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"Is there a doctor on board"? Who hasn't heard this announcement while flying, specially long distance. I once talk to an American medical doctor on a non-American carrier who told me he tries to travel with non-American carriers as much as possible, simply because it is the carrier's country's legislation that is in place on any flight. This way he isn't liable.

This discussion made me wonder if this is factual and if so does it mean you are no longer a medical doctor once you board an airplane from another country then where you are a doctor?

Does this also apply if you are traveling in a foreign country?

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Sure, but there aren't many other countries where people fairly regularly sue doctors who were trying to help them in life-threatening situations. –  jpatokal Mar 19 at 9:53
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Might depend on the airline? Lufthansa have a special program for Doctors to pre-register, which allows cabin crew to know immediately if there is a doctor, and provides the doctors with liability insurance –  Gagravarr Mar 19 at 10:58
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@Amber I don't know how it works in the US, but in Italy it's illegal to not help, to the extend that you are able. So not helping wont protect you from lawsuits, at least in Italy. –  Bakuriu Mar 19 at 12:32
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The issue this doctor faces I suspect is not about whether he counts as a doctor, but whether he could be sued under US law if he tries to help a passenger and something goes wrong. The US legal system is notoriously trigger-happy, and doctors are sued in the US much more frequently and for much larger sums than anywhere else. Many other countries have safeguards preventing doctors from being sued when they try to help in these circumstances. –  DJClayworth Mar 19 at 12:58
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@Amber, this is patently not correct. Please see Dutch Law article 450, you can be punished with up to 3 months in jail if you don't provide care "up to your ability" for someone who dies. –  Von Lion Mar 19 at 16:06
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5 Answers 5

up vote 27 down vote accepted

Your question has both legal, but perhaps more important, also moral aspects.

Generally speaking, when airborne, an aircraft is subject to the legislation of the carrier's home country. So far so good. I am not sure if medical doctors according to US law is both legally required to help in an emergency and liable to damages they inflict even if practicing in good faith, but if it is so, the doctor you are talking about is indeed relieved from these legal obligations when flying with a foreign carrier.

The legal regulations defining liabilities, but also the duty to help are however very different from country to country. E.g. German criminal code contains "non-assistance of a person in danger" (unterlassene Hilfeleistung) as an offense and obligates even lay-men to help in case of an accident or medical emergency. Failure to do so is punishable with a fine or even up to one year imprisonment.

I am also not aware of any country actually forbidding medical doctors or lay-men to provide assistance in case of emergencies. Members of "Médecins Sans Frontières" are regularly both assisting and practicing medicine in countries, in which they are in most cases probably not legally approved to work as doctors.

Even without any legal regulations, medical doctors at least ought (IMHO) to feel morally obligated to follow the Hippocratic oath and help wherever possible.

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+1 for that last one, however idealistic it seems (or is) nowadays. –  ldigas Mar 19 at 11:43
    
Also, "medical doctor" encompasses a wide range of skills and professions. Someone who has been an ocular oncologist or pediatric psychiatrist or arthroplastic surgeon for 20 years may be no better than a layman dealing with acute appendicitis or a severe allergic reaction in flight. According to my doctor friends in the U.S., if they identify themselves as doctors, they must stay with the patient and render all possible aid. If they do not believe they can provide meaningful assistance, however, they need not identify themselves. –  choster Mar 19 at 15:17
    
It's not about doctors being forbidden to provide assistance. It's that if they do, and something goes wrong, they may be sued for large amounts of money. It's also possible that their insurance wouldn't cover them, meaning that they would be personally out millions of dollars for trying to help. –  DJClayworth Mar 19 at 18:10
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@DJClayworth: Is that a problem in any other country on the earth except for the USA? –  Tor-Einar Jarnbjo Mar 19 at 21:36
    
@Tor-Einar Jarnbjo: perhaps not to the same degree, but in many (if not most) jurisdictions, people are held liable for damages incurred by gross negligence, and the standard for what constitutes gross negligence when providing first aid are different for doctors than for laypersons. –  Michael Borgwardt Mar 19 at 23:14
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There are at least four aspects to this question:

  • Legal obligation
  • Legitimation
  • Liability
  • Moral

Obligation

Legal obligation is a common misconception. While generally there exists an obligation not only for medical professionals but for every person to help in most (all?) countries in the world, this obligation does not work the way laymen think. You have the obligation to help another person if, and only if:

  1. The other person's life is in present and immediate danger or if there is a present and immediate danger which would lead to a very serious permanent damage (such as losing a hand)
  2. The risk for you is "acceptable". You have for example no obligation to enter a burning building or to unfasten your seatbelts in an airplane when turbulences are likely (or even during turbulences). You have no obligation to perform CPR without mask if the person has a rather obvious "infective" look or likely suffers from contact poisoning or such, etc, etc.

