BS: A 'rights' issue?

Subject: RE: BS: A 'rights' issue?
From: GUEST,Musket
Date: 15 Mar 16 - 02:22 PM

Fucking priceless.... Anyone would think nobody had ever read a worm post before. Mind you, a typo at one end of a word is one thing but both ends? Possibly thinks everyone is on his intellectual level, coming out with that one.

Regarding the thread.. This afternoon, I was doing some teaching and a registrar we have on the course from Cuba did his house jobs in Germany so over coffee I asked about disclosure. It seems the law is, as I thought, mirroring ours in just about every aspect.

Doctors have an obligation to act in the public interest where public safety could be compromised and report to appropriate authorities where risks could in their judgement exist or where criminal actions are suspected, (presenting with gunshot wounds etc.) In areas such as occupational health, a doctor can, with the patient's consent give pertinent detail or if the patient doesn't consent, say that they are fit or unfit for the duties described but not give details. Under employment law there, same as here, an applicant should not be discriminated against for opting for a yes or no only.

So, if in this case a doctor is refusing to disclose, the doctor is either a) of the opinion disclosure has already been adequately dealt with or b) may be being defensive in which case the airline has the right to ask the medical regulator to investigate fitness to practice.

Or in other words, no laws need changing based on what is in the public domain about this case and safeguards are in place so not seem to be failing if what we read reflects the facts. A court may force disclosure if pertinent to proceedings in the opinion of defence or prosecution but the remit of airline and police investigators is limited to their role.

If Musket is reading, he might clarify some of the above as he was involved in health regulation for many years.

Two other things here..

1. The patient's rights are not an issue as you lose most of them when deceased.

2. The incident was not on German soil.

Subject: RE: BS: A 'rights' issue?
From: akenaton
Date: 15 Mar 16 - 12:47 PM

If I were a "liberal" I would condemn it as Bigoted Ageism.

Even as a social conservative I find the reference disgusting, witless and demeaning.

Subject: RE: BS: A 'rights' issue?
From: MGM·Lion
Date: 15 Mar 16 - 12:43 PM

"Try reading it then or have nurse read it to you," predictably trot out the silly old Musket-mob at me again, as if this was a hilarious witticism, instead of [what might just have been] a joke when first aimed at me about 7 or so years ago, but which I suspect most Catters must be as bored out of their ☠☠ with as I am.

≈M≈

Subject: RE: BS: A 'rights' issue?
From: akenaton
Date: 15 Mar 16 - 12:39 PM

The doctors have refused to co-operate with the inquiry so good luck with any attempt to get at the truth.......I smell a rat.

Subject: RE: BS: A 'rights' issue?
From: Jim Carroll
Date: 15 Mar 16 - 12:15 PM

"Musket is right on this one."
I'm afraid that's the impression I was left with and that will remain the case until the poster specifies the "large part of it (our personal rights)" he is referring to - obviously not just the right to patient confidentiality which he has already made clear.   
"there should be no such thing as patient confidentiality in cases like this"
Of course there shouldn't but it is prejudging this particular case to suggest that it is the right to patient confidentiality at fault here, rather than a error on the part of some individual somewhere along the line.
Now - perhaps we might now learn what the rest of these rights are we need to have taken away from us
Jim Carroll

Subject: RE: BS: A 'rights' issue?
From: akenaton
Date: 15 Mar 16 - 11:40 AM

Rubbish, I don't have an anti rights agenda.....much of it is necessary and beneficial to society.
Some of it does no good at all...there should be no such thing as patient confidentiality in cases like this where the public are put in harms way.

The inverted commas were of course a typo on this occasion.
Doctors are doctors.....they come in all shapes and sizes and have myriad psychological hangups.....just like the rest of society.
However suicidal tendencies are not appropriate in an airline pilot.

Subject: RE: BS: A 'rights' issue?
From: Spleen Cringe
Date: 15 Mar 16 - 10:48 AM

Musket is right on this one. The OP is clearly using this tragedy to put over his 'anti-rights' agenda.

Subject: RE: BS: A 'rights' issue?
From: Donuel
Date: 15 Mar 16 - 09:41 AM

Here comes the closing thread solution.

the world along with mudcat has lost its finesse.

Subject: RE: BS: A 'rights' issue?
From: MGM·Lion
Date: 15 Mar 16 - 09:12 AM

☞〠☜

Subject: RE: BS: A 'rights' issue?
From: GUEST,Musket
Date: 15 Mar 16 - 09:09 AM

No? Try reading it then or have nurse read it to you. Three others had pointed it out prior to me. But as ever, wait for someone who you enjoy trying to put down before nursing a semi whilst you type. Your defence of Akenaton, whether it be this or any other subject of his mind is at best ill placed and at worst revealing.

