home country of Germany, would promote

confidence in the HCP from the patients’ point of view in that they can trust that whatever

information they relay will be bound by confidentiality. This system would also prevent

autonomy from being taken away from the undeserving in misjudged cases, leaving less room

for error in overly strong paternalism. But with that also comes the risk of misjudging the other

subset of cases like this one where, wrongfully so, a system of weak paternalism enabled an

atrocity to happen on account of confidentiality being too legally binding. This leaves a slippery

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slope for restricting the power of the HCP, as in cases like this when they are unable to act out

their beneficent duties to uphold the “survival of the community”.

From the information gathered it’s evident that while we must respect the autonomy of

the individual, there needs to be room for breaking of confidentiality when situations are as dire

as in such a case as this. Context must be key in each situation and we must put faith in the

beneficence of the HCP and their Hippocratic oath. On the contrary we must not let the

pendulum swing too far so as to assume strong paternalism in the majority of cases, but we must

judge based on case facts, the level of competency of the individual especially as it pertains to

the difficulty of the task at hand. The task in this case would be flying a commercial plane and

this obviously would require a very strong level of competency, and therefore an assumption of a

stronger paternalistic role of the HCP would be more appropriate all context considering. To

conclude, there is a middle ground between these two schools of thought, where we have to

balance the autonomy of the individual with the HCP’s paternalistic and beneficent role so as to

do the right thing generally speaking, and “above all, do no harm”.

Thomasma, D. C. (2009, July 29). Telling the truth to patients: A clinical ethics exploration:
Cambridge Quarterly of Healthcare Ethics. Cambridge Core. Retrieved November 18, 2021,
from https://www.cambridge.org/core/journals/cambridge-quarterly-of-healthcare-
ethics/article/abs/telling-the-truth-to-patients-a-clinical-ethics-
exploration/7C15EF325522254804E7F2A68A1642F1.

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