In his reply to my article, Dr. Miguel Faria, a very fine neurosurgeon and writer, states that it is unethical for physicians “to intrusively ask patients about the presence of guns in the home” and that by so doing, physicians become “snitches” against their own patients.
I agree that if the purpose of asking about guns is solely to report the possession of guns, and that if the physician asks “intrusively” and reports without the patient’s permission and in the absence of an imminent threat, it would be wrong.
But Florida law, which has been blocked in federal court, makes it illegal to ask about the presence of guns in the home in the absence of an emergency. The AMA supported the suit blocking the Florida law, as have a number of other physician groups. The basis for the objection is that encouraging patients to consider such safety measures as wearing seat belts and locking up guns goes a long ways towards preventing injuries and deaths. Nothing unethical about this at all.
Faria also suggests that I wrote “it is not OK for a psychiatrist to report a potential threat by a mentally disturbed patient.” I wrote nothing of the sort. What I did say is that mandatory reporting can create problems. Most, (but not all) states that have looked at this follow a Tarasoff-like policy that when a psychiatrist determines a patient presents an imminent risk to another person, the psychiatrist incurs a duty to protect that individual. This may involve reporting the threat, but a variety of other, potentially more protective means may be used to protect the person, e.g., involuntary hospitalization, notifying that individual, or perhaps reporting to authorities.
I agree with Faria that thoughtful consideration is needed in light of recent events and in the face of potential present danger. Knee-jerk reporting without considering measures which may be more effective protects neither the public nor personal rights.
Richard L. Elliott, M.D., Ph.D., is a professor of Medical Ethics at Mercer University School of Medicine.