Declaring oneself unfit to fly when it will inevitably lead to significant disruption and cost to your airline is a difficult decision

On 17 January 2022, about 30 minutes after takeoff from Fort-de-France, Martinique, on an ETOPS flight, an aircraft was approaching its initial cruise altitude when the apparently unconscious Captain appeared initially unresponsive. On being more aggressively roused, he seemed normal and a doctor on board initially assessed him as fit to continue. However, about two hours into the flight his condition subsequently deteriorated and the First Officer called the Chief Purser to take his seat to assist. A PAN, later upgraded to a MAYDAY, was declared and a diversion was made to Lajes where the Captain was hospitalised.