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April 13, 2017

Should airlines bump doctors from flights—ever? Ethicists weigh in

Daily Briefing

This story has been updated.

Viral video of a physician being dragged off of a United Airlines flight has raised an ethical conundrum: Should doctors get priority to stay in their seats when flights have more passengers than seats?

On April 9, the crew of a United Airlines flight departing from O'Hare International Airport told passengers that the flight was full and they needed four volunteers to reschedule their travel. When no passengers volunteered to give up their seats, the flight crew selected passengers to be bumped off the flight via a computer algorithm. One of the bumped passengers argued that he was a physician with patients to see the following day.

The individual refused to get up and became increasingly agitated as the flight crew pressured him to leave. Eventually, airport police were called, and they forcibly removed the man, who—based on video captured by fellow passengers—appeared to sustain wounds. United Airlines CEO Oscar Munoz on Wednesday said the airline would no longer use law enforcement to remove "a booked, paid, seated passenger."

Should doctors be treated differently?

While much coverage of the United Airlines controversy centers on the broader indignities of air travel, Medscape's Robert Lowes explored a more concrete ethical question: Given that doctors provide an important, sometimes life-saving service, should they be given priority to stay on flights so their work is not disrupted?

Historically, doctors received such preferential treatment in a variety of circumstances, according to Stuart Youngner, a professor of bioethics and psychiatry at Case Western Reserve University. "Doctors were treated like gods" in the 1970s, he told Lowes. "We didn't get speeding tickets. ... We double-parked with an 'MD on call' sign in the car."

But those days, Youngner notes, are "long gone"—and the medical ethicists whom Lowes spoke to generally argued against any blanket rule protecting doctors from being bumped from flights.

For instance, Nancy Berlinger, a research scholar at The Hastings Center, said an exemption specifically for doctors would discriminate against other essential health care providers, such as nurses, EMTs, or the only pharmacist in a rural town. "We all have good reasons (to stay on a flight), and we tend to think our reasons are really good ones," she said.

Linda Emanuel, a medical ethicist and professor of medicine at Northwestern University, argued that an exemption for doctors would be another example of physicians pulling rank, which is not "really necessary and it is arrogant."

Lowes also asked ethicists about some airlines' hardship policies, under which crew members can consider "passenger hardship" when determining who must leave an overbooked flight.

Emanuel said when appropriate, the hardship policy could ensure that physicians can keep their seats. "There are occasions when physicians are the only ones who can take care of patients who are in great need and under those circumstances I would hope that people would be happy to stand back just as they should be happy to stand back to let an ambulance by in traffic," she said.

However, Berlinger said it might be hard to tell which doctors truly have high-stakes professional commitments, particularly right before take-off. "Doctors themselves would disagree about who in their profession should be exempt," she said, adding that airlines may want to prioritize physicians directly involved in patient care above those who work in administration.

Youngner added that parsing the hardship exemption could get even harder if you look at situations which don't involve doctors. "What about the woman who says, 'My mother is dying. She may not make it until noon. I need to get there," he offered as an example (Masunaga/Lien, Los Angeles Times, 4/12; Wise, Reuters, 4/13; Lowes, Medscape, 4/11; Rappleye, Becker's Hospital Review, 4/11).

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