You’re a couple of hours out of Sydney on your way to Europe, you’ve settled into your in-flight movie and you’re finishing your second glass of shiraz when the announcement goes out: “If you are a doctor, could you please make yourself known to a crew member?”
If you’ve been practising medicine for some time, you may well have encountered such a scenario: by one estimate, an emergency requiring medical assistance occurs on one in 600 commercial flights. But as a doctor, what are your legal and ethical duties and your liabilities, and do your two glasses of shiraz matter?
The question of legal duty is complex. A new viewpoint published this week in JAMA states that physicians do not have the legal obligation to assist in the United States, Canada or the United Kingdom, but they may do in Australia and some European countries.
The situation in Australian airspace is ambiguous to say the least. Morag Smith, Senior Solicitor at Avant Law, says there is no common law requirement for doctors to provide assistance to non-patients in an emergency. But that advice would seem to be contradicted by a 1996 case in which a GP declined, when asked, to assist a child on holiday who was having an epileptic fit. The child ended up neurologically damaged and the doctor was successfully sued for negligence.
Regardless of legal obligation, most doctors and medical associations would agree that there is at the very least an ethical duty to assist if you feel you can make a difference.
The question of liability if you do assist in an in-flight emergency is more clear-cut. So-called ‘good Samaritan’ laws protect doctors and healthcare providers from legal liability as long as the care is given in good faith and the doctor is not impaired by alcohol or drugs at the time. Similar laws apply in the United States.
So then there’s the question of your shiraz, because, let’s face it, a long-haul flight without a glass of wine is a rare thing indeed for the non-tee-totallers among us.
It’s a grey area, but if you consider your competence may be impaired due to your alcohol intake, you may wish to inform the cabin crew before deciding whether you are in a position to assist. It may well be that there is another doctor on board who would perform better than you.
Here are a few tips should you ever find yourself being the “doctor on board” during a medical emergency:
- Inform the crew of any limits to your medical competence. If you haven’t practised for some time, it may be that another doctor or nurse on board is more competent;
- Check what medical equipment there is on board. This can vary considerably from airline to airline;
- Many airlines have access to surface medical support: ask the crew if this is the case and request immediate contact with the ground medical team;
- Get a history from the patient and obtain their consent to examination and any treatment;
- If a patient can’t consent, and there is no family member to consent for them, you can still proceed with treatment if you believe there are reasonable grounds to suppose the patient will benefit;
- Be ready to make a judgement call as to whether a patient can be helped by the plane being diverted or turned back.
Sources: Avant, JAMA