You have form Michael and suffering fools gladly isn't my strong point. The other Muskets may enjoy a joke with you but your posts dismay me.

The op suggested the rights of doctors and their patients are questioned by this incident and he put the word doctors as "doctors." He uses a similar tactic when describing marriage of normal people, my husband and I included.

Leave the forum yourself if decency offends you.

Subject: RE: BS: A 'rights' issue?
From: MGM·Lion
Date: 15 Mar 16 - 08:44 AM

That should have been the most valuable post, if the form-carrying poster had not degenerated into the fatuity of the final paragraph.

Am I ever glad you are not my doctor who hides behind the Popgun pseudonym [& note the pertinence of the first syllable of that word], if your diagnoses are as reliable as your Mudcat posts. There is not a hint of exploitation of this 'tragic episode' as a 'sick crusade against human rights' in the OP, except in the twisted thinking of one whose mind is made up about the poster so would prefer not to be confused with facts.

So just be off with you, whichever of the Muski·boobies you may happen to be -- and take the rest of them with you, please. The whole pack of you are a burden and a liability to this forum.

Subject: RE: BS: A 'rights' issue?
From: GUEST,Musket
Date: 15 Mar 16 - 08:08 AM

German law isn't my strong point, but EU concordats with respect to regulatory bodies means harmonisation of aspects of professional ethics, conduct and obligations.

I am a doctor, I am on the specialist register with The General Medical Council and could in theory practice under German law, as local registration is a quick process within EU states where you are already registered.

With regard to mental health, an example was given above of psychiatrists informing DVLA. Where a psychiatrist is involved in care, the patient would come under either The Mental Health Act 1983 where decisions are made for the patient by others or The Mental Capacity Act 2005 where the decision to disclose to DVLA was made in the best interest of the patient, as the patient lacked the capacity to be trusted to inform. In any case, and not just mental health but any aspect of health, a health care professional has the duty to disclose in the public interest where they have advised a patient of the patient's obligation to disclose and have grounds for concern that this would not happen, coupled with public safety risks if nothing is done. This is dealt with under The Health Act 2006 and a regulatory clause under The Health and Social Care Act 2008 regarding taking national guidelines into account when assessing and delivering care.

Again, having read a number of articles over this case, and it is of huge interest to our profession, should precedents follow, I am still not clear regarding detail. What is clear however is the wish of the OP to use this tragic episode for a sick crusade against human rights.

Subject: RE: BS: A 'rights' issue?
From: GUEST,Dave
Date: 15 Mar 16 - 07:02 AM

As far as the OP goes, this case will be dealt with under German law, with, as Musket says, regard to any international agreements Germany will have in place regarding the licencing of pilots. So any talk of the US constitution, or Magna Carta, simply is not relevant. Does anyone here know anything about German law? I don't. Musket's post implies he might.

Subject: RE: BS: A 'rights' issue?
From: GUEST,Dave
Date: 15 Mar 16 - 06:54 AM

Jim, surely you can getCooleeney cheeses.
Liverpool Cheese Company stock them sometimes, and there is a soft mushroomy one which is better than any Camembert you get round here.

Subject: RE: BS: A 'rights' issue?
From: GUEST,Raggytash
Date: 15 Mar 16 - 06:24 AM

Try the English Market in Cork Jim. I've had some good stuff from there.

Subject: RE: BS: A 'rights' issue?
From: Jim Carroll
Date: 15 Mar 16 - 06:15 AM

"Camembert" - sighhhhhh - can't get decent Camembert over here
Jim Carroll

Subject: RE: BS: A 'rights' issue?
From: MGM·Lion
Date: 15 Mar 16 - 05:36 AM

I wait with bated breath!


Like the cat that swallowed the Camembert and stood exhaling beside the mousehole, eh Jim?

≈M≈

Subject: RE: BS: A 'rights' issue?
From: GUEST
Date: 15 Mar 16 - 04:59 AM

It's not a rights issue. It's a risk management issue and a medical ethics issue. If someone could get sued it's a legal issue as well, and there seem to be a lot of things related to "duty of care" that have not been tested in the courts in the UK.

However, in the UK, Musket's example of a doctor the informing the DVLA of unfitness to drive suggests there is a way of sorting these things out. What happens if a doctor who signs an application for or renewal of a firearms licence sometime later thinks that the person is no longer fit?