You have no obligations whatsoever if the patient is merely drunk (which makes up ca. 90% of all "emergencies" that I've seen aboard an airplane during 20 years) or airsick or has a bad tummy (which are 9.9% of the remaining 10%). In fact, I have personally never seen a real emergency (one that deserves the word "emergency") aboard an airplane, but of course your mileage may vary.

Legitimation

Technically, aboard a foreign-company airplane, you are not legitimated to act as a medical professional most of the time. For example, the USA do not consider a German grade (although it is much better) valid, and Germany does not consider many (mostly eastern) grades valid, though the number has greatly decreased during the past few years due to EU memberships.

An airborne foreign airplane is "foreign ground", so technically you may be breaking the law by acting as medical professional even if you are normally legitimated. In practice, nobody cares, at least as long as nobody dies. The flight personnel only wants someone to take over, passengers don't know (and likely don't care at that very moment either), and medical professionals usually don't like thinking about legal stuff more than absolutely necessary (well, nurses do, but physicians usually don't).

Liability

In countries with somewhat "sane" jurisdictions, damages from administering first aid are generally covered by a commonwealth indemnity insurance. This is to ensure that people do not abstain from helping in fear of liabilities. In some other countries, you can be dragged to court for $100 million if something goes wrong.

However, medical professionals are never covered by the public insurance and are expected to have an indemnity insurance of their own (which isn't precisely free and which they must pay from their private money). Though I have never experienced this kind of problem, it is at least conceivable that the insurance company will try to perform a vanishing trick if you have "officially" operated outside your legitimation.

Reputable airlines used to give you a signed "cover everything, no matter what happens" waver contract before you start, but some have begun to greed out based on "you need to have an insurance anyway". Which of course means that since you get no payment for a presumably disturbing work and carry the complete risk, helping gets quite unattractive.

Moral (both ways)

There is nothing special about doctors or medical professionals in general as far as moral is concerned. The same moral applies to everybody else who likes to point a finger at someone else and say "their responsibility".

Helping someone who is in danger is a moral obligation for everybody. On the other hand, getting vomited over by a stinking drunk isn't anyone's obligation.

It is, on the other hand, a serious question of morality of getting stinking only because drinks are free (not only because of the vomiting part, but also in a sense of general safety, also towards the roughly 200 other people in the cabin).

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You cannot make such a detailed description of the legal obligation to help without limiting yourself to a specific legislation. In German law, the duty to aid help is even extended to the protection of material property and not at all restricted to life-threatening medical emergencies. The required scope of the help may be defined by the helper's experience and education. A medical doctor may be required to aid help in situations, where a lay-man is not. Risking a self-injury is not necessarily an exclusion criteria from the requirement to aid help. –  Tor-Einar Jarnbjo Mar 19 at 14:50
    
@Tor-EinarJarnbjo: That's wrong. Risking self-injury is certainly a valid exclusion criterion, especially in Germany (where I'm approbated). While a medical professional is required to provide generally more detailled and more error-free help by his education, this does not affect anything else. The "freie Arztwahl" works both ways, unless someone is in "Notfall"-condition, I can certainly choose whether I want to treat him. There exist rules for "Gefahr im Verzug", but in that case, again, I'm only obligated to do a phone call, I'm not obligated to risk my own safety. –  Damon Mar 19 at 15:07
    
@Tor-EinarJarnbjo: Those "superhuman hero doctors" who regularly get killed on the Autobahn because they are in some kind of must-help-I'm-invincible mindset (until they're hit by a car at ~150km/h) are a good example of what you need not do. Due diligence is required, nothing else. You need not try to wrestle down a drunk who will otherwise run into a train, and you don't need to hold someone who is jumping off a bridge, nor do you have to get in between a madman with a knife and his wife. There's police for that. You (anyone!) are required to to do what is "zumutbar". –  Damon Mar 19 at 15:13
    
I wrote that avoiding self-injury is not necessarily an exclusion criteria. You pointing out that no one demands you to obviously put your life in danger and take up a fight with an armed mad-man does not disqualify my statement. Merely the fear of getting infected by contact with body fluids or performing CPR or refusal to exit your own vehicle to help in a traffic accident (even if you are safer in the car) may not free you from the duty to help. –  Tor-Einar Jarnbjo Mar 19 at 15:54
    
@Damon you're making general statements, and generally speaking (rather than in the German context) your statements aren't valid. Similarly, in some countries you are legally protected under good samaritan laws against being sued or arrested when trying to help someone and failing. In other countries you're not, and helping someone is more likely to end you in prison or bankrupt than it is to get the person you're trying to help out of a bad situation. –  jwenting Mar 19 at 15:57
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There is a statement on these questions by the World Medical Association here:

http://www.wma.net/en/30publications/10policies/a26/

Therefore the World Medical Association calls on its members to encourage national airlines providing medium and long range passenger flights to take the following actions:

Equip their airplanes with a sufficient and standardised set of medical emergency materials and drugs that:

  • are packaged in a standardised and easy to identify manner;

  • are accompanied by information and instructions in English as well the main languages of the countries of departure and arrival; and

  • include Automated External Defibrillators, which are considered essential equipment in non-professional settings.

