Right of Refusal

If your doctor starts pestering you about guns, you have several options

By Dave Kopel, research director of the Independence Institute, & Timothy Wheeler, MD, Director of Doctors for Responsible Gun Ownership, a Project of the Claremont Institute.

National Review Online, July 5, 2001 8:50 a.m.  More by Kopel on doctors and gun control.

An NRO reader writes to ask: "So, what do I say to my 5-year-old daughter's doctor when she asks if there's a firearm in our home (my daughter has an annual checkup fast approaching)? I do have a registered handgun in our house, but my daughter doesn't know anything about it. And, for now, I don't think she has to know. I can certainly refuse to answer, right?"

The American Academy of Pediatrics (AAP), under the prodding of gun prohibitionist Katherine Christoffel, has developed a policy a strong antipathy to gun ownership. A few weeks ago, the president of the American Medical Association announced his determination to involve the AMA deeply in anti-gun political and "educational" work. Both groups are tied to the HELP (Handgun Epidemic Lowering Plan) Network, a consortium of gun-prohibition groups. The AAP and AMA also have working relationships with the Brady Campaign to Prevent Gun Violence, which was formerly known as Handgun Control, Inc., which in turn was formerly known as the National Coalition to Control Handguns, which, despite its name, supported handgun confiscation, with "control" seen only as an intermediate step.

Both the AAP and AMA advise doctors to probe their patients about guns in their homes. Both groups urge doctors to persuade families that they should get rid of their guns.

People in pain, people fearing cancer, and people who are injured and weak are vulnerable. They all look to their doctor to do right — right for the patient, rather than for the insurance company, or for the doctor's view of social policy. Doctors have a fiduciary relationship with their patients. They are obligated to set aside personal agendas and put the patient first. Putting the patient first means that the doctor must respect boundaries in the relationship with the patient. So when the doctor makes a pass at a patient, or tries to sell her real estate, or lobbies patients against gun ownership, the doctor is committing an ethical-boundary violation. Patients notice when a doctor abuses their trust or takes advantage of their pain and fear. [For more on boundary violations by medical professionals, see Frick, D., "Nonsexual Boundary Violations in Psychiatric Treatment," Review of Psychiatry, vol. 13, (Washington, D.C.: American Psychiatric Press, Inc.), 1994.]

What recourse do patients have when confronted with a doctor who asks politically motivated questions about their gun ownership? All patients should recognize that they have no obligation to answer such intrusive questions. There are several levels of measured response available to all patients, the consumers of health care.

First, the patient can change doctors. No doctor wants an unhappy patient. A politely stated objection to the doctor's boundary violation will be a warning for most doctors, giving them serious reservations about continuing such intrusive and improper questions.

Second, a patient can write a complaint to the member-service department of the doctor's health plan or HMO. The doctor will be required to respond to the complaint, and it will force him to think through the consequences of abusing the trust of his patient. In the furiously competitive service industry of medicine, a patient complaint is a black mark on the doctor's record. Patients not in an HMO can send the complaint to their county medical society.

The third option for patients whose doctors cross the line is to send a formal written complaint to the doctor's state medical-licensing board. Boards are increasingly attentive to allegations of unethical physician conduct arising from boundary violations.

Another option when the physician brings up firearms is to ask him to sign a form certifying that he is qualified to give such counseling, and will take responsibility for its consequences. Actually reading the form may help a physician think twice about whether he really ought to be telling people what to do about guns.

As with any relationship with a person who provides professional services, addressing a potential problem in a polite and friendly way is usually the best initial approach, with formal complaints reserved only for situations where a personal discussion cannot resolve the issue.

Medical-journal surveys reveal that most doctors are instinctively wary of asking their patients about guns in their homes. Many doctors understand that firearm ownership is normal behavior in America and that many Americans consider it a fundamental right. For example, a 1998 survey of internists and surgeons revealed that even though a large majority (87 to 94%) felt that firearm violence is a public-health issue, only a tiny fraction (2 to 4%) said they frequently talk to patients about firearms in the home. [Cassel CK, Nelson B. "Internists' and Surgeons' Attitudes Toward Guns and Firearm Injury Prevention," Annals of Internal Medicine(1998) 128:224-30.] This may be an indication that, despite a general concern about firearm injuries, doctors do not see politically motivated patient counseling as appropriate professional conduct. Thus, if your doctor starts pestering you about guns, you should understand that your doctor is not typical.

Even many doctors who do not personally own guns recognize the minefield of ethical concerns they would be entering if they brought up the subject. Most doctors also know that to taint this trusting relationship with a pitch for gun control or any other political cause is unprofessional conduct.

So the answer to the reader's question is: Of course you can refuse to answer. If a doctor asked you to list every sexual position you'd ever used, or asked if you had any liquor in your home, or asked if you were a Democrat, you would refuse to answer. "That's personal information which I'd prefer not to discuss," is a polite way to terminate the inquiry.

If you'd like to educate your doctor a little, give him a copy of the recent article "Physicians, Firearm Counseling, and Legal Liability", from the Southern Medical Journal, which explains the legal risks that physicians run by attempting to tell patients what to do with firearms. If you're feeling really generous, spend $5 to buy your doctor the 20-page booklet, Firearms: A Handbook for Health Professionals, which summarizes the best contemporary criminology research on firearms use in self defense. Call 909-621-6825 to order your copy. Operators are standing by.

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