Duty to Respond to In-Flight Medical Emergencies? Moral, Not Legal, Says Ethicist

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at New York University Grossman School of Medicine. I came across an interesting article recently in the Wall Street Journal, which was exploring the question of when and if physicians — and I guess you could include nurses in this, too — should respond to a medical emergency on an airplane.

I thought that this is really an interesting ethics question to examine. It covers anybody who is a physician or a nurse. Many people could be impacted potentially by having a medical incident with a pilot, a stewardess, or a passenger on a plane. What are our duties? What are the obligations? What rights do individuals have in these settings? What are the liabilities?

I did look around a little bit. You might also be thinking about places like cruise ships. It turns out that the big ones do have doctors on board and limited medical facilities, but they have them. Smaller voyages would probably be similar to the airplane situation, for example if you were on something that had 25 passengers.

I know some of you may be thinking, aside from airplanes, in what other situations could this question come up about your duties to help? It could come up on a big cruise ship, but I looked at that and all the big cruise lines have a medical doctor on board. Maybe a small trip with 25-50 people or on a ferry, it could come up in that context. Train trips, going across the country or down in the Northeast Corridor on Amtrak, I could imagine a medical emergency breaking out and there could be a call for someone to help. You may have other settings, including subways, buses, and other situations where you're in some public space of travel, and the question comes up, what do you do?

First, I think there is a moral duty to try and render help. If there's, say, an unruly passenger and they're threatening people on the plane or threatening a stewardess, if you're physically able, I do think you have a duty to step in and try to restrain, break up, or reduce the conflict situation, even if you're just a passenger or a stranger.

You want to maintain, obviously, a nonviolent stance. You don't want to do anything where you're harming the other person. Trying to get them to calm down, getting them in a seat, or working with other people to restrain them without hurting them, might be the kind of duties we'd say anybody would have these days when traveling, sadly, when a different ethos may prevail and there's more violence, drunkenness, and trouble on some of our public and commercial transportation.

I think doctors and nurses do have a special duty also to help if the stewardess or the pilot says they have a medical emergency, having skills and training that might be able to assist someone who's in trouble. I do think that requires both identifying yourself and trying to respond.

However, I'm well aware that not every medical emergency is something that falls into the expertise that you might have on a plane. Somebody who's a pathologist may not be in the best position to help out if someone's having a seizure. Someone who's a psychiatrist may not be in the best position to help if someone's having a heart attack.

You're limited in some ways by the expertise that you can bring and by what you can do. I think you could say to people, I'm a doctor, but I'm not in this area. I can rely on what I learned in med school recently, or a long time ago, or what I know to be true just in keeping my education up. Try to do your best, but there may be situations in which you don't have the skill set or the expertise to really be a much assistance.

I don't think you're obliged to try and do what you can't do. If you can render aid and you feel confident that you know how to clear an airway, do CPR, or perform other interventions that might help someone who's in trouble, I do think there's a moral duty.

Is there a legal duty? Actually, no, there isn't. We've never recognized a legal obligation to stop and aid someone. I think the state of Vermont has the closest law to that about rendering aid in a traffic accident situation, but even there, it's a weak law. I don't think there's any law applying to air travel, boats, or trains that says you're going to be liable if you don't jump in and if you don't identify yourself.

This is an ethics duty. It's not one of law. I think if you try to do your best and try and follow what you believe to be true, you're not going to get in any legal liability even if someone dies after you try to help them or if someone says you injured them when trying to help them.

If you do the basic standard of care in responding to emergencies and responding to situations where someone is in trouble, I think you're going to be okay in terms of any liability or dangerous exposure to the legal system from trying to render aid. If you go beyond what you know how to do, that may pose a problem. If you're within the realm of what you believe to be true, what you believe to be best, and what you believe you're capable of doing, then I really think you're going to be okay.

There are other situations, such as someone giving birth on the plane. Some people are comfortable trying to help out there and some people a little less so, but that's certainly a different situation than someone getting into trouble because they are having an incident that might kill them or disable them.

There are also situations where someone might be having anxiety or some type of mental problem and fear of flying, worries, or something else is troubling them, where a different type of expertise from knowing how to do a tracheotomy might be called upon.

There are a variety of situations that might trigger responses where a doctor felt that they can't handle that, but could handle this. There are a variety of situations where somebody might ask if a patient is dead. You might take vitals and say that it appears they have died. Airlines have procedures to handle that when a passenger dies on a plane.

There may be situations that involve psychiatric or obstetric issues that require different types of expertise where a response may or may not be possible.

Bottom line, don't let your reach extend beyond your grasp. That is to say, stick with what you know. Try to help if you can. You might ask around and see if others are there who could help as well. Maybe there are people with different skills that could help out and bolster an intervention.

I think part of being a doctor or part of commanding the public's respect is when you step up morally and say, within the limits of what I know and what I'm comfortable doing, I'm going to try and help.

I'm Art Caplan. I'm at the Division of Medical Ethics at New York University Grossman School of Medicine. Thank you for watching.

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Cite this: Duty to Respond to In-Flight Medical Emergencies? Moral, Not Legal, Says Ethicist - Medscape - May 20, 2024.