My view on this has been that, assuming that some sort of deliberate incident took place (whatever that may be), the person(s) flying would first have to incapacitate everyone else on board. If the aircraft really did go to 45000 ft then I really don't know what to say.
What I am not sure about is that alone wouldn't achieve that, so how do you deliberately cause decompression in a controlled way and/or cause hypoxia?