Subject: RE: BS: A 'rights' issue?
From: Jim Carroll
Date: 15 Mar 16 - 04:59 AM

"a large part of it is dangerous and counter productive."
No it isn't - only when it's abused or ignored.
Nobody gives us or anybody rights that aren't necessary, and quite often they are hard fought for.
Stop using an anomaly of a tragedy to attack a very necessary human right please.
Perhaps you might clairify your argument by listing those rights you believe to be "dangerous and counter productive." so we know what we are argguing about - I wait with bated breath!
Jim Carroll

Subject: RE: BS: A 'rights' issue?
From: Spleen Cringe
Date: 15 Mar 16 - 04:24 AM

It''s not a rights issue. It's a risk management issue and a medical ethics issue.

Subject: RE: BS: A 'rights' issue?
From: akenaton
Date: 15 Mar 16 - 04:22 AM

I also don't see how it could possibly be in the interests of the airline to knowingly employ someone with Mr Lubitz's mental problems.

Subject: RE: BS: A 'rights' issue?
From: akenaton
Date: 15 Mar 16 - 04:16 AM

The general concensus is that the doctors did not inform the employers on the grounds that they may have been sued.

In my opinion these people should have to answer in court for their lack of action.

Much of our "rights" legislation is beneficial ....a large part of it is dangerous and counter productive.

One size does not fit all.

Subject: RE: BS: A 'rights' issue?
From: GUEST
Date: 15 Mar 16 - 03:55 AM

Working for an airline used to be a dream job, today is basically a modern form of
slavery 

Subject: RE: BS: A 'rights' issue?
From: Jim Carroll
Date: 15 Mar 16 - 03:23 AM

"bad "rights" legislation?"
I often wonder why people use tragedies like this to attack a sysytem that, as flawed as it is, guarantees us some few 'rights'.
That our doctors are sworn to confidentiality is fine by me - I don't want the press, the police, the government to have access to information on me that they might use against me, should they wish to - we are entitled to the protection that these rights have.
It is possible here that some degree of discretion might have been used, given the position that this sad individual held, but that has little to do with the general fact that were are entitled to protection from intrusion, from the state, from the media and from the general public.
This was a horrendous tragedy, for the passengers and for the pilot, who was obviously disturbed.
Please, let's not use it to undermine a basic freedom.
Jim Carroll

Subject: RE: BS: A 'rights' issue?
From: Spleen Cringe
Date: 15 Mar 16 - 03:14 AM

In the UK a psychiatrist will generally notify, for example the DVLA, if they think a patient's mental state is such that they pose a risk to themselves or others when driving. In fact, mental health professionalservices have a duty to breach confidentiality when the risk of harm significantly outweighs the alternative. I don't no enough about how things work in Germany to comment specifically on this case, but I would suspect the issue isn't one of 'rights'. Though I don't understand why the OP implies such a downer on rights generally - in principle, human and civil rights are a good thing, no?

Subject: RE: BS: A 'rights' issue?
From: GUEST,Musket
Date: 15 Mar 16 - 03:14 AM

The whole issue of occupational health is mired in legislative contradictions in just about any country. Also, for pilots to have their licences recognised in countries other than their own, international agreements need to be in place. (Sure, your licence was issued in Khazakstan, but you want to land your plane in Italy...)

This has meant employers asking would be employees to consent to giving them knowledge of their health that not only satisfied their national legal rights but us st s level that suits other countries too.

A minefield for the employer and employee then. But with consent, fairly straightforward.

Then we come to the doctors. First and foremost, away from any interpretation of the Hippocratic oath, we have the contract. If a doctor feels a contract compromises professional integrity, they should not take it on. They should be comfortable with what is being asked of them.

But are we talking of a doctor carrying out an assessment on behalf of an employer or a patient seeking a consultation with his doctor?

Conclusions? The doctor in question may well be referred to his professional body to review why knowledge of a psychotic episode wasn't disclosed to his customer the airline if the former, but the crash investigators have no remit in Germany or most countries for that matter to force a doctor to disclose details of the patient consultation itself in either case.

A doctor the patient sees in the course of day to day health has a duty to advise the patient to inform his employer of any condition or disclosure pertinent to his work.

The confusion in all the stories over this event seem to confuse the reader between a doctor working on an occupational health contract and a doctor seeing a patient at the patient's instigation. If a patient tells a doctor he will not heed the advice, a doctor can, in both Germany and here in The UK make a decision to disclose in the public interest, but based on professional judgement. Examples here would include informing DVLA of fitness to drive.

