SICK

What Did Andreas Lubitz's Doctor Know?

Depression doesn’t cause mass murder. Something more was at play in the Germanwings co-pilot’s mind—and the only person that was told Lubitz was unfit to fly was Lubitz himself.

As the world grapples with the horrific news about the crash of a Germanwings flight from Barcelona to Düsseldorf, and its shift from unexplained tragedy to terrible crime, focus has tightened on the background and condition of Andreas Lubitz, copilot and perpetrator. There remains a great deal that has yet to be uncovered and reported. But a detail of Lubitz’s history that has already received a great deal of attention as a possible explanation is his history of depression.

Of all the unsettling details that are being brought to light, one in particular nags at me: It has been widely reported that Lubitz had been declared unfit to fly, and had hid this fact from his employers. A note making plain his lack of fitness was found torn up in his apartment.

But depression does not make someone murder 149 people

Whatever part of Lubitz’s psyche held the monstrous capacity for depraved indifference or outright malevolence on this scale, it cannot accurately be characterized as depression. Estimates from 2012 put the percentage of Americans suffering from a major depressive episode within the previous year at 6.9 percent, which amounts to about 16 million people. It should go without saying that the overwhelming majority of these people are recoiling from Lubitz’s decision to kill everyone on board his plane along with himself, just like people who have no mental-health diagnosis whatsoever.

Nowhere in the most recent list of criteria for a major depressive episode is there any mention of an increased capacity to harm others or disregard for the suffering of other people. While facts are still emerging about a second diagnoses for which he was receiving treatment, possibly also psychiatric in nature, it may be in the end that the language of medicine cannot render a satisfactory answer for why Lubitz did what he did.

Some acts are so horrifying they beggar any attempt to fully comprehend them, and pinning them on mental illness is both too simple in its tidiness and grossly unfair to the vast number of people whose own mental illnesses would never compel them to do likewise.

Yet it seems that, despite being deemed unfit to fly for whatever reason, he was still believed fit enough to deliver that information himself to his airline. The ramifications of that miscalculation were catastrophic.

As a physician, I consider patient confidentiality all but sacrosanct. I take it incredibly seriously, and all patients for whom it is developmentally appropriate have a portion of their annual checkups set aside for confidential time to talk with me on their own. I explain that, if they have an issue they need to discuss but that they feel they can’t tell anyone else, my office is a safe space to do so without judgment or fear of disclosure. It is something every patient is absolutely entitled to have.

But as I make a point of explaining when I have those conversations, there are a few exceptions even to that otherwise inviolable rule. In particular, if a patient is an imminent threat to their own safety or that of another person, I am ethically and legally compelled to disclose it. I cannot and will not keep secrets for patients who are actively suicidal or homicidal.

While I do not pretend to be any kind of expert on the laws governing medical confidentiality in Germany, if respect for Lubitz’s privacy was the primary factor in allowing him to keep secret a condition that made him a threat to the safety of his passengers, that respect was grossly misplaced. If ever there were a condition that called out for an exception to the rule, it would be “unfit to fly” a commercial airliner. If Lubitz’s physician was constrained by the law from informing Germanwings of his lack of fitness, confidentiality laws not only in Germany but worldwide need reconsideration and clarification. A medical reason not to be in the cockpit should be as explicit a reason to break confidentiality as having a patient who is actively suicidal.

I do not believe that a diagnosis of depression alone should be a sufficient reason to keep a pilot from flying, just as I do not believe it is accurate to say that Lubitz’s actions can be adequately explained by depression. However, pilots are uniquely entrusted with the safety of large numbers of people at any given time. If there is medical reason to rethink that trust for an individual pilot, that calls for giving medical providers freedom to communicate directly to the pilot’s employer without fear of legal reprisal.

As more information is made available in the days to come, there may come to light details that offer insight into how Lubitz was able to crash a plane into a mountain with his victims screaming audibly in the background. Or it may be that insight into a decision so utterly abhorrent will remain elusive. But whatever led him to that final act, hiding his unfitness to be in a position to do so was merely a step along the way. It should never have been up to him to disclose it in the first place.