Part 5: Doctor's Duty to Warn

Providers' Obligations to Report Suspicious Findings

Apr 10, 2015

by John Ogle, MD, MPH, FACEP

Commercial Pilot / USAF Flight Surgeon


The Germanwings crash series examines aircraft-assisted homicide from an aviation medicine perspective. This part deals with a physician, psychologist or therapist's duty to report pilots suspected of mental or physical instability--even if the patient lacks insight and remains unwilling to self-report.

Overview: Professional Duty to Warn

This is part 5 in our Germanwings crash series on preventing aircraft-assisted homicide. Previous sections discussed medical and psychological screening and pilot privacy considerations. This segment frames the difficult ethical consideration of when and how a physician, psychologist or other professional has a duty to warn others without the consent of their patient/client. Pilots can be held to higher standards than non-pilots, but any focus on aviation crime prevention balance the goals of justice, fairness and equality under the law.

Reporting Threats or Suspicions - Duty to Warn

HIPAA notwithstanding, privacy protections are not absolute for any patient. When a physician or therapist determines (per their professional standards) that the patient presents a serious danger to another, they're obligated to use reasonable care to protect the intended victim. When learning of an immediate or specific threat of harm to others, providers either may or must report suspicions to police; permitted vs mandatory disclosure depends on the jurisdiction.

The Slippery Slope of Reporting

The decision to notify authorities is challenging because dangerous ideas themselves are not criminal. It can be difficult to prospectively determine a reporting threshold. Proactive laws are better than reactive laws, but sociology, criminology and psychology interventions resist scientific analysis. Hindsight may prove clear, but too often policy derives from dramatic yet singularly anecdotal events like the Germanwings crash that resists sober and statistical methodology.

Prior to an actual crime, thoughtful providers may be reluctant to report. False reporting could initiate a chain of events based on suspicions alone. Similar to the nonrepudiation concept of the Flight Physical itself, once a provider notifies police, the report could irreversibly impact the patient's or pilot's career. This potentially generates burdens for the suspected individual that are not imposed on the general population (employment impacts, gun purchasing restrictions, etc).

Physicians and therapists are in the best position to judge the mental stability of any patients, clients or pilots. Unfortunately, single point mass murderers, by definition, would not yet have acted on their thoughts at the time of counseling. Mandatory reporting laws are a slippery slope when applied to aviation. Despite uproar generated by the Germanwings crash, it is not possible to completely outlaw the possibility of future violent tendencies prior to a criminal act.

Next WayPoint - Duty to Report Suspicions

This segment discussed professional duty to warn and the series continues with the next segment which compares and contrasts the crash to another single point mass murder. Part 6: Germanwings Crash & the Aurora Movie Theater Mass Murder... →

Continue to Part 3: Ongoing Mental Health Surveillance →

Author: John Ogle, MD, MPH, FACEP is one of our senior flight surgeons. An Emergency Physician and commercial pilot himself, the author holds degrees in aerospace engineering, medicine and epidemiology. He is an experienced Air Force crash investigator and former AME.

Editor's Note: This series contains Dr Ogle's personal and professional opinions. His preliminary ideas may or may not reflect those of the FAA, the US Air Force or Details of the horrific crash are still emerging at the time of publication.

— Editorial Staff

Reminder: use to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now