"If there is a doctor on board, would you please make yourself known to a member of the cabin crew?” Reflexively, my hand shoots up to press the button. Seven times I have responded to such requests. Mostly it has worked out well. Twice I thought the passenger had had too much alcohol. Once I comforted an anxious woman. Another time a young army recruit heading for basic training had unexplained arm pain. Sometimes it was more serious. A man with abdominal pain told me he had cancer and he needed my attention and reassurances. A woman had a cardiac emergency, and I had to request an unscheduled landing. Another emergency on a trans-Pacific flight required the extended care of several physicians.
Each time I wonder, “Who else on board is qualified to help but has not responded? Is there someone better qualified than I am?” Later, I ask myself, “Why do I respond?” I think about what it means to be a physician and possible limitations of my duty to respond. And, if I have a duty to respond, do I have a duty to be prepared to respond whenever I fly?
I have reflected on these questions for a long time. As I have become more distant from the direct care of patients, they now take on added relevance. I had practiced as an internist and gastroenterologist, but for most of the past 25 years I have been a medical school dean or the president of an academic medical center and have not had direct responsibility for the care of patients. Yet, during that time, four of my seven responses to requests for in-flight help have occurred. I know that the incidence of in-flight medical emergencies that involve communication with experts on the ground is about 1 in 600 flights.1 And although that is an underestimate for all in-flight medical emergencies, still, at seven, I seem to have had more than my share. Nevertheless, every time I board a plane I wonder, will it be my turn again?
Do I Have a Duty to Respond?
In the United States, Canada, and United Kingdom, physicians do not have the legal duty to assist unless there is a prior patient-physician relationship. In many European countries and Australia, physicians do have the legal duty to respond.2 Responders are protected legally in the United States, unless they are grossly negligent or intentionally cause harm.1- 3 The person providing assistance must do so voluntarily, in good faith, and not receive compensation, although travel vouchers, wine, and seat upgrades are permissible.
But does being a physician carry a moral obligation to respond? Am I ethically negligent if I don’t respond? Whether I feel I have a duty to respond may depend on how I feel about the question, When am I a physician? When am I not? Do I regard myself as being a physician all the time or do I shed the mantle of being a physician when I am not explicitly in that role? Some physicians say they always are a physician. That is their identity and they feel the obligation to respond to situations in which their expertise may be useful. Other physicians do not feel that obligation.
My perceived obligation also may be conditioned by my discipline or recent experience. Am I in a specialty in which I regularly and directly care for patients and thus am familiar with urgent medical situations? Or am I in a discipline that does not require direct patient care and feel my skills are not up to date? What if I am in the practice of administrative medicine,4 or retired, or otherwise disengaged from medical practice, even though I had been trained at one time to take care of medical emergencies?
How I perceive my duty may be influenced by the particular circumstances of the emergency. For example, is my duty to respond in an airline cabin different from my duty to stop at a roadside accident or to offer assistance in a restaurant or an auditorium? In roadside emergencies and in many public spaces, trained emergency personnel usually respond quickly and effectively, whereas in the “closed system” of an airline cabin, the options for medical expertise are more constrained.
Do I Have a Duty to Be Prepared?
Some physicians, when at gatherings or events, think in advance what they might do if there were a medical emergency. Should that apply to flying? If I feel that I do have some duty to respond during in-flight emergencies, should I prepare for that possibility in some way? Should I brush up on my knowledge and skills from time to time, particularly if I am in a discipline or position that does not require frequent patient contact? Should I avoid alcoholic drinks on board so that my judgment and behaviors will not be hindered? Should I even go so far as to be on the lookout for passengers who appear sick or in distress so that I am better prepared if I am called?