The family of the New Zealand boy who died while aboard a Samoa Airways flight on Boxing Day deserves answers about why the pilot didn't turn the plane around when the 9-year-old felt seriously ill.

The boy, a math whizz who was excited about his first trip to Samoa, suffered an asthma attack about half an hour after the plane departed from Auckland International Airport.

Witnesses have praised the efforts of cabin crew in helping the boy during the flight and say that both CPR was carried out by staff and a defibrillator was used when his condition deteriorated.

But the boy's relatives say they were told by the pilot about 90 minutes into the flight that it was too late to turn back to Auckland, according to a spokeswoman for the grieving family.

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Understandably, they want more details on why that decision was made and exactly what procedure Samoa's state-owned national carrier follows when a medical emergency happens on board.

And they are entitled to it - even if it doesn't ease their pain of losing a loved one.

"There's some concern by the family with the accountability so that it doesn't happen to anyone else. The main thing is to push them to review their procedures," a family spokesperson told the Herald on Tuesday.

Information has not been forthcoming from the airline, which refused to comment to both the Herald and local media in Samoa this week.

Medical issues also aren't something the Civil Aviation Authority looks into, unless the operation of the aircraft somehow contributed to the medical event. And given the incident happened mid-air, it's unclear if any coronial inquest could be ordered.

That leaves the airline as the organisation which the family can look to for a full account of what took place.

Some 60,000 Kiwis travel to Samoa each year - a big chunk of which would fly with Samoa Airways - and they, too, may want to know just how the carrier makes a decision on whether or not to divert a flight.

Mid-air emergencies happen relatively frequently on bigger international carriers but must test the mettle of crew whenever they occur.

A 2013 study by the University of Pittsburgh Medical Centre suggested there was one medical emergency in every 604 flights globally, but it could higher.

Generally, in case of a medical emergency in flight, cabin crew are in touch with medics on the ground.

They can also appeal for help from a doctor among the passengers if there is one on board.

Depending on the level of emergency and the position of the aircraft, the pilot can decide whether or not to divert the aircraft.

Even in the familiar surrounds of the emergency room, doctors can make the wrong call about how to treat the patient - so imagine how tough it is for pilots to know if they're making the right decision while also keeping a plane in the air.

No doubt pilots will do all they can to make an emergency landing if a person's life is at risk.

But if the medical event is not serious or a person is simply feeling unwell, they also need to weigh up the disruption caused to other passengers when making a diversion. People may miss connecting flights and important family events if a flight makes an unscheduled landing.

There is a cost for airlines involved as well.

A diversion can cost the likes of Emirates - one of the world's biggest airlines - anything from $75,000 to $900,000, according to estimates in 2017.

There's nothing to suggest that Samoa Airways' pilots allowed any such consideration to influence their decision making.

But the family of a dead 9-year-old, at the very least, should be told what did.