Provide stand-by medical assistance that can be contacted by radio or telephone to help either the flight attendants or to support a volunteering health professional, if one is on board and available to assist.

Develop medical emergency plans to guide personnel in responding to the medical needs of passengers.

Provide sufficient medical and organisational instruction to flight personnel, beyond basic first aid training, to enable them to better attend to passenger needs and to assist medical professionals who volunteer their services during emergencies.

Provide insurance for medical professionals and assisting lay personnel to protect them from damages and liabilities (material and non-material) resulting from in-flight diagnosis and treatment.

The World Medical Association calls on its members to encourage their national aviation authorities to provide yearly summarised reports of in-flight medical incidents based on mandatory standardised incident reports for every medical incident requiring the administration of first aid or other medical assistance and/or causing a change of the flight.

The World Medical Association calls on its members to encourage their legislators to enact legislation to provide immunity from legal action to physicians who provide emergency assistance in in-flight medical incidents.

In the absence of legal immunity, the airline must accept all legal and financial consequences of providing assistance by a physician.

The World Medical Association calls on its members to:

  • educate physicians about the problems of in-flight medical emergencies;

  • inform physicians of training opportunities or provide or promote the development of training programs where they do not exist; and

  • encourage physicians to discuss potential problems with patients at high risk for requiring in-flight medical attention prior to their flight.

The World Medical Association calls on IATA to further develop precise standards in the following areas and, where appropriate, work with governments to implement these standards as legal requirements:

  • medical equipment and drugs on board medium and long range flights;

  • packaging and information materials standards, including multilingual descriptions and instructions in appropriate languages;

  • medical emergency organisation procedures and training programs for medical personal.

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We're looking for long answers that provide some explanation and context. Don't just give a one-line answer; explain why your answer is right, ideally with citations. Answers that don't include explanations may be removed.

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Welcome to the site. In case linked sites go down, we like to quote the key content from them, instead of just linking. Could you perhaps elaborate a bit more in your answer? –  Mark Mayo Mar 19 at 12:49
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Please assume that you are.

I can only give you the answer for example Dutch law, but a lot of countries have similar regulations (apart from it being your ethical duty).

Dutch law Article 450 states (translated by me):

He who, witnessing immediate and life threatening danger to another, does not render aid to his ability, without reasonably endangering himself or others, will be, if the other dies, punished with up to 3 months in prison or a fine of the second order (as of 2014: €4,050).

So in general you are liable if you do not render aid to your ability (your ability might just be calling emergency services).

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On an international Delta flight, I sat next to a couple that on their previous connecting flight, had seen a man experience some sort of stroke or heart attack. Coincidentally, a steward from that flight who took care of the emergency was one of the crew of my flight, and he and the couple next to me started talking about it and shared the whole experience with me.

It turns out that for medical emergencies, crew members by law are trained in first-aid. Also I learned that they have access to a sort of "medical" phone on the back of the plane, which when used, immediately connects the crew with a doctor and he instructs the crew what to do in case of medical emergencies.

So it may not even matter (or airlines might not "care" whether there is a doctor on the plane or not), as the crew members are trained to at least be relays for the "on-call" doctor of the airline. I'm not sure where the doctor on the other end of the line has to be licensed from, nor if this is even a legal requirement for all airlines. But I learned this had occurred on a Delta international flight.

I'd imagine that if the "medical" phone is required my law, that the airlines would want to handle the issue using their protocols rather allowing than some random "doctor" that happened to be on the flight to intervene, due to legal liabilities. Of course the protocols and law become a bit fuzzy during an emergency at 5,000 feet, and I'm sure that the crew has a lot of discretion on deciding what's the best thing to do as an emergency evolves.

A quick google search on the subject leads me to articles like this one that confirm what I learned from that conversation.

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Some airlines (such as BA) carry additional medical supplies that the crew aren't allowed to use, but can be used by a Doctor if there's one on-board and they need it. So, at least some airlines have planned to allow "random" doctors on board to help where required! –  Gagravarr Mar 26 at 22:40
    
@Gagravarr true, yes. I imagine it can vary a lot by airlines, and by the laws in the home-base country of the airlines too. –  CesarDV Mar 28 at 14:59
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