A doctor working in occupational health can and should have disclosed such information to his client. However, an occupational health doctor should also have the latitude to be able to say "unfit for the role on medical grounds" without disclosing why. (Here in The UK, we call it "Caldicott" or "need to know" basis.)

There may be questions for a doctor to answer, but crash investigators have a different remit. For them it's "did the employer act appropriately on medical assessment?" or in the case of the employer seeing a doctor outside of work "did the employee fail to disclose?" If there are concerns that a doctor knew the patient wouldn't disclose, then an outcome from the investigation could be to refer a doctor to his professional body. But such a subjective question posed to a doctor wouldn't help the investigation. "Yes, I do expect patients to act on my diagnosis."

I have not read anywhere that an occupational health doctor failed to take anything into account or that a doctor elsewhere had concerns that a patient would fail to disclose. The consultation in question was shortly before the crash. This whole story is based on whether a doctor expected a pilot to carry out his professional obligation. There are protocols for dealing with such an event.

By the way, with regard to the OP, there were no "doctors" involved but there are doctors.

Subject: RE: BS: A 'rights' issue?
From: GUEST,Guest from Sanity
Date: 15 Mar 16 - 02:36 AM

michaelr: "What is unclear is whether this doctor was in the employ of the airline Lubitz was flying for. I would expect that airlines retain physicians to check on the health of personnel."

Yes, I said pretty much the same thing...BUT...was the doctor working with the airline, or privately, or for the issuer of the pilot's license...and all those may have different priorities, based on what 'mindsets' (which would be different from each other..as opposed to his conscience...AND, we may be dealing with international law, which may have a different set of guidelines to their priorities...That's why I went into all the 'examples'...cultural, versus legal, versus personal responsibilities, versus his doctors oath...and I know it was a lot of 'verbiage' (having to have typed it)...just to point out the possible conflicts of interests involved.

Of course you feel that way....as would a lot of us...based on your cultural background..as opposed to, let's say, a corporate background, and the legal guidelines to responsibility.

I tried to approach this, non-emotionally, NOT based on 'political persuasions'.

OK??

GfS

Subject: RE: BS: A 'rights' issue?
From: Kampervan
Date: 15 Mar 16 - 01:30 AM

In the UK, if you apply for a shotgun certificate (licence) you have to tick a box giving the police permission to contact your doctor and ask if the doctor knows of any reason why you should not be given a licence. The idea of this is to reduce the chances of someone with mental health problems getting hold of a shotgun legally.

Why can't anyone whose job involves risk to the public, e.g. airline pilots, bus drivers etc, be obliged to give a health professional employed by the airline or civil aviation authority access to their medical records.
That way the persons doctor has no conflict of interest, or 'rights issue' because the patient has given their permission for their records to be accessed?

Subject: RE: BS: A 'rights' issue?
From: michaelr
Date: 15 Mar 16 - 01:29 AM

I meant to add that for the doctors to remain silent now smells fishy in the extreme. The patient is not only deceased, but also likely guilty of the deaths of dozens of innocent people.

Subject: RE: BS: A 'rights' issue?
From: michaelr
Date: 15 Mar 16 - 01:26 AM

OK, just to cut through the verbiage, the doctor had a responsibility to "do no harm". He may have violated that by keeping mum about the nut.

What is unclear is whether this doctor was in the employ of the airline Lubitz was flying for. I would expect that airlines retain physicians to check on the health of personnel. If the doctor was working for the airline, he should have reported his concerns. If he was not, he could claim confidentiality.

Subject: RE: BS: A 'rights' issue?
From: GUEST,Guest from Sanity
Date: 15 Mar 16 - 01:07 AM

Hey, you know that question has been floating around on that, and a few other issues, where that has come into question....so, here's my two cents.....'Liberals' love to cite rights, as their basis for a lot of their behaviors, so in the blur of political correctness, some things get obscured .... When your 'will' infringes on some one else's 'rights', somebody has crossed the line. In America the guideline used to be the Constitution to define those lines....I say 'used to be' because depending on one's subscribed political agenda, they seem to cherry pick the Constitution, when convenient, and wishing other parts would just go away...when in actuality, the different provisions(amendments) were considered to be integral to making the WHOLE thing work together....sorta like to keep us all in balance...including room for the people to take whatever action needed to fix or replace their government, in any way THEY saw fit.

Now, growing up in that, along with everyone else sets up a mindset, which may not be as dominant in your country, as ours, but you seemed to be quite 'in touch' with most of it...if not all......so, back to the question on hand, the above in mind....

