RT Journal Article SR Electronic T1 Medical Privacy versus Public Safety in Aviation JF Journal of the American Academy of Psychiatry and the Law Online JO J Am Acad Psychiatry Law FD American Academy of Psychiatry and the Law SP 224 OP 232 DO 10.29158/JAAPL.003839-19 VO 47 IS 2 A1 Christopher A. Kenedi A1 Jacob M. Appel A1 Susan Hatters Friedman YR 2019 UL http://jaapl.org/content/47/2/224.abstract AB Confidentiality, considered a fundamental principle of medical ethics, is potentially at odds with public safety when an airplane pilot is experiencing symptoms of mental illness. Reporting requirements for pilots vary across the world, and pilots can be subject to multiple national regulatory authorities for international flights. Stigma exists about getting treated for depression. If one's livelihood and core sense of identity is placed at risk by seeking treatment, people will naturally avoid assessments and engagement with mental health clinicians, the very treatment that could mitigate risk. Suicide and homicide by aircraft are rare events and are difficult to predict, but the impact can be catastrophic. Variables other than mental illness, such as personality structure, occupational and relationship stressors, and coping mechanisms are also critical in conceptualizing risk in this population. Requirements for those employed in other methods of transportation are contrasted with those for pilots. Finally, legal and ethics concerns regarding reporting requirements for pilots are discussed and suggestions made.