Ethical and Safety Implications of Medical Emergency Landing Exploitations: A Call for Policy Action Open Access

Emergency medical landings are vital interventions designed to protect passenger health during flights. However, the increasing trend of passengers exploiting these situations for ulterior motives has raised significant ethical and operational concerns. Recent cases, including the January 1, 2025, Turkish Airlines incident,^[1] exemplify how these manipulations compromise the health and safety of all passengers, disrupt security, and challenge the ethical integrity of emergency protocols. The analysis will follow the Ethical Decision-Making Model,^[2] which offers a structured process for assessing and addressing ethical dilemmas. This model involves recognizing the ethical issue, evaluating the potential impacts of decisions, considering relevant stakeholders, and choosing the most ethically sound action.

In the most recent incident, four passengers fled a Turkish Airlines flight during an emergency landing at Malta International Airport. The landing was prompted by a reported medical emergency involving a Moroccan passenger, who was later found to be under arrest.^[1] This follows similar cases in 2021 and 2022, where passengers fabricated medical emergencies to initiate unscheduled landings.^[3] Another fake medical emergency that has been reported refers to a 2019 incident where an American Airlines flight bound for Miami diverted to Pensacola after a passenger faked a medical emergency to obtain a more spacious seat. Such cases, though notable, appear to be relatively rare compared with genuine medical diversions.^[4]

As detailed in Table 1, several cases of fake emergency medical landings were reported. The incidents can be categorized into two main groups. The first category involves incidents for personal reasons, primarily occurring in the United States. In 2019, an American Airlines flight was diverted when a passenger faked a medical emergency to secure a better seat, with no major consequences. The second category involves incidents for immigration purposes, primarily involving Moroccan passengers faking medical emergencies on flights between Turkey and Morocco, where Moroccan citizens do not require a visa to travel to Turkey. In 2021, an Air Arabia Maroc flight diverted because of a medical situation, during which four passengers escaped, sparking a manhunt in Spain. In 2022, a Pegasus Airlines flight was diverted, and migrants took advantage of the emergency landing to flee; they were later detained. Finally, in 2025, a Turkish Airlines flight diverted for medical reasons, with four passengers escaping during the emergency landing in Malta, prompting a search operation.

Such exploitations raise critical ethical concerns that threaten the integrity of emergency medical protocols in aviation. Drawing on Beauchamp and Childress’s Principles of Biomedical Ethics,^[5] these incidents violate the principles of autonomy, beneficence, and nonmaleficence in aviation medicine. When passengers manipulate emergency protocols, airline crews and ground authorities may become skeptical of genuine distress signals, potentially leading to delays or inadequate responses for passengers who are genuinely unwell.

As of today, the exact number of in-flight medical events each year remains uncertain because of the lack of a standardized global reporting and classification system.^[6] A recent 2024 publication from the Centers for Disease Control and Prevention Yellow Book reports^[7] that with over 4 billion airline passengers annually, medical emergencies occur on approximately one in every 604 flights. While most cases are managed in flight, 10% require flight diversions, mainly for cardiac arrest, chest pain, obstetric issues, or possible strokes. Despite these incidents, the in-flight death rate remains low at 0.3%. For instance, a study analyzing Air Canada’s in-flight medical diversions from 2004–2008 reported 220 diversions over 5 years. The primary causes were cardiac issues (26.4%), neurological problems (19.5%), gastrointestinal disturbances (11.4%), and syncope (10.0%).^[8] Similarly, a US study found that the most common reasons for flight diversions were cardiac incidents (28%), neurological problems (20%), and food poisoning (20%).^[9]

A study by Lewis et al^[10] analyzed the financial impact of in-flight medical emergency (IFME) diversions, finding that while such diversions occur in 2–13% of IFME cases, they generally result in lower costs and delays compared with nonmedical diversions. On average, IFME diversions cost around $38,000 per flight, factoring in direct operating expenses and passenger time value. Additionally, over 70% of diverted flights recover, with medical-related diversions resuming their intended route more quickly than nonmedical. Research from 2021^[11] estimated that the costs of en-route diversions ranged from $15,000–$893,000 based on two studies. Additionally, the general diversion rate across five studies was 11.1 diversions per 100,000 flights.

The information, released by Emirates Airlines in 2017, highlights that as the largest airline by international traffic, Emirates operates more than 3500 departures a week and more than 194,000 flights annually. In 2016, the airline handled more than 60 flight diversions due to medical emergencies. Each diversion can cost the airline between $50,000 and $600,000 USD, covering fuel, catering, landing fees, air navigation costs, passenger rebooking, and care for passengers and crew.^[12] While in-flight medical emergencies are a significant concern for airlines, leading to diversions and associated costs, there are limited data specifically quantifying the frequency of fake or intentionally fabricated medical emergencies. Most available statistics focus on genuine medical incidents.

Also, it is worth mentioning that the misuse of emergency protocols undermines pilot decision-making. Pilots rely on established procedures to assess and respond to medical emergencies, often consulting with ground-based medical experts to determine the necessity of unscheduled landings. However, repeated instances of exploitation may cause pilots to question the authenticity of reported emergencies, compromising their ability to prioritize passenger safety effectively. Such hesitation could have far-reaching implications for the health and well-being of genuinely ill passengers.

