THE ETHICS COLUMN
States Misfire with Doctors & Guns
By Jacob M. Appel, MD, JD
A recent ruling by the 11th Circuit Court of Appeals in Atlanta has generated exposure for the increasing—and often involuntary—embroilment of physicians in the national debate over gun control and the right to bear arms. By a 2-1 decision in Wollschlaeger vs. Governor of Florida, that court upheld a Florida statute prohibiting physicians from asking about or entering “information concerning firearm ownership into the patient’s medical record if the practitioner knows that such information is not relevant to the patient’s medical care or safety, or the safety of others.” Penalties include fines and a loss of the right to practice. Nine other states are considering similar legislation, so the outcome of this case (which will likely be appealed to the United States Supreme Court) has significant implications for the practice of medicine nationally.
Among those groups challenging the law were the Florida chapters of the American Academy of Pediatrics and the American Academy of Physicians. To the medical lobby, gun management is a public health issue. More than seven thousand children under twenty were hospitalized with gunshot wounds in 2009, while approximately one hundred die every year from accidental shootings. The AAP’s guide for healthcare, Bright Futures, instructs pediatricians to urge patients to “remove guns from home” or “if gun necessary, store unloaded and locked, with ammunition locked separately,” and to “ask if gun in home where child plays”—guidance that appears alongside recommendations regarding sunscreen use, smoke detectors and television viewing. Firearms advocacy organizations defended the law as a necessary protection for gun-owning patients in positions of what the court described as “relative powerlessness.”
Meanwhile, New York State has attempted to commandeer medical providers into the fight against gun violence. Following the Sandy Hook shooting, Governor Andrew Cuomo secured passage of a broad gun control statute, the New York Secure Ammunition and Firearms Enforcement Act of 2013, that included a provision requiring doctors to report patients who are “likely to engage in conduct that would result in serious harm to self or others,” so that these individuals can be prevented from obtaining firearms licenses. The goal of this mandatory reporting may be well-intentioned: namely, to prevent another Newtown-scale massacre. In reality, when most psychiatric patients can buy an arsenal on the street for a few hundred dollars, license restrictions are political fireworks rather than magic bullets. Like the Florida law, New York’s SAFE act impinges on the physicians-patient relationship—in this case, transforming the physician into agent of the government.
A common-sense middle ground does exist on this issue. Whatever the merits of either side of the gun debate, the dangers of entangling medical treatment with gun politics are grave. They represent an ongoing pattern of coopting physicians into state action: for forcible blood draws at DWI stop, for breaking prison hunger strikes, for conducting executions, etc. Far better to let doctors do what they do best: treat patients with their own good judgment. That means letting them asking whatever questions they wish, and share their guidance on public health as they see it—about guns and anything else—but also ensuring that their patients’ answers remain protected by medical confidentiality. #