The recommendations are delicate. The investigators from France's BEA air accident agency acknowledged today that it's not easy to balance patients' right to medical privacy and public safety, and said they don't want to stigmatize people suffering depression.
But they argue that aviation authorities around the world need clearer rules, after Germanwings co-pilot Andreas Lubitz locked his captain out of the cockpit and slammed Flight 9525 into an Alpine mountainside March 24, 2015.
Lubitz had suffered from depression in the past, but authorities and his airline later deemed him fit to fly.
What they didn't know is that his mental health troubles had returned.
The final crash report released by the BEA today lays out in chilling detail how bad things had become.
Lubitz consulted dozens of doctors about perceived vision troubles and sleeplessness in the months leading up to the crash.
One doctor prescribed antidepressants, including one whose side effects can include suicidal tendencies.
Another doctor referred Lubitz to a psychiatric clinic two weeks before the crash, suspecting a potential "psychotic episode," said Arnaud Desjardin, leader of the BEA's Germanwings investigation.
Neither did the doctors, citing Germany's strict medical confidentiality laws. The BEA says those rules need to change.
Among a list of 10 safety recommendations to international, European and German aviation authorities, the BEA said they should draw up new rules requiring medical workers to warn authorities when a pilot's mental health could threaten public safety.
It suggested more rules like those in the US and some other countries, which allow use of some antidepressants under medical supervision, to encourage pilots to seek treatment and come forward about depression.
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