2024-04-21 09:26:33
In a world where privacy is threatened, it is important to discuss confidentiality. In medicine, confidentiality requires multiple readings. Confidentiality, as people interested in bioethics and medical ethics know, is, along with truth, goodness, non-evil, justice, and autonomy, one of the six guiding principles. I share some reflections regarding the Andreas Lubitz case. In medical ethics, old stories are never old.
In 2015, Lubitz, a co-pilot for the Germanwings company, locked himself in the cockpit of the one covering the route between Barcelona and Düsseldorf and activated the autopilot. The plane crashed in the Alps. One hundred and fifty people died.
Over the past five years, Lubitz had visited 41 doctors for various reasons. The central theme was depression. Fifteen days before the suicide/murder, a doctor diagnosed a depressive state accompanied by psychosis; The doctor suggested hospitalization. Two scenarios. First. Did the doctors involved, especially the last one, not inform the company to preserve confidentiality? Second. Were the doctors poorly prepared. Were they negligent Were they not interested in “the matter”? I do not have items to discuss the questions in the second scenario. I am referring to confidentiality: when a doctor perceives “danger” from possible actions by his patient, he has a duty to break confidentiality and notify the authorities.
Confidentiality is an old medical topic. You hear a lot in medical consultations. Well-known are the cases of psychopaths who warn: “I want to kill my lover” – as was the case with Tarasoff – or of patients with AIDS who refuse to warn their partners regarding the infection, of children who steal money to get drugs, of patients who confess the desire to follow his wife, and if they notice an amasiatus, look for someone to murder the lover. What should the doctor do to warn those close to him or maintain confidentiality?
In the Tarasoff case – the boyfriend murdered Tatiana Tarasoff – the California Supreme Court held that the professionals involved in the case – psychiatrist, psychologist – should have warned Tatiana regarding the danger. Mental health experts responded that such an initiative would undermine patients’ trust. Furthermore, they added that threats most of the time do not succeed: the wrong warning can damage the relationship between patients, doctors and the couple.
In the Lubitz case, German regulations protect confidentiality. Maintaining secrecy led to the death of 150 people, including Lubitz, when the plane crashed.
Again two scenarios: Did the doctors have a duty to report to the authorities? If his license had been suspended, the tragedy would have been avoided. Second. What happens to people when doctors make mistakes or overdiagnose mental illnesses? Stigma leads to serious problems, including depression, inability to find work and resentment. The previous answers have a solution: Seeking a second or third opinion on the matter helps resolve the issue. Add. Within medical ethics, it is desirable to add voices.
Medical ethics is not an exact discipline. That’s why I’m excited. The problem is complex: What to do and how to behave in the cases indicated: whether or not to maintain confidentiality, become a witness and accomplice, participate in the stigmatization of people who do not deserve that label?
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