Medical privacy versus public safety in aviation

Confidentiality, considered a fundamental principle of medical ethics, is potentially at odds with public safety when an airplane pilot is experiencing symptoms of mental illness. Reporting requirements for pilots vary across the world, and pilots can be subject to multiple national regulatory authorities for international flights. Stigma exists about getting treated for depression. If one’s livelihood and core sense of identity is placed at risk by seeking treatment, people will naturally avoid assessments and engagement with mental health clinicians, the very treatment that could mitigate risk. Suicide and homicide by aircraft are rare events and are difficult to predict, but the impact can be catastrophic. Variables other than mental illness, such as personality structure, occupational and relationship stressors, and coping mechanisms are also critical in conceptualizing risk in this population. Requirements for those employed in other methods of transportation are contrasted with those for pilots. Finally, legal and ethics concerns regarding reporting requirements for pilots are discussed and suggestions made.