Flight 9525 Germanwings

Digging a bit deeper, the Aviation Medical Examiner, AME who did the co-pilot's last flight physical should shed some light on the subject of Andreas Lubitz fitness. The doctor patient confidentiality does not exist for an AME exam, nor does it exist with a murder investigation with a court order. European law may differ, but here in the US, the AME would be duty-bound to report psychotic ideation, drug use, alcohol abuse, depression or the use of anti depressive medications -- for that matter hypertension or cardiac medications. This sort of thing is the purpose of the exam. 

However, a copilot is not held to the same standard as the pilot in command. A second class medical will suffice for the co-pilot and the second class medical is required only once a year. The captain, on the other hand, carries a first class medical, required every 6 months. The examiner too is held to a higher standard. Class I AMEs have more training, more experience and are usually pilots themselves. The FAA requires an aviation currency for class 1 examiners.

In either case, European accident investigators need to review the co-pilot's last AME and interview the physician. There very well may have been a professional or system laps.

Additionally, there is a serious gap in standards for low cost charter and so called Regional Airlines in general and the co-pilot qualifications in particular. For instance, the co-pilot can qualify with a rather easy to achieve commercial license and the class II medical mentioned above. The commercial license falls far short of the Air Transport rating required of captains and first officers on the major airlines. The commuter and regional airlines are not so picky allowing the first officer, such as Andreas Lubitz to literally fly in training.

The question I would ask: was the physician who wrote the note excusing Lubitz from flying, the same physician who did the pilot's last AME? Was the condition depression, medication, psychosis or what? If the physician was the AME, why did he or she not report it rather than giving the pilot a note. The physician might well have experienced a professional conflict of interest. This very conflict could well constitute another week link in the system of safety. The AME treating the pilot as a private patient as well as doing aviation medical exams can lead to a conflict of interest unless the pilot acknowledges that confidentially is subordinate to the physician's primary duty to the FAA authority and aviation safety. Former military pilots are accustomed to the role of physician, wherein ones fitness to fly is completely in the hands of the Flight Surgeon. You cannot be slave to two masters. When doing employment examinations for businesses, the law is clear as to the physician's duty to the company, but with AMEs, where the exam as well as patient care is paid by the pilot, the duty becomes blurred. There is often a conflict of interest especially at the Commercial Pilot, Class II examiner level.