In our Constitution, which, as I said, 'used to be' our prime law, we are supposed to be guaranteed, without government impediments, of which we are all collectively supposed to be, 'life, liberty, and the pursuit of happiness'...

..OK, that is supposed to be the law.

Now, where the source of the conflict lays, is at what point can a doctor, or business, make a concerned decision, AND on what basis, to release private information, and breach doctor/patient privilege...even if means possibly safeguarding the lives of others...and keeping in mind that hindsight is usually 20/20...and inaccurate speculation can pose 'inconvenient consequences'...even to the point of infringing others rights, over a 'false flag'(Read: The boy that cried wolf), to the point of irresponsibility.

So, it depends on the mindset of the holder of the information...
Examples: If you are a doctor, in their oath they took, as doctors, there is a phrase that implies that they do no harm(health wise), to their patients...in fact, anyone.
Example: If you're a business, such, as in the airline, your primary concern is to safely transport people, minimize expenditures, make as much profit as possible, and not get sued.
Example: If you are a family of a loved one that went down, you are devastated, it is if, a part of your own life went down with them.
Example: If you're a radical Islamic, they were all martyrs, who were killed by an infidel pilot.
...and believe it or not, that's what is going on, within the mindsets, and cultural societies that people are accustomed to..how they inter-act..so on and so forth.

IN our primary law, the Constitution, was written to address, the mindset, of white, Europeans, who fled Europe, to get away from a monarchy/religious system, and give the governing power to the people. This was able to be done, because Europe was basically working around a Judaeo/Christian point of reference, incorporated loosely into their social fabric...also, the forerunner of the Constitution was the Magna Carta, in regards to governing and rights....all that being said, to contrast, let's say, coming from an Islamic social fabric mindset. (NOTE: I am only using the Islamic social culture, to illustrate the fact that 'common sense' may differ from culture to culture, and therefore one culture may not understand that not only do they not see eye to eye, they may see each other as a threat, or even an enemy...and therefore a wariness, and distrust...OK, enough of that illustration.

Now all the different cultural mindsets are going to have different priorities...However, in the case of the pilot and doctor, IF the doctor was aware that Mr.Lubitz's psychological condition included suicidal thoughts, to some degree or another, and a medical examination was a part, or condition, of him possessing a commercial pilot's license, or international pilot's license pilot's license, as a prerequisite to pilot, then it would be the obligation of the doctor, to advise Mr.Lubitz, that he would notify the company, or even the issuer of such said license, that his activities should be suspended, until further evaluation and/or treatment determines his capabilities.

Now the reason I went into the various 'mindsets', is that one might argue that the doctor was either negligent, or misdiagnosed, or under-evaluated Mr.Lubitz....OR, the doctor may have felt restrained from violating Mr.Lubitz patient/doctor confidentiality privilege.

If you are considering the airline's point of view, they are going to do everything possible to shift blame onto the doctor...thereby avoiding as much liability as possible.

If you are just a concerned western citizen, puzzled, then you may think, depending on your cultural point of reference, that somebody should have said something to prevent this from happening, and see it as 'common sense' versus the 'right to privacy'.

To the family and friends, they will approach this from an emotional point of view, perhaps to the extent of being co-victims, and feelings of their rights being ignored.

And, of course, if you were approaching this from a radical Islamist's point of view, you'd be out to avenge the martyrs, and take revenge on the infidel....regardless of mitigating circumstances.

Soooo, all those factors would have to be considered(maybe except the last one, if it doesn't apply) before a 'legal opinion' could be reached.

Personally, if the doctor was aware that Mr.Lubitz posed a risk to himself, or others, and said nothing to the agency that qualifies pilots, based on abilities and medical evaluations, based on privacy concerns', and/or the company that employed Mr.Lubitz, then I would say not only was his sense of 'civil rights' out of balance, but so was his obligation to what he felt was a conflict of interest, and that guidelines to clarify his priorities, as to whom he is serving, made perfectly clear, before further action could be taken.

So, not enough is known, at this time.....which doesn't bring any comfort to the loved ones left behind.

Just my first thoughts on the matter....

GfS

Subject: BS: A 'rights' issue?
From: akenaton
Date: 14 Mar 16 - 02:58 PM

The inquiry into the plane crash in the French Alps which killed over a hundred people, has found that "doctors, who confirmed Lubitz had "shown symptoms suggesting a psychotic depressive episode" just weeks before the crash, refused to speak to investigators, citing patient confidentiality.
These doctors also refused to inform Mr Lubitz's employers of his condition even though they knew he was a pilot.

Another examples of bad "rights" legislation?

Whole story HERE