Finally, these actions compromise overall flight safety by disrupting security and operational procedures during emergency landings. Unauthorized escapes not only endanger the perpetrators but also create chaos, placing all passengers at risk in scenarios requiring quick and coordinated evacuations. The exploitation of these protocols jeopardizes the foundational principles of aviation safety, demanding immediate and robust policy responses to prevent further occurrences.

In-flight medical emergencies are handled through coordinated efforts between flight crews and ground-based medical professionals.^[13] Pilots are trained to prioritize passenger health, often diverting flights to the nearest equipped airport. These decisions, based on medical necessity, require immediate and unambiguous trust in passenger reports. The misuse of such protocols undermines their effectiveness, creating operational inefficiencies and risking lives.

On the legal side, similar to how healthcare sectors impose penalties for the misuse of emergency services, the Federal Aviation Administration (FAA) in the US has outlined penalties for false reporting of emergencies. When passengers fake medical emergencies to avoid removal or obtain better seating, stricter penalties may be warranted, drawing from both aviation and healthcare regulatory frameworks. For instance, the FAA Modernization and Reform Act criminalizes false emergency reporting, and comparable penalties could be explored for passengers who misuse medical diversions. Additionally, the National Health Service in the United Kingdom implements fines for individuals misusing emergency services, which could inspire the implementation of fines or other penalties in aviation contexts. In Canada, the Air Navigation Services Act has penalties for misleading flight crews or authorities.

Regarding existing policies,the European Union has established regulations that require airlines to provide a certain level of care for passengers experiencing medical emergencies. However, these regulations also contain provisions aimed at preventing the misuse of emergency services, which could provide a useful framework for addressing fraudulent claims. In a similar vein, the International Civil Aviation Organization (ICAO) sets standards and regulations for air navigation, which could serve as a guideline for implementing uniform penalties for fraudulent emergency diversions. Integrating such legal precedents from both the aviation and healthcare sectors would provide a broader perspective on addressing misconduct. This would strengthen the argument for stricter penalties, ensuring that the aviation industry adopts more effective policies to discourage the misuse of emergency services and protect public trust. Grounding the paper’s recommendations in these existing frameworks enhances their practical relevance and supports more responsible and efficient management of in-flight medical emergencies.

Addressing the growing challenge of emergency landing exploitations requires a comprehensive and multifaceted approach. One critical step is the enhancement of vetting and surveillance processes. Airlines and aviation authorities should adopt advanced passenger screening systems to identify potential risks before flights. Additionally, improving surveillance measures at airports, particularly during emergency landings, can help detect and prevent unauthorized actions, ensuring the safety and security of all passengers and crew.

Another essential measure is the implementation of stricter legal deterrents. Establishing robust legal frameworks with stringent penalties for those who exploit emergency landings can serve as a powerful deterrent. These penalties should be designed to discourage individuals from engaging in such behavior while signaling a commitment to preserving the integrity of emergency protocols and prioritizing the safety of genuine passengers. Additionally, creating an internationally recognized framework for recording and categorizing in-flight medical incidents, including fake ones, would improve data accuracy, enhance airline response strategies, support better policy decisions, and help obtain higher-quality patient-passenger datasets.

Finally, targeted training for airline crews is vital to address this issue effectively. Crews must be equipped to identify and manage potential exploitations without compromising their ability to respond to legitimate medical emergencies. A review of existing protocols, accompanied by specialized training programs, can help strike a balance between vigilance and compassion, ensuring that the needs of genuinely ill passengers are met while minimizing opportunities for misuse. Together, these measures can help safeguard the integrity of emergency procedures in aviation.

Addressing the growing challenge of emergency landing exploitations requires a structured and prioritized approach, balancing aviation security, healthcare ethics, and legal enforcement. Table 2 outlines recommended actions. These measures will help prevent misuse while ensuring that genuine medical emergencies are addressed without skepticism or delay.

This issue extends beyond aviation into broader health policy and patient safety. Comparative analyses of emergency room abuse in hospitals reveal striking similarities in resource misallocation and ethical dilemmas. Just as frequent emergency room misuse strains medical personnel and increases costs, fabricated emergency landings divert airline and airport medical resources from genuine cases. Addressing these challenges requires policies that balance individual rights with collective safety, ensuring resources remain accessible to those in genuine need. Recent studies suggest the use of artificial intelligence (AI)–based triage systems in healthcare,^[14] which could serve as a model for aviation’s medical emergency assessments.

As illustrated in Figure 1, the manipulation of emergency protocols mirrors challenges faced in other healthcare settings, where trust and ethics are foundational.^[15] Addressing these challenges requires policies that balance individual rights with collective safety, ensuring resources remain accessible to those in genuine need.^[16]

Preserving the integrity of emergency medical protocols is paramount to safeguarding the health and safety of all passengers. To mitigate future exploitations, collaboration between aviation regulators and healthcare policymakers is essential. A unified strategy integrating aviation security, telemedicine verification, and AI-driven risk assessments can prevent exploitation without delaying genuine medical interventions. This issue calls for immediate and coordinated policy action to maintain trust, protect lives, and ensure the efficacy of emergency response systems in aviation and healthcare alike.