I’m seeing on CNN some discussion about what the physician should or should not have done regarding notifying Lufthansa and/or Germanwings about the copilot’s (Lubitz) medical condition and his reported unfitness for “work”.

Here in the US, as a psychologist, I have a “duty to warn” based on various court cases in the past. This duty to warn involves situations during which a client makes a specific, imminent threat against an identifiable individual. This derived from the Tarasoff case. The rulings in this case have been extended over the years. I don’t know what the requirements are for German doctors. If someone knows, please let me know!

So, would a “duty to warn” pertain here? Maybe. Let’s take the case to the US and say the pilot is seeing me. The pilot comes in and reports feeling very depressed. He hasn’t been sleeping. He’s refused medications (because of flying) but has engaged in therapy on a regular basis. Now he reports having some thoughts about wanting to die. I ask if he has a plan. No, he replies. It’s clear to me that he’s depressed and at some risk for suicide, but there’s nothing that would set off alarm bells here. In this case, I’d ask more about his ability to concentrate. I’d try to engage the pilot in a conversation about whether or not he feels able to fly. He says, “I don’t know.” Perhaps in that situation, I’d give him a note that would cover him if he chose not to go in to work.

Now let’s up the ante. Same initial situation, but now he reports some strong feelings of wanting to die. When asked if he has a plan, he looks up with a half smile and says, “I could always crash a plane into some mountains. That’d be the way to go.” His risk for suicide just goes up. He actually has a plan but it’s still vague. He could mean taking a private plane up and crashing it. I think in this scenario, I’d work really hard on getting him admitted to a hospital. But, he’s likely to refuse to do that since it would come to his employer’s attention and likely result in being grounded. This puts me in a real dilemma. If I take away something he loves (flying), am I increasing his level of depression and actually giving him even more reason to suicide? I think I’d put him on a daily call in to me and strongly recommend he take a few days off, perhaps even see me more frequently while he’s on sick leave.

Now, let’s say he says “Doc, I just want to die. I keep thinking about getting into the jet, waiting till the pilot goes to the bathroom, and then crashing the plane into a mountain.” I argue about the other people involved. “Their families will get over it.” or “People die all the time.” I ask when he’s going to do this. “Soon.”  Okay, the threat is imminent and specific enough that I’d feel compelled to do something. True, the victims as individuals aren’t specified, but it’s clear he’s talking about crashing an airliner. Needless to say, I’ve never been in this situation. However, I think, given the laws here in the US and my own morality, I’d act to get him involuntarily committed to a hospital. He clearly (at least to me at that point) is a danger to both self and others. I think I’d also contact his employer, just in case anything fell through and he was released and tried to go back to work. I could be faced with a lawsuit due to break of privacy, but I think I could fight that with the help of a good lawyer.