The co-pilot who crashed a Germanwings jetliner was treated years ago for suicidal tendencies, authorities said Monday. But although doctors who were worried about Andreas Lubitz’s mental health had recently told him to stay away from work, Germany’s strict medical privacy laws may have prevented them from circulating their concerns more widely.

The confidentiality restrictions are fueling an emerging debate about German laws that critics say emphasize personal privacy rather than the greater good. The details released Monday suggested that Lubitz had been treated for severe psychological issues for years before he steered Flight 9525 into a French Alpine mountainside, killing all 150 on board. But the airline that employed him said it was kept in the dark.

Germany has a deep-seated devotion to privacy, in part a legacy of the Nazi and East German Communist years when fearsome authorities pried into all aspects of their citizens’ lives. Any reforms are sure to be slow and controversial. Yet amid revelations from investigators that Lubitz’s mental health issues were well documented but a secret between him and his doctors, some lawmakers here are pressing for changes.

“An expert committee should be established, in which ethics experts, doctors, maybe also legal practitioners, properly think through when is it actually in the common interest to violate medical confidentiality,” Thomas Jarzombek, a member of the German parliament’s traffic committee, told a German television station.

Germany’s Bild newspaper reported that the co-pilot, Andreas Lubitz, suspected of deliberately crashing a plane in the French Alps told a former girlfriend he was planning a big gesture. (Reuters)

Prosecutors said Monday that psychologists and neurologists had recently written notes excusing Lubitz from work. Investigators found one such doctor’s note, torn up, in one of Lubitz’s residences, suggesting he was working to hide his health issues from his bosses.

Lubitz, 27, “had received psycho­therapy for an extended period of time, during which suicidal tendencies had been noted,” Düsseldorf prosecutor Christoph Kumpa said Monday. The treatment occurred several years ago, before Lubitz was issued a pilot’s license, and there was no medical evidence of suicidal thoughts since then, Kumpa said, despite broader mental health issues.

Germany’s medical system generally relies on individuals to pass along information about their fitness for work to their employers. Only in the most extreme circumstances are doctors empowered to breach patient confidentiality, and they face steep legal repercussions if they are later deemed not to have met the bar. Violations of medical privacy can carry criminal sentences of up to five years in jail.

The German laws, critics contend, could have made it less likely that any doctor aware of Lubitz’s health problems would pass the information on.

A spokeswoman for the German Health Ministry, Doris Berve-Schucht, said Monday that “a breach of confidentiality can be justified and appropriate” if a doctor judges that a life-threatening crime is imminent.

In some cases — including ones involving highly contagious diseases and evidence of abuse of a minor — doctors are indeed compelled by law to inform authorities.

In most cases of patients who may pose a potential danger to themselves or others, legal and medical experts say doctors here have some legal flexibility to inform authorities. But doctors hold no legal obligation to do so.

Keeping silent about the information is unlikely to bring repercussions; divulging it based on weak or false assumptions could garner serious charges.

The German norms contrast with those in the United States, where states have “duty to warn” or “duty to protect” laws that expose doctors who stay silent to potentially large civil lawsuits, creating an incentive to act. Federal medical privacy law leaves it to doctors’ judgment whether to break confidentiality and warn authorities if patients are a danger to themselves or others.

Doctors’ groups in Germany contend that Lubitz’s case is so unparalleled that moving to change medical privacy laws would amount to a national overreaction.

“Privacy between patient and doctor is a human right, and especially with our history in Germany, it is important we keep a firm line between privacy and government,” said Frank Ulrich Montgomery, president of the German Medical Association.

Some experts warned that the debate over mental illness following the Germanwings crash has the potential to cross a line by demonizing those who are grappling with psychological conditions.

“So what can anyone who is taking an antidepressant do? Only be basket weavers?” said Steven K. Hoge, chairman of the American Psychiatric Association’s Council on Psychiatry and Law.

German detectives investigating the plane crash have discovered that neurologists and psychologists found evidence of problems severe enough to justify excusing Lubitz from work, prosecutors said Monday. They did not say what specific diagnosis sparked the concerns.

Investigators have not found any evidence of advance planning to crash a plane, said Kumpa, the prosecutor.

The revelations added to the portrait of Lubitz that has emerged in recent days: a man who had finally achieved his dreams of becoming an airline pilot but who was plagued by psychological conditions that may have driven him to fear losing his job.

Kumpa said Monday that investigators have found no evidence that Lubitz was suffering from any physical ailments. An official familiar with the investigation said separately that Lubitz had been consulting doctors for vision issues but that those problems may have been psychosomatic.

The official familiar with the investigation a day earlier said that police had discovered papers with words and phrases in Lubitz’s handwriting suggesting deep stress about the future and about his vision, for which he had apparently been seeking treatment. The vision issues, layered on top of the preexisting psychological problems, apparently made Lubitz fear losing his job, officials said.

Düsseldorf police said Monday that they had deployed about 200 officers to an “Alps Special Commission” to investigate the crash, with 50 of them investigating exclusively the criminal aspects of the case.

Read more:

How a pilot can be locked out of the cockpit

Flight 9525’s final moments, minute by minute

Faiola reported from Berlin. Stephanie Kirchner in Berlin contributed to this report.